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Amputation risk score

Hammadur Sk Rahaman, Viveka P Jyotsna, V Sreenivas, Anand Krishnan, Nikhil Tandon
Background: A large number of patients with diabetes mellitus are unaware of foot care and are at risk of developing foot ulcer and amputation. This increases healthcare burden due to preventable complication of diabetes. Aims: We conducted this study to assess the effectiveness of a foot care education module for diabetes developed by us. Materials and Methods: One hundred and twenty-seven patients with diabetes mellitus attending our outpatient were randomized into intervention ( n = 63) and control groups ( n = 64)...
January 2018: Indian Journal of Endocrinology and Metabolism
Frank M Davis, Jeremy Albright, Katherine A Gallagher, Hitinder S Gurm, Gerald C Koenig, Theodore Schreiber, P Michael Grossman, Peter K Henke
OBJECTIVES: Acute limb ischemia (ALI) of the lower extremity is a potentially devastating condition that requires urgent and definitive management. This challenging scenario is often treated with endovascular, open surgical, or hybrid revascularization in an urgent basis, but the comparative effects of such therapies remain poorly defined. The purpose of this study was to compare outcomes of endovascular, open surgical, and hybrid revascularization for ALI in the contemporary era. METHODS: A large statewide cardiovascular consortium of 45 hospitals was queried for patients between January 2012 and June 2015 who underwent an endovascular, open surgical, or hybrid revascularization for ALI deemed at high risk of limb loss if not treated within 24 hours (Rutherford class IIA or IIB)...
March 5, 2018: Annals of Vascular Surgery
Christopher Tanga, Randall Franz, Joshua Hill, Michael Lieber, John Galante
Lower extremity arterial injuries (LEAIs) can be complicated injuries resulting in limb loss and death. Patients with LEAI often have multiple injuries increasing the risk for morbidity and mortality. We sought to evaluate the incidence and management of LEAI and to define associations between injuries and outcomes. We performed a retrospective review of LEAI at an urban level-1 trauma center from April 2005 to April 2015. Chi-square tests were used to compare independent groups with respect to mortality and amputation...
March 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Abhisekh Mohapatra, Mikayla N Lowenkamp, Jon C Henry, Aureline Boitet, Efthimios D Avgerinos, Rabih A Chaer, Michel S Makaroun, Steven A Leers, Eric S Hager
INTRODUCTION: Endovascular strategies are often preferred for revascularization of ischemic foot wounds secondary to infrapopliteal disease due to the less invasive technique and faster recovery. Bypass is typically reserved for failures or lesions not amenable to balloon angioplasty. However, the effects of an endovascular-first approach on subsequent bypass grafts is largely unknown. This study evaluates the effects of prior tibial interventions on successive bypasses to pedal targets...
February 23, 2018: Annals of Vascular Surgery
Florian Sevelda, Wenzel Waldstein, Joannis Panotopoulos, Alexandra Kaider, Philipp Theodor Funovics, Reinhard Windhager
BACKGROUND: The majority of metastatic bone lesions to the femoral bone can be treated without surgery or with minimally invasive intramedullary nailing. In rare patients with extensive metastatic disease to the femur, total femur replacement may be the only surgical alternative to amputation; however, little is known about this approach. QUESTIONS/PURPOSES: In a highly selected small group of patients with metastatic carcinoma of the femur, we asked: (1) What was the patient survivorship after this treatment? (2) What was the implant survivorship free from all-cause revision and amputation, and what complications were associated with this treatment? (3) What functional outcomes were achieved by patients after total femur replacement for this indication? METHODS: Eleven patients (three men, eight women) with a mean age of 64 years (range, 41-78 years) received total femur replacements between 1986 and 2016; none were lost to followup...
February 14, 2018: Clinical Orthopaedics and related Research
Reuben A Falola, Chrisovalantis Lakhiani, Jocelyn Green, Siya Patil, Brandon Jackson, Rachel Bratescu, Ersilia Anghel, John S Steinberg, Paul J Kim, Christopher E Attinger, Karen K Evans
BACKGROUND: Free tissue transfer is one option for preservation of form and function in the native limb, in the setting of soft tissue paucity. However, the data on patient functionality after microvascular intervention is inconsistently reported. The Lower Extremity Function Scale (LEFS) measures patient-reported difficulty in carrying out 20 physical activities, on a Likert scale, the sum of which correlates with descriptive functional stages of 1-5. We assess limb functionality in this cohort of microvascular patients using the LEFS survey...
February 16, 2018: Journal of Reconstructive Microsurgery
Jason Klein, Alex Ghasem, Samuel Huntley, Nathan Donaldson, Martin Keisch, Sheila Conway
BACKGROUND: High-dose-rate brachytherapy (HDR-BT) and external-beam radiation therapy (EBRT) are two modalities used in the treatment of soft tissue sarcoma. Previous work at our institution showed early complications and outcomes for patients treated with HDR-BT, EBRT, or a combination of both radiation therapy modalities. As the general indications for each of these approaches to radiation therapy differ, it is important to evaluate the use of each in an algorithmic way, reflecting how they are used in contemporary practice at sites that use these treatments...
March 2018: Clinical Orthopaedics and related Research
S Keisin Wang, Ashley R Gutwein, Natalie A Drucker, Michael P Murphy, Andres Fajardo, Michael C Dalsing, Raghu L Motaganahalli, Gary W Lemmon
OBJECTIVE: Single-length saphenous vein continues to be the conduit of choice in infected-field critical limb ischemia (CLI). However, half of these individuals have inadequate vein secondary to previous use or chronic venous disease. We reviewed our outcomes of infected-field infrainguinal bypasses performed with cryopreserved homografts (CH), a widely-accepted alternative to autogenous vein in this setting. METHODS: This is a retrospective, institutional descriptive analysis of infected-field infrainguinal revascularizations between 2012-2015...
February 5, 2018: Annals of Vascular Surgery
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
Hani El-Mowafi, Ahmed El-Hawary, Yasser Kandil
BACKGROUND: Charcot arthropathy of the peritalar complex carries a high risk of amputation if not properly managed. Our aim is to assess the functional outcome of severe Charcot arthropathy of the peritalar complex following enblock resection of the ulcer, massive debridement and stabilizing all the elements of the peritalar complex. METHODS: We prospectively studied 38 feet in 35 patients with peritalar complex Charcot arthropathy. All Feet underwent intense debridement and fusion using a combination of (Ilizarov) external fixation, and (plate and locked nail) internal fixation...
March 6, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Christian Wied, Nicolai B Foss, Peter T Tengberg, Gitte Holm, Anders Troelsen, Morten T Kristensen
Background and purpose - An enhanced treatment program may decrease 30-day mortality below 20% after lower extremity amputations (LEA). The potential and limitations for further reduction are unknown. We analyzed postoperative causes of 30-day mortality, and assessed failure to rescue (FTR) rate in LEA patients who followed an enhanced treatment program. Patients and methods - Medical charts of 195 primary LEA procedures were reviewed independently by 3 of the authors, and deaths during hospitalization following amputation were classified according to consensus...
February 1, 2018: Acta Orthopaedica
Nathan R Manley, Louis J Magnotti, Timothy C Fabian, Martin A Croce, John P Sharpe
BACKGROUND: Following venous injury, venorrhaphy can restore outflow, although it risks thrombosis and venous thromboembolism (VTE). Vein ligation is a faster option, although it potentially risks extremity edema. The purpose of this study was to evaluate the management of venous injury on VTE and extremity edema in patients with isolated lower-extremity venous injuries. METHODS: Patients with common iliac, external iliac, and femoral venous injuries over a 10-year period were stratified by age, shock, management of venous injury, injury severity, and timing and type of anticoagulation...
February 2018: Journal of Trauma and Acute Care Surgery
Marc Schindewolf, Torsten Fuss, Hanspeter Fink, Armin Gemperli, Axel Haine, Iris Baumgartner
Data on efficacy outcomes of endovascular versus surgical revascularization in patients with critical limb ischemia (CLI) in contemporary practice are limited. In this prospective cohort study, 353 consecutive patients with CLI were enrolled and allocated to endovascular (PTA [percutaneous transluminal angioplasty]), surgical (SURG), or no revascularization (No REVASC) after interdisciplinary consensus. Outcome measures were sustained primary clinical success (sPCS; survival without major amputation, repeated target extremity revascularization, and freedom from CLI), limb salvage, and amputation-free survival...
January 1, 2018: Angiology
Shipra Arya, Anjali Khakharia, Zachary O Binney, Randall R DeMartino, Luke P Brewster, Philip P Goodney, Peter W F Wilson
Background -Statin dose guidelines for Peripheral Artery Disease (PAD) patients are largely based on coronary artery disease and stroke data. The aim of this study is to determine the effect of statin intensity on PAD outcomes of amputation and mortality. Methods -Using an observational cohort study design and a validated algorithm we identified incident PAD patients (2003-2014) in the national Veterans Affairs data. Highest statin intensity exposure [high intensity vs low- moderate intensity vs antiplatelet therapy but no statin use (AP only)] was determined within one year of diagnosis of PAD...
January 12, 2018: Circulation
Eva Freisinger, Nasser M Malyar, Holger Reinecke, Michael Unrath
BACKGROUND: Few data discuss the impact of sex on diagnostic and therapeutic procedures and outcome of patients with peripheral artery disease (PAD). METHODS: We obtained data on 41,873 PAD patients between 2009 and 2011 (including a 4-year follow-up) from the largest German public health insurance (BARMER GEK). Propensity Score Matching (PSM) was performed to evaluate the impact of sex on treatment, complications, in-hospital and long-term outcome. RESULTS: Of 41,873 PAD patients, there were 23,282 (55...
March 15, 2018: International Journal of Cardiology
Jung Woo Kwon, Min Ki Hong, Bo Young Park
BACKGROUND: Symmetrical peripheral gangrene (SPG) is an uncommon syndrome showing symmetrical gangrene in acral regions without evidence of large-vessel occlusion or vasculitis. Intravenous vasopressors are frequently used to manage hemodynamically unstable patients. There have been few reports about SPG after using inotropics. However, risk factors for SPG have not been extensively studied. Therefore, the objective of this study was to analyze several cases of SPG and identify risk factors for SPG...
January 9, 2018: Annals of Plastic Surgery
Katriina Heikkila, David C Mitchell, Ian M Loftus, Amundeep S Johal, Sam Waton, David A Cromwell
Background -The availability and diversity of lower limb revascularisation procedures have increased in England in the past decade. We investigated whether these developments in care have translated to improvements in patient pathways and outcomes. Methods -Individual-patient records from Hospital Episode Statistics (HES) were used to identify 103 934 patients who underwent endovascular (angioplasty) or surgical (endarterectomy, profundaplasty or bypass) lower limb revascularisation for infrainguinal peripheral artery disease (PAD) in England between January 2006 and December 2015...
January 9, 2018: Circulation
Fredrik A Nilsen, Marius Molund, Kjetil H Hvaal
Few studies have evaluated the long-term clinical outcomes of Charcot foot. The present study evaluated the long-term effects of Charcot foot in a population treated with early weightbearing in a removable Charcot restraint orthotic walker. A retrospective study of 62 consecutive patients (74 feet) treated for Charcot foot from January 2003 to March 2014 was conducted. Of the 74 affected feet, 48 (64.9%) had developed an ulcer. The total amputation rate was 25.7% (19 feet), and 11 feet (14.9%) underwent major amputations...
January 5, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Gary Y Ang, Chun Wei Yap, Nakul Saxena
INTRODUCTION: The risk of lower extremity amputations (LEAs) in diabetics is 20 times higher than in non-diabetics. Clinical practice guidelines recommend that all diabetics should receive an annual foot examination to identify high-risk foot conditions. Despite this recommendation, there is little evidence in the literature to show its effectiveness in preventing LEA. This study aims to evaluate the effectiveness of diabetes foot screening in primary care in preventing LEA and to identify LEA risk factors...
November 2017: Annals of the Academy of Medicine, Singapore
Jing-Chun Zhao, Bo-Ru Zhang, Kai Shi, Xi Zhang, Chun-Hui Xie, Jian Wang, Qing-Hua Yu, Xin-Xin Gao, Lei Hong, Jia-Ao Yu
BACKGROUND: To investigate the clinical characteristics and treatment outcomes in necrotizing fasciitis (NF) patients in a reconstructive unit in northeastern China. METHODS: Medical records of patients diagnosed with and treated for NF in the extremities from November 2013 to December 2016 were retrospectively reviewed. Demographic data, clinical presentation, duration of signs and symptoms, location of infection, predisposing factors, causative microbiological organisms, laboratory risk indicator for necrotizing fasciitis (LRINEC) score, number of surgical debridements, length of hospital stay, treatments, and outcomes were recorded...
December 28, 2017: BMC Infectious Diseases
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