The PODdoctors with Dr. Dauphinee and Dr. Hussain Dr. Damien Dauphinee and Dr. Raafae Hussain

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, dive deep into a lesser-known yet intriguing condition called chilblains. Characterized by itchy, red, and tender skin lesions, chilblains is often exacerbated by cold, damp conditions, without necessitating freezing temperatures. Leveraging their practical experience, Dr. Dauphinee and Dr. Hussain delineate the distinction between chilblains and related conditions like Raynaud's phenomenon and frostbite. The doctors also provide tips for prevention and treatment, including wearing thick socks, using topical medications, and avoiding hot foot baths.

Quotes
"When chilblains occurs, you can put your feet in lukewarm water for a certain period of time. Not blazing hot, not boiling. You just want them to be lukewarm. If this is a more chronic problem, it flares up every couple months, or during the cold weather, your doctor might prescribe something topical.” -Dr. Raafae Hussain


“Between chilblains and frostbite, the difference is temperature. So it doesn't require a frigid 20, you know, in the teens Fahrenheit to cause chilblains. It could, like we talked about, be in the forties outside.” -Dr. Damien Dauphinee


Top Takeaways:
Chilblains: a condition characterized by itchy, red, and tender skin lesions, often exacerbated by cold, damp conditions, without necessitating freezing temperatures.Individuals with a history of Raynaud's or who are smokers may be more susceptible to developing chilblains.While self-limiting, recommendations include lukewarm foot baths, topical steroids, or vasodilators like topical Nitroglycerin for acute cases. Systemic medications are considered for more chronic issues.Appropriate insulative clothing and thick socks are key preventive measures during cold weather, especially for slender individuals who may be more prone to the condition.Patients with sensory loss due to neuropathy should take extra caution when using heat-related treatments to prevent accidental burns.


What You Will Learn:
What is chilblains?The difference between chilblains and frostbiteTreatment options and prevention tipsNeuropathy Consideration
Resources:
Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss the proper technique for applying wound dressings and the different types of wounds commonly seen in podiatric medicine. They emphasize the importance of maintaining a balanced, moist wound environment and provide tips for choosing the appropriate dressing based on the level of moisture or drainage. The doctors demonstrate a simple dressing change using Hydrofera Blue and Coban wrap, highlighting the importance of sterile technique and proper dressing application. They also debunk the myth that wounds need to be aired out and explain the benefits of modern wound dressings.
Quotes
" There's a lot of different types of wounds out there, but the dressings themselves are fairly similar. So there's primary intention healing wounds or secondary intention healing wounds, and there's tertiary intention healing wounds. Primary are your surgical incisions. The dressings on those are very simple. Secondary intention healings are like your sores and ulcers or big gouges. And tertiary intentions are more of like a delayed primary healing type of surgical incisions.” -Dr. Raafae Hussain


“It still seems to be deeply embedded in the brainstem of human beings that you need to let wounds air out. They don't need to be aired out. The dressing needs to be applied. And you need to change that dressing in a reasonable schedule to prevent maceration, which is the white stuff, and to prevent things from drying out. So if there's got to be a happy medium there somewhere where you're changing the dressing frequently enough that you're avoiding some of those complications we got way better wound dressings and capabilities in 2023.” -Dr. Damien Dauphinee


Top Takeaways:
Proper wound dressing technique involves moistening dry wounds and drying excessively moist or draining wounds.Hydrofera blue is a versatile dressing that absorbs drainage, provides antimicrobial properties and helps maintain a balanced wound environment.Coban wrap is an elastic dressing that can be easily molded and provides secure coverage for the wound.It is important to maintain sterile technique during dressing changes and to avoid using household scissors or unclean instruments.Modern wound dressings have advanced significantly, and the belief that wounds need to be aired out is outdated.

What You Will Learn:
How to do a wound dressing change Explanation of different types of wounds and dressings Debunking the myth of letting wounds air out Qualifications for being considered homebound for Medicare patients


Resources:
Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss a case of complex regional pain syndrome (CRPS) type two. They explain the difference between CRPS type one and type two, and how a discrete nerve injury can be misdiagnosed as CRPS. They share the story of a patient who developed debilitating nerve pain after bunion surgery and was suffering for six and a half years before being properly diagnosed. The doctors perform a diagnostic block and identify a specific nerve injury. They then perform a surgical procedure to cap the damaged nerve and bury it in muscle to prevent the development of a stump neuroma. The patient experiences significant pain relief and is on the path to recovery.
QUOTES:
"As long as that end nerve is no longer connected to the brain, that's going to wither and shrivel up and go through Wallerian degeneration and go away." -Dr. Damien Dauphinee
“Complex regional pain syndrome. There are two versions. There's a type one, which is nondescript, there's no specific nerve pathway, and there's a type two, which it's more associated with a specific nerve pathway, usually associated with an injury.” -Dr. Raafae Hussain
Top Takeaways:
Complex regional pain syndrome (CRPS) can be misdiagnosed if a discrete nerve injury is not identified.Discrete nerve injuries can cause chronic pain and other symptoms similar to CRPS.Surgical intervention, such as capping the damaged nerve and burying it in muscle, can provide significant pain relief for patients with a discrete nerve injury.
What You Will Learn:
Differentiating between general CRPS and discrete nerve injuryOptions for nerve reconstruction or cappingPreventing stump neuromaImportance of identifying discrete nerve injuries in CRPS patients The need for psychiatric care in some cases The importance of multimodal pain management CRPS Warriors support group for patients
Resources:
Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss the excision of a lipoma, a benign fatty nodule that can cause pain in the foot and ankle. They explain that lipomas are commonly found in the subcutaneous layer of the foot and ankle, and while they are usually benign, they can become painful. The doctors emphasize the importance of clinical diagnosis, as an MRI may not show whether the lipoma is causing pain. They also mention that lipomas are often misdiagnosed as underlying ankle sprains. The surgical procedure involves making an oblique incision along the relaxed skin tension lines, carefully dissecting the lipoma, and removing it as a solid piece. The doctors highlight the need to identify and protect the lateral branch of the superficial peroneal nerve during the procedure.
QUOTES:
"You can get something called lipidema, and that's a different animal where a known normal fatty deposit can become painful. A lipedema can be a real problem in different parts of the body, and that's a normal place for adipose tissue. But if it becomes painful, sometimes we have to consider removing it. I've not appreciated that as much over the years as I do now. I think I'm seeing that that can become a source of pain all by itself in some patients. And I think it's probably a poorly understood problem." -Dr. Damien Dauphinee
“So we get the closure on this and you'll see we'll do deep to superficial. The reason we do that is so the knot stays buried. It's not close to the skin. So when she ends up tying this, you'll see that the knot will stay nice and low and hopefully the patient won't ever feel it. And then as time goes on, the weeks go on, the stitches will dissolve away, and hopefully no more score. There no more palpable nodule there using.” -Dr. Raafae Hussain
Top Takeaways:
Lipomas are benign fatty nodules that can cause pain in the foot and ankle.Lipomas are commonly found in the subcutaneous layer and can be misdiagnosed as ankle sprains.Clinical diagnosis is crucial, as an MRI may not show whether the lipoma is causing pain.Surgical excision involves making an oblique incision along the relaxed skin tension lines and carefully dissecting the lipoma.
What You Will Learn:
Surgical procedure for lipoma excision Importance of dissecting carefully to avoid nerve damage Closure technique: two layers, running subcuticular, deep vertical mattress Superficial dressing choice: zebra foamPost-op shoe preferenceRisks: injury to lateral dors-cutaneous nerve branch, stunt neuromas
Resources:
Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss a surgical case of a gangrenous toe amputation in a patient with severe peripheral arterial disease and diabetes. The patient had dry gangrene and underwent vascular treatment to open up two vessels, but the tibialis anterior vessel remained blocked, leading to tissue death in the big toe. The doctors talk about the potential use of bone marrow aspirate concentrate injections to stimulate collateralization and neovascularization in patients with severe vascular disease.
QUOTES:
"The tibialis anterior vessel was the one that they were not able to open up. And that was his downfall because the tibialis anterior is the one that comes and perfuses the top half of your big toe. Kind of important when you have blood flow problems, you don't have blood flow coming in, you're losing that toe or whatever part of the body." -Dr. Damien Dauphinee
“Anytime we can get collateralization or new tributaries to grow into an area that is not getting enough blood flow, we can improve pain.” -Dr. Raafae Hussain
Top Takeaways:
Considerations for patients with severe vascular diseaseImportance of incision placement and goal of restoring healthy blood flow
What You Will Learn:
Gangrenous toe amputation caseBone marrow aspirate concentrate injectionsPotential use of BMAC for staving off major amputations
Resources:
Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss wet gangrene vs. dry gangrene and the advanced treatments available to prevent amputations in diabetic patients. They highlight the modern use of wound care technology such as antibiotic beads for wound healing and water jet wound cleaning. Dr. Dauphinee and Dr. Hussain also share their expertise in treating peripheral nerve problems and talk about the benefits of hyperbaric therapy for wounds.  
QUOTES:
"Ischemic pain is deep. It's not responsive to narcotics. The only thing that's gonna fix it is, unfortunately, amputation or fix the blood flow problem." -Dr. Damien Dauphinee
“One of the things to keep in mind about ABIs ankle-brachial index is it can be falsely elevated in diabetic patients.”  -Dr. Raafae Hussain
Top Takeaways:
External Fixation and Limb SalvageAdvanced Treatments for Diabetic Limb Preservation
What You Will Learn:
Diabetic limb preservationThe types of gangrene and treatment optionsWound care and recovery
Resources:
Visit our website: https://thepoddoctors.com/