Dr. Piccarelli was recently quoted in Podiatry Management in regards to a difficult case of an ulcer over the Achilles Tendon.
The Patient in question was a 78 year old Diabetic male who was status post Femoral/Poplited Artery Bypass, with an exposed Achilles Tendon. Due to the area being poorly supplied with blood, anatomically this is a difficult problem to heal.
"I have treated this problem before with success, utlizing debridement of a desiccated tendon and a skin substitute. In addition, the patient was immobilized with an ex-fix for about two months. It was a last option because a BKA (below knee amputation) was recommended for him. He was a well-controlled diabetic and very compliant. Without treatment, your patient may ultimately need a BKA."- Michael Piccarelli, DPM, Diplomate American Board of Podiatric Surgery, Fellow, American College of Foot & Ankle Surgeons Staten Island, NY
Dr. Piccarelli was the treating surgeon on a published case similar to the one presented.
"Use of External Ring Fixation in a Full-Thickness Achilles Wound: A Case Report"
by Lee C. Rogers, DPM, Nicholas J. Bevilacqua, DPM, Kenneth Francis, MD, Michael Piccarelli, DPM
The Foot & Ankle Journal 1(3):4
An 84 year-old male with a full-thickness Achilles ulcer for 4 months was successfully healed with split-thickness skin grafting after application of an external ring fixator as an offloading and immobilizing tool. This method allowe for weight-bearing during treament. The use of external fixation devices for soft tissue reconsruction of the lower extremity can be a useful adjunct.