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Limb salvage

Victoria Schlanser, Andrew Dennis, Katarina Ivkovic, Kimberly Joseph, Matthew Kaminsky, Thomas Messer, Stathis Poulakidas, Frederic Starr, Faran Bokhari
Reconstruction of skin and soft tissue wounds can pose a unique surgical challenge. This is especially true for cases of exposed bone and tendon where soft tissue loss is extensive and opportunities for tissue advancement or rotation are limited. A clinical case is presented describing an experience with dehydrated human amnion/chorion membrane (dHACM, EpiFix®/AmnioFix®, MiMedx Group, Marietta, GA) graft to obtain granulation over an open fracture with desiccated bone. The 22-year-old female trauma patient presented with high-grade bilateral lower extremity soft tissue loss after being run over and dragged by a semitruck...
December 5, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
Rafael de Athayde Soares, Marcelo Fernando Matielo, Francisco Cardoso Brochado-Neto, Marcus Vinícius Martins Cury, Veridiana Borges Costa, Maria Clara Pereira Sanjuan, Christiano Stchelkunoff Pecego, Roberto Sacilotto
Background: Endovascular treatment (ET) of iliac occlusive disease (IOD) is well established in literature. Use of stents in IOD has achieved long-term limb salvage and patency rates similar to those of open surgery, with lower morbidity and mortality rates. Objectives: To report the long-term outcomes, particularly limb salvage and patency rates, of ET for IOD and the factors associated with these outcomes. Methods: This retrospective cohort study included patients with IOD who underwent iliac angioplasty (IA), between January 2009 and January 2015...
January 2018: Jornal Vascular Brasileiro
Xiao-Tian Qi, Yang-Ling Li, Yan-Qi Zhang, Tong Xu, Bin Lu, Liang Fang, Jian-Qing Gao, Lu-Shan Yu, Di-Feng Zhu, Bo Yang, Qiao-Jun He, Mei-Dan Ying
Despite more effective chemotherapy combined with limb-salvage surgery for the osteosarcoma treatment, survival rates for osteosarcoma patients have stagnated over the past three decades due to the poor prognosis. Osteosarcoma cancer stem cells (OSCs) are responsible for the growth and metastasis of osteosarcoma. The existence of OSCs offers a theoretical explanation for therapeutic failures including tumor recurrence, metastasis, and drug resistance. Understanding the pathways that regulate properties of OSCs may shed light on mechanisms that lead to osteosarcoma and suggest better modes of treatment...
June 21, 2018: Acta Pharmacologica Sinica
Oded Ben-Amotz, Erwin A Kruger, Christine McAndrew, David Bozentka, David Steinberg, Benjamin Chang, Laurent Lantieri, L Scott Levin
Hand transplantation requires precise preoperative planning and surgical execution. Coordinating a transplant team-including surgeons, anesthesiologists, nurses, and supporting staff-is a time-sensitive challenge when a donor-recipient match is confirmed. International human limb transplantation occurs when the recipient and donor are in separate countries. We describe the logistics behind the first trans-Atlantic adult bilateral hand transplantation, which, to date, required the highest level of coordination and timing...
June 12, 2018: Plastic and Reconstructive Surgery
Alla Bezhentseva, Harpreet Singh, Randy J Boudrieau
OBJECTIVE:  This article describes corrective antebrachiocarpal re-alignment and arthrodesis for bilateral radial hemimelia (radial agenesis) in an 8-month-old domestic short-haired cat. METHODS:  Bilateral forelimb deformity of ulnocarpal varus with complete luxation and rotation of the antebrachiocarpal joint spaces, and joint contracture, was observed. Several carpal bones and metacarpal bones I and II and their associated phalanges were absent. Abnormal ambulation and weight bearing on the dorsolateral part of the manus were present...
June 20, 2018: Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T
R E Kalinin, I A Suchkov, R V Deev, N D Mzhavanadze, A A Krylov
Analysed in the article are the results of a comprehensive approach to treatment of patients presenting with lower limb critical ischaemia and diabetes mellitus by means of gene-induced angiogenesis. The study comprised a total of 65 patients found to have an ill-suited for surgical reconstruction peripheral arterial bed and undergoing conservative therapy. The patients were divided into two groups. The Study Group patients additionally to the conventional conservative therapy received 2 intramuscular injections of therapeutic agent Neovasculgen at a course dose of 2...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Rebecca Kern, Jill Cannoy
No abstract text is available yet for this article.
July 2018: Pediatric Physical Therapy
Saori Braun, Kristie Bjornson, Erin Dillon-Naftolin, Melissa Sheiko, Kit Song, Minsoo Kang
PURPOSE: The study purpose was to determine the minimum number of monitoring days necessary to reliably capture walking among individuals with lower limb salvage. METHODS: Nineteen participants with lower limb salvage wore an ankle-mounted motion sensor over a 7-day period to obtain step counts. Generalizability theory was used to examine the variance components in step counts (G study) and to determine the appropriate length of activity monitoring using various combinations of days (D study)...
July 2018: Pediatric Physical Therapy
Hyuk Jae Jung, Soon Chon Lee, Kyung Yun Kim, Sang Su Lee
The purpose of revascularization in lower extremity arterial occlusive disease is to prevent amputation and improve walking ability. Many surgical techniques for peripheral vascular disease (PAD) have been reported. The hybrid operation composed of open surgery and endovascular procedure has been increasingly used for multilevel revascularization. The goal of this study is to evaluate feasibility of simultaneous hybrid femoral endarterectomy and endovascular treatment in patients who need multilevel revascularization with critical limb ischemia...
April 2018: Indian Journal of Surgery
Dean J Arnaoutakis, Gaurav Sharma, Stuart Blackwood, Samir K Shah, Matthew Menard, C Keith Ozaki, Michael Belkin
BACKGROUND: Failure of endovascular aneurysm repairs (EVARs) requiring open conversion remains a major challenge. We analyzed indications for repair, operative strategies, and outcomes with a focus on iliac artery degeneration after endograft removal. METHODS: A prospective, institutional database was reviewed to identify patients who underwent explantation of a failed EVAR device. Demographics, reason for failure, operative details including extent of endograft removal, and complications/survival were examined...
June 15, 2018: Journal of Vascular Surgery
Jie Xu, Lu Xie, Wei Guo
BACKGROUND: Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy is the most-frequently employed strategy for patients with high-grade osteosarcoma. However, the contribution of neoadjuvant chemotherapy compared with postoperative adjuvant chemotherapy has not been tested rigorously in patients with nonmetastatic high-grade pelvic osteosarcoma. QUESTIONS/PURPOSES: (1) Does neoadjuvant chemotherapy followed by delayed surgery offer a survival benefit to patients with nonmetastatic high-grade pelvic osteosarcoma compared with immediate surgery and adjuvant chemotherapy? (2) Is the timing of chemotherapy and surgery associated with a difference in the survivorship free from local recurrence and the risk of complications? (3) Is the threshold of 90% necrosis after neoadjuvant chemotherapy appropriate to distinguish responders from nonresponders in patients with pelvic osteosarcoma? METHODS: Between 2000 and 2015, our center treated 112 patients with nonmetastatic high-grade primary pelvic osteosarcoma, of whom 93 underwent tumor resection with chemotherapy...
June 13, 2018: Clinical Orthopaedics and related Research
R Glenn Gaston, John W Bracey, Mark A Tait, Bryan J Loeffler
Control of independent digital flexion and extension has remained an elusive goal in myoelectric prosthetics for upper extremity amputees. We first performed a cadaver study to determine the feasibility of transferring the interossei muscles for each digit to the dorsum of the hand without damaging the neurovascular pedicles. Once this capability was ensured, a clinical case was performed transferring the interossei of the middle and ring fingers to the dorsum of the hand where they could serve as a myoelectric signal for a partial hand amputee to allow individual digital control with a myoelectric prosthesis...
June 13, 2018: Journal of Hand Surgery
Lakshmi Sudha Prasanna Karanam, Narendra Reddy Busireddy, Sridhar Reddy Baddam, Kiran Makineni, Vijaya Paidimukkala, P Raghavasarma
Aim: Acute arterial occlusions after total knee arthroplasty (TKA) are rare but very serious complication. We present a series of 9 patients who underwent endovascular recanalisation for acute thrombotic occlusion following TKA in our institution. The present series determine the importance of early diagnosis and role of early intervention for good clinical outcome in these cases. Methods: From 2013 to 2016, a total of 9 patients (3 male and 6 female) presented with acute popliteal thrombosis following TKA...
April 2018: Journal of Clinical Orthopaedics and Trauma
Marco Meloni, Valentina Izzo, Laura Giurato, Costantino Del Giudice, Valerio Da Ros, Valerio Cervelli, Roberto Gandini, Luigi Uccioli
Objective: To establish the rate of clinical recurrence of critical limb ischemia (CLI) in diabetic patients with ischemic foot ulcers (DFUs) treated by percutaneous transluminal angioplasty (PTA). Approach: The study group was composed of 304 patients with ischemic DFUs treated by PTA. We evaluated the rate of clinical recurrence of CLI requiring a second PTA (repeated PTA [rePTA]), the factors related to CLI relapse, and the outcomes of rePTA patients. The follow-up was 12.5 ± 6.6 months. Results: Seventy-four of 304 patients (24...
June 1, 2018: Advances in Wound Care
Shay I Warren, Taylor S Murtaugh, Akshay Lakra, Luke A Reda, Roshan P Shah, Jeffrey A Geller, H John Cooper
BACKGROUND: Soft-tissue deficiency is a potentially devastating complication of the infected total knee arthroplasty (TKA). Rotational muscle flaps are commonly used to address these defects. However, reported success rates vary widely. METHODS: We reviewed 26 consecutive patients who underwent rotational muscle flap surgery for full-thickness anterior soft-tissue defect during treatment of an infected TKA. Twenty-four cases used a medial gastrocnemius rotational flap, 1 used a lateral gastrocnemius flap, and 1 used a rectus femoris-vastus intermedius flap...
May 23, 2018: Journal of Arthroplasty
Julio J Jauregui, Vidushan Nadarajah, Joseph Munn, Robert Pivec, Bhaveen H Kapadia, Daniel M Lerman, Aditya V Maheshwari
The overall survivorship in patients with appendicular osteosarcoma has increased in the past few decades. However, controversies and questions about performing an amputation or a limb salvage procedure still remain. Using three peer-reviewed library databases, a systematic review of the literature was performed to evaluate all studies that have evaluated the outcomes of appendicular osteosarcoma, either with limb salvage or amputation. The mean 5-year overall survivorship was 62% for salvage and 58% for amputation ( p  > 0...
June 2018: Indian Journal of Surgical Oncology
Mohammad Abualhin, Alessia Sonetto, Gianluca Faggioli, Michele Mirelli, Antonio Freyrie, Enrico Gallitto, Andrea Stella, Mauro Gargiulo
INTRODUCTION: The aim of the study was to evaluate the outcomes of Duplex Ultrasonoghraphy(DUS) guided autologous vein bypass to paramalleolar (distal third of tibial arteries and peroneal artery) and inframalleolar arteries (dorsalis pedis, common plantar, medial and lateral plantar arteries) in patients with critical limb ischemia (CLI) and extensive tibial arteries disease TASC D. METHODS: Between January 2007 and October 2016, all paramalleolar or inframalleolar bypasses performed in patients with CLI, planned only on the basis of DUS were collected and analyzed retrospectively...
June 7, 2018: Annals of Vascular Surgery
S Klaphake, K de Leur, W Thijsse, G H Ho, H G W De Groot, E J Veen, H A W Haans, L van der Laan
BACKGROUND: Endovascular first strategy for critical limb ischemia is widely accepted, because of the increasing patency rates and minimal invasive character, especially in elderly patients. Nonetheless, the impact of reinterventions because of endovascular treatment failure in this population is not well known. The aim of this study is to evaluate the reintervention rate and outcome following reinterventions. MATERIALS AND METHODS: Patients aged >70 years with critical limb ischemia as a result of aortoiliac, femoropopliteal and/or crural disease, treated by 'endovascular first strategy' between 2006 and 2013, were retrospectively analyzed...
June 7, 2018: Annals of Vascular Surgery
Corine L Creech, Priscilla Zinyemba, Eric T Choi, Andrew J Meyr
The transmetatarsal amputation is considered a durable procedure with respect to limb salvage when managing the consequences of diabetic foot disease. The success of the procedure is, in part, determined by the preoperative appreciation of arterial and functional status. The objectives of the present investigation were to determine the length of the remaining first metatarsal required during transmetatarsal amputation to preserve the anastomotic connection of the deep plantar perforating artery and subsequent "vascular arch" of the foot and the insertion of the tibialis anterior tendon...
June 4, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Katja Boernert, Gili Ganot, Martin Keith Ulrich, Lukas Daniel Iselin
Background: Severe injuries of the foot are a life-changing event. They often lead to some form of disability, and are therefore very challenging to manage. Injuries of the extremity, especially the foot and ankle, are distinct predictors of poor outcome in polytrauma patients.Degloving injuries of the lower extremity involving the heel and foot are a rare and unique subgroup of severe foot injuries.Treating degloving injuries is challenging. The surgical approach has to take into consideration both osseous and massive soft tissue injuries aiming to preserve the unique architecture of the lower limb and reconstruct the soft tissue...
June 2018: Trauma Case Reports
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