Index. Springer International Publishing Switzerland 2015 T.J. Boffeli (ed.), Osteomyelitis of the Foot and Ankle, DOI /

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1 A Acute hematogenous osteomyelitis (AHO) conventional radiography, 70 foot, laboratory aides, 69 magnetic resonance imaging, 70, 71 microbiology, 69 pathophysiology, signs and symptoms, 68 skeletal scintigraphy, 70 treatment, X-rays, 70 Acute osteomyelitis, 16, 308 empirical therapy, 57 immunosuppressive medications, 15 oral therapy, 58 targeted therapy, Ankle-foot orthosis (AFO), 253, 304, 313, 317, 326, 328, 329 Antibiotic beads, 131, 133, 162, 185, 188, 189, , 246, 247, 250, 303 ABLC beads, 115 plantar ulcer, 161 polymethylmethacrylate (see Polymethylmethacrylate (PMMA)) side effects, 114 soft tissue void/bone defect, 114 vs. spacer, 120 Antibiotic spacers, 63, 108, 109 antibiotic-loaded bone cement (ABLC) diabetic foot, high-dose ABLC, 120 postoperative infection/septic joint, removal and wound closure, 120, 122 technique, 120 trauma, ulcer excision and MTP joint resection, 122, 123 vs. beads, 120 Antibiotic therapy, 82, 83, 108, 148, 159, 161, 187, 204, 223, 228, 248, 288, 313, 314, 331 advantages and disadvantages, 7 elusion properties, 114 empirical therapy, MRSA, 56 parenteral and oral antibiotics, 56 targeted therapy, 56, B Baseball flap midfoot amputation technique bone resection, 279 clinical and radiographic follow-up of, 280 complete open fifth ray amputation, 278 DPAA and MPAA flap, 268, 279 gangrene/frostbite, 268, 278 medial and lateral soft tissue necrosis, 268, 278 rotated and sutured, year clinical and radiographic results of, 281 Below knee prosthetics, 283 Bone biopsy, 159 amputation, 41 antibiotic exposure, 41 calcaneal osteomyelitis cortical window with internal medullary debridement technique, 302 wound excision with cortical debridement, 307 Charcot arthropathy, 159 distal fibular osteomyelitis, lateral ankle decubitus ulceration, 328 distal Symes amputation, tip-of-toe ulcers, 210 fl uoroscopy, 40 "gold standard" status, 40 histopathologic evaluation and microbiologic culture, 41 incision and drainage procedure, 41 joint arthroplasty, 42, 44 open corticotomy, partial first ray amputation, 188 percutaneous trephine technique, 41 selection, 39 trephine bone biopsy, 41, 42, 44, 46 calcaneus, 46 hallux, 43 large bones of rearfoot/ankle, 44, 46 small bones of forefoot, 42 WBC count, 40 wound excision, C Calcaneal osteomyelitis, 46, 106 clinical and radiographic workup CT and bone scan, 298, 300 MRI, , 300 X-rays, 297, 300 cortical window with internal medullary debridement technique bone biopsy, 302 bone grafting, incision approach, 302 patient selection, 301 postoperative care, 302, 303 preoperative radiographs, 301 stage 2 procedure, 301, 303 isolated medical management, 298 leg amputation, partial calcanectomy (see Partial calcanectomy) Springer International Publishing Switzerland 2015 T.J. Boffeli (ed.), Osteomyelitis of the Foot and Ankle, DOI /

2 340 Calcaneal osteomyelitis (cont.) treatment pathways, wound excision with cortical debridement biopsy results, 308 bone biopsy, 307 decubitus, traumatic/surgical wound, 302 distal healing, 310 distal wound, partial closure of, 310 exposed and necrotic Achilles tendon, 308 exposed hardware and concern for osteomyelitis, 306 hardware removal and cortical debridement, 307 healing of incision, 305 infected sinus tract, 306 initial postoperative lateral radiograph, 305 nonhealing surgical wound, 304 patient selection, posterior calcaneus, cortical debridement of, 310 postoperative care, 304 preoperative and postoperative X-rays, 309 single-staged debridement, 309 surgical technique, wound closure options, 304 Central metatarsal osteomyelitis partial central ray amputation acute soft tissue infection, 222 extension of incision, 223 intramedullary canal, 223 margin pathology specimen, 223 metatarsal fragment, 222 periosteum, 222 6week post-operative clinical appearance, 223 prevention, 217 proximal metatarsal amputation accessory incision, 224, 225 dead space management, 226 heterotopic ossification, 224 metatarsal base amputation, 224, 225 metatarsal head resection, 227 mid-shaft metatarsal amputation, 224, 225 panmetatarsal head resection, 225, 227 plantar flap closure, 227 plantar rotational flap, 227 soft tissue disruption, 226 transmetatarsal amputation, 228 staged surgical approach, 228 surgical management anesthesia care, 219 dorsal metatarsal head resection, 222 indications, 219 isolated metatarsal head resection, 219 MRI, 219 plantar ulcer excision, 222 two-week post-operative radiographic appearance, 222 surgical modalities nonhealing and recurrent forefoot ulcers, 220 open gastrocnemius recession, 220 pre and 2-week post-postoperative clinical appearance, 220 structural deformities, 219 tendo-achilles lengthening (TAL), 218 Central toe osteomyelitis complete toe amputation, MPJ disarticulation, 211, 214, 215 diagnosis of, digital gangrene, 197, 198, distal Symes amputation, tip-of-toe ulcers, 205 advancement flap closure, 209 bone biopsy technique, 210 clinical results, 212 dorsal and plantar incision, 207 hemostasis with, incision technique, 208 instrumentation, 206 operative room setup, 206 postoperative results, 210 stage 2 distal Symes amputation, 211, 212 elective hammertoe surgery, 200, 202 fl exor and extensor tenotomy, 200, 201 hallux valgus deformity, 200, 202 ideal level of amputation, 204, 205 interdigital ulceration, 200, 202 intravenous antibiotics, 204 isolated medical management, 204 late stage onset of, 197 neuropathic ulcers, partial toe amputation, proximal phalanx, 204, 206, 213 PIPJ arthroplasty, 206, 213, 214 postoperative care, 211 prophylactic treatment, 199 second digital amputation, 200, 202 staged surgery, 204 surgical goals, 204 wound care challenges for, Chainsaw injury, Charcot arthropathy, 109, 158, 244, 264, 273 bone and joint imaging, 160 bone biopsy, 159 bone cultures, 159, 160 clinical evaluation, diagnosis, 157, 160 laboratory evaluation, 159 preoperative evaluation, probe to bone test, 158 treatment antibiotic cement beads/spacers, 161 arthrodesis, 162 culture and sensitivity-based antibiotics, 161 internal and external fixation, 162 intraoperative cultures, 161 medial column screw, 163 negative pressure therapy, 162 non-weight bearing, 162 single-stage procedure, 163, 164 weight bearing, 161 ulceration, 158 Chopart s amputation technique cuboid osteomyelitis, MPAA rotational flap (see Cuboid osteomyelitis) navicular preservation, 286, 287 partial foot prosthesis, 283, 296 patient selection criteria for, plantar space infections, 287 healing, 295 navicular preservation, 295 open TMA, postoperative X-rays, 292 stage 1 guillotine type forefoot amputation, 293 V to T rotational flap, 294 postoperative care, 296 rehabilitation, 283 staged surgical approach, 284 tendon balancing procedures, , 295 traditional approach active ankle dorsiflexion, 284, 285 anterior calcaneal remodeling, 284, 286

3 341 dorsal and plantar fish mouth incision design, 284, 285 full depth incision, 284, 285 healing, 286 midtarsal joint disarticulation, 284, 285 no-touch suture technique, 284 talus head, weight bearing, 286, 287 tibialis anterior tendon (TA), loss of, 284, 285 wound closure, 284, 286 Chronic osteomyelitis, 7, 13, 16, 51, 52, 56, 58, 108, 113, 161, 163, 219, 288, 305 empirical therapy, 58 oral therapy, targeted therapy, 58 Complete blood count (CBC), 69, 141 Crush injury, Cuboid osteomyelitis late stage pan metatarsal head resection, 288 MPAA rotational flap, Chopart s amputation forefoot disarticulation, 290 incision design, 289 partial foot prosthesis, 292 plantar flap remodeling, 290 postoperative weight bearing radiographs, 291 preoperative weight bearing radiographs, 291 raising of flap, 290 wound closure, 291 residual clubfoot deformity, 288 D Degloving injury, 148, 149, Diabetic foot osteomyelitis (DFO), 99, 116 adjuvant agents, bone eradication and soft tissue infection bone margin culture, 102 hybrid external fixation, 100 intraoperative specimens, 102 reconstruction considerations, 100 resection and reconstruction, 100 single-stage procedure, 100 surgical intervention, 100 tissue reconstruction advanced moist wound therapy, 103 angiosomes, 105 calcaneal osteomyelitis, 106 free muscle flaps, 105 limb function, 102 metatarsal phalangeal joint, 104 negative-pressure wound therapy, 102, 103 single-stage resection approach, 104 split-thickness skin graft (STSG) wound, 107 surgical debridement, 102 Distal fibular osteomyelitis, lateral ankle decubitus ulceration AFO bracing, 325, 326, 328 conservative surgical intervention, 326 diagnosis of bone biopsy, 328 bone scan and CT, 328 MRI, 327, 328 X-rays, 327 distal fibulectomy, 326, 331, hematogenous osteomyelitis, 325 late-stage development, musculocutaneous flaps, 326, neuromuscular contracture Achilles tendon lengthening, 329 posterior tibial tendon, Z-lengthening of, 328 soft tissue release, 329 neuropathic ulcers, 325 postoperative care, 331, 337 residual wound defect, 325 secondary osteomyelitis corticotomy, 333 recurrent soft tissue infection, 333 small lateral malleolar pressure sore, surgical treatment, 333 unilobed flap, rotation and closure of, 334 wound margins, undermining of, 333 small lateral malleolar pressure sore, wheelchair-related foot and ankle pressure sores, 325, 326 wound excision and lateral cortical debridement interval healing, 332 near-complete wound healing, 332 NPWT, 330 preoperative and postoperative radiographs, 331 progressive healing, 332 secondary osteomyelitis, 331 soft tissue undermining, 330 Distal Symes amputation, 200, 205 advancement flap closure, 209 bone biopsy technique, 210 clinical results, 212 dorsal and plantar incision, 207 hemostasis with, incision technique, 208 instrumentation, 206 operative room setup, 206 postoperative results, 210 stage 2 distal Symes amputation, 211, 212 Dorsalis pedis artery angiosome (DPAA), 268, 279 E Erythrocyte sedimentation rate (ESR), Extensor hallucis longus (EHL), 169 F Fifth metatarsal phalangeal joint (MPJ) osteomyelitis fi fth metatarsal head resection, 233, 236 partial fifth ray amputation with digital fillet flap, plantar ulceration, rotational flap for, 233, tennis racket incision, 233, 237 Fifth ray osteomyelitis complete fifth ray amputation antibiotic bead placement, 245, 247 antibiotic bead removal, 246, 247 cuboid remodeling, 245, 246, 248 fi fth metatarsal dissection, 246 fi fth metatarsal removal, 245, 246 healed incision, 250 incision planning, 245 indications, 244 peroneal tendon transfer, , 248, 249 plantar ulceration, preoperative appearance of, 245, 250 postoperative X-rays, 244, 249 preoperative X-rays, 244 soft tissue balancing procedures, 250, 251 tennis-racquet incision, 245 wound closure, 245, 249 fi fth MPJ ulceration and osteomyelitis ( see Fifth metatarsal phalangeal joint (MPJ) osteomyelitis) fi fth toe amputation

4 342 Fifth ray osteomyelitis (cont.) fifth metatarsal head removal, 233, 234 primary wound closure, 233, 234 proximal and middle phalanges, 232, 234 tennis racket incision, 234 trap door digital fillet flap technique, infected gangrene, internal pedal amputations, 230 lateral column decubitus ulcers, 229 location of, 229, 230 neuropathic ulcers, PIPJ arthroplasty and partial syndactylization, procedure selection for, 230 structural deformities, 230, 231 surgical goals, 229 traditional podiatric reconstructive procedures, 230 First ray osteomyelitis, complete first ray amputation antibiotic bead implantation, 193 bead removal, clinical appearance after, 195 extensive osteomyelitis, 192, 194 first metatarsal cuneiform joint, disarticulation, 196 first metatarsal head resection and biopsy, 194 heterotopic ossification, 192 midshaft plantar ulcer, 192 peroneus longus, preservation of, recurrence of HO, 193 recurrent plantar ulceration, 192 stage 2 and 3 procedures, 195 tibialis anterior, preservation of, 185 complete hallux amputation, 174, , 185 complications, 187 elective procedure pathways, 169, 170 foot and ankle deformities, 167 hallux distal Symes amputation ( see Hallux distal Symes amputation) hallux hammertoe deformity EHL lengthening, 169 elective hammertoe surgery, 169 hallux IPJ fusion/arthroplasty, 169, 173 tip-of-toe ulcers, FHL tenotomy ( see Tip-of-toe hallux ulceration) hematogenous osteomyelitis, 167, 168 infected gangrene, 167, 168 IPJ plantar ulcer, hallux IPJ arthroplasty benefits of, 170 bone resection, intraoperative imaging, 176 dorsal incision, 169 functional hallux limitus, 173 incision plan, 174 IPJ sesamoid bone, removal of, 177 patients, clinical exam of, 170 patient selection, 170 postoperative results, 178 preoperative imaging, 174 raising of unilobe flap, 175 rotation of unilobed flap, 177 secondary dorsal incision, 176 staged surgery, 171 valgus deformity of toe, 173 wound closure, 178 wound excision technique, 175 location of, 169, 170 medial column, 167 nail bed wounds, 167, 168 neuropathic ulcers, 167, 168 open fractures, 167, 168 partial first ray amputation ( see Partial first ray amputation) partial hallux amputation, , 185 plantar MPJ ulcers ( see Plantar first metatarsophalangeal joint (MPJ) ulceration) postoperative management, procedure selection flowchart, 169, 170 puncture wound, 167, 168 reconstructive podiatric procedures, 169 surgical treatment pathways, 169, 170 toenail-related infections, 167, 168 ulcerated tophaceous gout, 167, 168 Flexor hallucis longus (FHL) tenotomy, 169, 171, 172, 304 G Gustilo Anderson classification, 139, 140 H Hallux distal Symes amputation, disarticulation, hallux interphalangeal joint, 175, 183 incision and drainage of infection, 175, 182 incision plan, 175, 183 intraoperative radiographs, 175, 184 neuropathic and ischemic ulcers, 175, 181 patient selection for, 175, 181 proximal phalanx head, remodeling, 175, 183, 184 vascular intervention, clinical appearance after, 175, 182 wound closure, 175, 184 wound excision, 175, 182 wound healing, 175, 184 Hallux interphalangeal joint (IPJ) arthroplasty benefits of, 170 bone resection, intraoperative imaging, 176 dorsal incision, 169 functional hallux limitus, 173 incision plan, 174 IPJ sesamoid bone, removal of, 177 patients, clinical exam of, 170 patient selection, 170 postoperative results, 178 preoperative imaging, 174 raising of unilobe flap, 175 rotation of unilobed flap, 177 secondary dorsal incision, 176 staged surgery, 171 valgus deformity of toe, 173 wound closure, 178 wound excision technique, 175 Hallux valgus deformity, 43, 179, 200, 202 Heterotopic ossification (HO), 192, 254 clinical presentation, 129 etiology of, incidence of, 127 metatarsal amputation sites, 128 pharmacological prophylaxis, radiation therapy prophylaxis, 133, 135 surgical prophylaxis, antibiotic-impregnated beads, 134 histologic features, 133 osteoprogenitor cells, 133 soft tissue closure, 131 techniques, 134

5 343 treatment and prophylactic measures antibiotic beads, 131 bone growth, 131 intraoperative findings, 131 metatarsal resection site, 131 radiographs, 131 Hyperbaric oxygen (HBO) therapy, 7, 63 I Infected implants, 117 and epidemiology, pathogenesis, surgery, protocols, removal of 1-stage approach, stage approach, salvage strategies, treatment debridement, 79 exogenous and hematogenous colonization, 78 preclinical research, 80 stabilization, Staphylococcus aureus, J Joint arthroplasty, 40, 42 44, 171, 233 Joint sepsis, 143, 144, 168, 179 clinical presentation and diagnosis, of foot, medical and surgical treatment ankle portals, 94 anterolateral ankle portals, 93 antiseptics, 93 arthroscopic debridement, 95 doppler ultrasound, 94 insufficient response, 96 intraoperative fluoroscopy, 93 intraoperative staging, 95 open arthrotomy, 95 standard anteromedial portals, 93 Staphylococcus aureus, 92 2 weeks postoperatively arthroscopy portals, 96 L Lateral ankle decubitus ulceration. See Distal fibular osteomyelitis, lateral ankle decubitus ulceration Lateral plantar artery angiosome (LPAA) rotational flap, 261, 287 dorsal soft tissue defects, 262 forefoot and vascular intervention, demarcation of, 264 forefoot, medial necrosis of, 263 forefoot resection, 264, 265 intraoperative assessment of, 266 metatarsal resection, 262, 264 necrotic tissue resection, 262, 264 pivot point of, 262 postoperative radiographs, 267 postoperative results, 267 raising of flap, 262, 265 rotated and sutured, Lawn mower injury, Lisfranc tarsometatarsal amputation Achilles tendon lengthening, 258 dorsal and plantar fish mouth incision design, 258, 262 extensive tissue necrosis, frostbite, 257, 261 forefoot disarticulation, 258, 260, 262 forefoot gangrene, 257, incision technique, 258 lateral column breakdown, 253 level of, 253, 254 medial cuneiform, TA and PL insertions, 258, 263 midfoot ulceration, 257, 261 MPAA rotational flap (see Medial plantar artery angiosome (MPAA) rotational flap) musculotendinous structures, loss of, 253 peroneus brevis function, loss of, 257 peroneus longus function, loss of, 257 postoperative care, 270 postoperative radiographs, 263 PT tendon open Z-lengthening, 258, 262 tarsal bone remodeling, 258, 263 tendon balancing procedures, need for, 253 tibialis anterior function, loss of, 257 wound closure, 260 M Medial plantar artery angiosome (MPAA) rotational flap, 261 baseball flap midfoot amputation, 268, 279 choke vessels, 266 cuboid osteomyelitis, Chopart s amputation forefoot disarticulation, 290 healing, 292 incision design, 289 partial foot prosthesis, 292 plantar flap remodeling, 290 postoperative weight bearing radiographs, 291 preoperative weight bearing radiographs, 291 raising of flap, 290 wound closure, 291 Lisfranc amputation Charcot related plantar lateral midfoot wound, 273 healing of, 275 incision plan, 273 intraoperative imaging in, 274 postoperative radiographs of, 275 tarsal bone remodeling, 273 wound closure, 274 pivot point approach, 265 transmetatarsal amputation incision planning, 270 intraoperative flap creation, 271 metatarsal resection, 269 necrotic tissue resection, 269 plantar lateral forefoot gas gangrene, 268 postoperative radiographs of, 272 rotated and sutured, 272 Medical management adjunctive therapies, 63 anaerobes, 61 antibiotic therapy empirical therapy, MRSA, 56 parenteral and oral antibiotics, 56 targeted therapy, 56, coagulase-negative staphylococci, 60 duration of therapy, enterococci and vancomycin-resistant enterococci, 60 gram-negative organisms, 60 61

6 344 Medical management (cont.) indications, local antibiotic therapy, 63 oral antibiotics, organisms, 59, 60 polymicrobial infections, 61 prosthesis infections, 61 Staphylococcus Aureus and MRSA, Streptococcus spp., 60 Metatarsophalangeal joint (MPJ), 87, 97, , , 173, 176, , 185, 190, 201, 202, , 214, 215, 233, 256 partial fifth ray amputation ( see Partial fifth ray amputation, MPJ osteomyelitis) plantar first MPJ ulceration ( see Plantar first metatarsophalangeal joint (MPJ) ulceration) Methacillin-resistant S. aureus (MRSA), 4, Midfoot amputation, 163, 167, 220, 253, 258, baseball flap technique, 268, Lisfranc amputation (see Lisfranc tarsometatarsal amputation) transmetatarsal (see Transmetatarsal amputation (TMA)) Motor vehicle collision (MVC), N Negative pressure wound therapy (NPWT), 141, 330 O Open fractures, 1, 2, 67, 77, 82, 116 fi rst ray osteomyelitis, 167, 168 traumatic injuries antibiotics, 148 chainsaw injury, definition, 148 degloving injury, industrial crush injury, lawn mower injury, motor vehicle collision, road rash injury, Osteomyelitis acute phase reactants C-reactive protein, 22 erythrocyte sedimentation rate, procalcitonin, blood cultures, 21 bone biopsy, 20 calcaneal (see Calcaneal osteomyelitis) central metatarsal osteomyelitis ( see Central metatarsal osteomyelitis) of central toe ( see Central toe osteomyelitis) charcot arthropathy (see Charcot arthropathy) classifications, clinical findings and laboratory markers, 23 clinical signs and symptoms, computed tomography, diagnosis, 5 6 epidemiological data, 1 etiology and classification, 2 3 fifth ray ( see Fifth ray osteomyelitis) of first ray ( see First ray osteomyelitis) laboratory evaluation, leukocytosis, 21 limb salvage, 1 magnetic resonance imaging abscesses, 33 bone marrow, 30, 31 callus formation, 30 gadolinium contrast enhanced imaging, 33 marrow edema, 32 meta-analysis, 34 soft tissue structures, 30 STIR imaging, 30 tendon involvement, 34 T1 weighted imaging, 31 T2 weighted imaging, 32 ulcerations, 30, 31 management, 6 8 neuroarthropathy, nuclear medicine scans labeled white blood cell scans, technetium 99m phosphate bone scans, 28 pathologic diagnosis acute osteomyelitis, 50, 51 bone culture, 49 chronic osteomyelitis, 52 cortex subperiosteal scalloping, 50 histologic features, 51 osteoclasts, 49 osteocytes, 49 postsurgical changes, 51, 52 septic arthritis, 52 sequestrum, 51 pathophysiology and microbiology, 3 4 populations at risk, 4 5 positron emission tomography imaging, probe-to-bone (PTB), radiography, 27 risk factor bacteremia, in adults, 14 circulation disorders, 15 comorbidities, 14 environmental settings, 15 exposures, 13 illicit drug abusers, 15 patient s age and gender, prescription medications, 15 trauma/osseous surgery, 15 traumatic injuries (see Traumatic injuries) vital signs, wound characteristics depth, 18 duration, 17 size, 18 O-to-Z flap technique fl ap closure, 173, 180 incision design, 173, 179 sesamoidectomy surgical technique, 173, 180 P Partial calcanectomy fl ap design and wound closure options decubitus ulcer, zones of, 307, 309, 311 fl ap planning, 309, 312 wheelchair-bound patients, 309, 311 goal of, 314 junctional heel ulceration, 314, 319, 320 patient selection, , 311 plantar heel decubitus ulceration, 314, posterior heel decubitus ulceration, 313 contralateral leg amputation, 317 fl ap creation and closure, 318 stage 1 surgery, 318

7 345 postoperative care heel off-loading posterior splint, 313, 316 pillow dressing, 313, 315 rigid ankle-foot orthoses, 313, 317 surgical technique bone resection, extent of, 311, 313 Eschar excision, 312 flap closure, 311, 313 guide pin technique, 311, 313 no-touch technique, patient positioning, 309 preoperative antibiotics, 309 Partial fifth ray amputation, MPJ osteomyelitis digital fillet flap, plantar ulceration, rotational flap for, 233 bone exposure, 238 flap closure, 240 flap design, 238 metatarsal head resection, 239 predisposing factors, 238 raising of flap, 238 tissue, marking of, 238 tennis racket incision, 233, 237 Partial first ray amputation plantar MPJ ulcer, rotational flap for incision planning, 181, 190 intraoperative imaging, 181, 191 metatarsal resection, 181, 190 raising of flap, 181, 190 wound closure, 184, 191 traditional technique bone biopsy, 188 dorsal and plantar flap incision design, 179, 187 hallux, infection and necrosis of, incision technique, 179 metatarsal head resection, , 189 MPJ disarticulation, 179, 188 no-touch technique, 179, 187 plantar tissue necrosis, 186 proximal medullary canal, 180, 189 raising of flap, 188 serial X-rays, 186 tennis racquet-type incision, 179 wound closure, 180, 189 Partial foot prosthetics, 283, 292, 296 Partial hallux amputation, 167, , 185 Partial syndactylization technique, Patzaki classification system, 142 Pedal puncture wounds, 141, 142 Peripheral vascular disease (PVD), 5 Plantar first metatarsophalangeal joint (MPJ) ulceration bilobed rotational flap, 173, 181 diabetic patients, peripheral neuropathy, 171 metatarsal/proximal phalanx, 173, 179 O-to-Z flap closure of, 173, 180 incision design, 173, 179 sesamoidectomy surgical technique, 173, 180 partial first ray amputation ( see Partial first ray amputation) related deformities, 173 sesamoid bone, osteomyelitis of, 173, 179 Polymethylmethacrylate (PMMA), 108, 121 antibiotic selection, 114 cardiopulmonary complications, 114 methyl methacrylate, 113 Postamputation heterotopic ossification. See Heterotopic ossification (HO) Posterior tibial (PT) tendon, 258, 262 Probe-to-bone (PTB), Proximal interphalangeal joint (PIPJ) arthroplasty dorsal ulceration, hammertoe deformity, 206, 213, 214 fi fth toe osteomyelitis, Pseudomonas, 143, 148 P. aeruginosa, 4 Puncture wounds antibiotics, foreign body, removal of, imaging technique, 142, 143 Patzaki classification system, 142 pedal, 141, 142 surgical treatment, R Radionuclide imaging, 160 Rigid ankle-foot orthoses, 317 Road rash injury, S Skeletal reconstruction, 121 Small lateral malleolar pressure sore, Staphylococcus aureus, 3, 69, 92, , 148 T Tendo-Achilles lengthening (TAL), 250, 255, 287, 295 Tetanus prophylaxis, 139, 140 Tip-of-toe hallux ulceration FHL tenotomy clinical appearance after, 169, 172 percutaneous plantar incision, 169, 171 preoperative and postoperative radiographs, 169, 172 hallux distal Symes amputation, 169 with hammertoe contracture, 169, 171 Transmetatarsal amputation (TMA), 241. See also Lisfranc tarsometatarsal amputation ankle tourniquet, 256 atraumatic surgical technique, 256 biomechanical consequence, 254 cross-contamination, risk of, delayed posterior lengthening, 256 dorsal and plantar fish mouth incision design, forefoot disarticulation, 256, 259 gangrene-related TMA, 255 gastrocnemius recession, 255 heterotopic ossification, 254 interrupted skin sutures, 257, 260 level of, 253, 254 LPAA rotational flap dorsal soft tissue defects, 262 forefoot and vascular intervention, demarcation of, 264 forefoot, medial necrosis of, 263 forefoot resection, 264, 265 intraoperative assessment of, 266 metatarsal resection, 262, 264 necrotic tissue resection, 262, 264 pivot point of, 262 postoperative radiographs of, 267 postoperative results, 267 raising of flap, 262, 265 rotated and sutured, margin biopsy, 257, 260 metatarsal osteomyelitis, 254

8 346 Transmetatarsal amputation (TMA) (cont.) metatarsal preservation approach, 254 metatarsal resection, 256, 259 MPAA rotational flap (see Medial plantar artery angiosome (MPAA) rotational flap) pathologic mechanics, 254 patient selection criteria, 256, plunge-cut technique, 256, 258 postoperative care, 268, 270 postoperative imaging, 257, 261 profound equinus contracture, 256 TAL procedures, 255 V to T flap technique, 268 incisions, 276, 277 intraoperative imaging, 278 larger central plantar soft tissue defects., 268, 277 plantar forefoot wound, 276 postoperative radiographic imaging, 276, 278 second metatarsal head, resection of, 276 wound closure, 278 zone of resection, 254 Trap door digital fillet flap technique, Traumatic injuries antibiotic and bacteria concern, 139, 140 Gustilo-Anderson classification, 139, 140 irrigation and debridement, 141 lower extremity, 139 open fractures antibiotics, 148 chainsaw injury, definition, 148 degloving injury, industrial crush injury, lawn mower injury, motor vehicle collision, road rash injury, puncture wounds antibiotics, foreign body, removal of, imaging technique, 142, 143 Patzaki classification system, 142 pedal, 141, 142 surgical treatment, radiographs, 141 tetanus prophylaxis, 139, 140 Trephine bone biopsy calcaneus, 46 hallux, 43 large bones of rearfoot/ankle, 44, 46 small bones of forefoot, 42 V V to T flap technique, 268 incisions, 276, 277 intraoperative imaging, 278 larger central plantar soft tissue defects., 268, 277 plantar forefoot wound, 276 postoperative radiographic imaging, 276, 278 second metatarsal head, resection of, 276 wound closure, 278 W Waldvogel classification, 2