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1.
Vasc Health Risk Manag ; 18: 201-209, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35401004

RESUMEN

The Klippel-Trénaunay syndrome is an unusual syndrome of vascular and dermatologic manifestation in which patients demonstrate hemihypertrophy of the soft tissue and bones of one limb, cutaneous haemangiomas and varicosities in anatomically abnormal positions. Described in 1900 by two French physicians, the etiology remained unclear until recently, when evidence emerged that there was a genetic basis for this sporadic disorder. Genes that encoded pathological angiogenic factors and caused vascular dysmorphogenesis, explaining the molecular bases of this syndrome, were identified. Several angiogenic genes were identified but one gene, the AGGF1 (formerly VG5Q) gene, was seen in mutations involving patients diagnosed with Klippel-Trénaunay syndrome. Furthermore, this syndrome was also noted to have overlapping clinical features linked with the "overgrowth syndromes," in which genetic mutations along somatic lines were identified. These involved The PI3K enzyme which forms part of the phosphoinositide 3-kinase pathway which is encoded by the PIK3CA-gene. This enzyme mediates embryonic cellular growth in-utero and diseases involved in this pathway are classified as members of the PIK3CA-related overgrowth syndrome. This paper reviews the status of what is now known about the molecular genetics of this unusual, but clinically challenging disorder and its differentiation from similar diseases, linked with the PIK3CA-gene and the related overgrowth syndromes.


Asunto(s)
Síndrome de Klippel-Trenaunay-Weber , Proteínas Angiogénicas/genética , Fosfatidilinositol 3-Quinasa Clase I/genética , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Síndrome de Klippel-Trenaunay-Weber/genética , Síndrome de Klippel-Trenaunay-Weber/patología , Mutación , Fosfatidilinositol 3-Quinasas/genética
2.
Clin Exp Dermatol ; 47(5): 981-982, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-34994981

RESUMEN

We comment on a previous letter regarding Achenbach syndrome, and suggest that punch biopsy should be performed in all clinically suspected cases to obtain histological confirmation of the disease.


Asunto(s)
Neoplasias Cutáneas , Biopsia , Hematoma , Humanos , Masculino , Piel/patología , Neoplasias Cutáneas/patología , Síndrome
3.
Cureus ; 13(11): e19886, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34966604

RESUMEN

Necrotizing soft tissue infection of the breast is an extremely rare event in routine surgical practice. It is the most aggressive form of soft tissue infection and a real surgical emergency. It is associated with a high risk of mortality if not diagnosed promptly. A Literature search has revealed only a few such cases. The exact etiology is variable and very often multifactorial. Early recognition and prompt surgical treatment along with broad-spectrum antibiotic therapy are of paramount importance to prevent mortality. In this report, we present the first case of necrotizing fasciitis of the breast following an insect bite in the literature, in a 57-year-old diabetic patient with a delayed presentation that required a life-saving mastectomy.

4.
Vasc Health Risk Manag ; 17: 809-816, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34934323

RESUMEN

Achenbach's syndrome describes the sudden occurrence of bruising, pain and swelling of one or more digits of the hand involving the volar aspect of the proximal and middle phalanges. Also known as the paroxysmal finger hematoma, it presents in dramatic fashion, sometimes with a prodrome of tingling, itching or numbness but despite its dramatic presentation, all investigations are normal. Routine blood investigations, as well as coagulation and thrombophilia screens are all negative as are vascular imaging and echocardiography. The diagnosis is solely clinical. Due to the nature of its presentation, almost all patients are referred for an urgent vascular consultation but the condition resolves spontaneously usually within 2-3 days, although the discoloration may persist for longer. Its appearance usually leads clinicians to start anticoagulation in the belief that it may progress but, in fact, it settles as quickly as it appears. Though there are episodic cases which recur years later, it is generally self-resolving with no complications nor residual morbidity. Although the etiology was previously unknown, there is now a recognized genetic link. Genes related to the acute phase reactive proteins and the coagulation and complement cascades appear to be linked to Achenbach's syndrome. This evidence may explain why only certain individuals seem prone to this acutely painful, bruising disorder. We review this interesting disorder and compare patients from the tropical Caribbean region with similar cases from the temperate United Kingdom and discuss whether there are climatic variations in presentations.


Asunto(s)
Dedos/irrigación sanguínea , Hematoma/etiología , Diagnóstico Diferencial , Traumatismos de los Dedos/complicaciones , Hematoma/diagnóstico por imagen , Hematoma/genética , Hematoma/patología , Humanos , Dolor , Recurrencia , Síndrome
5.
Vasc Health Risk Manag ; 17: 489-495, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34429609

RESUMEN

BACKGROUND: Acute upper limb ischemia is an uncommon clinical manifestation of thromboembolism seen predominantly in patients with atrial fibrillation. Treatment can be by conservative or surgical means but the consensus is that after conservative treatment, symptoms still persist. In this series, an attempt was made at limb preservation and return to functional capacity by early surgery in all patients diagnosed with acute limb ischemia. METHODS: Patients referred with upper limb ischemia (22) were stratified into non-acute (6) treated with anticoagulation alone and those with acute ischemia. Sixteen (16) patients, age range 30-92 years (median 62.4 years) comprising mainly females (13), had clinical evidence of severe ischemia and underwent immediate brachial embolectomy with postoperative anticoagulation. RESULTS: Sixteen patients underwent 20 embolectomies with immediate reperfusion of limbs and relief of symptoms. Two patients had two re-operations each due to recurrent symptoms but both recovered with good outcome, one going on to have an axillary-radial bypass. There was no limb disability nor limb loss, but one postoperative mortality. All other patients were seen at their 1-year review and at 5 years, eleven out of 15 patients were still alive with most resuming an active lifestyle and some returning to work. CONCLUSION: Good outcomes were obtained in this series in both the short and long term. Despite one mortality, there was no limb loss nor disability in a mainly elderly population. Prompt surgery and meticulous long-term anticoagulation reduced complications and improved limb salvage rates ensuring that patients had a good quality of life after surgery.


Asunto(s)
Anticoagulantes/administración & dosificación , Embolectomía/efectos adversos , Isquemia/cirugía , Recuperación del Miembro/métodos , Extremidad Superior/irrigación sanguínea , Warfarina/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Femenino , Humanos , Isquemia/diagnóstico , Recuperación del Miembro/efectos adversos , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Extremidad Superior/cirugía
6.
Am J Case Rep ; 22: e932132, 2021 Jul 13.
Artículo en Inglés | MEDLINE | ID: mdl-34255765

RESUMEN

BACKGROUND Internal hernias involve protrusion of the small bowel through a peritoneal or mesenteric space in the abdominal or pelvic cavity. Congenital internal small bowel hernias are rare and patients with them usually present with small bowel obstruction (SBO) at a young age, whereas in older patients, internal small bowel hernias usually are acquired secondary to previous surgery. The present report is of a rare case of SBO due to dual congenital internal small bowel hernias in a 51-year-old man with no history of abdominal surgery. CASE REPORT We report a case of dual congenital internal hernias of the small bowel in a patient who presented with symptoms and signs of SBO. He had no history of abdominal trauma, surgery, or comorbid conditions. His abdomen was mildly distended with minimal tenderness in the upper left quadrant but there was no guarding or rebound tenderness. Abdominal X-rays confirmed the SBO. A contrast-enhanced computed tomography scan of the patient's abdomen revealed SBO with transition at 2 points, suggestive of a closed-loop obstruction. However, the exact cause of the SBO was confirmed at laparotomy, which revealed dual internal hernias (intramesosigmoid and paraduodenal). The hernias were managed individually and the patient had a successful outcome after surgery. CONCLUSIONS Although the present report is of a rare presentation of internal small bowel hernia, the case underscores that patients with this condition may present with SBO. Successful surgical management requires knowledge of the intra-abdominal peritoneal spaces and management of the hernia sac.


Asunto(s)
Hernia Abdominal , Obstrucción Intestinal , Dolor Abdominal , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico por imagen , Hernia Abdominal/cirugía , Humanos , Hernia Interna , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado/cirugía , Masculino , Persona de Mediana Edad
7.
Ther Clin Risk Manag ; 17: 635-640, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34177265

RESUMEN

BACKGROUND: Peripheral arterial embolism from malignant disease is uncommon and a rare cause of limb ischemia. In the acute setting, patients can present with severe ischemia of either the upper or lower limb, and urgent surgical intervention is often required to avoid severe debilitation and limb loss. PATIENTS: Our case series comprised three patients who presented with upper and lower limb ischemia and were found to have concomitant malignancy. All three patients were female, with a median age of 54.3 years, and none of the patients was on active chemotherapy. One presented with stage IIb uterine carcinoma, one with stage IIIb ovarian carcinoma, and the other with stage IIIb cervical carcinoma. These patients were referred for vascular management, with two being acute and the other acute on chronic. RESULTS: Of the three patients, two presented with acute limb ischemia and underwent arterial thrombectomy, one of the upper and the other the lower limb. The third patient, with acute-on-chronic upper limb ischemia, was treated conservatively with intravenous heparin followed by oral anticoagulation. All three had limb salvage and survival outcome at 1 year post-treatment. CONCLUSION: In this small series, surgical intervention in two patients and conservative management in the other patient led to limb salvage with a reasonably good quality of life. Even though the long-term survival for patients with malignant disease is generally poor, surgical intervention can achieve limb salvage with a reasonably good quality of life.

8.
Cureus ; 13(4): e14291, 2021 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-33968505

RESUMEN

The presentation of a massive upper gastrointestinal bleed (UGIB) due to an aortoenteric fistula (AEF) is a rare occurrence. A high index of suspicion is required to rapidly make the diagnosis and execute prompt surgical management. Despite the many surgical options described, the survival rate continues to be low. Conventional surgical management is associated with a high morbidity and mortality. However, in emergencies, patients are unsuitable for major vascular surgery and may benefit from the less invasive staged procedure. This is a case report of a secondary aortoenteric fistula (SAEF) presenting as a massive UGIB, two years after an abdominal aortic aneurysm repair using a Dacron graft. Due to a lack of endovascular service in our setting, we proceeded with an upper gastrointestinal endoscopy followed by exploratory laparotomy. A damage control approach was chosen for our patient, i.e., local repair of the graft and aorta, as our patient was on double inotropes on the table. The patient died within 24 hours as a result of massive blood volume loss.

10.
Trauma Case Rep ; 29: 100346, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32793794

RESUMEN

Concomitant ipsilateral femoral neck and shaft fractures are uncommon high-energy injuries characteristically occurring in young adults. Between 75 and 100% of these injuries occur in association with polytrauma to other organ systems. Associated femoral neck fractures are typically undisplaced, occurring in 2-9% of all femoral shaft fractures. These injuries present both technical and infrastructural challenges particularly in a low resource environment. Several methods of treatment have been used to successfully treat these fractures but there exists no consensus about the optimal management strategy. The "rendezvous" technique using dual implants in an overlapping fashion has been proposed as one method to treat these fractures. We present three cases of ipsilateral hip and femoral shaft fractures which were satisfactorily treated using this technique. The "rendezvous" technique is a simple method, with a good clinical outcome and a low complication rate that can be used to treat ipsilateral femoral neck and shaft fractures.

11.
Cureus ; 12(12): e12281, 2020 Dec 25.
Artículo en Inglés | MEDLINE | ID: mdl-33520491

RESUMEN

Phyllodes tumors are rare fibroepithelial tumors of the breast. They account for less than 0.5% of breast cancers. Bilateral presentation is a rare event, and seems to be associated with the more benign subtype but, reports are scarce. It is more common to have multiple ipsilateral tumors or bilateral asynchronous presentations. However, bilateral synchronous phyllodes are seldom reported. A literature search has revealed only five cases of synchronous and one case of metachronous bilateral phyllodes tumor of the breast. The age ranges of these patients are between 16-42 years. We are reporting the world's first case of bilateral synchronous phyllodes tumor of the breast in a patient over the age of 50 years.

12.
Trop Doct ; 50(1): 94-99, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31495274

RESUMEN

Despite the proven benefits of laparoscopic surgery, it is indeed very costly. The aim of our study was to show an effective way to reduce one of the costs. Between January 2012 and December 2018, we used sterile unpowdered latex-free surgical gloves for specimen retrieval in 243 selected cases of laparoscopic cholecystectomy and appendectomy. The mean retrieval time was 6.7 ± 3.6 min. All procedures were performed safely. Minor wound infection was noted in three patients but there was no case of port site hernia in our series. We conclude that specimen retrieval using sterile, unpowdered, latex-free surgical gloves is safe, effective and cheap. No special additional preparation is required.


Asunto(s)
Guantes Quirúrgicos , Laparoscopía/economía , Laparoscopía/instrumentación , Manejo de Especímenes/economía , Manejo de Especímenes/instrumentación , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/economía , Procedimientos Quirúrgicos del Sistema Digestivo/instrumentación , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Guantes Quirúrgicos/efectos adversos , Humanos , Laparoscopía/efectos adversos , Estudios Prospectivos , Manejo de Especímenes/efectos adversos , Manejo de Especímenes/métodos , Infección de la Herida Quirúrgica/epidemiología , Resultado del Tratamiento
13.
Int J Breast Cancer ; 2019: 8018242, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30984428

RESUMEN

Background: Breast cancer is the leading form of cancer in women in Trinidad and Tobago. Traditionally the practice of mastectomy or wide local excision with or without axillary clearance was applied to most of these patients. This is often associated with significant morbidity and a poor cosmetic outcome with both negatively impacting the patients quality of life. The aim of our study was to assess the mastectomy and axillary clearance rate before and after the introduction of a specialty breast clinic in September 2012. Design and Methods: This is a retrospective comparative study of all female patients who underwent breast cancer surgery at our tertiary hospital 3 years prior to and 3 years after starting of breast clinic (between January 2010 and December 2015). Patients were identified from the surgical log books of our hospital. There are 5 surgical units at our hospital and in one of those units the lead surgeon had a special interest in surgical oncoplastic breast surgery. That unit formed the breast clinic in August 2012. Results: There were 532 women (256 before breast clinic and 276 after breast clinic era) with histologically verified breast cancer operated on between January 2010 and December 2015. The overall mastectomy rate was reduced from 62% to 51% (0.7 to 0.4) and the axillary clearance rate from 66.79% versus 37.31% (0.6 to 0.4) after the introduction of the clinic with p values of 0.007 and 0.009, respectively. Conclusions: The introduction of breast clinic has significantly reduced the mastectomy and axillary clearance rate at our teaching hospital.

14.
Int J Surg Case Rep ; 51: 125-129, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30223197

RESUMEN

INTRODUCTION: Phytobezoars are a very rare cause of large bowel obstruction. Mango seeds as a phytobezoar causing large bowel obstruction have not been reported in the English literature. PRESENTATION OF CASE: We present the case of a 69 years old female who presented to us with clinical and radiological signs of acute large bowel obstruction. On laparotomy, it was noted that mango seeds as a phytobezoar was responsible for the obstruction in the descending colon. DISCUSSION: Phytobezoars are a rare but known cause of small bowel obstruction. Large bowel obstruction is even rarer. The literature has documented a few cases of small bowel obstruction caused by mango seeds but none for large bowel obstruction. The most frequent reported sites of large bowel obstruction are the sigmoid colon and recto-sigmoid junction. However, phytobezoar causing descending colonic obstruction without any pre-existing underlying pathology has not been reported. CONCLUSION: The association of bezoar with acute large bowel obstruction is a very rare however; it must be entertained in the differential diagnosis of any large bowel obstruction. Early diagnosis and treatment can avoid lethal complications. Our case being the first case of mango seeds phytobezoar in descending colon with acute large bowel obstruction; signifies its importance for reporting in the English literature.

15.
Injury ; 49(6): 1188-1192, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29704953

RESUMEN

Popliteal artery trauma is uncommon but is associated with a high risk of limb loss depending on the scenario involving blunt or penetrating trauma as well as the severity and extent of injury that has occurred. In our setting there is a significant amount of gang and civilian warfare resulting in Vascular Trauma. There were 32 patients over a decade who sustained traumatic injury to the popliteal artery consisting of 30 males (94%) and 2 females with an age range 16-59 years with a mean of 32. There were 20 cases of penetrating trauma (63%) and 12 cases of blunt trauma (37%). Of the penetrating trauma, 18 were due to gunshot wounds (GSWs) (90%) and 2 stabs. The majority (7/12; 58%) of blunt trauma was due to falls, and 42% (5/12) secondary to motor vehicular accidents (MVAs). In terms of extent of injury, 21 of 32 patients (65%) sustained an isolated popliteal artery injury, whilst 6 (19%) had injury to both the popliteal artery and vein and another 5 (16%) had combined popliteal artery, vein and nerve injuries. There were 14 cases with associated orthopaedic injuries: 7 posterior knee dislocations, 1 fracture/dislocation of the knee, 2 femoral fractures, 2 tibial plateau fractures and 2 tibia/fibula fracture. Methods of repair included 14 reversed vein grafts, 16 polytetrafluoroethylene (PTFE) grafts and 2 primary. The overall amputation rate was 28% (9 patients). Of the penetrating trauma patients 25% required amputations composed of 5 GSWs, 33% of the blunt trauma patients required amputations. It was noted that factors associated with (but not statistically significant) poor outcomes included combined artery/vein injury, artery/vein/nerve injury, concomitant fracture/dislocation and delayed transfer to a Vascular Surgery Unit. The type of graft or repair did not affect outcome. The incidence of popliteal artery trauma was calculated at 2.46 per 100,000 population per year.


Asunto(s)
Amputación/estadística & datos numéricos , Traumatismos de la Pierna/fisiopatología , Recuperación del Miembro/métodos , Arteria Poplítea/lesiones , Lesiones del Sistema Vascular/cirugía , Heridas no Penetrantes/fisiopatología , Heridas Penetrantes/fisiopatología , Adolescente , Adulto , Femenino , Hospitales de Enseñanza , Humanos , Traumatismos de la Pierna/complicaciones , Traumatismos de la Pierna/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Trinidad y Tobago/epidemiología , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/fisiopatología , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/cirugía , Heridas Penetrantes/complicaciones , Heridas Penetrantes/cirugía , Adulto Joven
16.
Int J Surg Case Rep ; 42: 133-137, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29245098

RESUMEN

INTRODUCTION: Non-fatal human dog bites are commonplace amongst animal attacks on human beings and these present with mainly skin and soft tissue injuries. However, they can also present with life threatening head and neck injuries, massive soft tissue trauma, as well as combined orthopedic and vascular extremity injuries where a high possibility of limb loss exists. PRESENTATION OF CASES: We present two adult dog bite victims with multiple bites inflicted by large canines identified as Pit-Bull Terriers. They were presented with deep lacerations to the axillary area resulting in limb ischemia and loss of upper limb pulses. The right axillary artery was crushed in both patients whilst the axillary vein was lacerated in one. The vessels were repaired; the wounds debrided and both limbs were salvaged. DISCUSSION: Canine attacks by Pit Bull Terriers and Rottweiler's can occur at any age and in any anatomical area of the body particularly the limbs. Injuries involving the extremities presenting with no pulses or pulsatile bleeding demand an urgent exploration as any undue delay is intolerable especially if there are bony injuries like fractures or fracture/dislocation. All patients with complex neurovascular injuries should be managed by a multidisciplinary team for an optimal outcome. CONCLUSION: Attacks by Pit Bull Terriers are more likely to cause severe morbidity than other breeds of dogs. Immediate surgical exploration is required to prevent catastrophic outcomes, especially limb loss. Stronger animal control laws, public education and responsible dog ownership may reduce deaths from these canines.

17.
Trop Doct ; 47(4): 355-359, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28764591

RESUMEN

Many patients with massive lower gastrointestinal (GI) haemorrhage from diverticulosis are subjected to total colectomy when preoperative localisation is unavailable. We dissected colectomy specimens and noted that there was limited retrograde reflux in most of these cases. Therefore, we sought to assess the value of a positive endoluminal erythrocyte presence (PEEP) test (presence of fresh blood in the caecum) to direct segmental colectomies in 14 patients who required emergency operations for massive lower GI haemorrhage. Overall, 13 (93%) patients who had segmental colectomy guided by the PEEP test had successful control of bleeding. There was no mortality and a 14% postoperative morbidity after segmental resections guided by the PEEP test. One patient had persistent bleeding and required a completion colectomy on the third postoperative day. We propose that the PEEP test be added to the surgical armamentarium to guide segmental resection in the absence of localisation by conventional means. However, we advocate blind total colectomy if the PEEP test is equivocal and early completion colectomy if there is significant re-bleeding.


Asunto(s)
Ciego/patología , Colectomía/métodos , Diverticulosis del Colon/cirugía , Eritrocitos/patología , Hemorragia Gastrointestinal/cirugía , Adulto , Anciano , Diverticulosis del Colon/diagnóstico , Femenino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
18.
BMJ Case Rep ; 20172017 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-28720692

RESUMEN

Primary omental gastrointestinal stromal tumours (GISTs) are classified as extra-GISTs with a reported incidence of <1% of all GISTs. There are only a few cases in the English literature reporting omental GIST with none reporting acute intra-abdominal haemorrhage as a presenting feature. We report a case of a 67-year-old man who presented with haemorrhage from a primary omental GIST requiring emergency laparotomy.


Asunto(s)
Abdomen/patología , Tumores del Estroma Gastrointestinal/patología , Hemorragia/etiología , Epiplón/patología , Neoplasias Peritoneales/patología , Anciano , Hemoperitoneo/etiología , Humanos , Masculino
20.
Plast Reconstr Surg Glob Open ; 4(10): e1034, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27826464

RESUMEN

BACKGROUND: Brachial artery repair may be technically challenging with a paucity of guidelines. The use arm vein (AV) from the traumatized limb is herein described. METHODS: Data were prospectively collected from 2002 to 2016 on brachial artery injury including age, sex, mechanism/site of injury, and repair technique. Categories included AV and non-arm vein (NAV) groups. One-year outcomes were noted. RESULTS: All 31 cases studied were of men with an age range of 16 to 73 years (mean = 28). Injuries included 13 gunshots, 7 stabbings, 6 glass injuries, 2 dislocated elbows, 1 crush, 1 impalement, and 1 avulsion. Site of injuries included the antecubital region in 25, midbrachial in 5, and proximal brachial in 1, with 4 associated fractures. Repair was done using reversed AV from the traumatized limb in 15 cases and NAV in 16. In the AV group, the adjacent basilic vein was used in 9 cases, the adjacent cephalic vein in 3, and the distal (or wrist area) cephalic vein in 3. The limb salvage rates in the AV versus NAV groups were 100% and 94%, respectively (Fisher's exact t test, P = 1.00), with no major technique-related complications. CONCLUSIONS: The outcomes of using reversed AV from the traumatized limb are equivalent to those of other standard techniques such as primary repair, polytetrafluoroethylene, or reversed great saphenous vein, with a 1-year limb salvage rate of 100%. Additionally, advantages include decreased wound complications, better vein graft--artery caliber match, and shorter operating times while maintaining acceptable patency rates.

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