Verrucae

Anxiety about minor conditions such as plantar warts can create undue pressure on the GP for cure at all costs. Possibly the true basis of the problem--misinformation at school--lies beyond the practitioner's sphere of action. How to approach the problem as it appears in the surgery is the subject of this discussion.

Surgical treatment of fungal mycetoma

Chemotherapy for chronic fungal infections is often ineffective, and the associated delay in surgical treatment may result in radical procedures being performed to effect a cure. The author describes four patients with chronic fungal lesions, three involving a foot and one the abdominal wall, all of which failed to respond to antifungal chemotherapy. The lesions were excised, using procedures aimed at preserving function. Infection recurred in two patients during a 9-month follow-up. The author concludes that surgical therapy should be instituted early in the disease to forestall spread to deeper structures and preserve functional integrity of the affected parts.

[Lichen ruber ulcerosus plantae]

A 66-year-old patient suffering from painful ulcerative lichen planus of the feet is presented. Various treatments (topical and oral corticosteroids, irradiation and a 6-month therapy with acitretin) were tried without success. Skin grafting in the affected areas was helpful and resulted with an acceptable and painless state.

Phaeohyphomycosis caused by Phialophora richardsiae

A case of phaeohyphomycosis caused by Phialophora richardsiae is presented. The patient was a 30-year-old man with end stage malignant lymphoma. A subcutaneous abscess that developed on the dorsum of the right foot was removed surgically but immediately recurred. The causative mold was isolated from the pus in the lesion and identified as P. richardsiae. This is the fifth known case of phaeohyphomycosis caused by P. richardsiae and the first recorded in Japan.

The efficacy of laser surgery for verruca plantaris: report of a study

Many therapeutic modalities are available to eradicate plantar verrucae. Lately, lasers have gained a great deal of notoriety in the treatment of verrucae. In this study, we chose to evaluate the success of using one laser treatment for full eradication of verrucae. The results indicated that the greatest success rate occurred with solitary lesions. Other studies of methods of verrucae treatment yielded similar results to those of the laser, with cryotherapy achieving the highest success rate. However, the higher rate was based on an average of two treatments, whereas this study obtained similar results with just one. The laser also has the advantages of minimal postoperative pain, minimal healing time, and less damage to perilesional tissue. These advantages make the laser a viable option in the treatment of verrucae plantaris.

Carbon dioxide laser use for certain diseases of the toenails

The CO2 laser has facilitated the treatment of many toenail conditions. Satisfactory wound healing and cure rates have been equivalent to current standards of treatment. Pain was markedly diminished as compared with pain in traditional methods of treatment, and time until comfortable ambulation was dramatically shortened. Healing times were consistent with those in other methods of treatment. The protocol for CO2 treatment of nail conditions has been thoroughly described. Evaluation of 50 patients after 4 years from treatment date is tabulated. The CO2 laser must be strongly considered as a treatment modality for toenail pathology. Because of markedly reduced pain, minimal disability, and satisfactory long-term results, the laser is becoming a valuable treatment of choice for pathologic conditions of the nail.

Keloids and hypertrophic scars in the foot

The occurrence of keloids in the foot is rare but should always be a surgical consideration for those individuals who may be predisposed to this pathology. Failure to recognize the potential for keloids or hypertrophic scar development may result in a severe deformity that is functionally, cosmetically, and emotionally undesirable.

Matricectomy utilizing negative galvanic current

An established technique for matricectomy procedures has been described with the effects of negative galvanic current on tissue being elucidated. An ongoing prospective study is in progress to verify previous claims. This procedure appears to offer distinct advantages over conventional procedures and now appropriate instrumentation is readily available, being manufactured specifically for this technique.

Surgical treatment of painful lichen planus of the hand and foot

Lichen planus of the hands and feet, although uncommon, can be very disabling with painful hypertrophic areas or ulcers, mainly of palmar and plantar surfaces. These lesions may not respond to conventional medical treatment. A case of surgical treatment with excision and split skin grafting of ulcerative lichen planus of the soles, with a fourteen year follow up, is reported. Only three other reported cases with a longer review period could be found. A second patient is described in which excision and grafting of painful, hypertrophic, ulcerative lichen planus of the hands achieved a satisfactory long term outcome. No other examples could be found in the English literature. It is suggested that surgical treatment should be considered more often and sooner in painful lichen planus of the hands and feet.

Summary of carbon dioxide laser usage in plastic surgery

Pathophysiology and clinical usage of the carbon dioxide laser is reviewed. The unique light is capable of relatively bloodless excision when finely focused or vaporization and cautery when defocused. Malignant and infectious lesions can be resected and sterilized by the laser's heat. "Laserbrasion" can remove superficial lesions such as tattoos, xanthelasma, warts and other similar lesions.

Actinomadura pelletieri mycetoma from the Transvaal. A case report

The osteophilic red grain mycetoma due to Actinomadura pelletieri is rare in southern Africa. This report describes an elderly patient with extensive bone involvement in which lymphatic spread to the inguinal lymph nodes had occurred. The diagnosis and management are discussed.

The bilobed flap in sole surgery

The bilobed flap is a simple reconstructive technique principally used to correct substantial defects in the facial region. We present our experience with this local flap in the difficult plantar area, with excellent short-term functional results. We describe the special characteristics of the bilobed flap in this zone, and comment on its indications and possible complications.

Intramedullary decompression with condylectomy for intractable plantar keratoma

A previously unreported method to relieve excessive plantargrade pressure which may create an intractable plantar keratoma associated with metatarsal head pain is presented. This method is referred to as an intramedullary metatarsal decompression with condylectomy and is performed through a dorsal minimum incision. The rotary action of the bur is demonstrated. This method has proved less traumatic than previous procedures, permitting immediate ambulation with little postoperative pain or edema. In a series of cases, I have compared this method with control studies on the same patient in which intramedullary metatarsal decompression was performed on one foot and a neck osteotomy on the opposite foot. Results with intramedullary metatarsal decompression have been comparable but have fewer postoperative sequelae. Exuberant bone callus formation dorsally and at the osteotomy site, lateral displacement of bone segments, frequency of transfer lesions, delayed healing or nonunion of the osteotomy site, and the possibility of synostosis when two adjacent bones were osteotomized are all decreased. A short review of the rationale, selection of cases, and criteria for orthotics is presented. The concept and simplified method of treatment applied in a series of cases is described.

Preoperative work-up and criteria

No matter what the underlying podiatric problem, if surgical correction is considered, a good preoperative work-up is essential. This article deals with the preoperative work-up and criteria for a variety of ambulatory surgical procedures.

Anaesthesia for surgery in a patient with a transplanted heart

Five-year survival following cardiac transplantation approaches 50% and such patients occasionally present for non-cardiac surgery. The application of a simple general anaesthetic technique is described in a patient undergoing minor surgery, and the problems involved in managing heart transplant recipients are discussed.

Under heel foot wart

Using carbon dioxide laser, the authors proved the existence of a new type of wart, localized under the heel. Its considerable extension between the dermis and epidermis, far from the visible excrescence, may explain the absence of positive response to classical treatment in some cases.

Plantar inclusion cyst: a review of the literature

Cystic lesions on the plantar surface of the foot are rare and usually a consequence of trauma. Patients generally present complaining of a firm ovoid or nodular mass under a weightbearing area that exhibits dull to exquisite tenderness upon direct pressure. A careful history often reveals past injury of varying severity with subsequent evolution of a gradually enlarging mass closely adjoining the area of insult. A frequently overlooked finding of interest is a mixed histologic picture with features common to both foreign body reactions as well as inclusion cysts.

Dermatologic review: scalpel technique in removing heloma and hyperkeratosis

The aim of this manuscript is to document, with the aid of illustrations, the theory, prehensions and motions of the basic professional chiropodial skill in painlessly debriding hyperkeratosis and enucleating heloma from the human foot.

Intractable plantar keratosis

As I mentioned in the beginning of this discussion, it is imperative to treat all of these intractable plantar keratoses conservatively with proper shoes, metatarsal supports, and local care of the lesion before considering any type of surgical intervention. Many patients will respond to conservative management, and it is certainly the treatment of choice if the patient is satisfied with it.

The tilt-up osteotomy for correction of intractable plantar keratoses

The purpose of this paper is to describe and follow-up a new surgical technique used for the correction of intractable plantar keratoses. Twenty-five osteotomies were studied from 8 to 20 months postoperatively. The results showed a 60% success rate, but a patient satisfaction rate of 92%. The tilt-up osteotomy is a promising new procedure for the correction of intractable plantar keratoses.

[Conduction anesthesia in operations on the limbs]

Conduction anesthesia with 1-2% solution of trimekain or novokain with a vasoconstrictor was used in 142 operations on the upper and lower extremities. The technique of blockade of nerve trunks of the upper and lower extremities is described. Good results of the anesthesia were obtained. There were only two complications, no lethal outcomes.

A dorsal wedge V osteotomy for painful plantar callosities

A dorsal closing wedge proximal V metatarsal osteotomy is described for treatment of painful plantar callosities due to prominence of any of the five metatarsal heads. Forty-one osteotomies were performed over a 3-year period. In all patients so treated relief of symptoms was achieved, plantar callosities were resolved, and no significant complications occurred.

Pustulosis palmaris et plantaris due to tonsillar focal infections. From the analysis of long-term observed cases

We studied the effects of tonsillectomy in patients with pustulosis palmaris et plantaris (PPP) and suspected of having focal tonsillar infections which could still be observed more than one year after tonsillectomy. The rate of healing with tonsillectomy, including 6 cases with remarkable effect, was 76%. The clinical findings from which we expect an effect of tonsillectomy are (a) late onset PPP and early tonsillectomy, (b) tonsils with grade I hypertrophy, oozing of pus, and localized dark-redness on the anterior palatine arches, (c) anamnestic tonsillitis, and (d) positive results both at tonsillar provocation and negation tests. From the analyses of pre- and postoperative clinical examinations we found that the preoperative values of serum complement (C3), and neutrophils, lymphocytes and eosinophils in peripheral blood were significantly depressed in the effectively treated group, compared with the 'ineffective' group or the control group.

Evaluation of tonsillectomy as a treatment for pustulosis palmaris et plantaris

One hundred and twenty-four cases of pustulosis palmaris et plantaris (PPP) were studied by questionnaire survey to evaluate the effectiveness of tonsillectomy as treatment. We found that tonsillectomy as a method of treatment for PPP showed a significantly high rate of cure, against which other methods of treatment, e.g. corticosteroid therapy, PUVA therapy and so on, were compared. The examination, by means of Kaplan-Meier's method, showed a 59.2% cure rate for patients one year after tonsillectomy and 71.8% 2 years after the operation. When patients are older than 60 years, the prognosis is good, regardless of the method of treatment.

Conceptual understanding of pustulosis palmaris et plantaris as an immune complex disease due to focal tonsillar infections

The relationship between pustulosis palmaris et plantaris (PPP) and immune complexes was studied in 17 patients who underwent tonsillectomy. By means of the Clq-binding test, immune complexes were detected in a considerable number of sera from these patients. Patients with a high serum level of immune complexes which decreased following tonsillectomy were found to benefit by a remarkable improvement in their skin lesions. There was a close association between the degree of improvement in skin lesions following tonsillectomy, and the changes in circulating immune complex levels after tonsillectomy. Immunofluorescence showed that all 6 patients with PPP tested had deposits of IgG, IgM, IgA or C3 in their skin lesions. These results suggest that PPP may be an immune complex disease, and that it may be closely associated with the tonsil as a focus for the release of antigens or immune complexes.

Coverage of heel and sole defects: a new subfascial arterialized flap

Defects of the heel and sole represent difficult reconstructive problems in terms of tissue availability and postoperative morbidity. Although local flaps offer the optimal type of coverage, their application has been restricted to defects of limited size. A study of the plantar skin and fascia, as well as its neurovascular supply, was undertaken in cadavers. Mobility of local flaps is greatest with a narrow pedicle. Dissection deep to the plantar fascia allows the inclusion of the medial or lateral plantar nerve and artery with the flap, thereby allowing considerably mobility while preserving vascularity and sensibility. Several variations of the flap are presented with clinical examples.

Cryosurgery of porokeratosis plantaris discreta

Porokeratosis plantaris discreta is a distinct clinical and pathological entity often resistant to conservative management. Twenty-one lesions of porokeratosis plantaris discreta were treated cyrosurgically in 11 patients. Removal of the blister roof two weeks after cryosurgery with retreatment of any residual lesion proved an effective method for removal of such lesions without scarring. A cure rate of 90.5% was achieved using this technique.

Surgical treatment of fungating lesion of foot due to Moraxella phenylpyruvica. Case report

We present a case report of a man who had an abscess-like lesion on his left foot. The lesion discharged pus, enlarged, and became thicker, so that we could not differentiate the real toes from the out-growths. Moraxella phenylpyruvica and Pseudomonas putrefaciens were identified; direct agglutination tests were postive M. phyenylpyruvica. He was given antibiotics and antituberculosis therapy and had topical treatments. The foul odor disappeared with treatment, and the lesions were removed surgically 3 months later. The M. phenylpyruvica finally disappeared after the surgery. The final condition of this patient was markedly improved, although he had some residual scar contracture.