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Above knee amputation

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https://www.readbyqxmd.com/read/29461402/management-of-mangled-extremities-and-orthopaedic-war-injuries
#1
Todd O McKinley, Jean-Claude DʼAlleyrand, Ian Valerio, Seth Schoebel, Kevin Tetsworth, Eric A Elster
In 16 years of conflict, primarily in Iraq and Afghanistan, wounded warriors have primarily been subjected to blast type of injuries. Evacuation strategies have led to unprecedented survival rates in blast-injured soldiers, resulting in large numbers of wounded warriors with complex limb trauma. Bone and soft tissue defects have resulted in increased use of complex reconstructive algorithms to restore limbs and function. In addition, in failed salvage attempts, advances in amputation options are being developed...
March 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29452439/assessment-of-function-after-free-tissue-transfer-to-the-lower-extremity-for-chronic-wounds-using-the-lower-extremity-functional-scale
#2
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
https://www.readbyqxmd.com/read/29439896/high-failure-rates-of-concomitant-periprosthetic-joint-infection-and-extensor-mechanism-disruption
#3
Lucas A Anderson, Brian M Culp, Craig J Della Valle, Jeremy M Gililland, R Michael Meneghini, James A Browne, Bryan D Springer
BACKGROUND: Patients presenting with both chronic periprosthetic joint infection (PJI) and extensor mechanism disruption (EMD) pose a significant challenge. As there is little in the literature regarding outcomes of patients with concomitant PJI and EMD, we performed a multicenter study to evaluate the outcomes. METHODS: Sixty patients with concomitant diagnoses of PJI and EMD were evaluated from 5 institutions. Patient demographics, presentation type, surgical management, and outcomes including recurrent infections, final surgery, and ambulatory status were documented...
January 31, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29429146/graft-type-for-femoro-popliteal-bypass-surgery
#4
REVIEW
Graeme K Ambler, Christopher P Twine
BACKGROUND: Femoro-popliteal bypass is implemented to save limbs that might otherwise require amputation, in patients with ischaemic rest pain or tissue loss; and to improve walking distance in patients with severe life-limiting claudication. Contemporary practice involves grafts using autologous vein, polytetrafluoroethylene (PTFE) or Dacron as a bypass conduit. This is the second update of a Cochrane review first published in 1999 and last updated in 2010. OBJECTIVES: To assess the effects of bypass graft type in the treatment of stenosis or occlusion of the femoro-popliteal arterial segment, for above- and below-knee femoro-popliteal bypass grafts...
February 11, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29397412/resection-arthrodesis-using-distraction-osteogenesis-then-plating-as-a-hybrid-surgical-technique-for-the-management-of-bone-sarcomas-of-the-distal-tibia
#5
Teng-Fei Lou, Hua Li, Yi-Min Chai, Chun-Yang Wang, Sheng-He Liu, Musha Hamushan, Fan Wu, Wei-Jie Cai, Pei Han
PURPOSE: We report the oncological and functional results of limb salvage for bone sarcomas involving the distal tibia using hybrid surgical technique of resection arthrodesis by bone transport then plating. METHODS: Five patients (mean age 18.6 years) with primary distal tibial sarcomas (two Ewing's sarcomas and three osteosarcomas) were treated by this method. The average duration of follow-up is 53 months. All patients accepted distraction osteogenesis with a standard technique using external fixator after wide (four cases) or marginal (one case) resection in the first operation...
February 3, 2018: International Orthopaedics
https://www.readbyqxmd.com/read/29374491/prosthetic-energy-return-during-walking-increases-after-3%C3%A2-weeks-of-adaptation-to-a-new-device
#6
Samuel F Ray, Shane R Wurdeman, Kota Z Takahashi
BACKGROUND: There are many studies that have investigated biomechanical differences among prosthetic feet, but not changes due to adaptation over time. There is a need for objective measures to quantify the process of adaptation for individuals with a transtibial amputation. Mechanical power and work profiles are a primary focus for modern energy-storage-and-return type prostheses, which strive to increase energy return from the prosthesis. The amount of energy a prosthesis stores and returns (i...
January 27, 2018: Journal of Neuroengineering and Rehabilitation
https://www.readbyqxmd.com/read/29363894/lutonix%C3%A2-014-dcb-global-below-the-knee-registry-study-interim-6-month-outcomes
#7
Marcus Thieme, Michael Lichtenberg, Marianne Brodmann, Angelo Cioppa, Dierk Scheinert
BACKGROUND: Most common clinical presentation of peripheral artery disease (PAD) comprises intermittent claudication (IC), but about one third of patients will progress to critical limb ischemia (CLI), characterized by rest pain and/or tissue loss, which is the most severe limb manifestation of PAD. Paclitaxel-coated balloons are well established for the endovascular treatment of femoropopliteal lesions in patients with IC and CLI. This ongoing multicenter registry study is exploring the role of the Lutonix® 014 drug- coated balloon (DCB) in the treatment of below-the-knee (BTK) arteries and CLI...
January 23, 2018: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29327570/the-detour-procedure-no-more-need-for-conventional-bypass-surgery
#8
Dainis Krievins, Janis Savlovskis, Natalija Ezite, Andrew Hill, Kaspars Kisis, Marcis Gedins, Edgars Zellans, Andrew Holden
BACKGROUND: Long segment occlusive disease in the superficial femoral artery remains a treatment challenge despite advances in open surgical and endovascular approaches. We report initial clinical results of an entirely new procedure to perform femoropopliteal bypass using the DETOUR System to create a stentgraft bypass which originates in the SFA, travels through the femoral vein, and ends in the popliteal artery, bypassing the diseased segment. METHODS: Review the initial results of the first five patients at a single site enrolled in IRB-approved, prospective clinical study using the DETOUR System...
January 9, 2018: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29306852/trichosporon-asahii-septic-thrombophlebitis-following-lower-extremity-amputation-in-an-immunocompetent-host
#9
Pradeep Kumar Mada, Folusakin Ayoade, Ailing Li, John Todd
A 59-year-old man with a history of peripheral vascular disease status post femoral popliteal bypass presented with critical limb ischaemia of the left leg. An arterial Doppler ultrasound showed an occluded graft requiring an above knee amputation. Five days after surgery, the patient developed fever, leucocytosis, significant stump swelling and pain, and serosanguinous discharge from his wound. Wound swab cultures from the stump grew Trichosporon asahii A venous Doppler ultrasound revealed extensive thrombosis of the left lower extremity...
January 6, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29301794/surgical-trauma-induces-overgrowth-in-lower-limb-gigantism-regulation-with-use-of-rapamycin-is-promising
#10
Rohan Sebastian Pinto, William David Harrison, Kenneth Graham, Durai Nayagam
We describe an unclassified overgrowth syndrome characterised by unregulated growth of dermal fibroblasts in the lower limbs of a 35-year-old woman. A PIK3CA gene mutation resulted in lower limb gigantism. Below the waist, she weighed 117 kg with each leg measuring over 100 cm in circumference. Her total adiposity was 50% accounted for by her legs mainly. Liposuction and surgical debulking were performed to reduce the size of the limbs but had exacerbated the overgrowth in her lower limbs. Systemic sepsis from an infected foot ulcer necessitated treatment by an above-knee amputation...
January 4, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29284534/perineural-local-anaesthetic-catheter-after-major-lower-limb-amputation-trial-placement-study-protocol-for-a-randomised-controlled-pilot-study
#11
David C Bosanquet, Graeme K Ambler, Cherry-Ann Waldron, Emma Thomas-Jones, Lucy Brookes-Howell, Mark Kelson, Tim Pickles, Debbie Harris, Deborah Fitzsimmons, Neeraj Saxena, Christopher P Twine
BACKGROUND: Pain after major lower limb amputation for peripheral arterial disease (PAD) is a significant problem. A perineural catheter (PNC) can be placed adjacent to the major nerve at the time of amputation with a continuous local anaesthetic infusion given postoperatively to try and reduce pain. Although low-quality observational data suggest that PNC usage reduces postoperative opioid requirements, there are limited data regarding its effect on pain. The aim of PLACEMENT is to explore the feasibility of running an effectiveness trial to assess the impact of a PNC with continuous local anaesthetic infusion, inserted at the time of amputation, on short and medium-term postoperative outcomes...
December 28, 2017: Trials
https://www.readbyqxmd.com/read/29276305/stable-robust-hybrid-zero-dynamics-control-of-powered-lower-limb-prostheses
#12
Anne E Martin, Robert D Gregg
To improve the quality of life for lower-limb amputees, powered prostheses are being developed. Advanced control schemes from the field of bipedal robots, such as hybrid zero dynamics (HZD), may provide great performance. HZD-based control specifies the motion of the actuated joints using output functions to be zeroed, and the required torques are calculated using input-output linearization. For one-step periodic gaits, there is an analytic metric of stability. To apply HZD-based control on a powered prosthesis, several modifications must be made...
August 2017: IEEE Transactions on Automatic Control
https://www.readbyqxmd.com/read/29224940/results-of-nonoperative-management-of-acute-limb-ischemia-in-infants
#13
S Keisin Wang, Gary W Lemmon, Natalie A Drucker, Raghu L Motaganahalli, Michael C Dalsing, Ashley R Gutwein, Brian W Gray, Michael P Murphy
OBJECTIVE: Acute limb ischemia (ALI) in infants poses a challenge to the clinician secondary to poor operative outcomes, limb loss risk, and lifelong morbidity. This retrospective study reviewed a 10-year institutional experience with the nonoperative management of ALI in infants. METHODS: Infants (aged ≤12 months) diagnosed with ALI by duplex ultrasound and treated with initial nonoperative management at a tertiary care children's hospital were identified through vascular laboratory arterial duplex ultrasound records and International Classification of Diseases and Current Procedural Terminology codes associated with ALI...
December 7, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29217448/perioperative-outcomes-after-regional-versus-general-anesthesia-for-above-the-knee-amputations
#14
Andrew J B Pisansky, Ethan Y Brovman, Christine Kuo, Alan D Kaye, Richard D Urman
BACKGROUND: Nontraumatic lower extremity amputation (LEA) remains a common procedure among patients who frequently have significant comorbidities. Patients undergoing above knee amputation (AKA) have the highest rates of mortality in this cohort, yet there is little evidence to support selection between peripheral nerve block or neuraxial regional anesthesia (RA) versus general anesthesia (GA) techniques. The objective of this study was to determine whether RA (neuraxial or peripheral nerve block) techniques were associated with more favorable outcomes versus general anesthesia among patients undergoing AKA...
December 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29181352/a-case-report-of-dual-incision-technique-for-total-femur-arthroplasty-as-a-salvage-procedure-in-infected-non-unions
#15
Aniruddh Agrawal, Vinod Agrawal, Sandeepkumar Yadav, Shushil K Soni, Sawan Kumar Pawar
Introduction: Total femur arthroplasty (TFA) is a rare salvage limb procedure which serves as an effective alternative to limb amputation. Most commonly, it is indicated for oncologic orthopedic cases, and very few cases of a purely traumatic history for TFA have been documented. The decision to perform this complex procedure involves paying careful attention to reconstructive needs and functional expectations of the patient. Alternatives to this procedure are quite detrimental and include hip disarticulation and above-the-knee amputation...
July 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/29175037/results-from-a-multicenter-registry-of-heparin-bonded-expanded-polytetrafluoroethylene-graft-for-above-the-knee-femoropopliteal-bypass
#16
Gabriele Piffaretti, Walter Dorigo, Patrizio Castelli, Carlo Pratesi, Raffaele Pulli
OBJECTIVE: The aim of the study was to retrospectively analyze early and follow-up results of above-the-knee femoropopliteal bypasses (AKb) performed with a bioactive heparin-bonded expanded polytetrafluoroethylene (HB-ePTFE) graft in patients with peripheral arterial obstructive disease in a multicentric retrospective registry involving seven Italian vascular centers. METHODS: During a 14-year period ending in March 2016, an HB-ePTFE graft was used in 1401 interventions performed for peripheral arterial obstructive disease...
November 23, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29147164/a-series-of-210-peripheral-arterial-disease-below-knee-amputations-and-predictors-for-subsequent-above-knee-amputations
#17
Jing Ting Wu, Maggie Wong, Zhiwen Joseph Lo, Wei-En Wong, Sriram Narayanan, Glenn Wei Leong Tan, Sadhana Chandrasekar
Objective: To review patient characteristics and outcomes after peripheral arterial disease (PAD)-related below-knee amputation (BKA), and identify risk factors predicting subsequent above-knee amputation (AKA). Materials and Methods: A retrospective study of 210 BKAs between May 2008 and December 2015. Results: The mean age of the study population was 66 years. Most of the patients had cardiovascular comorbidities, and 33% had end-stage renal failure (ESRF); 89% were American Society of Anesthesiologists 3 or 4...
September 25, 2017: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/29132347/knee-arthrodesis-versus-above-the-knee-amputation-after-septic-failure-of-revision-total-knee-arthroplasty-comparison-of-functional-outcome-and-complication-rates
#18
Sven Hungerer, Martin Kiechle, Christian von Rüden, Matthias Militz, Knut Beitzel, Mario Morgenstern
BACKGROUND: After septic failure of total knee arthroplasty (TKA) and multiple revision operations resulting in impaired function, bone and/or soft-tissue damage a reconstruction with a revision arthroplasty might be impossible. Salvage procedures to regain mobility and quality of life are an above-the-knee amputation or knee arthrodesis. The decision process for the patient and surgeon is difficult and data comparing arthrodesis versus amputation in terms of function and quality of life are scarce...
November 13, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29128877/the-location-of-the-medial-parapatellar-arthrotomy-influences-intraoperative-patella-tracking
#19
Scott R Nodzo, Maximilian Kasparek, Kilian Rueckl, Friedrich Boettner
PURPOSE: The medial parapatellar arthrotomy (MPPA) is a commonly utilized surgical approach; however, the placement of the arthrotomy and its influence on intraoperative patellar tracking has not been evaluated. METHODS: Six knees from three fresh frozen cadavers with transthoracic amputations were operated on. All underwent standard posterior stabilized total knee arthroplasty using a medial parapatellar approach placed at the border of the vastus medialis oblique (VMO)-quadriceps junction...
November 11, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/29127251/looking-beyond-the-indication-bone-scan-for-trauma-providing-unsuspected-initial-diagnosis-of-acute-critical-lower-limb-arterial-compromise
#20
Fathima Fijula Palot Manzil, Samuel E Almodovar, Pradeep Bhambhvani
We report a case of rare incidental initial detection of unsuspected arterial supply compromise to the right lower extremity on a bone scan done to rule out fracture in a patient with right hip pain following a fall. Follow up CT angiogram confirmed near complete occlusion of right lower extremity arteries for which patient underwent above knee amputation.
November 10, 2017: Journal of Nuclear Medicine Technology
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