RESUMO
Background: Diseases of the bovine digit and hoof remain major problems in dairy farming and the beef cow industry. Severe claudication accompanying swelling and pain at the lesion is often observed in deep digital sepsis, septic arthritis, severe sole ulcers, and chronic interdigital phlegmon. In addition, digital amputation is often performed in cases of white line disease or severe trauma, such as bone fractures. There are few reports of amputation of the medial digit of the bovine front hoof. In this case, amputation of the medial digit of the front leg of a pregnant cow was performed; its hospitalization and return to productivity is reported. Case: The bovine was a 9-year-old Holstein cow in the 6th month of pregnancy, weighing 671 kg. Upon admission, the cow could not bear weight on its right front leg, and swelling and a purulent discharge were observed in the coronary area of the medial digit. X-ray examination results indicated a periosteal reaction centered on the 3rd phalanx of the medial digit of its right front leg hoof and slight periosteal reactions at the adaxial sides of the middle and proximal phalanges, strongly suggestive of septic arthritis caused by infection. According to the X-ray examination results, no abnormalities of the lateral digit of the front right hoof were observed; thus, it was estimated that the post-amputation hoof would be able to bear weight. Therefore, a decision was made to perform immediate amputation of the medial digit of the right front leg hoof to reduce pain for improved delivery of the offspring and improved milk production during the lactation period, rather than allowing the lesion progress until the dry period or the expected date of delivery. According to the X-ray examination results, amputation of the 1st phalanx alone was expected to suffice for removal of the cause of the pain; thus, a decision was made to perform amputation at the edge adjacent to the 2nd phalanx. The right front medial digit was prepared for aseptic surgery, and infiltration anesthesia was performed. An incision was made with a surgical knife at the interdigit of the right front limb. A wire saw was inserted into the site to cut the 2nd phalanx in the anti-axial direction down to the skin to resect the lesion. White viscous pus was discharged at the resection site; therefore, the wound was lavaged with tap water and packed with povidone iodine-impregnated gauze. The wound was also covered with a diaper and dressed with non-elastic and elastic bandages. The dressing was changed daily to aid wound healing. No problems were observed in the standing-up motion or other relevant movements immediately after the surgery. Granulation tissue formed rapidly, approximately 2 weeks after the surgery, and the lesion dried gradually. Approximately one month after the surgery, the subject exhibited little difficulty in both standing up and walking. The subject successfully delivered its 7th offspring at the farm on postoperative day 93. Discussion: The animal of this study was a 9-year-old, pregnant cow, and although amputation of the front medial digit is a relatively rare procedure, the cow was able to deliver and return to production, owing to sufficient postoperative treatment and care. The case also demonstrated the advantage of X-ray examination in bovine hoof diseases for accurate diagnosis, precise operation, and prognostic assessment.
Assuntos
Animais , Feminino , Gravidez , Bovinos , Dedos do Pé/cirurgia , Dedos do Pé/lesões , Membro Anterior/lesões , Amputação Cirúrgica/veterinária , Artrite Infecciosa/veterinária , Claudicação Intermitente/veterináriaRESUMO
Introducción: Las úlceras del pie diabético resultan las complicaciones más frecuentes en las personas con diabetes. Se conocen diferentes formas de tratamiento para esta enfermedad, con más o menos efectividad, pero no resuelven el problema en la totalidad de los casos. El estimulador eléctrico Stimul W® y el medicamento Heberprot-P® se han empleado, de manera independiente y con resultados satisfactorios, como alternativas para el tratamiento de estas lesiones. Comprobar si la acción combinada de ambos procedimientos permite alcanzar mejores resultados, permitiría contribuir a resolver un problema de alta prevalencia mundial. Objetivo: Exponer el resultado de la aplicación de la combinación del estimulador Stimul W® y el medicamento Heberprot-P® en el tratamiento de un paciente con úlcera del pie diabético. Presentación del caso: Paciente masculino de 69 años de edad, con diabetes mellitus de tipo 2, que presentaba una úlcera del pie diabético en la parte externa del pie derecho, con abundante tejido necrótico en forma de fístula en la base de los dos dedos restantes y falta de granulación. Los tratamientos anteriores no dieron el resultado esperado. Se decidió, como terapia de curación, aplicar durante 12 sesiones la combinación del estimulador Stimul W® y el medicamento Heberprot-P®. Conclusiones: Se logró la cicatrización de la lesión, al obtener un 100 por ciento de tejido de granulación y la disminución significativa de sus dimensiones, lo que mostró que la terapia aplicada constituye una alternativa para el tratamiento de este tipo de úlcera(AU)
Introduction: Diabetic foot ulcers are the most frequent complications in people with diabetes. Different forms of treatment for this disease are known, with more or less effectiveness; but they do not solve the problem in all cases. The electrical stimulator Stimul W® and the drug Heberprot-P® have been used independently, and with satisfactory outcomes, as alternatives for the treatment of these lesions. Checking whether the combined action of both procedures allows to achieve better outcomes would contribute to solve a problem of high worldwide prevalence. Objective: To present the outcomes of applying the combination of the stimulator Stimul W® and the drug Heberprot-P® for treating a patient with diabetic foot ulcer. Case presentation: A 69-year-old male patient, with type 2 diabetes mellitus, who presented with a diabetic foot ulcer on the outside of the right foot, with abundant necrotic tissue in the form of a fistula at the base of the two remaining toes and lack of granulation. The previous treatments did not permit the expected outcomes. It was decided, as a healing therapy, to apply the combination of the stimulator Stimul W® and the drug Heberprot-P® for twelve sessions. Conclusions: Healing of the lesion was achieved by obtaining 100 percent granulation tissue and a significant reduction in its dimensions, which showed that the applied therapy constitutes an alternative for the treatment of this type of ulcer(AU)
Assuntos
Humanos , Masculino , Idoso , Dedos do Pé/lesões , Úlcera do Pé/terapia , Pé Diabético , Diabetes Mellitus Tipo 2/etiologiaRESUMO
Closed degloving injuries are uncommon, high-energy injuries that separate the bony structures from the soft tissue and frequently result in amputation. Because the epidermis is often intact, it is difficult to visualize the extent of the soft tissue damage. Although there is no gold standard of treatment for closed degloving injuries at present, previous cases have reported that neurovascular presentation is a key predictor of amputation Herein, we report a closed degloving injury involving the second through fifth phalanges of the left foot following a crushing injury with a forklift. Despite adequate capillary refill upon initial presentation, the patient ultimately underwent transmetatarsal amputation.
Assuntos
Lesões por Esmagamento , Lesões dos Tecidos Moles , Amputação Cirúrgica , Humanos , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/cirurgia , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/lesões , Dedos do Pé/cirurgiaRESUMO
INTRODUCTION: Turf-Toe includes a wide variety of traumatic injuries of the metatarsophalangeal joint of the first toe (MTF1). It is a potentially severe injury and there is no consensus for surgical management. The objective of this case report was to describe a patient with traumatic Turf-Toe injury grade III with a sesamoid fracture treated surgically. CLINICAL CASE: 24-year-old male with motorcycle fall with hyperflexion of the MTF1 joint, presented pain, edema and functional limitation; the radiographs showed soft tissue edema, lateral displacement of lateral sesamoid with fracture. Traumatic Turf-Toe was established. The ultrasound of the MTF1 joint showed breakage of the plantar plate and collateral ligaments. Patient was surgically managed with sesamoid reduction and plantar plate repair; postoperative evolution was satisfactory. At 8 weeks the patient was assessed with the AOFAS forefoot scale, obtaining 82 points, SF-12 with 87% and VAS of two and returned to his daily activities. CONCLUSION: We describe a patient with traumatic Turf Toe grade III injury, not related to sports practice; first report in the literature of the use of ultrasound in the evaluation of patients with lesion of the metatarso-phalangic joint of the first toe.
INTRODUCCIÓN: Turf-Toe incluye una gran variedad de lesiones traumáticas de la articulación metatarsofalángica del primer dedo del pie (MTF1). Es una lesión potencialmente grave y no existe consenso para el manejo quirúrgico. El objetivo de este reporte fue describir el caso de un paciente con lesión Turf-Toe traumática grado III con fractura sesamoidea tratado quirúrgicamente. CASO CLÍNICO: Masculino de 24 años con caída de motocicleta con hiperflexión de la articulación MTF1 presentó dolor, edema y limitación funcional; las radiografías mostraron edema de tejidos blandos, desplazamiento lateral de sesamoideo lateral con fractura. Se estableció el diagnóstico de Turf-Toe traumático. En el ultrasonido de la articulación MTF1, se demostró rotura de la placa plantar y ligamentos colaterales. Se manejó quirúrgicamente con reducción del sesamoideo y reparación de la placa plantar. La evolución postoperatoria fue satisfactoria; a las ocho semanas el paciente fue valorado con escala AOFAS de antepié obteniendo 82 puntos, SF-12 con 87% y EVA de 2 y retornó a sus actividades cotidianas. CONCLUSIÓN: Describimos un paciente con lesión Turf-Toe traumática grado III, no relacionada con la práctica deportiva. Primer reporte en la literatura del uso del ultrasonido en la evaluación de pacientes con lesión de la articulación metatarso-falángica del primer dedo del pie.
Assuntos
Traumatismos em Atletas , Traumatismos do Pé , Articulação Metatarsofalângica , Adulto , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/cirurgia , Humanos , Masculino , Radiografia , Dedos do Pé/lesões , Adulto JovemRESUMO
Paciente EMC, masculino, 76 años, aún trabajador agrícola. Estado físico: conservado. Antecedentes de salud hasta hace más/menos un año que comienza con claudicación a la marcha en ambos miembros inferiores, más marcada en el izquierdo. En estos momentos el dolor se establece en reposo y aparece lesión seca en el tercer dedo del pie izquierdo...
Assuntos
Humanos , Masculino , Idoso , Dedos do Pé/lesõesRESUMO
Traumatic degloving injuries of the lower extremity are commonly diagnosed by soft tissue deficits and separation of soft tissue planes. The management of open degloving injuries is well documented with established treatment protocols. Because closed degloving injuries of the lower extremity are so rare, the protocol management is not well established. Unlike open degloving injuries, evidence of soft tissue injury and detachment of the tissue planes can be subtle. Owing to the rarity of these injuries, little has been described regarding the long-term outcomes. In the present report, 2 closed degloving cases are presented. The first case presented is of a 27-year-old railroad worker who sustained a severe closed degloving injury of his foot with digital soft tissue envelope transposition. The second case involved a 60-year-old automobile manufacturer, whose foot was crushed by a hydraulic fork lift, creating a degloving injury of the third, fourth, and fifth toes. The follow-up duration from the date of injury for patient 1 was 26 months and for patients 2 was 16 months. The purpose of presenting these cases is to report these rare injuries with the treatment, complications, and outcomes.
Assuntos
Amputação Cirúrgica/métodos , Lesões por Esmagamento/cirurgia , Avulsões Cutâneas/cirurgia , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Adulto , Lesões por Esmagamento/diagnóstico por imagem , Avulsões Cutâneas/diagnóstico por imagem , Seguimentos , Traumatismos do Pé/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Radiografia/métodos , Reoperação/métodos , Medição de Risco , Estudos de Amostragem , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/lesões , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
Background: Squamous cell carcinoma (SCC) is regarded as one of the most common diagnosis in lesions of the digit, should be included in the differential diagnosis of lesions of the digit, and seems to exhibit a distinct behavior. Metastases in bone tissue are rare. Bones such as tibia, ulna and vertebrae have been reported as carcinoma metastasis sites. However, no reports of carcinoma metastasis in pelvic bones of dogs are available. This report aims at describing a case of distant and unusual metastasis of squamous cell carcinoma in the pelvis of a dog after an attempt of surgical resection of the primary lesion in the digit. Case: A six-year-old male Rottweiler dog was referred to the Veterinary Hospital of the Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Jaboticabal, Brazil, with a history of a non-healing lesion on the distal medial aspect of the left thoracic limb after amputation of the first digit, which had been performed four months earlier owing to the same problem. Surgical excision of the lesion was performed followed by wound treatment aimed at healing by second intention as an attempt to preserve the limb. Histological analysis revealed a diagnosis of squamous cell carcinoma. There was recurrence of the lesion presented as circular areas with differentiated hemorrhagic tissue amidst the granulation tissue. Another excisional biopsy confirmed squamous cell carcinoma recurrence. After that, the affected limb was amputated with a good recovery. Three months later, the patient was presented with lameness in the left pelvic limb and severe pain in the hip region. Radiographic examination revealed intense periosteal reaction in the body of the left ilium extending to the left sacroiliac joint. Incisional biopsy revealed squamous cell carcinoma metastasis. Due to the clinical presentation, the patient was euthanized and subjected to necropsy. The spleen and lung also exhibited metastatic nodules not detected on previous radiographic examination. Discussion: Squamous cell carcinoma (SCC) is the most common diagnosis in lesions of the digit and this occurrence in Rottweilers is common. Surgical intervention is still the treatment of choice for tumors of the digit. The occurrence of metastases in this patient might be related to the delay in opting for amputation. It has been suggested that the occurrence of metastasis in SCC of the digit is more likely to happen as compared to other parts of the body, but it is not clear why these lesions exhibit a distinct behavior. There are reports of carcinoma metastasis in pelvic bones; however, the primary site was not the digit. The occurrence of this type of bone metastasis is rare and, the few reports found in the literature describe it mostly in the axial skeleton in humans, which is different from what was observed in the case reported here. The most affected sites for metastasis of tumors of epithelial origin are the humerus, femur and spine. SCC should always be considered in the differential diagnosis of lesions of the digit due to its capacity to form metastasis in distant sites. Metastasis can occur in uncommon and less likely sites, such as pelvic bones. After definitive diagnosis, an aggressive treatment is recommended as an attempt to avoid additional complications. Further studies should be conducted with the aim of establishing alternative treatments and management procedures for these patients.
Assuntos
Animais , Masculino , Cães , Neoplasias Pélvicas/veterinária , Carcinoma de Células Escamosas/veterinária , Dedos do Pé/lesões , Doenças do Cão/diagnóstico , Membro AnteriorRESUMO
In this case of a 3-year-old patient who had a left big-toe amputation through the proximal phalange, re-plantation was performed successfully. Big-toe amputations are not frequent entities, but it should always be re-planted to avoid unsatisfactory aesthetic and functional outcomes. There are just a few reports in literature and their follow-up is very brief compared with our report.