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These include delayed primary closure, skin grafting, local, pedicle or free-tissue transfer.<\/jats:p>","DOI":"10.12968\/jowc.2006.15.6.26925","type":"journal-article","created":{"date-parts":[[2014,5,23]],"date-time":"2014-05-23T15:59:10Z","timestamp":1400860750000},"page":"276-280","source":"Crossref","is-referenced-by-count":22,"title":["Unstable acute and chronic Charcot\u2019s deformity: staged skeletal and soft-tissue reconstruction"],"prefix":"10.12968","volume":"15","author":[{"given":"T.","family":"Zgonis","sequence":"first","affiliation":[{"name":"Department of Orthopaedics; Director, Fellowship Training Programs, The University of Texas Health Science Center at San Antonio, San Antonio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.S.","family":"Roukis","sequence":"additional","affiliation":[{"name":"Limb Preservation Service, Departement of Vascular surgery, Madigan Army Medical Center, Takoma, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.G.","family":"Frykberg","sequence":"additional","affiliation":[{"name":"Podiatry Section, Carl T. 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From this information a detailed three-dimensional view of the origin, course and distribution of vessels supplying a given composite block of tissue has been created."},{"key":"p_17","doi-asserted-by":"publisher","DOI":"10.1016\/S1067-2516(99)80038-6"},{"key":"p_18","doi-asserted-by":"publisher","DOI":"10.1016\/S1067-2516(00)80044-7"},{"key":"p_21","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/S0030-5898(20)31815-0","volume":"24","year":"1993","journal-title":"Orthop Clin N Amer"},{"key":"p_22","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199406000-00027"},{"key":"p_23","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200005000-00062"},{"key":"p_24","volume-title":"J., Morain","author":"Manchot C.","year":"1983"},{"key":"p_26","unstructured":"Churchill Livingstone, 1988."},{"key":"p_27","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(87)90185-8"},{"key":"p_28","volume-title":"WB Saunders","author":"Taylor G.I.","year":"1990"},{"key":"p_29","volume-title":"Aston, S.J., Beasley, R.W., Thorne, C.H.M. (eds). Grabb and Smith's Plastic Surgery","author":"Taylor G.I.","year":"1997","edition":"5"},{"key":"p_30","first-page":"627","volume":"78","author":"Hidalgo D.A.","year":"1986","journal-title":"Plast Reconstr Surg"},{"key":"p_32","doi-asserted-by":"publisher","DOI":"10.1016\/S1071-0949(97)80025-X"},{"key":"p_33","unstructured":"The most common type of muscles in the foot are classified as type II and include the abductor hallucis, abductor digiti minimi, flexor digitorum brevis and extensor digitorum brevis,24-29with one dominant pedicle at their origin and several minor ones entering the muscle belly."},{"key":"p_34","unstructured":"Musculocutaneous flaps are preferable, although their use in the foot and ankle is limited due to the resultant large donor defects when harvested as a unit. With this in mind, our preference is to harvest muscle in isolation, followed by coverage with a split-thickness skin graft. The advantages include constant and reliable blood supply, easy and rapid flap dissection, and adequate vascularised coverage to exposed bone, which can aid eradication of osteomyelitis through increased distribution of systemic antibiotics30-32(Fig 2)."},{"key":"p_39","series-title":"Fig 3","volume-title":"which preserves the fine perivascular anastomosis","author":"Each"},{"key":"p_42","doi-asserted-by":"publisher","DOI":"10.1016\/S1083-7515(02)00012-8"},{"key":"p_43","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-198308000-00002"},{"key":"p_44","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199806000-00061"},{"key":"p_45","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S0891-8422(23)01124-2","volume":"17","author":"Paragas L.K.","year":"2000","journal-title":"Clin Podiatr Med Surg"},{"key":"p_46","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198802000-00014"},{"key":"p_48","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(91)90122-Z"},{"key":"p_49","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/S0094-1298(20)30845-2","volume":"18","author":"Seales J.M.","year":"1991","journal-title":"Clin Plast Reconstr Surg"},{"key":"p_51","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198167020-00007"},{"key":"p_52","doi-asserted-by":"publisher","DOI":"10.1016\/S0891-8422(03)00072-7"},{"key":"p_53","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200209150-00007"},{"key":"p_54","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-198504000-00012"},{"key":"p_55","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0891-8422(23)01155-2","volume":"17","author":"Attinger C.E.","year":"2000","journal-title":"Clin Podiatr Med Surg"},{"key":"p_58","unstructured":"In recent years, reconstructive foot surgery has assumed an important role in Charcot's feet that cannot be effectively treated with bracing or footwear therapy.38-40While in optimal circumstances surgical treatment for Charcot's deformities will be unnecessary, patients often initially present in the active stage with severe unstable deformities. It has long been held that surgery in the acute stage is inadvisable due to the extreme oedema, hyperaemia and osteopenia present during this phase. However, this has since been the topic of some debate, with one report suggesting that, in the presence of acute subluxation without significant fractures, typified by talonavicular dislocation, primary fusion might in fact be the most appropriate treatment.41"},{"key":"p_59","unstructured":"Surgery on the chronically deformed or unstable quiescent Charcot's foot has become more common in current practice.42-45Most surgical interventions consist of plantar exostectomies to remove bony prominences associated with recurrent ulcers, and isolated or extended arthrodesis procedures are more frequently reserved for realignment and stabilisation of severely deformed feet.45-49"},{"key":"p_61","unstructured":"Multiplanar external fixation devices have been introduced for the treatment of Charcot's neuroarthropathy in the past decade.42-44As previously noted, treatment of acute Charcot events has traditionally been conservative as physicians used prolonged total-contact casting and offloading, with no formal attempt to reduce the deformity but rather to simply promote osseous consolidation. In addition, treatment of chronic deformities has involved below-knee casting, non-weight bearing for a long period and attempted reconstruction via traditional plate and screw internal fixation techniques.52-54Only recently have surgeons considered reconstruction via tarsal osteotomies, as evidenced by the limited number of papers describing external fixation for such treatment.42-44,55"},{"key":"p_63","unstructured":"Instability, gross deformity and progressive destruction, despite immobilisation, are the primary indications for surgical intervention in the Charcot's foot deformity.56-58Additionally, recurrent ulceration overlying resultant bony prominences of the collapsed rear, mid and forefoot may require partial ostectomy in conjunction with appropriate footwear therapy to effect final healing. In some patients pain or varying degrees of discomfort will frequently accompany the deformity and may be resistant to conservative care. Attributable to chronic instability, such discomfort can be eliminated with limited arthrodeses and soft-tissue coverage at the primary focus of the neuroarthropathy."},{"key":"p_68","doi-asserted-by":"crossref","unstructured":"applications. Ann Plast Surg 2003; 50: 90-99.","DOI":"10.1097\/00000637-200301000-00016"},{"key":"p_70","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200012000-00006"},{"key":"p_73","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200204010-00011"},{"key":"p_75","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198167020-00007"},{"key":"p_78","volume-title":"A.C., Alain, G. (eds). 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