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Erik Hanson-Viana, Mónica González-Rodríguez, Diego García-Vivanco, Mariel González-Calatayud
INTRODUCTION: Popliteal injuries are significant health risk that could induce permanent functional impairment, limb loss, and in some cases death. Currently, there is a controversy about the required treatment between amputation and a limb salvage surgery, which in some cases could cause more prominent functional impairment than the amputation. Different indicators help to predict, in some extent, the risk of amputation, however most of them were described two decades ago. PRESENTATION OF CASE: A patient with a prolonged hot ischemia and in critical conditions, which had no favorable clinical indicators for revascularization is shown and discussed...
June 20, 2018: International Journal of Surgery Case Reports
Alexander Meyer, Anne Schilling, Magdalena Kott, Ulrich Rother, Werner Lang, Susanne Regus
BACKGROUND: Evaluation of below-the-knee open revascularization (OR) versus endovascular revascularization (EVT) in patients with end-stage renal disease and critical limb ischemia (CLI) was performed. PATIENTS AND METHODS: Seventy-seven dialysis patients with CLI and infrapopliteal involvement from 2007 to 2017 were included. Thirty-five patients received OR and 42 patients were treated with EVT. Survival, amputation-free survival (AFS) and wound-healing were evaluated...
January 1, 2018: Vascular and Endovascular Surgery
Kateryna Karimova, Lorenz Uhlmann, Marc Hammer, Corina Guethlin, Ferdinand M Gerlach, Martin Beyer
OBJECTIVES: To compare the development of diabetes complications, measured in terms of clinical end points, of patients enrolled in general practitioner (GP)-centered healthcare (Hausarztzentrierte Versorgung [HZV]) and patients in usual GP care (non-HZV) over 4 years. STUDY DESIGN: Retrospective closed cohort study based on German claims data. METHODS: The main end points in our evaluation were dialysis, blindness, amputation, stroke, myocardial infarction, cardiovascular disease, hypoglycemia, and mortality...
July 2018: American Journal of Managed Care
Matthew T Houdek, Peter S Rose, Todd A Milbrandt, Anthony A Stans, Steven L Moran, Franklin H Sim
INTRODUCTION: Lower extremity intercalary allograft reconstruction has traditionally been used to facilitate limb salvage. Combing the allograft with a vascularized fibula graft (FVFG) has been described; however there is a paucity of data comparing the outcome of these reconstructions. MATERIAL AND METHODS: 29 pediatric patients (15 males, 14 females) underwent lower extremity limb salvage with the use of intercalary cadaveric allograft at a mean age of 12 years...
July 10, 2018: Plastic and Reconstructive Surgery
David S Kauvar, Diane Miller, Thomas J Walters
BACKGROUND: The effect of battlefield extremity tourniquet (TK) use on limb salvage and long-term complications following vascular repair is unknown. This study explores the influence of TK use on limb outcomes in military lower extremity arterial injury. METHODS: The study database includes cases of lower extremity vascular injury from 2004-2012 with data recorded until discharge from military service. We analyzed all limbs with at least one named arterial injury from the femoral to the tibial level...
July 17, 2018: Journal of Trauma and Acute Care Surgery
Apurva Patel, Roosha Parikh, WahWah Htun, Robert Bellavics, John T Coppola, Myo Maw, Olivier F Bertrand, Joseph A Puma, Zoltán Ruzsa, Tak W Kwan
BACKGROUND: Improved equipment and techniques have resulted in transition from surgical bypass to endovascular intervention to treat superficial femoral artery (SFA) chronic total occlusions (CTO). A change in access site to radial (TRA) or tibiopedal (TPA) artery for the treatment of these SFA CTO has been reported. The feasibility, efficacy and safety of these two access sites for treatment of SFA CTO have not been reported. METHODS: We performed an as treated analysis of 184 SFA CTO interventions in 161 patients from 01/2014 to 09/2016 using either primary TRA or TPA (operator discretion) at two institutions...
July 18, 2018: Catheterization and Cardiovascular Interventions
B M Biccard, A Sigamani, M T V Chan, D I Sessler, A Kurz, J G Tittley, T Rapanos, J Harlock, D Szalay, M E Tiboni, E Popova, S M Vásquez, B Kabon, M Amir, M Mrkobrada, B R Mehra, H El Beheiry, E Mata, B Tena, S Sabaté, M K Zainal Abidin, V R Shah, K Balasubramanian, P J Devereaux
BACKGROUND: In the POISE-2 (PeriOperative ISchemic Evaluation 2) trial, perioperative aspirin did not reduce cardiovascular events, but increased major bleeding. There remains uncertainty regarding the effect of perioperative aspirin in patients undergoing vascular surgery. The aim of this substudy was to determine whether there is a subgroup effect of initiating or continuing aspirin in patients undergoing vascular surgery. METHODS: POISE-2 was a blinded, randomized trial of patients having non-cardiac surgery...
July 18, 2018: British Journal of Surgery
C Del Giudice, D Van Den Heuvel, J Wille, T Mirault, M Messas, R Ferraresi, S Kum, M Sapoval
PURPOSE: To report our initial experience of fully percutaneous deep venous arterialization (pDVA) for the treatment of chronic critical limb ischemia (cCLI) after failed distal angioplasty. MATERIALS AND METHODS: pDVA was performed in five consecutive patients by creating an arteriovenous fistula (AVF) between a below the knee artery and its satellite deep vein. In this early experience, only patients with failed prior interventional attempts at establishing flow with no distal targets for an arterial bypass were selected...
July 17, 2018: Cardiovascular and Interventional Radiology
Xin Zhao, Baolin Guo, Hao Wu, Yongping Liang, Peter X Ma
Developing injectable antibacterial and conductive shape memory hemostatic with high blood absorption and fast recovery for irregularly shaped and noncompressible hemorrhage remains a challenge. Here we report injectable antibacterial conductive cryogels based on carbon nanotube (CNT) and glycidyl methacrylate functionalized quaternized chitosan for lethal noncompressible hemorrhage hemostasis and wound healing. These cryogels present robust mechanical strength, rapid blood-triggered shape recovery and absorption speed, and high blood uptake capacity...
July 17, 2018: Nature Communications
A Liew, C Baustian, D Thomas, E Vaughan, C Sanz-Nogués, M Creane, X Chen, S Alagesan, P Owens, J Horan, P Dockery, M D Griffin, A Duffy, T O'Brien
Intramuscular administration of mesenchymal stromal cells (MSCs) represents a therapeutic option for diabetic critical limb ischemia. Autologous or allogeneic approaches may be used but disease-induced cell dysfunction may limit therapeutic efficacy in the former. Our aim was to compare the efficacy of allogeneic and autologous MSC transplantation in a model of hindlimb ischemia in diabetes mellitus and to determine whether allogeneic transplantation would result in the activation of an immune response. MSCs were isolated from C57BL/6 (B6) and diabetic obese C57BKSdb/db mice...
January 1, 2018: Cell Transplantation
Trung T Nguyen, Derong Ding, William R Wolter, Matthew M Champion, Dusan Hesek, Mijoon Lee, Rocio L Pérez, Valerie A Schroeder, Mark A Suckow, Shahriar Mobashery, Mayland Chang
Chronic wounds are a complication of diabetes. Treatment for diabetic foot ulcers is complex with little clinical recourse, resulting in 108,000 lower-limb amputations annually in the United States alone. Matrix metalloproteinases (MMPs) play important roles in the pathology and in the repair of chronic wounds. We previously identified active MMP-8 and MMP-9 in wounds of diabetic mice and determined that MMP-8 accelerates wound repair, while MMP-9 is the culprit for the diabetic wound being refractory to healing...
July 13, 2018: European Journal of Pharmacology
Andreas Rothgangel, Susy Braun, Bjorn Winkens, Anna Beurskens, Rob Smeets
OBJECTIVE: To compare the effects of traditional mirror therapy (MT), a patient-centred teletreatment (PACT) and sensomotor exercises without a mirror on phantom limb pain (PLP). DESIGN: Three-arm multicentre randomized controlled trial. SETTING: Rehabilitation centres, hospital and private practices. SUBJECTS: Adult patients with unilateral lower limb amputation and average PLP intensity of at least 3 on the 0-10 Numeric Rating Scale (NRS)...
July 1, 2018: Clinical Rehabilitation
Leila Taghiyar, Samaneh Hosseini, Fatemeh Safari, Fatemeh Bagheri, Nesa Fani, Martin J Stoddart, Mauro Alini, Mohamadreza Baghaban Eslaminejad
Limb/digit amputation is a common event in humans caused by trauma, medical illness, or surgery. Although the loss of a digit is not lethal, it affects quality of life (QoL) and imposes high costs on amputees. In recent years, the increasing interest in limb regeneration has led to enhanced scientific knowledge. However, the limited ability to develop functional limb regeneration in the clinical setting suggests that a challenging issue remains in limb regeneration. Recently, the emergence of regenerative engineering is a promising field to address this challenge and close the gap between science and clinical applications...
July 16, 2018: Journal of Tissue Engineering and Regenerative Medicine
Karla M C Oliveira, Lukas Pindur, Zhihua Han, Mit B Bhavsar, John H Barker, Liudmila Leppik
This study was designed to characterize morphologic stages during neuroma development post amputation with an eye toward developing better treatment strategies that intervene before neuromas are fully formed. Right forelimbs of 30 Sprague Dawley rats were amputated and limb stumps were collected at 3, 7, 28, 60 and 90 Days Post Amputation (DPA). Morphology of newly formed nerves and neuromas were assessed via general histology and neurofilament protein antibody staining. Analysis revealed six morphological characteristics during nerve and neuroma development; 1) normal nerve, 2) degenerating axons, 3) axonal sprouts, 4) unorganized bundles of axons, 5) unorganized axon growth into muscles, and 6) unorganized axon growth into fibrotic tissue (neuroma)...
2018: PloS One
Robert Tyler Youngblood, Brian J Hafner, Katheryn J Allyn, John C Cagle, Paul Hinrichs, Christian Redd, Andrew C Vamos, Marcia A Ciol, Nate Bean, Joan E Sanders
BACKGROUND: The volume of a prosthesis user's residual limb changes during the day and may affect the fit of the prosthesis. These changes must be managed by the user to prevent discomfort, skin breakdown, and falls. OBJECTIVES: The objectives were to test how activity, time of day, and intermittent doffing affected residual limb fluid volume in people with transtibial amputation. STUDY DESIGN: Standardized, repeated measure (A-B-A) out-of-laboratory protocol...
July 1, 2018: Prosthetics and Orthotics International
Dariush Kamali, Matthew Thomas, Peter Van Loo, Ian Nichol
BACKGROUND: Transmetatarsal amputation (TMA) has a reputation for failure, centred around wound breakdown. No study has looked at the direct association between the patency of individual crural arteries and the healing of TMA. TMA relies on a posterior skin flap which derives its blood supply from the posterior tibial (PT) artery. We investigated the association between PT patency and achievement of successful TMA. METHODS: A retrospective review of all patients undergoing TMA for complications of peripheral arterial occlusive disease in a regional vascular tertiary referral centre over a 9 year period (2006-2015)...
June 2018: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
Lina Sjödin, Anders Enocson, Pierre Rotzius, Lasse J Lapidus
AIMS: Transfemoral amputation (TFA) is associated with a high postoperative mortality though it is unclear whether diabetes is associated with an increased mortality or not. The aim was to examine mortality at 1 week and 1 year after first-ever TFA with special reference to diabetes. METHODS: We included 162 first-ever TFAs from 1996 to 2012. Mortality data were collected with the use of the Swedish personal identification number. RESULTS: The median age was 85 years...
July 12, 2018: Diabetes Research and Clinical Practice
Vijay Viswanathan, Umapathy Dhamodharan, Valarmathi Srinivasan, Rama Rajaram, Vivekanandhan Aravindhan
Compared to other complications the genetics of diabetic foot ulcer is poorly studied. The Interleukin (IL)-6 (-174G > C/rs1800795), Tumor Necrosis Factor (TNF)-α (-308G > A/rs1800629) and (-238G > A/rs361525) and Stromal cell Derived Factor (SDF)-1 (+801G > A/rs1801157) are well characterized single nucleotide polymorphisms (SNPs) which were previously shown to be associated with Diabetic Foot Ulcer (DFU). In the present study, we looked at the association of these SNPs with foot microbial infection, Wagner's ulcer grade and treatment procedure, along with serum levels of these cytokines (intermediate phenotype) and other serum biomarkers (adiponectin, leptin, CRP and HOMA-IR) in subjects with DFU...
July 13, 2018: International Journal of Biological Macromolecules
Kayla D Stone, Femke Bullock, Anouk Keizer, H Chris Dijkerman
Body ownership (the feeling that my body belongs to me) can be easily perturbed in healthy individuals by inducing bodily illusions. For example, dis-integrating vision, touch, and proprioception can produce the feeling that your limb is 'lost', such as in "the disappearing hand trick" (DHT). Following this illusion, participants report that the hand feels as though it is no longer part of the body, that it does not belong to them anymore, and that they do not know its location. However, it remains unknown whether this illusion can also be applied to the feet...
July 12, 2018: Neuropsychologia
Anna G Couch, Jonathan Foo, Alicia M James, Stephen Maloney, Cylie M Williams
Background: In the management of diabetes and high-risk patients, timely treatment with scheduled medicines is critical to prevent severe infections and reduce the risk of lower extremity amputation. However, in Australia, few podiatrists have attained endorsement to prescribe. The aims of this study were to identify the costs associated with developing and implementing a podiatry prescribing mentoring program; and to compare the cost of this program against potential healthcare savings produced...
2018: Journal of Foot and Ankle Research
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