The aim of this work is to present a clinical case of wrist arthroplasty failure due to chronic infection and try to discuss and draw a therapeutic approach (algorithm) for similar cases taking in consideration the degree of osteolysis, the presence of detachment and inherent instability and the condition of the soft tissues. The authors report a case of an individual, male, 58 years old, manual worker, that appears with pain and inflammatory signs on right wrist arthroplasty, with fistulous track. The revison procedure was performed in 2 stages: the first stage revision consisted on removal the implant, debridement and interposition of cement spacer with antibiotics and immobilization, the second stage revision a radio-metacarpal arthrodesis with plate and interposition of autologous graft harvested. The improvement of the implants in recent years have contributed to the increasing use of arthroplasty as a treatment option with good results. Although it presents itself with an attractive option in terms of future functional capabilities, arthroplasty remains with some risks and have a higher rate of complications in the medium and long term than fusion, so the selection of patients should be careful. The main problem of wrist arthroplasty revision is due to bone stock loose to promote fusion and the shortening after implant removal. At 1,5 years follow-up, we denote a higher patient satisfaction, without pain, radiological fusion and 28 points in DASH score The success of wrist arthroplasty depends on careful patient selection, careful preoperative planning, rigorous technique and an appropriate program of functional rehabilitation. The wrist arthrodesis can always be seen as an ultimate salvation procedure in the treatment of failure of wrist arthroplasty, either a mechanical or infectious failure.
Diabetic foot is a disease with social, familiarly and economic charge. Usually the patients with neuropathic diabetic foot have a compromise in large vessels of the calf that invalids most of the techniques of Plastic Surgery for reconstruction for skin losses of the foot. The authors describe the utilization of little fragments of skin (proximally 4 mm diameter) draw under local anaesthesia in the tight. The receptor area due not have infection and clean of necrotic tissue. Tendons have also due excised or recovered of granulation tissue With this technique they have treated 4 patients; 3 have total recuperation of the lesion and in one, with a scar in the hallux, all the skin has lost. The largest area of the lesion treated has 8 x 6 cm, and time o healing has 12 weeks. The reconstitution of the donor area is complete at 4 weeks with no scars. The authors conclude that this technique is valid for dorsal loss of skin due to neuropathic diabetic foot.
