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Diabetic limb salvage

Abhisekh Mohapatra, Jon C Henry, Efthimios D Avgerinos, Rabih A Chaer, Steven A Leers, Aureline Boitet, Michael J Singh, Eric S Hager
OBJECTIVE: Ischemic heel ulcerations are generally thought to carry a poor prognosis for limb salvage. We hypothesized that patients undergoing infrapopliteal revascularization for heel wounds, either bypass or endovascular intervention, would have lower wound healing rates and amputation-free survival than patients with forefoot wounds. METHODS: A retrospective chart review was performed of patients who presented between 2006 and 2013 to our institution with ischemic foot wounds and infrapopliteal arterial disease and underwent either pedal bypass or endovascular tibial artery intervention...
February 28, 2018: Annals of Vascular Surgery
Zhiwen Joseph Lo, Zhimin Lin, Uei Pua, Lawrence Han Hwee Quek, Bien Ping Tan, Sundeep Punamiya, Glenn Wei Leong Tan, Sriram Narayanan, Sadhana Chandrasekar
BACKGROUND: To review patient characteristics and outcomes of inpatient diabetic foot limb salvage and identify risk factors predicting for endovascular limb salvage failure. METHODOLOGY: Retrospective study of limb salvage attempts in 809 patients between August 2013 and July 2015. RESULTS: 68% of our study population were male with mean age at 65 years-old and 73% presented with Rutherford grade 6 critical limb ischaemia, with the remaining 27% Rutherford grade 5...
February 8, 2018: Annals of Vascular Surgery
Hyun-Ji Park, Rui Kuai, Eun Je Jeon, Yoojin Seo, Youngmee Jung, James J Moon, Anna Schwendeman, Seung-Woo Cho
Therapeutic strategies using endogenous stem cell mobilizer can provide effective cell-free therapy for addressing various ischemic diseases. In particular, substance P (SP) exhibited therapeutic regeneration by facilitating mobilization of endogenous stem cells from bone marrow to the injured sites. However, its therapeutic effect has been limited due to short half-life and rapid degradation of administered SP peptides in vivo. Here we sought to develop high-density lipoprotein (HDL)-mimicking nanodiscs conjugated with SP (HDL-SP) in order to increase the in vivo half-life, bone marrow targeting, and therapeutic efficacy of SP for the treatment of diabetic peripheral ischemia...
January 19, 2018: Biomaterials
Moses Lee, Woo Jin Choi, Seung Hwan Han, Jinyoung Jang, Jin Woo Lee
BACKGROUND: Tibiotalocalcaneal (TTC) fusion using a retrograde intramedullary (IM) nail is an effective salvage option for terminal-stage hindfoot problems. However, as many patients who receive TTC fusion bear unfavorable medical comorbidities, the risk of nonunion, infection and other complications increases. This study was performed to identify the factors influencing outcomes after TTC fusion using a retrograde IM nail. METHODS: Between September 2008 and February 2012, 34 consecutive patients received TTC fusion using a retrograde IM nail for limb salvage...
July 22, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Nuria Seguí, Carlos Ruiz-Carmona, Alina Velescu, Eduardo Mateos, Roberto Elosua, Albert Clará
BACKGROUND: The treatment of acute limb ischemia (ALI) has barely changed over the last years. However, the progressive implementation of anticoagulants, antiplatelet agents or statins within the population might have modified the profile and prognosis of patients suffering an ALI. The aim of this study was to evaluate the current results of the management of ALI secondary to a native artery occlusion. METHODS: Retrospective study of 220 consecutive patients (mean age 78 years; 49% male) was conducted between 2007 and 2015...
February 5, 2018: World Journal of Surgery
Nicola Troisi, Filippo Turini, Emiliano Chisci, Leonardo Ercolini, Pierfrancesco Frosini, Renzo Lombardi, Francesca Falciani, Cristiana Baggiore, Roberto Anichini, Stefano Michelagnoli
Objective: To retrospectively evaluate the impact of pedal arch quality on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization. Materials and Methods: Between January 2014 and June 2015, 137 consecutive diabetic patients with foot wounds underwent infrainguinal endovascular revascularization (femoro-popliteal or below-the-knee, arteries). Postprocedural angiography of the foot was used to divide the patients into the following three groups according to the pedal arch status: complete pedal arch (CPA), incomplete pedal arch (IPA), and absent pedal arch (APA)...
January 2018: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Rebecca Craig-Schapiro, Besma Nejim, Isibor Arhuidese, Mahmoud B Malas
While studies demonstrate poor outcomes of lower extremity revascularization in end-stage renal disease patients, little is known about results in renal transplant patients. We analyzed 2-year primary patency and limb salvage outcomes and associated risk factors of transplant (N=202) and non-transplant patients (N=25,274) in the Vascular Quality Initiative database undergoing infrainguinal bypass from 2003-2016. Multivariable Cox regression analysis and coarsened exact matching with many-to-one were employed...
December 29, 2017: American Journal of Transplantation
Caitlin W Hicks, Joseph K Canner, Hikmet Karagozlu, Nestoras Mathioudakis, Ronald L Sherman, James H Black, Christopher J Abularrage
OBJECTIVE: We have previously demonstrated that the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification correlates with wound healing time in patients with diabetic foot ulcers (DFUs) treated in a multidisciplinary setting. Our aim was to assess whether the charges and costs associated with DFU care increase with higher WIfI stages. METHODS: All patients presenting to our multidisciplinary diabetic limb preservation service from June 2012 to June 2016 were enrolled in a prospective database...
December 13, 2017: Journal of Vascular Surgery
Catherine N Tchanque-Fossuo, Andrew M Wishy, Kaitlyn I M West, David L Dawson, Sara E Dahle, John G Carson
BACKGROUND: Diabetes mellitus is a worldwide pandemic that impacts more than 387 million people, with 29 million individuals affected in the United States alone. Diabetic patients have a 25% lifetime risk of developing a diabetic foot ulcer (DFU). Having a DFU is associated with a risk of recurrence approaching 70%. In addition, 1 in 6 patients with DFU will have a lower-limb amputation, with an associated increase in mortality ranging from 47% to 70%. Therefore, limb salvage is critical in patients with DFU...
January 2018: Advances in Skin & Wound Care
Frances K Barg, Peter F Cronholm, Ebony E Easley, Trocon Davis, Michelle Hampton, D Scot Malay, Cornelius Donohue, Jinsup Song, Stephen R Thom, David J Margolis
The purpose of this study was to explore perceptions among people with type 2 diabetes about foot ulcers and lower extremity amputations. This was a qualitative observational study utilizing open-ended, semistructured interviews of 39 people with diabetes who were purposively selected because they had either a foot ulcer (n = 19) or a lower extremity amputation (n = 20). Interviews were audio-recorded, deidentified, and entered into NVivo 10.0 for coding and analysis. Our integrated analytic approach combined inductively and deductively derived codes that were applied to all transcripts...
September 2017: Wound Repair and Regeneration
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
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
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
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...
January 2018: Diabetes Research and Clinical Practice
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
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
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...
January 2018: Diabetes Care
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
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
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
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