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Limb salvage

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https://www.readbyqxmd.com/read/29452441/assessing-the-safety-and-efficacy-of-regional-anesthesia-for-lower-extremity-microvascular-reconstruction-enhancing-recovery
#1
Qing Zhao Ruan, Shawn Diamond, Scott Zimmer, Matthew L Iorio
BACKGROUND: Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap. METHODS: A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed...
February 16, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29443850/does-an-algorithmic-approach-to-using-brachytherapy-and-external-beam-radiation-result-in-good-function-local-control-rates-and-low-morbidity-in-patients-with-extremity-soft-tissue-sarcoma
#2
Jason Klein, Alex Ghasem, Samuel Huntley, Nathan Donaldson, Martin Keisch, Sheila Conway
BACKGROUND: High-dose-rate brachytherapy (HDR-BT) and external-beam radiation therapy (EBRT) are two modalities used in the treatment of soft tissue sarcoma. Previous work at our institution showed early complications and outcomes for patients treated with HDR-BT, EBRT, or a combination of both radiation therapy modalities. As the general indications for each of these approaches to radiation therapy differ, it is important to evaluate the use of each in an algorithmic way, reflecting how they are used in contemporary practice at sites that use these treatments...
March 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29437636/outcomes-following-limb-salvage-after-combat-hindfoot-injury-are-inferior-to-delayed-amputation-at-five-years
#3
P M Bennett, T Stevenson, I D Sargeant, A Mountain, J G Penn-Barwell
OBJECTIVES: The surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function. METHODS: Follow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures...
February 2018: Bone & Joint Research
https://www.readbyqxmd.com/read/29437061/mid-term-follow-up-of-patients-with-hindfoot-arthrodesis-with-retrograde-compression-intramedullary-nail-in-charcot-neuroarthropathy-of-the-hindfoot
#4
M Chraim, S Krenn, H M Alrabai, H-J Trnka, P Bock
AIMS: Hindfoot arthrodesis with retrograde intramedullary nailing has been described as a surgical strategy to reconstruct deformities of the ankle and hindfoot in patients with Charcot arthropathy. This study presents case series of Charcot arthropathy patients treated with two different retrograde intramedullary straight compression nails in order to reconstruct the hindfoot and assess the results over a mid-term follow-up. PATIENTS AND METHODS: We performed a retrospective analysis of 18 consecutive patients and 19 operated feet with Charcot arthropathy who underwent a hindfoot arthrodesis using a retrograde intramedullary compression nail...
February 2018: Bone & Joint Journal
https://www.readbyqxmd.com/read/29428535/diabetic-foot-limb-salvage-a-series-of-809-attempts-and-predictors-for-endovascular-limb-salvage-failure
#5
Zhiwen Joseph Lo, Zhimin Lin, Uei Pua, Lawrence Han Hwee Quek, Bien Ping Tan, Sundeep Punamiya, Glenn Wei Leong Tan, Sriram Narayanan, Sadhana Chandrasekar
BACKGROUND: To review patient characteristics and outcomes of inpatient diabetic foot limb salvage and identify risk factors predicting for endovascular limb salvage failure. METHODOLOGY: Retrospective study of limb salvage attempts in 809 patients between August 2013 and July 2015. RESULTS: 68% of our study population were male with mean age at 65 years-old and 73% presented with Rutherford grade 6 critical limb ischaemia, with the remaining 27% Rutherford grade 5...
February 8, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29428222/cost-utility-analysis-in-orthopaedic-trauma-what-pays-a-systematic-review
#6
S Coyle, S Kinsella, B Lenehan, J M Queally
BACKGROUND: As healthcare systems come under ever-increasing pressure to provide more care with fewer resources, emphasis is being placed on value-based systems that maximise quality and minimize cost. The aim of this study was to determine which interventions in fracture care have been demonstrated to be cost effective. METHODS: A systemic review of cost-utility studies on the management of fractures from 1976 to 2015 was carried out using a search of the Cost-Effectiveness Analysis Registry, National Health Service Economic Evaluation Database (NHS EED) and MEDLINE...
January 31, 2018: Injury
https://www.readbyqxmd.com/read/29421564/high-density-lipoprotein-mimicking-nanodiscs-carrying-peptide-for-enhanced-therapeutic-angiogenesis-in-diabetic-hindlimb-ischemia
#7
Hyun-Ji Park, Rui Kuai, Eun Je Jeon, Yoojin Seo, Youngmee Jung, James J Moon, Anna Schwendeman, Seung-Woo Cho
Therapeutic strategies using endogenous stem cell mobilizer can provide effective cell-free therapy for addressing various ischemic diseases. In particular, substance P (SP) exhibited therapeutic regeneration by facilitating mobilization of endogenous stem cells from bone marrow to the injured sites. However, its therapeutic effect has been limited due to short half-life and rapid degradation of administered SP peptides in vivo. Here we sought to develop high-density lipoprotein (HDL)-mimicking nanodiscs conjugated with SP (HDL-SP) in order to increase the in vivo half-life, bone marrow targeting, and therapeutic efficacy of SP for the treatment of diabetic peripheral ischemia...
January 19, 2018: Biomaterials
https://www.readbyqxmd.com/read/29421428/cryopreserved-homografts-in-infected-infrainguinal-fields-are-associated-with-frequent-reinterventions-and-poor-amputation-free-survival
#8
S Keisin Wang, Ashley R Gutwein, Natalie A Drucker, Michael P Murphy, Andres Fajardo, Michael C Dalsing, Raghu L Motaganahalli, Gary W Lemmon
OBJECTIVE: Single-length saphenous vein continues to be the conduit of choice in infected-field critical limb ischemia (CLI). However, half of these individuals have inadequate vein secondary to previous use or chronic venous disease. We reviewed our outcomes of infected-field infrainguinal bypasses performed with cryopreserved homografts (CH), a widely-accepted alternative to autogenous vein in this setting. METHODS: This is a retrospective, institutional descriptive analysis of infected-field infrainguinal revascularizations between 2012-2015...
February 5, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29421414/how-to-treat-a-patient-with-thromboangiitis-obliterans-a-systematic-review
#9
REVIEW
Bahare Fazeli, Maliheh Dadgar Moghadam, Shabnam Niroumand
To date, there is still no treatment protocol for patients with thromboangiitis obliterans (TAO) who are also afflicted with critical limb ischemia (CLI). Smoking cessation on its own cannot be considered a treatment for the purposes of salvaging a limb of a TAO patient with CLI. The aim of this review was to evaluate different studies of various treatment protocols for avoiding amputation in TAO patients. A systematic search for relevant studies dating from 1990 to the end of 2016 was performed on the PubMed, SCOPUS, and Science Direct databases...
February 5, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29417035/a-misplaced-intramuscular-injection-and-limb-threatening-ischemia
#10
Sumantra Sarkar, Sarbani Misra, Madhumita Nandi, Rakesh Mondal
Femoral artery thrombosis is a rare complication of intramuscular (IM) injection in children. A 12-month-old boy presented with right lower limb ischemia and digital gangrene 3 days after an injection of ceftriaxone administered to his medial aspect of the right thigh. Successful thrombolysis and partial limb salvage was possible with enoxaparin despite a late presentation. Unnecessary and unsafe IM injection in community practice might lead to such devastating outcome which should be avoided.
July 2017: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/29416172/gait-analysis-in-patients-with-wide-resection-and-endoprosthesis-replacement-around-the-knee
#11
Vivek Ajit Singh, Chan Wei Heng, Nor Faissal Yasin
Background: Limb salvage surgery with endoprosthesis for bone tumor around the knee is reported to have good functional and oncological outcomes. However, the functional assessment using musculoskeletal tumor society (MSTS) and Toronto extremity scoring system remains subjective. We performed gait analysis as an objective assessment of their functional outcome. Materials and Methods: Gait analysis was performed in 20 patients with endoprosthesis replacement around the knee...
January 2018: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/29416171/methotrexate-free-chemotherapy-and-limb-salvage-surgery-for-paediatric-osteosarcoma-in-india
#12
Reghu Kesavapillai Sukumaran, Binitha Rajeshwari, Subin Sugath, S Guruprasad Chellappan, Priyakumari Thankamony, Kusumakumary Parukuttyamma
Background: Osteosarcoma (OS) is the most common primary malignant tumor of bone. The survival of OS patients has steadily improved from <20% in the early 20th century to around 70% with current treatment. There are very few studies in pediatric OS from India analyzing various aspects of the disease. This study focuses on the clinical profile, treatment options, and their complications and survival outcomes in pediatric osteosarcoma (OS) patients. Materials and Methods: This was a retrospective observational study which included pediatric patients <14 years of age, with newly diagnosed OS confirmed by histological diagnosis...
January 2018: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/29413783/total-calcanectomy-for-metastasis-of-renal-cell-carcinoma-in-the-calcaneus-a-case-report
#13
Ichiro Tonogai, Toshihiko Nishisho, Ryo Miyagi, Koichi Sairyo
We present a rare case of metastasis of renal cell carcinoma to the calcaneus in a 59-year-old man who presented with pain and inability to bear weight on the left foot 3 years after right nephrectomy for renal cell carcinoma. He successfully underwent en bloc resection of his right calcaneus with a limb salvage procedure, total calcanectomy without bony reconstruction. Histological findings identified the lesion as a metastasis originating from a renal cell carcinoma. Recent follow-up examination showed no recurrence...
February 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/29413782/the-role-of-negative-pressure-wound-therapy-in-salvaging-a-six-year-old-child-s-crushed-foot-a-case-report
#14
Dimitrios Begkas, John Michelarakis, Hristos Mirtsios, Panagiotis Deimedes, Dimitrios Bougiouklis
Crushed extremity is an infrequent injury in children and represents a major challenge for the orthopaedic surgeon. Sometimes the decision making process, whether to amputate or save a limb, is very difficult. Several scoring systems have been developed in order to determine the fate of crushed extremities, but they are not always predictive when patients are children. In the past few years, advances in bone and soft tissue reconstruction techniques have improved outcomes, even in the most extreme cases. Negative Pressure Wound Therapy has become an accepted option in the treatment of crushed limbs...
February 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/29409424/subcutaneous-and-intramuscular-injection-of-petrol-hydrocarbon-a-case-report-and-review-of-the-literature
#15
Evelyn Patricia Murphy, Deirdre Seoighe, Suzanne Beecher, Joseph F Baker, Alan Hussey
Deliberate injection of hydrocarbon remains an uncommon method of self harm. There is a paucity of information pertaining to soft tissue toxicity throughout the literature. Prompt recognition of the potential ramifications is needed to try salvage limb function. Hydrocarbon toxicity can result in multi organ failure. This case report demonstrates the recommended diagnostic approach, work up and treatment involved in such a case. A 26 year old male deliberately injected petrol into the anterior compartment of his non dominant forearm in a suicide attempt...
March 2018: Journal of Hand Surgery Asian-Pacific Volume
https://www.readbyqxmd.com/read/29409267/uncontrolled-diabetes-as-a-potential-risk-factor-in-tibiotalocalcaneal-fusion-using-a-retrograde-intramedullary-nail
#16
Moses Lee, Woo Jin Choi, Seung Hwan Han, Jinyoung Jang, Jin Woo Lee
BACKGROUND: Tibiotalocalcaneal (TTC) fusion using a retrograde intramedullary (IM) nail is an effective salvage option for terminal-stage hindfoot problems. However, as many patients who receive TTC fusion bear unfavorable medical comorbidities, the risk of nonunion, infection and other complications increases. This study was performed to identify the factors influencing outcomes after TTC fusion using a retrograde IM nail. METHODS: Between September 2008 and February 2012, 34 consecutive patients received TTC fusion using a retrograde IM nail for limb salvage...
July 22, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/29409204/correction-of-ankle-and-hind-foot-deformity-in-charcot-neuroarthropathy-using-a-retrograde-hind-foot-nail-the-kings-experience
#17
N Vasukutty, H Jawalkar, A Anugraha, R Chekuri, R Ahluwalia, V Kavarthapu
BACKGROUND: Corrective fusion for the unstable deformed hind foot and mid foot in Charcot Neuroarthropathy (CN) is quite challenging and is best done in tertiary centres under the supervision of multidisciplinary teams. METHODS: We present a follow up to our initial report with a series of 42 hind foot corrections in 40 patients from a tertiary level teaching hospital in the United Kingdom. The mean patient age was 59 (33-82). 17 patients had type1diabetes mellitus, 23 had type 2...
April 28, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/29409179/limb-salvage-for-malignant-bone-tumours-of-distal-tibia-with-dual-ipsilateral-vascularized-autogenous-fibular-graft-in-a-trapezoid-shaped-array-with-ankle-arthrodesis-and-preserving-subtalar-joint
#18
Chunlin Zhang, Bingfang Zeng, Kunpeng Zhu, Lei Zhang, Jianping Hu
BACKGROUND: The treatment of malignant tumours of the distal tibia is a challenging surgical problem due to the scarce soft tissue coverage and the instability of the ankle joint that often occurs after resection. However, there is no consensus on the ideal treatment for malignant tumours of the distal tibia. METHODS: We report a new reconstruction for five patients with high-grade osteosarcoma of distal tibia, using dual ipsilateral vascularized autogenous fibular graft in a trapezoid-shaped array and external fixator, with ankle arthrodesis and preserving subtalar joints...
December 20, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/29407071/amputation-versus-conservative-treatment-in-severe-open-lower-limb-fracture-a-functional-and-quality-of-life-study
#19
M Fioravanti, P Maman, G Curvale, A Rochwerger, J C Mattei
INTRODUCTION: Severe lower-limb trauma is a major event in a patient's life, and treatment is a challenge that has not been sufficiently studied. The main objective of the present study was to assess the difference in disability between amputees and patients who kept their leg after severe open lower-limb fracture. HYPOTHESIS: The study hypothesis was that amputation allows better functional recovery and quality of life, in the same time-frame. MATERIALS AND METHODS: All male and female patients aged over 18 years admitted to one of the trauma centers of Marseille (France) for major lower-limb trauma with Gustilo IIIb or IIIc fracture were included...
January 30, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/29404750/acute-limb-ischemia-secondary-to-native-artery-occlusion-results-of-a-contemporary-case-series
#20
Nuria Seguí, Carlos Ruiz-Carmona, Alina Velescu, Eduardo Mateos, Roberto Elosua, Albert Clará
BACKGROUND: The treatment of acute limb ischemia (ALI) has barely changed over the last years. However, the progressive implementation of anticoagulants, antiplatelet agents or statins within the population might have modified the profile and prognosis of patients suffering an ALI. The aim of this study was to evaluate the current results of the management of ALI secondary to a native artery occlusion. METHODS: Retrospective study of 220 consecutive patients (mean age 78 years; 49% male) was conducted between 2007 and 2015...
February 5, 2018: World Journal of Surgery
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