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transmetatarsal amputation

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https://www.readbyqxmd.com/read/29126044/medial-forefoot-fillet-flap-for-primary-closure-of-transmetatarsal-amputation-a-series-of-four-cases
#1
Eliezer Sidon, Shai Shemesh, Yoav Rosenthal, Snir Heller, Steven Velkes, Alon Burg
Amputation of the forefoot is a salvage procedure for several forefoot acute or chronic infection. A good, sensate and durable skin cover is important for quicker and better rehabilitation. The use of filleted flaps (or "spare parts technique") has been published in the past as a creative technique. The purpose of this article is to introduce a reproducible, pre-planned, technique that requires less creativity for the use of the "spare parts". The authors describe a case series of 4 patients with deep infection and osteomyelitis of the forefoot, without involvement of the medial skin that underwent two staged procedure for transmetatarsal amputation with medial forefoot fillet flap...
June 29, 2017: Foot
https://www.readbyqxmd.com/read/29121845/improving-outcomes-for-lower-extremity-amputations-using-intraoperative-fluorescent-angiography-to-predict-flap-viability
#2
Andrew E Yang, Charles A Hartranft, Alisha Reiss, Charles R Holden
OBJECTIVES: Nearly 25% of vascular surgery patients operated on for peripheral vascular disease are readmitted within 30 days. Development of adjuncts to minimize wound complications remains an area of great interest. Here, we present our experience with intraoperative fluorescent angiography (IFA) as a tool to predict skin flap viability following lower extremity amputations (LEAs). METHODS: Experience with IFA using indocyanine green (ICG) dye was reviewed retrospectively at a single institution...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29062634/septic-shock-following-prostate-biopsy-aggressive-limb-salvage-for-extremities-after-pressor-induced-ischemic-gangrene
#3
Jocelyn Lu, Tammer Elmarsafi, Chrisovalantis Lakhiani, Sarah R Sher, Christopher Attinger, Karen K Evans
Vasopressors used to treat patients with septic shock can cause ischemic necrosis of appendages such as the ears and nose, as well as the extremities. Cases of quadruple-extremity necrosis have high morbidity and mortality, and a profound negative impact on quality of life. This case report details the successful limb salvage and return to function using free tissue transfer as a means to salvage bilateral lower extremities in a patient who suffered vasopressor-induced ischemia of upper and lower extremities after prostate biopsy-induced septic shock...
September 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/29020882/quality-of-time-spent-without-symptoms-of-disease-or-toxicity-of-treatment-for-transmetatarsal-amputation-versus-digital-amputation-in-diabetic-patients-with-digital-gangrene
#4
Mohamed Elsherif, Wael Tawfick, Patrick Canning, Niamh Hynes, Sherif Sultan
Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed initially either by digital amputation or by transmetatarsal amputation. The null hypothesis is that transmetatarsal amputation had less theatre trips and better healing. Materials and Methods A parallel observational comparative study of all diabetic patients who underwent either digital or transmetatarsal amputation in a tertiary referral center from 2002 through 2015. Comorbid conditions, subsequent amputations, hospital stay, and readmission were noted...
January 1, 2017: Vascular
https://www.readbyqxmd.com/read/28920529/surgical-interventions-for-organ-and-limb-ischemia-associated-with-primary-and-secondary-antiphospholipid-antibody-syndrome-with-arterial-involvement
#5
Carlos A Hinojosa, Javier E Anaya-Ayala, Karla Bermudez-Serrato, Ramón García-Alva, Hugo Laparra-Escareno, Adriana Torres-Machorro, Rene Lizola
OBJECTIVE: The association of antiphospholipid antibody syndrome (APS) and hypercoagulability is well known. Arterial compromise leading to ischemia of organs and/or limbs in patients with APS is uncommon, frequently unrecognized, and rarely described. We evaluated our institutional experience. METHODS: Retrospective review was conducted. From August 2007 to September 2016, 807 patients with diagnosis of APS were managed in our Institution. Patients with primary and secondary APS who required interventions were examined...
November 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28915308/mutilating-purpura-fulminans-in-an-adult-with-meningococcal-sepsis
#6
María Elena Arnáiz-García, Ana María Arnáiz-García, Francisco Gutierrez-Diez, Juan Francisco Nistal, Jose María González-Santos, Ivana Pulitani, Carlos Amado-Diago, Javier Arnáiz
We report a dramatic case of meningococcal sepsis manifesting as purpura fulminans in an elderly diabetic woman. Hemodynamic instability and severe bilateral cutaneous lesions involving her hands and feet developed rapidly. Specific antibiotic therapy and the administration of inotropic and vasopressor drugs were initiated. The severity and extension of the cutaneous lesions (attributed to purpura fulminans) worsened because of the need for vasoconstrictors for the treatment of septic shock. Bilateral transmetatarsal and metacarpal amputations were required to stabilize the patient...
September 2017: Puerto Rico Health Sciences Journal
https://www.readbyqxmd.com/read/28682674/free-flap-transfer-for-coverage-of-transmetatarsal-amputation-stump-to-preserve-residual-foot-length
#7
Hyung Min Hahn, Kwang Sik Jeong, Myong Chul Park, Dong Ha Park, Il Jae Lee
Surgical management of soft-tissue defects of the forefoot and midfoot caused by trauma or diabetic complications can be challenging because locoregional tissue is insufficient to provide adequate flap. This deficiency necessitates higher-level amputations, such as Chopart or even transtibial amputation, resulting in far more debilitating functional outcomes than are seen with partial foot amputation. The purpose of this study was to examine the surgical outcomes after transmetatarsal amputation and a free-flap transfer to preserve foot length...
March 2017: International Journal of Lower Extremity Wounds
https://www.readbyqxmd.com/read/28633785/the-lisfranc-amputation-a-more-reliable-level-of-amputation-with-proper-intraoperative-tendon-balancing
#8
Christopher J Greene, Christopher Bibbo
Traditional transmetatarsal amputations are a reliable level of amputation. However, amputations at the Lisfranc level have met with limited success owing to improper biomechanics resulting from tendon imbalance, ultimately leading to foot deformity positions and an unstable soft tissue envelope with ensuing skin breakdown, infection, and below-the-knee amputation. We describe proper tendon rebalancing that results in improved biomechanics and a more reliable and stable amputation at the more proximal Lisfranc level...
July 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28476393/is-it-worth-discriminating-against-patients-who-smoke-a-systematic-literature-review-on-the-effects-of-tobacco-use-in-foot-and-ankle-surgery
#9
REVIEW
Jason H Kim, Sandeep Patel
Although numerous studies have linked smoking with lower extremity wound and bone healing complications, a comprehensive study on the effects of smoking in foot and ankle surgery has not yet been reported. The purpose of the present study was to report the results of our systemic literature review, identifying the effects of tobacco use on common foot and ankle procedures. The systematic literature review was performed according to guidelines set by the PRIMSA statement (Preferred Reporting Items for Systematic Review and Meta-Analyses)...
May 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28475445/outcomes-after-foot-surgery-in-people-with-a-diabetic-foot-ulcer-and-a-12-month-follow-up
#10
E Lenselink, S Holloway, D Eefting
OBJECTIVE: The aim of this study was to retrospectively measure the outcomes of foot-sparing surgery at one year follow-up for patients with diabetic foot ulcers (DFUs). We assessed wound healing and the need for further surgery in relation to the variables that influence healing. METHOD: Data were retrospectively collected by reviewing the electronic files of patients attending the Wound Expert Clinic (WEC). Outcomes of surgical debridement, toe, ray and transmetatarsal amputations were assessed...
May 2, 2017: Journal of Wound Care
https://www.readbyqxmd.com/read/28399654/long-term-outcomes-following-syme-s-amputation
#11
Elissa S Finkler, Daniel A Marchwiany, Adam P Schiff, Michael S Pinzur
BACKGROUND: The metabolic cost of walking after Syme's ankle disarticulation amputation is minimally more than that for nonamputation. The ability to end weightbearing makes prosthetic fitting relatively simple, and very few patients require extensive rehabilitation or placement in a skilled nursing or rehabilitation facility. In spite of these potential benefits, there is a paucity of objective information on the actual long-term outcomes. METHODS: Fifty-one patients were identified who underwent single-stage Syme's ankle disarticulation amputation with excision of the lateral and medial malleoli by a single surgeon during a 23-year period...
July 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28258947/an-approach-to-transmetatarsal-amputation-to-encourage-immediate-weightbearing-in-diabetic-patients
#12
Michael B Canales, Maureen E Heurich, Ashley M Mandela, Mark C Razzante
Transmetatarsal amputation remains the standard treatment for the unsalvageable diabetic forefoot; however, this operation is often complicated by wound dehiscence, ulceration, and the need for additional surgery and tendon balancing. The technique described in the present report provides an uncomplicated suturing method for closure of a standard transmetatarsal amputation. A drill hole is created through the first, second, and fourth metatarsals, which facilitates added stability to the plantar flap of the residual metatarsals...
May 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28257912/warfarin-associated-venous-limb-gangrene-in-cancer-related-dvt-case-report
#13
Vladimir Cojocari, Dumitru Casian, Eugen Gutu
INTRODUCTION: Warfarin anticoagulation of oncologic patients with DVT may paradoxically progress to phlegmasia cerulea dolens and limb gangrene, due to cancer-associated disseminated intravascular coagulation. This case report, written in line with the SCARE criteria, endorses venous thrombectomy in selected patients to attempt limb salvage. A young woman's warfarin associated acute ileofemoral phlegmasia that developed over cervical cancer radiation therapy induced DVT, was successfully resolved by clot removal...
2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27696694/the-care-of-transmetatarsal-amputation-in-diabetic-foot-gangrene
#14
REVIEW
Michele Ammendola, Rosario Sacco, Lucia Butrico, Giuseppe Sammarco, Stefano de Franciscis, Raffaele Serra
Diabetic foot ulcerations may determine minor or major amputation, with a high impact on patients' life expectation and quality of life and on economic burden. Among minor amputations, transmetatarsal amputation (TMA) appears to be the most effective in terms of limb salvage rates and in maintaining foot and ankle biomechanics. In spite of this, TMA needs particular pre- and postoperative management in order to avoid the frequent failure rates. A systematic review was undertaken of studies concerning TMA and its care in diabetic foot gangrene...
February 2017: International Wound Journal
https://www.readbyqxmd.com/read/27555884/the-evaluation-of-off-loading-using-a-new-removable-orthosis-in-diabetic-foot-orthodiab-randomized-controlled-trial-study-design-and-rational
#15
RANDOMIZED CONTROLLED TRIAL
Kamel Mohammedi, Louis Potier, Maud François, Dured Dardari, Marilyne Feron, Estelle Nobecourt-Dupuy, Manuel Dolz, Roxane Ducloux, Abdelkader Chibani, Dominique-François Eveno, Teresa Crea Avila, Ariane Sultan, Laurence Baillet-Blanco, Vincent Rigalleau, Gilberto Velho, Florence Tubach, Ronan Roussel, Jean-Claude Dupré, Dominique Malgrange, Michel Marre
BACKGROUND: Off-loading is essential for diabetic foot management, but remains understudied. The evaluation of Off-loading using a new removable oRTHOsis in DIABetic foot (ORTHODIAB) trial aims to evaluate the efficacy of a new removable device "Orthèse Diabète" in the healing of diabetic foot. METHODS/DESIGN: ORTHODIAB is a French multi-centre randomized, open label trial, with a blinded end points evaluation by an adjudication committee according to the Prospective Randomized Open Blinded End-point...
2016: Journal of Foot and Ankle Research
https://www.readbyqxmd.com/read/27496697/the-development-and-validation-of-a-novel-outcome-measure-to-quantify-mobility-in-the-dysvascular-lower-extremity-amputee-the-amputee-single-item-mobility-measure
#16
Daniel C Norvell, Rhonda M Williams, Aaron P Turner, Joseph M Czerniecki
OBJECTIVE: This study describes the development and psychometric evaluation of a novel patient-reported single-item mobility measure. DESIGN: Prospective cohort study. SETTING: Four Veteran's Administration Medical Centers. SUBJECTS: Individuals undergoing their first major unilateral lower extremity amputation; 198 met inclusion criteria; of these, 113 (57%) enrolled. INTERVENTIONS: None. MAIN MEASURES: The Amputee Single Item Mobility Measure, a single item measure with scores ranging from 0 to 6, was developed by an expert panel, and concurrently administered with the Locomotor Capabilities Index-5 (LCI-5) and other outcome measures at six weeks, four months, and 12 months post-amputation...
September 2016: Clinical Rehabilitation
https://www.readbyqxmd.com/read/27475711/reoperation-and-reamputation-after-transmetatarsal-amputation-a%C3%A2-systematic-review-and-meta-analysis
#17
REVIEW
Jakob C Thorud, Daniel C Jupiter, Jonathan Lorenzana, Tea Tu Nguyen, Naohiro Shibuya
Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many investigators have reported a high occurrence of more proximal amputation after transmetatarsal amputation. A systematic review was performed to evaluate the occurrence of reamputation and reoperation after transmetatarsal amputations. A search of the Medline, CINAHL, and Cochrane Central databases yielded 159 abstracts. After review, 24 reports were included in the study...
September 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/27372177/lacking-the-protective-label-of-diabetes-phenytoin-induced-distal-symmetrical-peripheral-neuropathy-a-clinical-case-report
#18
A M Mahon
This report documents an unusual case of distal symmetrical peripheral neuropathy (DSPN) in an otherwise healthy patient without diabetes mellitus (DM) presenting to a podiatric wound care clinic. The development of gas gangrene coupled with Charcot neuroarthropathic changes ultimately resulted in a potentially life-saving transmetatarsal (TMT) amputation. Causation of, or at least a contributor to, the DSPN was likely phenytoin usage for epileptic seizures. Long-term use of phenytoin can lead to axonal shrinkage and random clusters of nerve demyelination [1]...
November 2016: Journal of Tissue Viability
https://www.readbyqxmd.com/read/27079487/serratia-marcescens-bullous-cellulitis-in-a-splenectomized-patient-a-case-report-and-review-of-the-literature
#19
John B Fournier, Ganary Dabiri, Vinod Thomas, Gail Skowron, Polly Carson, Vincent Falanga
Serratia marcescens is a Gram-negative bacillus belonging to the Enterobacteriaceae family. Cutaneous infection with Serratia is rare, and usually occurs in immunocompromised individuals. Primary cutaneous infections are uncommon, but they are typically severe and are associated with significant morbidity and mortality. The pathogenetic factors leading to S. marcescens infection are not fully understood, but contributing virulence factors include proteases, secreted exotoxins, and the formation of biofilm. We report a case of cellulitis occurring in a splenectomized patient, which led to multiple wound debridements and a transmetatarsal amputation...
June 2016: International Journal of Lower Extremity Wounds
https://www.readbyqxmd.com/read/27031281/group-b-and-f-beta-streptococcus-necrotizing-infection-surgical-challenges-with-a-deep-central-plantar-space-abscess-a-diabetic-limb-salvage-case-report
#20
Jason M Mendivil, David Jolley, Jodi Walters, Jim Dancho, Billy Martin
We present the case of a 66-year-old, type II diabetic male with a deep wound to the plantar-lateral aspect of his right hallux. On examination, the central plantar compartment of his right foot was moderately erythematous and tender on palpation. After obtaining a deep wound culture, treatment was complicated by a progression of a group B and F beta streptococcus, necrotizing infection. The patient underwent a right hallux amputation, followed by a plantar medial incision for drainage of an abscess to the medial and central plantar compartments of the foot...
May 2016: Journal of the American Podiatric Medical Association
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