The research team at OFAC had a tremendous showing at the annual scientific meeting of the American Orthopedic Foot and Ankle Society (AOFAS) recently in Washington, D.C. This international meeting is the largest orthopedic foot and ankle specialty meeting of the year and has physicians from all across the globe presenting their research and learning new techniques.

OFAC by far had the strongest research presence with 22 poster presentations and 2 abstracts presented on the main stage. Congratulations go out to all the OFAC physician authors including our out-going fellows Drs. DeVries, Cuttica and Ringus. OFAC’s research committee is led by Drs. Berlet and Hyer, but our research success would not be possible without the hard work of Emily Stansbury, our research assistant.

Special Congratulations to Dr. DeVries for winning 3rd Place Award for his poster presentation on Predictive Factors for Major Amputation in Tibiotalocalcaneal Arthrodesis with a Retrograde Intramedullary Nail- Utilization of the RAIN Database

Part of our mission at OFAC is heavily rooted in the education and training of future physician leaders in foot and ankle. In addition to our graduating fellows, we had several surgical residents and medical students actively involved in research as well. Congratulations also to resident Drs. Granata and Swiatek and student Dr. Granata for their work and success.

Two abstracts were presented on the national stage: (1) Interpositional Arthroplasty of the First Metatarsalphalangeal Joint Using a Regenerative Tissue Matrix for the Treatment of Advanced Hallux Rigidus: 5 year Case Series Follow-Up, and (2) A Retrospective Comparative Analysis of Charcot Ankle Stabilization Using an Intermedullary Rod with or without Application of Circular External Fixator.

OFAC's Dr. DeVries presenting at AOFAS national meeting

Our 22 academic posters that were presented included:

1. Magnetic Resonance Imaging Evaluation of Osteochondral Lesions of the Talus Following Arthroscopic Drilling

2. Autogenous Bone Graft Harvest Using Reamer Irrigator Aspirator (RIA) Technique for Tibiotalocalcaneal Arthrodesis

3. Outcomes of Treatment in Osteochondral Lesions of the Distal Tibial Plafond

4. Bi-Plane Chevron Medial Malleolar Osteotomy for Increased Exposure of the Medial Talar Dome

5. Wound Complications in Operative Treatment of Calcaneal Fractures

6. Revision Total Ankle Replacement: Agility ™ to INBONE ™ – Anterior and Posterior Approaches to the Difficult Revision.

7. Comparative Analysis of the Union Rate of Revisional Tibiotalocalcaneal Arthrodesis with Intramedullary Nailing with or without Recombinant Human Bone Morphogenetic Protein-2 – Utilization of the RAIN Database

8. Predictive Factors for Major Amputation in Tibiotalocalcaneal Arthrodesis with a Retrograde Intramedullary Nail – Utilization of the RAIN Database

9. Evaluating Two Types of Fixation for a 1st Tarsometatarsal Arthrodesis: A retrospective comparative cohort

10. Comparative Analysis of the Union Rate of Tibiotalocalcaneal Arthrodesis with Intramedullary Nailing with or without Implantable Bone Stimulation – Utilization of the RAIN Database

11. Retrograde Intramedullary Nail Arthrodesis for Avascular Necrosis of the Talus – Utilization of the RAIN Database

12. The Use of Bone Growth Stimulators in Diabetic Patients: A Retrospective Case Series of Ankle Fusions

13. Subchondral Drilling of Full-Thickness Cartilage Defects of the First Metatarsal Head: A Retrospective Case Series

14. Ankle Arthrodesis in High Risk Patients: A Retrospective Review of Implantable Bone Growth Stimulators

15. Lower Extremity Implant Registries: Has the time come in the US?

16. Cannulated Screw Fixation of Jones 5th Metatarsal Fracture: A Comparison of Titanium and Stainless Steel Screw Fixation

17. Porcine Dermal Matrix for Tendon Augmentation, Prospective Multicenter Series

18. Xenograft Soft Tissue Scaffold for Tissue Augmentation in Foot & Ankle Surgeries

19. Surgical Technique: Retrograde Drilling of Medial Osteochondral Lesions of the Talus

20. A Retrospective Review of Insertional Achilles Tendinosis Treated with the Dual Incisional Surgical Technique

21. Retrospective Review of First Metatarsophalangeal Joint Arthrodesis Using a Locked Plate and Compression Screw Technique

22. Retrospective Comparison of Four Plate Constructs for First Metatarsophalangeal Joint Fusion: Static Plate, Static Plate with Lag Screw, Locked Plate, Locked Plate with Lag Screw.

We’ll be showcasing our research posters in front of our office each day. If you have interest, please stop by.

As was mentioned in Dr Decarbo’s earlier link, the physicians of OFAC were awarded an “Honorable Mention” in the Manuscript Competition at the 68th Annual Scientific Conference of the American College of Foot and Ankle Surgeons in Las Vegas, Nevada. Congratulations to Dr Decarbo, lead author of the winning manuscript!

OFAC also presented 2 other manuscripts and 12 scientific poster presentations. The physicians of OFAC continue to lead the charge in education and research in the field of foot and ankle surgery. This was the single largest presence of any group or institution in the entire country.

Our other manuscripts were:

1. Evaluation of Two Types of Fixation for a 1st Tarsometatarsal Arthrodesis: A Retrospective Comparative Cohort. Authors: Drs. DeVries, Granata and Hyer

2. Age Stratification of Outcomes for Osteochondral Lesions of the Talus. Authors: Drs Deol, Berlet, Hyer, Philbin, Lee

Our scientific posters were:

1. A Retrospective Review of First Metatarsophalangeal Joint Arthrodesis Using a Locked Plate and Compression Screw Technique. Authors: Drs Ringus, Swiatek, Hyer

2. A Retrospective Comparative Analysis of Charcot Ankle Stabilization using an Intramedullary Rod with and without Application of Circular External Fixator. Authors: Drs DeVries, Hyer

3. Xenograft Soft Tissue Scaffold for Tissue Augmentation in Foot & Ankle Surgeries. Authors: Drs Hyer, Berlet, Lee

4. Conversion of Failed Total Ankle Arthroplasty to Tibial Stemmed Prosthesis: Techniques for Anterior and Posterior Approaches. Authors: Drs DeVries, Hyer, Berlet, Lee

5. A Retrospective Comparison of Four Plate Constructs for First Metatarsophalangeal Joint Fusion: Static Plate, Static Plate with Lag Screw, Locked Plate, Locked Plate with Lag Screw. Authors: Drs Swiatek, Ringus, Hyer

6. Surgical Technique: Retrograde Drilling of Medial Osteochondral Lesions of the Talus. Authors: Drs Hyer, Berlet, Lee, Granata.

7. Autogenous Bone Graft Harvest Using Reamer Irrigator Aspirator (RIA) Technique for Tibiotalocalcaneal Arthrodesis. Authors: Drs Cuttica, DeVries,Hyer

8. Porcine Dermal Matrix for Tendon Augmentation; A Prospective, Multi-center Series. Authors: Drs. Hyer, Liden

9. Cannulated Screw Fixation of Jones’ 5th Metatarsal Fracture: A Comparison of Titanium and Stainless Steel Screw Fixation. Authors: Drs Hyer, Cuttica, DeVries

10. Interpositional Arthroplasty of the First MTP Joint Using a Regenerative Tissue Matrix for the Treatment of Advanced Hallux Rigidus: 5-year Case Series Follow-up. Authors: Drs Hyer, Granata, Berlet, Lee

11. Wound Complications in Operative Treatment of Calcaneal Fractures. Authors: Drs DeCarbo, A. Granata, Hyer

If you have any questions or interest in these posters or manuscripts, please don’t hesitate to contact OFAC for more information.

In addition to our large research presence at ACFAS, the physicians of OFAC also led educational lab and lecture sessions on the following:

1. Advanced Techniques in Diabetic Reconstruction Workshop: Dr Hyer

2. The Evolution of Surgery: Dr Hyer

3. Surgery in the Advanced Aged Flatfoot: Dr Hyer

4. Curbside Consult Forum: Dr DeCarbo

5. Traumatic Complications-Malunited Ankle Fractures: Dr Hyer

6. Cavus Foot Reconstruction Workshop: Dr Hyer

As you can see, the physicians of OFAC are the leading experts in all aspects of foot and ankle care. If you need the highest level of expert care, don’t hesitate to contact us.

Skin grafts are a critical part of care for patients suffering from acute wounds, chronic wounds or burns. Currently, a split thickness skin graft is the gold standard for coverage when treating these conditions. However, donor site morbidity or a lack of donor skin due to the size of the wounds needing covered create situations where split thickness skin grafts (or allografts and xenografts) may not be feasible.

At the Orthopedic Foot & Ankle Center, I had the opportunity to be the first in Ohio to use a “Minced” skin autograft for the coverage of chronic wounds. This exciting technique has several advantages over a split thickness skin graft in certain situations. Split thickness skin grafts are usually expanded no more than six times with a maximum of nine times. With a minced skin technique, we’re able to expand the skin autograft up to 100 times, enabling us to effectively to cover much larger wound areas with less donor skin.

THE FOLLOWING PHOTOGRAPHS GIVE YOU A GLIMPSE INTO THE MINCED SKIN AUTOGRAFT TECHNIQUE.

A single-use disposable kit with dermatome and mincer.

The wound bed is prepared in the typical fashion to receive the graft.

The graft is taken with the non-powered dermatome.

The donor site after the graft is taken.

The autograft skin placed on the back table.

The autograft skin is then minced into pieces 0.8mm X 0.8mm.

The minced skin ready to be grafted.

The graft is then inserted into the wound and covered with a non-adherent dressing.

Using this new technique, we’re now able to cover acute and chronic wounds as well as burns while using minimal donor tissue.  We’ll be following this patient and carefully watching his progress. I encourage you to check back often to see the benefits of this technique in treating chronic wounds.

I’ve always wanted to be on the forefront of medical technology and perform the latest procedures – that’s what inspired me to be a surgeon. At OFAC, that’s exactly what I’m able to do every day. I’m glad I can help more patients with the minced skin autograft technique, and I look forward to even more advancements.

Will DeCarbo, DPM, AACFAS – Fellowship Trained Foot & Ankle Surgeon

  One of the many challenging and complex problems our diabetic patients face is Charcot foot or neuroarthropathy. This condition creates destruction and collapse of the bones in the foot and can lead to amputations.

"Normal" foot on xray

“Charcot Foot” with joint dislocations

The physicians at OFAC  are skilled at this complex reconstructive surgery and are constantly developing and using new techniques to improve patient outcomes. Recently, Dr. Hyer is one of the first physicians in the world to utilize this innovative, new intramedullary compression device within the bones of the foot as part of this reconstruction. This new implant (called TarsX) provides a much stronger form of fixation compared to typical screws and plates that are used and should allow for better bone healing. 

Here is a video of technique on cadaver specimen (you’re warned!)

Case Presentation

This case has a typical pattern of midfoot joint destruction with severe foot deformity as a result.

Severe Charcot Midfoot deformity with planned correction

Reconstruction in process. Half of implants in.

Reconstruction and realignment finished. Complete implants in.

Implants in. Realigned foot and arch achieved.

  Please check back often for updates and new techniques such as this for these challenging cases.

Dr. Hyer