FOOT and ANKLE SURGEONS "REGROW" PATIENTS TOES FOLLOWING A MANGLING POWER LAWNMOWER INJURY

Des Plaines, IL March 29, 2004--Unlike the management of traumatic finger and thumb injuries, the traditional approach to severe toe and forefoot injuries has simply involved cleaning the wound [irrigation and debridement and partial or complete amputation. If the wounds actually heal, the end result is usually irregularly shaped toe or partial foot stumps that are difficult to fit in normal show gear, require an expensive prosthetic onsole to be worn at all times, and may lead to functional gait impairment. However, a recent scientific article published in the Plastic & Reconstructive Surgery by Thomas S. Roukis, DPM and Adam S. Landsman, DPM, PhD from the Weil Foot & Ankle Institute in Des Plaines, Illinois, may change the current thinking on the need for toe or forefoot amputations following traumatic injuries or the complications associated with diabetes.

According to Dr. Roukis, "The toes consist of a series of specialized tissues which, when damaged from a traumatic injury or complications associated with diabetes, such as ulcerations and infections, are extremely difficult to replace. The current treatment involves surgically cleaning the wound and performing a partial or complete amputation and pull the remaining skin together. If this approach works the end result is a deformed toe and/or forefoot that is unsightly, does not fit in normal shoes, and requires the use of a prosthetic insole." Instead of performing this procedure, Drs. Roukis and Landsman have devised a sophisticated approach learned through international travel and extensive experience to treat this difficult condition. "Instead of the traditional approach, what we have done", according to Dr. Landsman, "is to remove the infected tissue, cover it with healthy neighboring skin, and then lengthen the remaining nubs of bone with a "mini" external fixator." An external fixator consists of several small pins that pass through the remaining bones and are supported by light-weight rods. The patient turns a small set-screw several times a day and this stretches the bone to the length that we determine is appropriate. It essentially is regrowing the toe like a salamander regrows their tail." According to Dr. Roukis, "This approach not only works, but makes perfect sense. The literature supports the fact that once a toe is amputated the neighboring toes and forefoot are at great risk to develop ulcers, infections, and amputation. This is especially true in the diabetic population where the literature states only a 12-month time seperation between amputation of the big toe and the entire forefoot. This is something that we simply can not accept and, therefore, offer this technique to our patients in an attempt to go back in time and return their foot to as close to the way it was before the amputation as possible."

According to Drs. Roukis and Landsman, since they have been using this specialized approach they have been able to not only avoid many toe and forefoot amputations but allow the people to walk without specialized shoes and prosthetic insoles. "It may not mean much to some people but our patients are so happy that they can walk in public without having to hide their foot in a shoe. The boost in self-esteem and simple independence our technique has afforded these people is reason enough to use it", states Dr. Roukis. However, the techniques described are very specialized and should only be attempted by surgeons with extensive training and knowledge of the principles involved in performing them. Dr. Roukis states, "That is why we have traveled all over the world to learn these techniques. They are difficult to perform and require extensive follow-up both in the hospital, as well as, on an out-patient basis. However, the end result of a saved toe or forefoot is so rewarding that I hope this becomes the standard of care once surgeons are able to learn these techniques." Dr. Roukis has recently returned from Scotland and Russia where he further enhanced his understanding of these specialized techniques.

The full scientific paper can be found at: Roukis TS, Landsman AS, et al. Toe reconstruction following a lawnmower injury using a distally based adipofascial turnover flap and distraction osteogenesis. Plast. Reconstr. Surg. 113(2):793-795, 2004.

Drs. Roukis and Landsman are in private practice at the Weil Foot and Ankle Institute in Des Plaines, IL.

To make an appointment, or for a second opinion, with either Dr. Roukis or Dr. Landsman, call: 847-390-7666 or visit: www.footankledeformity.com.





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