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https://www.readbyqxmd.com/read/28441640/lack-of-association-between-limb-hemodynamics-and-response-to-infrapopliteal-endovascular-therapy-in-patients-with-critical-limb-ischemia
#1
J A Mustapha, Larry J Diaz-Sandoval, George Adams, Michael R Jaff, Robert Beasley, Theresa McGoff, Sara Finton, Larry E Miller, Mohammad Ansari, Fadi Saab
BACKGROUND: Non-invasive limb hemodynamics may aid in diagnosis of critical limb ischemia (CLI), although the relationship with disease severity and response to endovascular therapy is unclear. METHODS AND RESULTS: This prospective, single-center study enrolled 100 CLI patients (Rutherford class 4-6) who underwent infrapopliteal endovascular revascularization (175 lesions) in the Peripheral RegIstry of Endovascular Clinical OutcoMEs (PRIME) registry. Hemodynamic measures included ankle-brachial index (ABI), toe-brachial index (TBI), and toe pressure (TP)...
May 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28435579/peripheral-gangrene-complicating-systemic-lupus-erythematosus-in-a-patient-with-spina-bifida-a-case-report
#2
S Vijay, V K Imthiaz, S Hitesh
An adolescent girl, a known case of spina bifida with systemic lupus, presented with bluish discolouration of three toes of the right foot. She had thrombosis of bilateral popliteal arteries. She underwent percutaneous transluminal angioplasty (PTA) of both legs and Chopart amputation of the right foot. Systemic lupus erythematosus (SLE) occurring in a patient with spina bifida has not been previously reported. Weakness, sensory loss, lack of normal ambulation, endarteritis, antiphospholipid antibody syndrome are common contributory factors for peripheral gangrene in patients with spina bifida with systemic lupus erythematosus...
March 2017: Malaysian Orthopaedic Journal
https://www.readbyqxmd.com/read/28390770/rationale-and-design-of-the-marrowstim-pad-kit-for-the-treatment-of-critical-limb-ischemia-in-subjects-with-severe-peripheral-arterial-disease-mobile-trial-investigating-autologous-bone-marrow-cell-therapy-for-critical-limb%C3%A2-ischemia
#3
S Keisin Wang, Linden A Green, Raghu L Motaganahalli, Michael G Wilson, Andres Fajardo, Michael P Murphy
OBJECTIVE: Critical limb ischemia (CLI) continues to place a significant encumbrance on patients and the health care system as it progresses to limb loss and long-term disability. Traditional methods of revascularization offer a significant benefit; however, for one-third of CLI patients, these surgical options are not technically possible or patency is severely limited by disease burden (deemed "poor-option" for revascularization). In a previous phase I trial, we demonstrated intramuscular injection of concentrated bone marrow aspirate (cBMA) via MarrowStim (Zimmer Biomet, Warsaw, Ind) harvest is safe and may decrease major amputation in patients with CLI unfit for surgical revascularization...
April 5, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28363293/cold-injuries
#4
REVIEW
Deana S Shenaq, Lawrence J Gottlieb
New treatments of frostbite have led to unprecedented salvage of extremities including fingers and toes. Success is predicated on prompt institution of time-sensitive protocols initiated soon after rewarming, particularly the use of thombolytics. Unfortunately, in the urban setting, most patients are not candidates for these treatment modalities. Triple-phase bone scans have allowed for early determination of devitalized parts that need amputation. Reconstructive surgical techniques are typically used to salvage limb length in these devastating injuries...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28346194/case-report-diabetic-foot-ulcer-infection-treated-with-topical-compounded-medications
#5
Kelechi E Agbi, Maria Carvalho, Ha Phan, Cristiane Tuma
An adult diabetic male with three toes amputated on his right foot presented with an ulcer infection on his left foot, unresponsive to conventional antifungal oral medication for over two months. The ulcerated foot wound had a large impairment on the patient's quality of life, as determined by the Wound-QoL questionnaire. The compounding pharmacist recommended and the physician prescribed two topical compounded medicines, which were applied twice a day, free of charge at the compounding pharmacy. The foot ulcer infection was completely resolved following 13 days of treatment, with no longer any impairment on the patient's quality of life...
January 2017: International Journal of Pharmaceutical Compounding
https://www.readbyqxmd.com/read/28340671/unique-techniques-or%C3%A2-approaches-in-microvascular-and-microlymphatic-surgery
#6
REVIEW
Jin Bo Tang, Luis Landín, Pedro C Cavadas, Alessandro Thione, Jing Chen, Gemma Pons, Jaume Masià
Several methods can be used for identifying tissues for transfer in donor-site-depleted patients. A fillet flap can be temporarily stored in other parts of the body and transferred back to the site of tissue defect, including covering the amputated stump of the lower extremity. Human arm transplant is rare and has some unique concerns for the surgery and postsurgical treatment. Cosmetics of the narrow neck of transferred second toes can be improved with insertion of a flap. Lymphedema of the breast after cancer treatment can be diagnosed with several currently available imaging techniques and treated surgically with lymphaticovenous anastomosis...
April 2017: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/28340660/severe-crush-injury-to-the-forearm-and-hand-the-role-of-microsurgery
#7
REVIEW
Francisco Del Piñal, Esteban Urrutia, Maciej Klich
The main goals of treating severe crush injuries are debriding away devitalized tissue and filling any resultant dead space with vascularized tissue. In the authors' experience, the most ideal methods for soft tissue coverage in treating crush injuries are the iliac flap, the adipofascial lateral arm flap, and the gracilis flap. Accompanying bone defects respond very well to free corticoperiosteal flaps. Digital defects often require the use of complete or subtotal toe transfer to avoid amputation and restore function to the hand...
April 2017: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/28336529/toe-imaging-of-a-large-aortic-mass-an-unusual-cause-of-systemic-embolization-in-a-septic-patient
#8
Sarah R Blake, Jamal Khan, Adrian Chenzbraun
A 72-year-old woman presented with sepsis and lower limb ischaemia. Transoesophageal echocardiography (TOE) for suspected endocarditis revealed no cardiac pathology or source of emboli but a large thrombus-like mass was noted in a normal size descending aorta (Fig. 1A, Video 1). Repeat TOE after two weeks of anticoagulation showed two new masses and no change in the size of the original one (Fig. 1B). The patient died following bilateral leg amputation. There was no PM to provide pathology confirmation but the most likely diagnosis was of a thrombus, possibly infected...
March 23, 2017: Echo Research and Practice
https://www.readbyqxmd.com/read/28292565/toe-pressure-and-toe-brachial-index-are-predictive-of-cardiovascular-mortality-overall-mortality-and-amputation-free-survival-in-patients-with-peripheral-artery-disease
#9
J-E Wickström, M Laivuori, E Aro, R T Sund, O Hautero, M Venermo, J Jalkanen, H Hakovirta
OBJECTIVE/BACKGROUND: Peripheral haemodynamic parameters are used to assess the presence and severity of peripheral artery disease (PAD). The prognostic value of ankle brachial index (ABI) has been thoroughly delineated. Nonetheless, the relative usefulness of ankle pressure (AP), ABI, toe pressure (TP), and toe brachial index (TBI) in assessing patient outcome has not been investigated in a concurrent study setting. This study aimed to resolve the association of all four non-invasive haemodynamic parameters in clinically symptomatic patients with PAD with cardiovascular mortality, overall mortality, and amputation free survival (AFS)...
March 11, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28265729/quality-control-of-the-foot-revascularization-using-indocyanine-green-fluorescence-imaging
#10
Nicla Settembre, Petteri Kauhanen, Anders Albäck, Kristyna Spillerova, Maarit Venermo
OBJECTIVES: Critical limb ischemia (CLI) is a clinical diagnosis, confirmed by objective tests, usually ankle-brachial index (ABI), toe pressure (TP) and TcPO2. Furthermore, the anatomical lesions in patients affected by CLI were visualized by ultrasound, angiography, CTA, or MRA. Indocyanine green fluorescence imaging (ICG-FI) is a diagnostic modality for assessing foot perfusion. We aimed to study the usefulness of ICG-FI in the quality control of revascularization. MATERIALS AND METHODS: One hundred and four CLI limbs in 101 patients were studied with ICG-FI using SPY Elite before and after open or endovascular revascularization...
March 6, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28242264/association-between-phantom-limb-complex-and-the-level-of-amputation-in-lower-limb-amputee
#11
Bayram Kelle, Erkan Kozanoğlu, Ömer Sunkar Biçer, İsmet Tan
OBJECTIVE: The aim of this study was to evaluate the natural course of phantom limb complex without any treatment after lower limb amputation. METHODS: The study design was consisted of a combination of retrospective review and cross-sectional interview. 101 patients with lower limb amputation were included into the study. Patients were divided into three groups according to the amputation level: i) from hip disarticulation to knee disarticulation (including knee disarticulation) (25 patients, mean age: 55...
February 24, 2017: Acta Orthopaedica et Traumatologica Turcica
https://www.readbyqxmd.com/read/28166136/aesthetic-multiple-toe-reconstruction-with-combined-iliac-bone-graft-and-wraparound-free-anterolateral-thigh-flap-a-case-report-and-literature-review
#12
Soo-Ha Kwon, William Lao, Cheng-I Yen, Yu-Te Lin, Katie Pei-Hsuan Wu, Tommy Nai-Jen Chang
Compared with upper extremity injuries, toe amputations and their replantations are rare because of the difficulty of their relatively thinner soft tissue envelope. Consequently, fewer reconstructive options are available for toes and they are rarely reported in the literature. In this study, we reported a case of right third to fifth toe amputations and their subsequent reconstruction with iliac bone grafts and a free anterolateral thigh flap. After serial debulking and division procedures, 3 toes were divided successfully...
March 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28041815/non-invasive-lower-limb-small-arterial-measures-co-segregate-strongly-with-foot-complications-in-people-with-diabetes
#13
Sean Michael Lanting, Stephen M Twigg, Nathan Anthony Johnson, Michael Kevin Baker, Ian Douglas Caterson, Vivienne Helaine Chuter
AIMS: It is unclear how well non-invasive lower-limb vascular assessments can identify those at risk of foot complications in people with diabetes. We aimed to investigate the relationship between a history of foot complication (ulceration or amputation) and non-invasive vascular assessments in people with diabetes. METHODS: Bilateral ankle-brachial index (ABI), toe brachial index (TBI) and continuous wave Doppler (CWD) were performed in 127 adults with diabetes (97% type 2; age 66...
March 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/28035696/hydrophilic-polymer-vasculopathy-with-coinciding-pseudoxanthoma-elasticum-like-changes-in-an-amputated-toe
#14
Silvija P Gottesman, Elham Yousefi, Raavi Gupta
For the past decades, hydrophilic polymer gel coating have been widely used on endovascular devices to decrease friction and to aid with binding and delivering of medications in drug-eluting stents. In the recent years, hydrophilic polymer emboli disease has been recognized as an iatrogenic adverse effect which has led to considerable morbidity and mortality of patients. This under-recognized embolic phenomenon now has reproducible pathognomonic histologic findings. Small- to medium-sized blood vessels are occluded with basophilic, amorphous, non-refractile, non-polarizable and whirled aggregates of foreign body material...
April 2017: Journal of Cutaneous Pathology
https://www.readbyqxmd.com/read/28035313/rare-case-of-tibial-hemimelia-preaxial-polydactyly-and-club-foot
#15
Guinevere Granite, John E Herzenberg, Ronald Wade
A seven-month old female presented with left tibial hemimelia (or congenital tibial aplasia; Weber type VIIb, Jones et al type 1a), seven-toed preaxial polydactyly, and severe club foot (congenital talipes equinovarus). Definitive amputation surgery disarticulated the lower limb at the knee. This case report describes the anatomical findings of a systematic post-amputation examination of the lower limb's superficial dissection, X-rays, and computed tomography (CT) scans. From the X-rays and CT scans, we found curved and overlapping preaxial supernumerary toes, hypoplastic first metatarsal, lack of middle and distal phalanges in one supernumerary toe, three tarsal bones, hypoplastic middle phalanx and no distal phalanx for fourth toe, and no middle or distal phalanges for fifth toe...
December 16, 2016: World Journal of Clinical Cases
https://www.readbyqxmd.com/read/28033059/an-unusual-presentation-of-verrucous-carcinoma-of-the-foot-with-bone-invasion
#16
Ho Min Lee, Young Sung Kim, Jong Pil Kim, Jong Im Lee, Kyeong Soo Uhm
Verrucous carcinoma of the foot is a rare malignancy, and proper diagnosis can be delayed. Furthermore, misdiagnosis often results in delayed appropriate treatment. Herein, we present an unusual case of verrucous carcinoma of the fifth toe with bone invasion in a 63-year-old woman that was mistaken for a plantar wart for 3 years. The condition was treated by ray amputation. We emphasize the need for appropriate biopsy to achieve an accurate diagnosis.
November 2016: Journal of the American Podiatric Medical Association
https://www.readbyqxmd.com/read/27959471/lumbar-sympathectomy-techniques-for-critical-lower-limb-ischaemia-due-to-non-reconstructable-peripheral-arterial-disease
#17
REVIEW
Veena Kl Karanth, Tulasi Kota Karanth, Laxminarayan Karanth
BACKGROUND: Critical lower limb ischaemia (CLI) is a manifestation of peripheral arterial disease (PAD) that is seen in patients with typical chronic ischaemic rest pain or patients with ischaemic skin lesions - ulcers or gangrene - for longer than 2 weeks. Critical lower limb ischaemia is the most severe form of PAD, and interventions to improve arterial perfusion become necessary. Although surgical bypass has been the gold standard for revascularisation, the extent or the site of disease may be such that the artery cannot be reconstructed or bypassed...
December 13, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27919605/not-all-patients-with-critical-limb-ischaemia-require-revascularisation
#18
T B Santema, R M Stoekenbroek, J van Loon, M J W Koelemay, D T Ubbink
OBJECTIVES: International guidelines recommend revascularisation as the preferred treatment for patients with critical limb ischaemia (CLI). Most contemporary research focuses on the outcome of invasive procedures for CLI, but little is known about the outcome of conservative management. Amputation free survival (AFS) and overall survival (OS) was investigated in patients with CLI who did or did not receive revascularisation, and characteristics associated with clinical outcomes were explored...
December 2, 2016: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27913807/determination-of-a-threshold-compromise-value-for-the-perfusion-index-by-laser-doppler-imaging-after-digital-revascularization
#19
Y-Y Chu, D-Y Yu, C-W Chang, F Fang, H-T Liao
We have used laser Doppler imaging to monitor the microcirculation of replanted digits during the post-operative period in 103 patients who underwent either replantation after traumatic amputation or toe-to-finger reconstruction. The blood flow (perfusion unit) in each revascularized digit was compared with that of an unaffected digit. The perfusion index was defined as the perfusion value of a revascularized digit divided by the perfusion value of the neighbouring normal digit. The ideal threshold value of the perfusion index (0...
December 1, 2016: Journal of Hand Surgery, European Volume
https://www.readbyqxmd.com/read/27909213/hammertoe-correction-with-k-wire-fixation-compared-with-percutaneous-correction
#20
Mustafa Yassin, Avraham Garti, Eyal Heller, Dror Robinson
BACKGROUND: Kirschner wire (K-wire) fixation for correction of hammertoe deformity is the gold standard for hammertoe surgery fixation, the current study compares it to percutaneous surgery with 3M Coban dressings. METHODS: All hammertoe corrections performed were retrospectively reviewed. For the K-wire fixation group: resection arthroplasty of the proximal interphalangeal joint was performed and fixed with a K-wire. The percutaneous technique used involved percutaneous diaphyseal osteotomy of the middle and proximal phalanges combined with tendon release...
November 30, 2016: Foot & Ankle Specialist
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