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lower extremity reconstruction

Siba Haykal, Mélissa Roy, Ashit Patel
BACKGROUND:  In 1986, Marko Godina published his seminal work regarding the timing of free-flap reconstruction for traumatic extremity defects. Early reconstruction, compared with delayed and late reconstruction resulted in significant decreases in free-flap failure rate, post-operative infections, hospitalization time, bone healing time, and number of additional anesthesias. The objective of this manuscript was to evaluate whether these principles continue to apply. METHODS:  A meta-analysis was performed analyzing articles from Medline, Embase, and Pubmed...
February 2, 2018: Journal of Reconstructive Microsurgery
M H Zou, L Ma, Y S Xia, S C Yang, W D Chen, F Cao, X X Chen
Objective: To review the early and mid-term results of end-to-side anastomosis technique for interrupted aortic arch in neonates and infants. Methods: Clinic data of 46 patients were diagnosed as interrupted aortic arch in Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center between January 2010 and December 2016 were analyzed retrospectively. Twenty-six cases were neonates. The median age underwent surgery was 23 days (range: 2 days to 8 years). Anatomical subtypes included 36 cases of type A and 10 cases of type B...
March 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Christina Enciso Holm, Christian Bardram, Anja Falk Riecke, Peter Horstmann, Michael Mørk Petersen
PURPOSE: Previous studies reported variable outcome and failure rates after mega-prosthetic reconstructions in the lower extremities. The purpose of this study was to make a long-term single-center evaluation of patients treated with limb-sparing surgery and reconstruction with mega-prostheses in the lower extremities. METHODS: We identified 50 patients (osteosarcoma (n = 30), chondrosarcoma (n = 9), osteoclastoma (n = 6), Ewing sarcoma (n = 4), angiosarcoma (n = 1)), who underwent limb-sparing reconstruction of the lower extremities (proximal femur (n = 9), distal femur (n = 29), proximal tibia (n = 9), and the entire femur (n = 3)) between 1985 and 2005...
March 12, 2018: International Orthopaedics
Zi-Jian Li, Min-Wei Zhao, Lin Zeng
Background: Total knee arthroplasty (TKA) is the most frequently performed procedure in treating advanced knee osteoarthritis. Excessive perioperative blood loss can sometimes lead to postoperative anemia. Tranexamic acid (TXA) is a potent fibrinolysis inhibitor which has been extensively used at the surgical incision and closure to lower overall blood loss in adult reconstruction surgery. Our previous study suggested that about two-thirds of the total blood loss (TBL) came from hidden blood loss (HBL) on postoperative days 1 and 2...
March 20, 2018: Chinese Medical Journal
Rajsrinivas Parthasarathy, Vipul Gupta, Aditya Gupta
OBJECTIVES: Blister like aneurysm (BLA) is extremely challenging to treat; endoluminal reconstruction has emerged as the most promising treatment method. When to treat after the ictus, the timing of administration of antiplatelet and causal relationship between platelet function testing results and thromboembolism is unclear. We theorized that Prasugrel with a lower incidence of resistance may be a safe suitable alternative to clopidogrel in patients treated with a flow diverter. METHODS: Prospectively collected data from consecutive patients treated for a ruptured blister with a flow diverter was reviewed...
March 6, 2018: British Journal of Radiology
Oliver J Gagné, Andrea Veljkovic, Mark Glazebrook, Timothy R Daniels, Murray J Penner, Kevin J Wing, Alastair S E Younger
BACKGROUND: People who are affected by end-stage ankle arthritis are as disabled as those suffering from arthritis in other main articulations of the lower extremity. Once these patients become unable to perform their job duties, they leave the workforce and require financial aid from government agencies, which represents a considerable economic burden. Regardless of whether arthrodesis or arthroplasty is performed, we hypothesized that patients younger than 55 years at the time of surgery should be able to return to work within 2 years and require less social assistance...
March 1, 2018: Foot & Ankle International
Anthony N Hage, Ravi N Srinivasa, Steven D Abramowitz, Kyle J Cooper, Minhaj S Khaja, Geoff D Barnes, Jeffrey Forris Beecham Chick
Thrombosis of the inferior vena cava and iliac veins, known as iliocaval thrombosis, is a common cause of significant morbidity. Patients with chronic iliocaval obstruction often present with life-limiting occlusive symptoms secondary to recurrent lower extremity deep venous thrombosis, swelling, pain, venous stasis ulcers, or phlegmasia. Endovascular iliocaval reconstruction is a technically successful procedure that results in favorable clinical outcomes and stent patency rates with few complications and is often able to relieve debilitating symptoms in affected patients...
March 1, 2018: Vascular Medicine
Sabine A Egeler, Tim de Jong, Antonius J M Luijsterburg, Marc A M Mureau
BACKGROUND: Reconstruction of severe lower extremity injuries using free flaps has become a reliable approach. Knowledge of long-term surgical outcomes, limb function, and quality of life is limited. METHODS: Two hundred thirty-nine patients undergoing a free flap reconstruction of an open lower extremity fracture between 1993 and 2014 were divided into three groups and studied, as follows: group 1, early free flap reconstruction within 6 weeks; group 2, delayed reconstruction after 6 weeks; and group 3, delayed reconstruction with osteomyelitis...
March 2018: Plastic and Reconstructive Surgery
Ae Ryoung Kim, Dae Hyun Kim, So Young Park, Sunghyon Kyeong, Yong Wook Kim, Seung Koo Lee, Deog Young Kim
This study aimed to investigate the long-term motor outcome according to early diffusion tensor tractography findings for the affected corticospinal tract (CST) in poststroke hemiplegic patients. A total of 48 supratentorial subacute patients after stroke were enrolled, who had a brain MRI scan within 6 weeks from onset, and no stroke recurrence reported within the 2-year follow-up period. Diffusion tensor images were obtained and CSTs were reconstructed. The participants were classified into three groups: type A, the CST originating from the primary motor cortex was preserved around the lesion area; type B, the CST was similar to type A, except that the fiber originated from the area adjacent to the primary motor cortex; and type C, the CST was interrupted or not shown...
February 23, 2018: Neuroreport
L Scott Levin
No abstract text is available yet for this article.
March 2018: Plastic and Reconstructive Surgery
Charalampos Siotos, Mohamad E Sebai, Eric L Wan, Ricardo J Bello, Mehran Habibi, Damon S Cooney, Michele A Manahan, Carisa M Cooney, Stella M Seal, Gedge D Rosson
BACKGROUND: Lymphedema remains a significant complication following breast cancer surgery when there is axillary lymph node intervention. Previous systematic reviews have identified risk factors for breast cancer-related lymphedema, including increased BMI, number of lymph nodes dissected and radiotherapy. However, they have not examined the effect of breast reconstruction on lymphedema occurrence. In this systematic review and meta-analysis, we sought to evaluate the association between breast reconstruction (BR) and lymphedema...
February 21, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Peter Morse, Shannon R Kjeldsen, Mark G Meekan, Mark I Mccormick, Julian K Finn, Christine L Huffard, Kyall R Zenger
The southern blue-ringed octopus, Hapalochlaena maculosa (Hoyle, 1883) lacks a planktonic dispersal phase, yet ranges across Australia's southern coastline. This species' brief and holobenthic life history suggests gene flow might be limited, leaving distant populations prone to strong genetic divergence. This study used 17,523 genome-wide SNP loci to investigate genetic structuring and local adaptation patterns of H. maculosa among eight sampling sites along its reported range. Within sites, interrelatedness was very high, consistent with the limited dispersal of this taxon...
February 2018: Ecology and Evolution
C Hierholzer, J Friederichs, P Augat, A Woltmann, O Trapp, V Bühren, C von Rüden
Key factors for successful osteosynthetic fracture stabilization are anatomical fracture reduction, restoration of axis and torsion alignment as well as tissue-preserving operative techniques. In long bone fractures, the use of intramedullary long bridging nailing offers ideal conditions for bone healing, as axial and rotational stability is provided by canal-filling nails and locking screws. In addition, the tissue in the fracture region is protected as the intramedullary nail insertion is distant from the fracture...
February 20, 2018: Der Unfallchirurg
Qing Zhao Ruan, Shawn Diamond, Scott Zimmer, Matthew L Iorio
BACKGROUND: Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap. METHODS: A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed...
February 16, 2018: Journal of Reconstructive Microsurgery
Deep Dutta, Raghuvansh Kumar Pandey, Rakhee Gogoi, Nagender Solanki, Renu Madan, Anupam Mondal, Shruti Dogra, Pradeep Thapa
BACKGROUND: Tumor induced osteomalacia (TIO) are extremely rare paraneoplastic syndrome with less than 300 reported cases. This report highlights the pitfalls and challenges in diagnosing and localizing TIO in patients with refractory and resistant osteomalacia. PATIENT AND METHODS: 41- year gentleman with 4-year history of musculoskeletal weakness and pathologic fractures presented in wheelchair bound incapacitated state of 1-year duration. Investigations were significant for severe hypophosphatemia, severe phosphaturia, normal serum calcium, reduced 1,25-dihydroxy vitamin-D, elevated ALP, elevated intact parathyroid hormone (iPTH), and pseudo-fractures involving pelvis and bilateral femur...
February 14, 2018: Endokrynologia Polska
Adrien Daigeler, Cornelius Schubert, Tobias Hirsch, Björn Behr, Marcus Lehnhardt
INTRODUCTION: There are many techniques to identify vessels in perforator surgery, each with specific disadvantages. Handheld Dopplers are easy to use, but inaccurate with respect to the exact localisation of the perforator. Angio-CT is invasive, time consuming, and expensive. In contrast, duplex sonography is a reliable, easy-to-use and availabe alternative for pre-, intra-, and postoperative visualisation of vessels. Power Doppler further increases sensitivity and allows visualisation of vessels smaller than 0...
February 12, 2018: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
Divya Srinivasan, Eva Tengman, Charlotte K Häger
BACKGROUND: Recent studies highlight the need for understanding movement control of adjacent joints when evaluating knee function following anterior cruciate ligament (ACL) injury. However, while short-term adaptations to lower-extremity joint coupling have been studied, little is known about any potential long-term adaptations in neuromuscular control displayed by ACL-injured individuals. The aim of our study was to determine whether coordination variability of the hip-knee joint couplings during the one-leg hop is altered about 20 years after injury in two ACL-injured groups compared to healthy knee controls...
February 6, 2018: Clinical Biomechanics
Vivek Ajit Singh, Chan Wei Heng, Nor Faissal Yasin
Background: Limb salvage surgery with endoprosthesis for bone tumor around the knee is reported to have good functional and oncological outcomes. However, the functional assessment using musculoskeletal tumor society (MSTS) and Toronto extremity scoring system remains subjective. We performed gait analysis as an objective assessment of their functional outcome. Materials and Methods: Gait analysis was performed in 20 patients with endoprosthesis replacement around the knee...
January 2018: Indian Journal of Orthopaedics
B Qu, F Yu, G-N Sheng, W Zhang, Y-M Zhang, Y-L Deng, Y Shi, Z-Y Shen
The rat orthotopic liver transplantation model with extremely short anhepatic phase was established to study its protective effect on the recipients and graft. One hundred fifty adult male Wistar rats were randomly divided into three groups: group A (n = 30), using magnetic rings for the suprahepatic vena cava reconstruction; group B (n = 30), using 7/0 Prolene sutures for suprahepatic vena cava running anastomosis as control; and a sham-operated group (n = 30) as a blank control group. The changes in liver enzyme, serum creatinine, endotoxin, and cytokine levels and histopathology were recorded...
January 2018: Transplantation Proceedings
Michael J Orseck, Christopher Robert Smith, Sean Kirby, Manuel Trujillo
Successful outcomes after microsurgical reconstruction of the lower extremity include timely return to ambulation. Some combination of physical examination, ViOptix tissue oxygen saturation monitoring, and the implantable venous Doppler have shown promise in increasing sensitivity of current flap monitoring. We have incorporated this system into our postoperative monitoring protocol in an effort to initiate earlier dependency protocols. A prospective analysis of 36 anterolateral thigh free flap and radial forearm flaps for lower extremity reconstruction was performed...
February 2, 2018: Annals of Plastic Surgery
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