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Limb salvage

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https://www.readbyqxmd.com/read/28203023/-randomized-controlled-trial-to-superficial-femoral-artery-recanalization-for-lower-extremity-arteriosclerosis-obliterans
#1
J M Zhuang, X Li, T R Li, J Zhao, J Y Luan, C M Wang
OBJECTIVE: To evaluate the safety and effectiveness of neglecting superficial femoral artery (SFA) recanalization for chronic lower extremity arteriosclerosis obliterans (ASO). METHODS: Thirty-six cases treated for severe stenosis or occlusion of superficial femoral artery resulted from ASO were randomly divided into 2 groups. Twenty of them were treated by endovascular reconstruction of superficial femoral artery and the other 16 cases were not treated with their superficial femoral artery, but were only treated with the accompanied iliac and/or profunda femoral artery lesion...
February 18, 2017: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://www.readbyqxmd.com/read/28199936/the-longitudinal-split-technique-for-narrow-canal-tibia-in-a-case-of-distal-femur-replacement-for-osteosarcoma
#2
Toru Akiyama, Shotaro Kanda, Kazuo Saita
INTRODUCTION: There are currently no available prostheses that can be used for extremely small femurs or tibias of adult patients in countries where allograft is unavailable. CASE REPORT: We report the case of a 17-year-old girl requiring special limb salvage technique for distal femur reconstruction following resection of malignant tumor. This technique was needed because of a very narrow canal of the tibia. We split bilateral tibial cortices longitudinally with osteotomies to enlarge tibial canal enough to insert conventional endoprosthesis...
January 31, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28199363/infrapopliteal-angioplasty-using-a-combined-angiosomal-reperfusion-strategy
#3
G K Ambler, A L Stimpson, B G Wardle, D C Bosanquet, U K Hanif, S Germain, C Chick, N Goyal, C P Twine
INTRODUCTION: Infra-popliteal angioplasty continues to be widely performed with minimal evidence to guide practice. Endovascular device selection is contentious and there is even uncertainty over which artery to treat for optimum reperfusion. Direct reperfusion (DR) targets the artery supplying the ischaemic tissue. Indirect reperfusion (IR) targets an artery supplying collaterals to the ischaemic area. Our unit practice for the last eight years has been to attempt to open all tibial arteries at the time of angioplasty...
2017: PloS One
https://www.readbyqxmd.com/read/28195984/reconstruction-following-tumor-resections-in-skeletally-immature-patients
#4
Adam S Levin, Alexandre Arkader, Carol D Morris
Reconstruction options in children after bone tumor resection are as varied as they are challenging. Advances in biologic and endoprosthetic design have led to many choices, all of which must be considered in the context of prognosis, treatment limitations, and patient/family expectations. The current experience and results of limb-sparing surgery following bone sarcoma resection in growing children are discussed, including allograft, autograft, and metallic prostheses alone and in combination, especially as they pertain to the knee...
March 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28194714/is-limb-salvage-with-microwave-induced-hyperthermia-better-than-amputation-for-osteosarcoma-of-the-distal-tibia
#5
Kang Han, Peiye Dang, Na Bian, Xiang Chen, Tongtao Yang, QingYu Fan, Yong Zhou, Tingbao Zhao, Pingshan Wang
BACKGROUND: Amputation has been the standard surgical treatment for distal tibia osteosarcoma owing to its unique anatomic features. Preliminary research suggested that microwave-induced hyperthermia may have a role in treating osteosarcoma in some locations of the body (such as the pelvis), but to our knowledge, no comparative study has evaluated its efficacy in a difficult-to-treat location like the distal tibia. QUESTIONS: Does microwave-induced hyperthermia result in (1) improved survival, (2) decreased local recurrence, (3) improved Musculoskeletal Tumor Society (MSTS) scores, or (4) fewer complications than amputation in patients with a distal tibial osteosarcoma? METHODS: Between 2000 and 2015, we treated 79 patients for a distal tibia osteosarcoma without metastases...
February 13, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28194713/use-of-compressive-osseointegration-endoprostheses-for-massive-bone-loss-from-tumor-and-failed-arthroplasty-a-viable-option-in-the-upper-extremity
#6
Krista A Goulding, Adam Schwartz, Steven J Hattrup, R Lor Randall, Donald Lee, Damian M Rispoli, Daniel M Lerman, Christopher Beauchamp
BACKGROUND: Endoprostheses using principles of compressive osseointegration have shown good survivorship in several studies involving the lower extremity; however, no series to our knowledge have documented the use of this technology in the management of massive bone loss in the upper limb. QUESTIONS/PURPOSES: (1) What proportion of upper extremity implants using compressive osseointegration fixation principles achieved durable short-term fixation, and what were the modes of failure? (2) What surgical complications resulted from reconstruction using this technique? METHODS: A multiinstitutional retrospective review identified nine patients (five women; four men) who underwent 13 endoprosthetic replacements between 2003 and 2014 using compressive osseointegration (Compliant(®) Pre-stress Device [CPS]; Biomet Inc, Warsaw, IN, USA) in the upper extremity, including two proximal humeri, two humeral diaphyses, seven distal humeri, and two proximal ulna...
February 13, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28193445/endovascular-management-for-peripheral-arterial-trauma-the-new-norm
#7
Anand Ganapathy, Ahmed F Khouqeer, S Robb Todd, Joseph L Mills, Ramyar Gilani
BACKGROUND: Endovascular therapy is well studied in atraumatic conditions; and there appears to be a growing interest in its application to traumatic injuries. The objective of this study is to compare open and endovascular techniques in the management of peripheral arterial trauma. METHODS: This is a retrospective review of patients admitted to a Level I Trauma Center sustaining injuries to the subclavian, axillary, superficial femoral, and popliteal arteries. Demographics, surgical interventions, complications, and clinical outcomes were evaluated in patients requiring open or endovascular repair between 2009 and 2015...
February 4, 2017: Injury
https://www.readbyqxmd.com/read/28170200/glyoxalase-1-overexpression-reverses-defective-proangiogenic-function-of-diabetic-adipose-derived-stem-cells-in-streptozotocin-induced-diabetic-mice-model-of-critical-limb-ischemia
#8
Zhiyou Peng, Xinrui Yang, Jinbao Qin, Kaichuang Ye, Xin Wang, Huihua Shi, Mier Jiang, Xiaobing Liu, Xinwu Lu
Adipose-derived stem cell (ADSC)-based therapy is promising for critical limb ischemia (CLI) treatment, especially in patients with diabetes. However, the therapeutic effects of diabetic ADSCs (D-ADSCs) are impaired by the diabetes, possibly through intracellular reactive oxygen species (ROS) accumulation. The objective of the present study was to detect whether overexpression of methylglyoxal-metabolizing enzyme glyoxalase-1 (GLO1), which reduces ROS in D-ADSCs, can restore their proangiogenic function in a streptozotocin-induced diabetic mice model of CLI...
January 2017: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/28168319/outcomes-and-disability-after-massive-proximal-upper-extremity-reconstruction-in-a-resource-limited-setting
#9
Aviram M Giladi, R Raja Shanmugakrishnan, Hari Venkatramani, S Raja Sekaran, Kevin C Chung, S Raja Sabapathy
BACKGROUND: At Ganga Hospital in Coimbatore, India, a unique approach is applied to treat massive upper limb injuries. However, long-term outcomes of complex reconstruction performed in the resource-limited setting are not known. This hinders understanding of outcomes and disability from these injuries and prevents systematically addressing care delivery around upper extremity trauma in the developing world. This project aims to analyze the details of the unique Ganga Hospital reconstruction experience and use patient-reported outcome measures for the first time in this patient population to evaluate post-injury recovery and disability ...
February 6, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28159052/complex-ankle-arthrodesis-with-step-cut-osteotomy-in-charcot-arthropathy-with-bone-loss
#10
Sean Booth, Moez Ballal, Anand Pillai
We report a case of a complex limb salvage ankle arthrodesis in a patient with Charcot arthropathy. A step-cut osteotomy was performed in order to tackle the issues of anterior tibial bone loss; worsening leg length discrepancy; soft tissue contraction; joint instability and high risk of non-union. The construct formed by the step-cut allowed for the preservation of good bone stock; avoidance of further limb shortening; increased torsional stability and increased surface area for bony union. This resulted in a patient with a stable, plantigrade foot appropriate for footwear...
March 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28149236/brachial-artery-protected-by-wrapped-latissimus-dorsi-muscle-flap-in-high-voltage-electrical-injury
#11
E Gencel, C Eser, O Kokacya, E Kesiktas, M Yavuz
High voltage electrical injury can disrupt the vascular system and lead to extremity amputations. It is important to protect main vessels from progressive burn necrosis in order to salvage a limb. The brachial artery should be totally isolated from the burned area by a muscle flap to prevent vessel disruption. In this study, we report the use of a wrap-around latissimus dorsi muscle flap to protect a skeletonized brachial artery in a high voltage electrical injury in order to salvage the upper extremity and restore function...
June 30, 2016: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/28149224/delayed-surgical-debridement-and-use-of-semiocclusive-dressings-for-salvage-of-fingers-after-purpura-fulminans
#12
Paula A Pino, Javier A Román, Felipe Fernández
Background: Purpura fulminans is a condition characterized by rapidly evolving skin necrosis and disseminated intravascular coagulation. Early recognition and aggressive supportive management has led to a decrease in its mortality rate, but most of these patients must undergo extensive soft tissue debridement and partial or total limb amputation. There is controversial evidence about the timing of surgery, suggesting that some patients may benefit from delayed debridement with limb preservation. Methods: We present a case of an 86-year-old patient who developed skin necrosis of his four limbs after infectious purpura fulminans...
December 2016: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28145569/modified-thomas-splint-cast-combination-for-the-management-of-limb-fractures-in-small-equids
#13
Søren Ladefoged, Sigrid Grulke, Valeria Busoni, Didier Serteyn, Alexandra Salciccia, Denis Verwilghen
OBJECTIVE: To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC). STUDY DESIGN: Retrospective case series. ANIMALS: Client owned horses and donkeys. METHODS: Medical records, including radiographs, were reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up >6 months after discharge was obtained via telephone consultation with owners or veterinarians...
February 1, 2017: Veterinary Surgery: VS
https://www.readbyqxmd.com/read/28131536/dual-antiplatelet-therapy-improves-outcome-in-diabetic-patients-undergoing-endovascular-femoropopliteal-stenting-for-critical-limb-ischaemia
#14
O Thott, F Granath, J Malmstedt, C-M Wahlgren
OBJECTIVE: The purpose of this study was to analyse the effect of dual antiplatelet therapy (DAPT) compared to aspirin on outcome after endovascular interventions in patients with CLI. METHODS: This was a population based retrospective nationwide cohort analysis. Several linked national databases in Sweden: Swedish National Vascular Registry, Prescribed Drug Registry and National Discharge Registry. A total of 1941 patients (median age 79; range 43-103 years; women 58%) were identified with CLI who had undergone primary femoropopliteal endovascular intervention between 2006 and 2012...
January 25, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28122002/a-comparison-of-four-year-health-outcomes-following-combat-amputation-and-limb-salvage
#15
Ted Melcer, Jay Walker, Vibha Bhatnagar, Erin Richard, V Franklin Sechriest, Michael Galarneau
Little research has described the long-term health outcomes of patients who had combat-related amputations or leg-threatening injuries. We conducted retrospective analysis of Department of Defense and Department of Veterans Affairs health data for lower extremity combat-injured patients with (1) unilateral amputation within 90 days postinjury (early amputation, n = 440), (2) unilateral amputation more than 90 days postinjury (late amputation, n = 78), or (3) leg-threatening injuries without amputation (limb salvage, n = 107)...
2017: PloS One
https://www.readbyqxmd.com/read/28121893/complications-and-long-term-outcomes-of-free-fibula-reconstruction-following-resection-of-a-malignant-tumor-in-the-extremities
#16
Matthew T Houdek, Eric R Wagner, Allen T Bishop, Alexander Y Shin, Peter S Rose, Franklin H Sim, Steven L Moran
BACKGROUND: To achieve limb salvage and provide the patient with a functional extremity, vascularized free fibula transfer has become the workhorse for segmental bony reconstruction. Because of various host factors, there has been a high complication rate following oncologic reconstruction. The authors reviewed the experience of their institution with the use of free fibula reconstruction following an oncologic resection in the extremities. METHODS: The authors reviewed 56 cases of free fibula transfer performed for limb salvage following oncologic resection from 1994 through 2013...
February 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28112411/medial-sural-artery-as-a-salvage-recipient-vessel-for-complex-post-traumatic-microvascular-lower-limb-reconstruction
#17
Amresh Baliarsing, Shivprasad Date, Pedro Ciudad
BACKGROUND: Complex lower extremity trauma still poses a formidable challenge for micro vascular reconstruction. The extensive surrounding zone of trauma can make it difficult to find a suitable recipient pedicle for anastomosis. A need was felt for exploration of newer recipient vessels in lower extremity which could be harnessed for reliable and tension free micro anastomosis. The purpose of the present report is to highlight the possibility of using medial sural artery for safe micro vascular anastomosis in selected scenarios like vessel depleted extremity...
January 23, 2017: Microsurgery
https://www.readbyqxmd.com/read/28104214/wound-blush-obtainment-is-the-most%C3%A2-important-angiographic-endpoint-for%C3%A2-wound-healing
#18
Makoto Utsunomiya, Mitsuyoshi Takahara, Osamu Iida, Yasutaka Yamauchi, Daizo Kawasaki, Yoshiaki Yokoi, Yoshimistu Soga, Norihiko Ohura, Masato Nakamura
OBJECTIVES: This study aimed to assess the optimal angiographic endpoint of endovascular therapy (EVT) for wound healing. BACKGROUND: Several reports have demonstrated acceptable patency and limb salvage rates following infrapopliteal interventions for the treatment of critical limb ischemia (CLI). However, the optimal angiographic endpoint of EVT remains unclear. METHODS: We conducted a subanalysis of the prospective multicenter OLIVE (Endovascular Treatment for Infrainguinal Vessels in Patients with Critical Limb Ischemia) registry investigation assessing patients who received infrainguinal EVT for CLI...
January 23, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28095625/potentiation-of-biological-effects-of-mesenchymal-stem-cells-in-ischemic-conditions-by-melatonin-via-upregulation-of-cellular-prion-protein-expression
#19
Jun Hee Lee, Yong-Seok Han, Sang Hun Lee
Mesenchymal stem cells (MSCs) are promising candidates for stem cell-based therapy in ischemic diseases. However, ischemic injury induces pathophysiological conditions, such as oxidative stress and inflammation, which diminish therapeutic efficacy of MSC-based therapy by reducing survival and functionality of transplanted MSCs. To overcome this problem, we explored the effects of melatonin on the proliferation, resistance to oxidative stress, and immunomodulatory properties of MSCs. Treatment with melatonin enhanced MSC proliferation and self-renewal via upregulation of cellular prion protein (PrP(C) ) expression...
January 17, 2017: Journal of Pineal Research
https://www.readbyqxmd.com/read/28093811/routine-use-of-distal-arterial-perfusion-in-pediatric-femoral-venoarterial-extracorporeal-membrane-oxygenation
#20
Christine A Schad, Brian P Fallon, Julie Monteagudo, Shunpei Okochi, Eva W Cheung, Nicholas J Morrissey, Angela V Kadenhe-Chiweshe, Gudrun Aspelund, Steven Stylianos, William Middlesworth
Lower-extremity ischemia is a significant complication in children on femoral venoarterial extracorporeal membrane oxygenation (VA ECMO). Our institution currently routinely uses distal perfusion catheters (DPCs) in all femoral arterial cannulations in attempts to reduce ischemia. We performed a single-center, retrospective review of pediatric patients supported with femoral VA ECMO from January 2005 to November 2015. The outcomes of patients with prophylactic DPC placement at cannulation (prophylactic DPC) were compared to a historical group with DPCs placed in response only to clinically evident ischemic changes (reactive DPC)...
January 2017: Artificial Organs
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