Nerve Decompression and Distal Transtibial Amputation

Approximately 20% of patients with diabetic peripheral neuropathy (DPN) endorse painful sensations such as prickling, stabbing, and burning pain that reflect small-fiber involvement. Although glycemic control is crucial to delay the onset and progression of DPN, there have been many reports on the use of decompression nerve surgery to aid in the treatment of DPN.

An Update on the Practical Management of a Hexapod System in Lower Limb Orthoplastic Reconstruction for Acute Shortening and Relengthening Procedures

Background. The use of circular external fixation is a fundamental necessity in the armamentarium of a lower limb orthoplastic reconstructive surgeon. External fixation offers orthoplastic surgeons the ability to address soft tissue and osseous defects simultaneously. Using Ilizarov principles, the reconstructive surgeon must have the ability to address unique scenarios when performing orthoplastic principles. This article offers practical surgical management concepts based on experience using the TL-Hex Orthofix Truelok Hexapod System for acute shortening and relengthening. A soft tissue and osseous defect can be managed through this surgical approach as a limb salvage alternative to amputation. The information provided will lead to improved management strategies and outcomes for the practitioner and patient when presented with soft tissue and osseous defects.

Utilization of Intraoperative Biphasic Waveform Nerve Stimulator for Performing Nerve Transfer for the Treatment of Drop Foot: Addendum to Evaluation and Treatment of Foot Drop Using Nerve Transfer Techniques

This article provides the surgeon with a detailed technique guide using an alternating current biphasic waveform intraoperative nerve stimulator, such as the Checkpoint surgical nerve stimulator. The Checkpoint surgical nerve stimulator is an intraoperative hand-held biphasic device that is essential when performing nerve transfer techniques for the treatment of drop foot. This specific device provides the surgeon safe, accurate, reproducible, and continuous stimulation without fatigue or a decreased response to the nerve. An in-depth technique guide is provided while using this device while performing a nerve transfer for the treatment of drop foot.

Management of Osseous Defects of the Tibia Utilizing Orthofix Hexapod Circular External Fixator: A Technique Guide-An Orthoplastic Approach for Combined Soft Tissue and Osseous Defects

Malunions, nonunions, avascular necrosis, neoplasms, and osteomyelitis of the tibia can be difficult limb salvage cases to manage, especially when large bone defects are present. This article aims to demonstrate the orthoplastic limb salvage options that the authors use with bone transport using the Orthofix TrueLok-Hexapod system (Orthofix Medical Inc, Lewisville, TX, USA).

An Updated Nerve Sparing Surgical Technique for Addressing Morton's Neuroma

Morton's neuroma is a common painful pathology that occurs in the plantar forefoot. Many treatment options exist and surgical management is used after conservative treatment options fail. While within the literature, there is a high success rate with primary neurectomy procedures, the risk of recurrence of symptoms or "stump neuromas" remains difficult to treat and can lead to debilitating pain. This article expands on a previously published article to discuss an update on a nerve sparing, microneurosurgical, procedure for the management of Morton's neuromas.

Implantable Neuromodulation Device in the Lower Limb: An Adjunctive Procedure in Patients with Continued Chronic Pain After Failed Revisional Microneurosurgical Procedure in a Nonreconstructable Zone of Injury

Implantable peripheral nerve stimulators are used with the goal to decrease the neuropathic pain level and possibly the need for opioid analgesics. Peripheral nerve injuries and pathology must be thoroughly evaluated before implantation of neuromodulation devices. Ultrasound-guided nerve blocks and a peripheral nerve stimulator trial is performed before surgical implantation. In this article, the authors discuss indications, clinical and diagnostic examinations, and their surgical technique for implantation of the Bioventus StimRouter.

Redefining the Topography of the Tibial Nerve: Updated Treatment Guide for Tibial Nerve Entrapments: An Addendum to Surgical Treatment Protocol for Peripheral Nerve Dysfunction of the Lower Extremity: A Systematic Approach

Dysfunction of the tibial nerve can progress to painful and potentially disabling conditions. There are multiple sites of entrapment along the course of the tibial nerve. Detailed knowledge of the anatomy and anatomic variations is critical for a surgeon to be able to properly diagnose and treat patients with tibial nerve injuries. Repair of tibial nerve injuries involves a thorough history, physical examination, diagnostic studies, and microsurgical techniques. This article discusses sites of tibial nerve entrapment and use of a surgical algorithm that provides a systematic approach that has been successful within the literature in treating chronic tibial neuritic pain.

Understanding the Arterial Anatomy and Dermal Perfusion of the Lower Extremity with Clinical Application

Respecting vascular territories is crucial for flap design and viability. There are 6 angiosomes in the foot and ankle originating from the posterior tibial, anterior tibial, and peroneal arteries. Reliable perforators from the 3 major source vessels of the lower extremity are found in 5-cm intervals within intermuscular septa. Computed tomography angiography, Doppler, and infrared cameras can be used preoperatively to help identify the perforators of the lower extremity.