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https://www.readbyqxmd.com/read/29883293/negative-pressure-wound-therapy-in-reconstructing-extensive-leg-and-foot-soft-tissue-loss-in-a-child-a-case-study
#1
Iulia Tevanov, Dan Mircea Enescu, Madalina Carp, Andrei Dusca, Alin Ladaru, Alexandru Ulici
Open fractures of the leg with large loss of tissue require extensive reconstructive methods that can injure the donor area. The use of negative pressure wound therapy (NPWT) may minimise the impact of these reconstructive methods because of its capacity to create granulation tissue that will form a wound bed for the skin graft, thus reducing the volume of soft tissue defect and saving the donor region. This case study describes the effectiveness of NPWT in the treatment and reconstruction of an open fracture of the leg, with massive loss of soft tissue, associated with elastic intramedullary nailing in a 10-year-old female patient, who was a victim of a car accident...
June 1, 2018: Journal of Wound Care
https://www.readbyqxmd.com/read/29876159/the-impact-of-microsurgery-on-congenital-hand-anomalies-associated-with-amniotic-band-syndrome
#2
David T W Chiu, Anup Patel, Sara Sakamoto, Alice Chu
Background: Amniotic Band Syndrome is a clinical constellation of congenital anomalies characterized by constricting rings, tissue synechiae and amputation of body parts distal to the constriction bands. Involvement of the hand with loss of multiple digits not only leads to devastating deformities but also loss of functionality. Methods: In this series, utilizing microvascular transfer of the second toe from both feet, along with local tissue reconfiguration, a tetra-digital hand with simile of normal cascade was reconstructed...
April 2018: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/29804922/an-innovative-application-of-the-free-vascularized-medial-femoral-condyle-flap-in-the-prevention-of-recurring-neuropathic-ulcer-in-the-diabetic-foot-a-case-report
#3
Martin Grohmann, Stefan Benedikt, Anna Vasilyeva, Heinz Bürger, Abigail Forbes, Michael Valentin Schintler
Despite various therapy options, the prophylactic and symptomatic treatment of recurrent ulcerations in the diabetic foot are still challenging. We report the application of a free vascularized medial femoral condyle flap to prevent the recurrence of pressure ulcer in a patient with diabetic foot syndrome. Our patient had type 2 diabetes and presented with pressure ulcers and osteomyelitis of metatarsal heads 2 and 3 after a great toe amputation. We chose to use a medial femoral condyle flap as a damper in the area of the metatarsal heads because of the relatively young age and good vascularity of our patient...
May 24, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/29782037/multiloculated-solitary-unicameral-bone-cyst-in-a-young-dog
#4
Sarah C Roode, Heather R Shive, Willemijn Hoorntje, Jennifer Bernard, Devorah M Stowe, Roy R Pool, Carol B Grindem
A 20-month-old female spayed Staffordshire Terrier (22.3 kg) presented to the Orthopedic Surgery Service at North Carolina State University Veterinary Teaching Hospital for evaluation of a 6-week history of toe-touching to nonweight-bearing lameness in the right hind limb. Radiographs of the right stifle revealed a multiloculated lytic lesion of the distal femur, with a large open lytic zone centrally, numerous osseous septations peripherally, and focal areas of cortical thinning and loss. An aspirate of the right distal femoral lesion yielded mildly cloudy serosanguineous fluid...
May 21, 2018: Veterinary Clinical Pathology
https://www.readbyqxmd.com/read/29777849/non-invasive-diagnostic-methods-for-better-screening-of-peripheral-arterial-disease
#5
REVIEW
Neelamshobha Nirala, R Periyasamy, Awanish Kumar
BACKGROUND: Peripheral arterial disease (PAD) is a common circulatory problem in which narrowed arteries reduce blood flow to extremities usually legs. It does not receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain while walking which is known as claudication. It is a common manifestation of type II Diabetes, but the relationship between other vascular diseases and lower limb (LL)-PAD has been poorly understood and investigated. METHODS: When assessing a patient with clinically LLPAD, two questions are in order to establish a diagnosis: one is non-invasive testing and other is invasive...
May 16, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29777842/nationally-representative-readmission-factors-in-patients-with-claudication-and-critical-limb-ischemia
#6
Rennier A Martinez, Michelle Shnayder, Joshua Parreco, Lukas Gaffney, Marcus Eby, Nicholas Cortolillo, Michael Lopez, Jack Zeltzer
INTRODUCTION: Hospital readmissions are not only associated with increased mortality, morbidity and costs but also, with current healthcare reform, tied to significant financial and administrative penalties. Some studies show that patients undergoing vascular surgery may have higher than average readmission rates. The recently released Nationwide Readmission Database (NRD) is the most comprehensive national source of readmission data, gathering discharge information from 22 geographically dispersed states, accounting for 51...
May 16, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29755399/leg-prosthesis-with-somatosensory-feedback-reduces-phantom-limb-pain-and-increases-functionality
#7
Caroline Dietrich, Sandra Nehrdich, Sandra Seifert, Kathrin R Blume, Wolfgang H R Miltner, Gunther O Hofmann, Thomas Weiss
Phantom limb pain (PLP) develops in most patients with lower limb amputation. Changes in the peripheral and central nervous system (CNS) are hypothesized to contribute to PLP. Based on ideas to modify neural reorganization within the CNS, the aim of the study was to test, whether prostheses with somatosensory feedback might help to reduce PLP, and increase the functionality of movement with a prosthesis. We therefore equipped the prostheses of 14 lower leg amputees with a simple to use feedback system that provides electrocutaneous feedback to patients' thigh whenever the foot and toes of the prosthesis touch the ground...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29745908/local-use-of-granulocyte-macrophages-colony-stimulating-factor-in-treatment-of-chronic-diabetic-neuropathic-ulcer-case-review
#8
E Karlafti, Ch Savopoulos, A Hatzitolios, T Didangelos
One of the main causes of amputations in patients with Diabetes Mellitus patients is a chronic diabetic foot ulcer. The authors present a clinical case and discussion of a successful use of Granulocyte-Macrophages Colony Stimulating Factor (GM-CSF) treatment for the promotion of healing of a chronic diabetic foot ulcer. A 65 year-old woman was admitted to the Diabetes Center with complaints of a deep non-healing chronic foot ulcer for the last 18 months. At the examination a 5 cm ulcer on the plantar surface of the right foot was revealed...
April 2018: Georgian Medical News
https://www.readbyqxmd.com/read/29705012/an-alternative-thumb-reconstruction-by-double-microsurgical-transfer-from-the-great-and-second-toe-for-a-carpometacarpal-amputation
#9
REVIEW
Ignacio Roger de Oña, Andrea Garcia Villanueva, Alexis Studer de Oya
Thumb amputation at the carpometacarpal level is very incapacitating. Pollicization may be considered. We describe an alternate technique for thumb reconstruction at the level of the metacarpal base using a trimmed great toe along with a vascularized second metatarsophalangeal joint, including the second metatarsal, all supplied on a single vascular pedicle. Two patients who had a combined soft tissue defect and amputation of the thumb close to the carpometacarpal joint were reconstructed with this method. A transposition of the second toe was performed on top of the remaining proximal phalanx of the great toe to decrease donor site morbidity...
April 25, 2018: Journal of Hand Surgery
https://www.readbyqxmd.com/read/29689575/investigating-patients-perception-of-microvascular-free-toe-flap-for-reconstruction-of-amputated-thumbs-a-guide-for-surgeons-during-informed-consent
#10
Johnny Ionut Efanov, Christopher Wong, Clarence Guilbault, Joseph Bou-Merhi, Patrick G Harris, Ali Izadpanah, Michel Alain Danino
BACKGROUND:  After thumb amputations, restoration of function and aesthetic can be accomplished with microvascular free toe flaps. However, many patients in clinical practice do not choose this reconstruction despite positive reported outcomes. This study aims to determine patients' perceptions with respect to free toe flaps to improve areas of informed consent. METHODS:  A retrospective survey was administered to patients with thumb amputations. Participants were required to complete a questionnaire about patient demographics, the Brief Michigan Hand Questionnaire (bMHQ), the standard gamble/time trade-off questionnaires for utility scores, and a questionnaire investigating potential reasons for electing not to undergo a free toe transfer...
April 24, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29685512/causes-and-outcomes-of-finger-ischemia-in-hospitalized-patients-in-the-intensive-care-unit
#11
Gregory J Landry, Courtney J Mostul, Daniel S Ahn, Bryant J McLafferty, Timothy K Liem, Erica L Mitchell, Enjae Jung, Cherrie Z Abraham, Amir F Azarbal, Robert B McLafferty, Gregory L Moneta
OBJECTIVE: Vascular surgeons may be consulted to evaluate hospitalized patients with finger ischemia. We sought to characterize causes and outcomes of finger ischemia in intensive care unit (ICU) patients. METHODS: All ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed. All were evaluated with finger photoplethysmography. The patients' demographics, comorbidities, ICU care (ventilator status, arterial lines, use of vasoactive medications), finger amputations, and survival were also recorded...
April 20, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29658630/lumbar-sympathectomy-versus-prostanoids-for-critical-limb-ischaemia-due-to-non-reconstructable-peripheral-arterial-disease
#12
REVIEW
Indrani Sen, Sunil Agarwal, Prathap Tharyan, Rachel Forster
BACKGROUND: Peripheral arterial disease (PAD) is a common circulatory problem that can lead to reduced blood flow to the limbs, which may result in critical limb ischaemia (CLI), a painful manifestation that occurs when a person is at rest. The mainstay of treatment for CLI is surgical or endovascular repair. However, when these means of treatment are not suitable, due to anatomical reasons or comorbidities, treatment for pain is limited. Lumbar sympathectomy and prostanoids have both been shown to reduce pain from CLI in people who suffer from non-reconstructable PAD, but there is currently insufficient evidence to determine if one treatment is superior...
April 16, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29655809/acute-limb-ischemia-in-an-8-year-old-patient-a-case-report
#13
Young Erben, Samuel M Miller, Brandon J Sumpio, Brian J Dillon, Alfred I Lee, Peter Blume, Bauer E Sumpio, Carlos Mena-Hurtado
We report the case of an 8-year-old patient with a history of nephrotic syndrome, who presented to the emergency department with right foot pain. The patient's mother described intermittent pain that woke her son from sleep and was accompanied by the foot turning purple and becoming cold to touch. Physical examination revealed capillary refill of over 10 seconds in the right and less than 2 seconds in the left foot. Ankle-brachial indices (ABIs) were 0.0 on the right and 0.96 on the left. The patient was admitted and started on therapeutic intravenous heparin...
April 13, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29644884/prospective-analysis-of-surgical-bone-margins-after-partial-foot-amputation-in-diabetic-patients-admitted-with-moderate-to-severe-foot-infections
#14
Brian M Schmidt, Jonathan B McHugh, Rajiv M Patel, James S Wrobel
BACKGROUND: Osteomyelitis is common in diabetic foot infections and medical management can lead to poor outcomes. Surgical management involves sending histopathologic and microbiologic specimens which guides future intervention. We examined the effect of obtainment of surgical margins in patients undergoing forefoot amputations to identify patient characteristics associated with outcomes. Secondary aims included evaluating interobserver reliability of histopathologic data at both the distal-to and proximal-to surgical bone margin...
April 1, 2018: Foot & Ankle Specialist
https://www.readbyqxmd.com/read/29644037/obstructive-hydrocephalus-secondary-to-odontoid-pannus-case-report-and-review-of-literature
#15
Wai Cheong Soon, Gopiga Thanabalasundaram, Kyaw Zayar Thant, Ebere Sunny Ogbonnaya, Stuart Edward Harrisson
Odontoid pannus or periodontoid pseudotumour is associated with a variety of rheumatological conditions. We report a case of an 80-year old man who presented with acute hydrocephalus following an emergency operation to amputate his infected left big toe. Imaging revealed a large tissue mass causing severe compression at the cervico-medullary junction and obstruction of CSF flow. The acute hydrocephalus was presumed to be related to neck manoeuvring during general anaesthesia. Following an initial emergency CSF diversion through external ventricular drainage catheter insertion, the patient subsequently underwent ventriculo-peritoneal insertion and posterior spinal decompression and fixation...
April 2018: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/29614465/running-at-submaximal-speeds-the-role-of-the-intact-and-prosthetic-limbs-for-trans-tibial-amputees
#16
Siobhan C Strike, Daniela Arcone, Michael Orendurff
BACKGROUND: Dynamic Elastic Response prostheses are designed to absorb and return strain energy in running. Past research has focused on running prostheses with a single toe spring designed for high speeds. RESEARCH QUESTION: To determine how runners with amputation modulate the ground reaction force of each limb to run at different speeds using a general-purpose dynamic prosthesis which has a heel spring. METHODS: Overground running data were collected in 16 recreational runners (8 transtibial amputee using their own BladeXT prosthesis and 8 controls) using Vicon Nexus V...
May 2018: Gait & Posture
https://www.readbyqxmd.com/read/29611173/the-relationship-between-pulse-waveform-analysis-indices-endothelial-function-and-clinical-outcomes-in-patients-with-peripheral-artery-disease-treated-using-percutaneous-transluminal-angioplasty-during-a-one-year-follow-up-period
#17
Paweł S Kaczmarczyk, Paweł Maga, Rafał Niżankowski, Rafał Januszek, Marzena Frołow, Mikołaj Maga, Jolanta Kościelniak, Andrzej Belowski
BACKGROUND: The aim of the current study was to assess the relationship between potential predictors of clinical outcomes after percutaneous transluminal angioplasty (PTA) of peripheral arteries during a one-year follow-up. Indices of endothelial function (EF), arterial pulse waveform analysis (aPWA) and markers of peripheral arteries ischemia were among those mostly examined. METHODS: The study comprised of 72 individuals with PAD who underwent PTA of the peripheral arteries...
April 3, 2018: Cardiology Journal
https://www.readbyqxmd.com/read/29608373/cold-susceptibility-of-digit-stumps-resulting-from-amputation-after-freezing-cold-injury-in-elite-alpinists
#18
Jurij Gorjanc, Shawnda A Morrison, Rok Blagus, Igor B Mekjavic
Gorjanc, Jurij, Shawnda A. Morrison, Rok Blagus, and Igor B. Mekjavic. Cold susceptibility of digit stumps resulting from amputation after freezing cold injury in elite alpinists. High Alt Med Biol. 16: 000-000, 2018. AIM: The aim of the study was to assess whether previous freezing cold injury in fingers and/or toes might predispose alpinists to greater risk of further freezing cold injury, primarily due to a greater vasoconstrictor response to cold, resulting in a lower perfusion, reflected in lower skin temperature...
April 2, 2018: High Altitude Medicine & Biology
https://www.readbyqxmd.com/read/29602374/-venolymphatic-malformation-with-bone-erosion-an-unusual-affectation-in-these-lesions
#19
Ana Teijo, Felipe Sacristán, Jesús Del Pozo, Tania Pérez, Laura López, Ana Reguera, Pilar Casteleiro, Ángeles Vázquez-Barro, Ángel Concha
A 30 year old male presented with a cutaneous lesion on the distal area of the 5th toe with involvement of the outer edges. Macroscopically, it was a 1cm violaceous and keratotic lesion. Radiography showed an increase in soft tissue, possibly due to a vascular lesion. MRI showed a hyper-intense signal with erosion of the distal phalanx compatible with a low-flow vascular malformation. The distal phalanx was amputated. Histopathology revealed a lesion formed by venous and D2-40 positive lymphatic vessels. This case highlights the fact that even minimal skin involvement in vascular malformations may conceal an important deeper lesion, such as erosion of the cortical bone...
April 2018: Revista Española de Patología
https://www.readbyqxmd.com/read/29576595/therapeutic-efficacy-of-autologous-non-mobilized-enriched-circulating-endothelial-progenitors-in-patients-with-critical-limb-ischemia-the-scelta-trial
#20
Francesco Liotta, Francesco Annunziato, Sergio Castellani, Maria Boddi, Brunetto Alterini, Giovanni Castellini, Benedetta Mazzanti, Lorenzo Cosmi, Manlio Acquafresca, Filippo Bartalesi, Beatrice Dilaghi, Walter Dorigo, Gabriele Graziani, Benedetta Bartolozzi, Guido Bellandi, Giulia Carli, Alessandro Bartoloni, Aaron Fargion, Filippo Fassio, Paolo Fontanari, Giancarlo Landini, Eleonora A M Lucente, Stefano Michelagnoli, Carolina Orsi Battaglini, Grazia Panigada, Clara Pigozzi, Valentina Querci, Veronica Santarlasci, Paola Parronchi, Nicola Troisi, Cristiana Baggiore, Paola Romagnani, Edoardo Mannucci, Riccardo Saccardi, Carlo Pratesi, Gianfranco Gensini, Sergio Romagnani, Enrico Maggi
BACKGROUND: The therapeutic efficacy of bone marrow mononuclear cells (BM-MNC) autotransplantation in critical limb ischemia (CLI) has been reported. Variable proportions of circulating monocytes express low levels of CD34 (CD14+ CD34low cells) and behave in vitro as endothelial progenitor cells (EPCs). The aim of the present randomized clinical trial was to compare the safety and therapeutic effects of enriched circulating EPCs (ECEPCs) with BM-MNC administration.Methods and Results:ECEPCs (obtained from non-mobilized peripheral blood by immunomagnetic selection of CD14+ and CD34+ cells) or BM-MNC were injected into the gastrocnemius of the affected limb in 23 and 17 patients, respectively...
May 25, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
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