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Diabetic limb salvage

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https://www.readbyqxmd.com/read/29156168/new-fixation-methods-for-the-treatment-of-the-diabetic-foot-beaming-external-fixation-and-beyond
#1
REVIEW
Roberto A Brandão, Jeffrey S Weber, David Larson, Mark A Prissel, Patrick E Bull, Gregory C Berlet, Christopher F Hyer
Surgical correction of complex foot and ankle deformities secondary to Charcot neuroarthropathy remains a significant surgical challenge. New technological advancements in hardware have allowed for the use of augmented fixation techniques in midfoot deformity correction, including the use of indication-specific locking plates and beaming techniques that offer enhanced stability. Severe hindfoot deformity management can employ the use of internal fixation, including intramedullary hindfoot nails and circular external fixation frames for limb salvage...
January 2018: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/29153533/outcomes-at-a-single-center-after-subintimal-arterial-flossing-with-antegrade-retrograde-intervention-for-critical-limb-ischemia
#2
Anish Kaushal, Graham Roche-Nagle, Kong T Tan, Elizabeth Liao, Naomi Eisenberg, George D Oreopoulos, Dheeraj K Rajan
OBJECTIVE: The subintimal arterial flossing with antegrade-retrograde intervention technique has been used to overcome antegrade recanalization failures for peripheral lower limb arterial occlusive disease. There are few outcomes published for this technique and we sought to evaluate outcomes at our institution over a 7-year period. METHODS: A retrospective review was performed of all subintimal arterial flossing with antegrade-retrograde intervention procedures of infrainguinal occlusive disease from 2009 to 2016...
November 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29126421/peroneal-artery-perforator-flap-for-the-treatment-of-chronic-lower-extremity-wounds
#3
Liang Cheng, Xiaqing Yang, Tingxiang Chen, Zhijie Li
BACKGROUND: Reconstruction of chronic lower extremity wounds remains challenging. These wounds are mainly associated with diabetes mellitus, infections, and osteomyelitis. Although several reconstructive techniques are available, the peroneal artery perforator flap has unique advantages. METHODS: In this study, we discuss our experiences with peroneal artery perforator flaps in 55 patients who had suffered from chronic lower limb wounds. The size of the defect, comorbidities, etiology, flap size, and complications were recorded and analyzed based on a retrospective chart review...
November 10, 2017: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/29107761/improved-limb-salvage-for-patients-with-vascular-disease-and-tissue-loss-associated-with-new-model-of-provision-targeted-at-the-diabetic-foot
#4
Dean T Williams, Anna Powell-Chandler, Quratulain Qureshi, Aeliya Zaidi, Christopher J Whitaker
AIMS: The establishment of a vascular surgeon-led emergency diabetic foot service in 2006 has evolved to provide lower limb wound care for patients with and without diabetes. We aimed to determine whether the service was associated with sustained, improved limb salvage rates for the whole population, analyse key aspects of service provision and compare outcomes against published studies. METHODS: The vascular unit serves a largely rural population of approximately 240,000...
October 28, 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/29096337/viability-of-permanent-pmma-spacer-with-combined-free-fasciocutaneous-tissue-transfer-for-failed-charcot-reconstruction-a-38-month-prospective-case-report
#5
Tammer Elmarsafi, John S Steinberg, Paul J Kim, Christopher E Attinger, Karen K Evans
INTRODUCTION: Charcot Neuroarthropathy is a complex lower extremity pathology which predisposes the afflicted limb to ulcerations, osteomyelitis, and risk of major amputation. Charcot Neuroarthropathy often requires osseous reconstruction, which can be complicated with osteomyelitis and hardware infection. When soft tissue and osseous deficits must be concomitantly addressed, the use of PMMA spacers can be combined with free tissue transfers. PRESENTATION OF CASE: 71year old Caucasian male with Diabetic Charcot Neuroarthopathy underwent osseous reconstruction with internal hardware...
October 4, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29092990/multiple-limb-salvage-attempts-for-diabetic-foot-infections-is-it-worth-it
#6
C C Hong, J H Tan, S H Lim, A Nather
AIMS: Limb salvage for diabetic foot infections often require multiple procedures. Some patients will eventually end up with below knee amputation (BKA) when all limb salvage attempts fail. We seek to study the patients' ability to return to normal life, functional status, prosthesis usage and perspectives on multiple limb salvage procedures that culminated in BKA to review if they would undertake a similar path if their situation was repeated. PATIENTS AND METHODS: A total of 41 patients who underwent BKA between July 2011 and June 2013 were reviewed...
November 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/29074815/hyperbaric-oxygen-therapy-in-the-treatment-of-ischemic-lower-extremity-ulcers-in-patients-with-diabetes-results-of-the-damo2cles-multicenter-randomized-clinical-trial
#7
Katrien T B Santema, Robert M Stoekenbroek, Mark J W Koelemay, Jim A Reekers, Laura M C van Dortmont, Arno Oomen, Luuk Smeets, Jan J Wever, Dink A Legemate, Dirk T Ubbink
OBJECTIVE: Conflicting evidence exists on the effects of hyperbaric oxygen therapy (HBOT) in the treatment of chronic ischemic leg ulcers. The aim of this trial was to investigate whether additional HBOT would benefit patients with diabetes and ischemic leg ulcers. RESEARCH DESIGN AND METHODS: Patients with diabetes with an ischemic wound (n = 120) were randomized to standard care (SC) without or with HBOT (SC+HBOT). Primary outcomes were limb salvage and wound healing after 12 months, as well as time to wound healing...
October 26, 2017: Diabetes Care
https://www.readbyqxmd.com/read/28924874/predictive-parameters-for-clinical-outcome-in-patients-with-critical-limb-ischemia-who-underwent-percutaneous-transluminal-angioplasty-pta-a-systematic-review
#8
Sanne M Schreuder, Yvette M G A Hendrix, Jim A Reekers, Shandra Bipat
PURPOSE: To identify possible risk factors in predicting clinical outcome in critical limb ischemia (CLI) patients undergoing percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS: PubMed and EMBASE were searched for studies analyzing CLI and clinical outcome after PTA from January 2006 to April 2017. Outcome measures were ulcer healing, amputation free survival (AFS)/limb salvage and overall survival. Data on predictive factors for ulcer healing, AFS/limb salvage and survival were extracted...
September 18, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28887250/analysis-of-patients-undergoing-major-lower-extremity-amputation-in-the-vascular-quality-initiative
#9
Joshua Gabel, Brice Jabo, Sheela Patel, Sharon Kiang, Christian Bianchi, Jason Chiriano, Theodore Teruya, Ahmed M Abou-Zamzam
BACKGROUND: Despite an aggressive climate of limb salvage and revascularization, 7% of patients with peripheral artery disease undergo major lower extremity amputation (LEA). The purpose of this study was to describe the current demographics and early outcomes of patients undergoing major LEA in the Vascular Quality Initiative (VQI). METHODS: The VQI amputation registry was reviewed to identify patients who underwent major LEAs. Patient factors, limb characteristics, procedure type, and intraoperative variables were analyzed by the level of amputation...
September 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28876595/acute-upper-limb-ischaemia-in-diabetic-patients-a-recent-experience
#10
R du Toit, A T O Abdool-Carrim, T Monareng
BACKGROUND: The outcome of acute upper limb ischaemia in diabetic patients is not well known. We report our recent experience with 5 patients. METHOD: Retrospective case reviews. RESULTS: All patients presented with Rutherford 2b ischaemia at a median 1.6 days after symptom onset. Age range: 43-76 years. M:F 1:4. Mean HbA1c: 10.1% (range 6.1 - 14.0) Mean LDL cholesterol: 3.1g/dL (range 1.61 - 4.80) Other comorbidities included: Ischaemic heart disease, atrial fibrillation, dyslipidaemia, hypertension, morbid obesity...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28807382/association-between-statin-therapy-and-amputation-free-survival-in-patients-with-critical-limb-ischemia-in-the-critisch-registry
#11
MULTICENTER STUDY
Konstantinos Stavroulakis, Matthias Borowski, Giovanni Torsello, Theodosios Bisdas
OBJECTIVE: Secondary prevention in patients with critical limb ischemia (CLI) is crucial for the reduction of cardiovascular morbidity and mortality. Nonetheless, current recommendations are extrapolated from other high-risk populations because of the lack of CLI-dedicated trials. The aim of this explorative study was to evaluate the association of statin therapy with the outcomes of CLI patients. METHODS: The First-Line Treatments in Patients With Critical Limb Ischemia (CRITISCH) registry is a prospective multicenter registry analyzing the effectiveness of all available treatment strategies in 1200 CLI patients...
November 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28756043/impact-of-angiosome-and-nonangiosome-targeted-peroneal-bypass-on-limb-salvage-and-healing-in-patients-with-chronic-limb-threatening-ischemia
#12
MULTICENTER STUDY
Jean-Baptiste Ricco, Mauro Gargiulo, Andrea Stella, Mohammad Abualhin, Enrico Gallitto, Mathieu Desvergnes, Romain Belmonte, Fabrice Schneider
BACKGROUND: Direct (DIR) or indirect (IND) revascularization of pedal angiosomes in patients with chronic limb-threatening ischemia (CLTI) has an unclear impact on limb salvage and healing. The aim of this study was to evaluate the outcomes of DIR and IND revascularization in patients with a peroneal bypass and tissue loss. METHODS: We conducted a retrospective study of a prospectively maintained database in two European university centers from 2004 to 2015. We extracted from this database all patients with CLTI and tissue loss who had received a bypass to the peroneal artery...
November 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28705338/-femoropopliteal-angioplasty-short-and-mid-term-results
#13
M Ben Hammamia, M Ben Mrad, B Derbel, R Miri, J Ziadi, F Ghedira, R Denguir, T Kalfat
BACKGROUND: Percutaneous endovascular therapy is becoming a primary option for managing femoropopliteal occlusive disease. The purpose of this study was to evaluate the mid-term results of endovascular treatment of femoropopliteal arterial disease. METHODS: Femoropopliteal percutaneous transluminal angioplasty was performed on 162 consecutive limbs (160 patients) from January 2006 to January 2016. RESULTS: In our study, 87.6% of patients had critical limb ischemia...
July 2017: J Med Vasc
https://www.readbyqxmd.com/read/28697694/midterm-outcomes-from-a-pilot-study-of-percutaneous-deep-vein-arterialization-for-the-treatment-of-no-option-critical-limb-ischemia
#14
Steven Kum, Yih Kai Tan, Michiel A Schreve, Roberto Ferraresi, Ramon L Varcoe, Andrej Schmidt, Dierk Scheinert, Jihad A Mustapha, Darryl M Lim, Derek Ho, Tjun Y Tang, Vlad-Adrian Alexandrescu, Pramook Mutirangura
PURPOSE: To report the initial clinical experience with percutaneous deep vein arterialization (PDVA) to treat critical limb ischemia (CLI) via the creation of an arteriovenous fistula. METHODS: Seven patients (median age 85 years; 5 women) with CLI and no traditional endovascular or surgical revascularization options (no-option CLI) were recruited in a pilot study to determine the safety of PDVA. All patients were diabetic; 4 had Rutherford category 6 ischemia...
July 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28648324/drug-coated-balloon-angioplasty-for-the-management-of-recurring-infrapopliteal-disease-in-diabetic-patients-with-critical-limb-ischemia
#15
Luis M Palena, Larry J Diaz-Sandoval, Efren Gòmez Jabalera, Olga Peypoch Perez, Enrico Sultato, Cesare Brigato, Enrico Brocco, Marco Manzi
OBJECTIVE: To describe the 1-year outcomes of recurring infrapopliteal disease after endovascular revascularization with the Lutonix drug-coated balloons (LDCB) in diabetic patients with critical limb ischemia (CLI), and to benchmark our findings with previously published objective performance goals (OPG) addressing safety and efficacy of new catheter-based therapies for CLI. METHODS: The present study was a retrospective, single-center, and single-arm trial of symptomatic diabetic patients with CLI, who underwent LDCB-angioplasty for recurring infrapopliteal disease...
June 20, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28630829/are-we-justified-doing-salvage-or-amputation-procedure-based-on-mangled-extremity-severity-score-in-mangled-upper-extremity-injury
#16
R Siva Kumar, Prahalad Kumar Singhi, M Chidambaram
INTRODUCTION: Mangled upper limb injuries are at surge because of industrialization, modernization, and severe motor vehicle accidents. The utility of various scoring systems are meant for decision making in mangled lower limb injuries, and the same have been extrapolated for mangled upper limb injuries to make a decision of salvage or amputation for the lack of separate scoring system. MATERIALS AND METHODS: We applied mangled extremity severity score (MESS) and mangled extremity syndrome index (MESI) scoring systems to 10 cases of mangled upper limb injuries during the period of November 2010 to September 2012 presented at our tertiary trauma care center...
January 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/28578624/outcomes-after-endovascular-revascularization-in-octogenarians-and-non-octogenarians-with-critical-limb-ischemia
#17
Christian Uhl, Markus Steinbauer, Giovanni Torsello, Theodosios Bisdas
PURPOSE: To determine the outcome and periprocedural risk of endovascular revascularization in octogenarians with critical limb ischemia (CLI) compared with their younger counterparts. METHODS: The multicenter, prospective registry for First-line Treatments in Patients With Critical Limb Ischemia (CRITISCH) enrolled 642 patients treated with endovascular techniques ( ClinicalTrials.gov identifier NCT01877252). The patients were dichotomized according to age <80 years (n=421; mean age 69 years, 292 men; group 1) or ≥80 years (n=221; mean age 85 years, 113 men; group 2)...
August 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28567565/promoting-limb-salvage-through-multi-disciplinary-care-of-the-diabetic-patient
#18
REVIEW
Nichol L Salvo, Mark D Walsh, Luke P Brewster
Despite an explosion in the number of options available for helping diabetic patients heal wounds, major amputation remains a critical issue for these persons. Since diabetes prematurely ages tissues and no organ system is immune to its presence, it makes inherent sense that multi-disciplinary team approaches to these patients is necessary to make significant strides forward. Here, we present literature from the fields of podiatric surgery/medicine, vascular and plastic surgery and introduce the successes that a multi-disciplinary limb salvage center can have on the lives and limbs of patients with diabetes...
July 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28553572/think-before-chopping-a-diabetic-foot-insight-to-vascular-intervention
#19
EDITORIAL
Ahsan Zil-E-Ali, Saadia Shafi, Muhammad Hammad Ali
Diabetes mellitus is a most commonly occurring chronic disease around the world, resulting in damage to multiple organs. One of the consequences of poorly controlled diabetes is vascular damage resulting in peripheral artery disease, leading to inadequate perfusion of the foot and eventually gangrene and amputation. Research over the past decade or so has provided us with the statistics that vascular intervention has better clinical outcomes including patient mortality, morbidity, quality of life, and patient satisfaction...
April 25, 2017: Curēus
https://www.readbyqxmd.com/read/28541016/pedal-arch-patency-and-not-direct-angiosome-revascularization-predicts-outcomes-of-endovascular-interventions-in-diabetic-patients-with-critical-limb-ischemia
#20
Nicola Troisi, Filippo Turini, Emiliano Chisci, Leonardo Ercolini, Pierfrancesco Frosini, Renzo Lombardi, Francesca Falciani, Cristiana Baggiore, Roberto Anichini, Stefano Michelagnoli
BACKGROUND: Aim of this study was to evaluate the impact of pedal arch status and direct-angiosome revascularization (DAR) on clinical outcomes in diabetic patients with foot wounds undergoing endovascular revascularization. METHODS: Between January 2014 and June 2015 93 diabetic patients with foot wounds underwent endovascular revascularization of at least one below-the-knee vessel. Patients were divided into three groups according to the pedal arch status: complete pedal arch (CPA), incomplete pedal arch (IPA) and absent pedal arch (APA)...
May 24, 2017: International Angiology: a Journal of the International Union of Angiology
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