RESUMO
Four patients with five severely traumatized lower legs but preserved feet were treated with fillet flaps from the foot to cover an elective, below knee amputation stump. The posterior tibial neurovascular bundle nourished and innervated this flap. While the posterior tibial artery and vein may be cut and re-anastomosed to prevent kinking and occlusion, the posterior tibial nerve should always be kept in continuity to maintain the quality of sensation to this flap. Four flaps survived and one necrosed secondary to venous insufficiency. Due to its innervation and the unique qualities of heel skin, the flap is very durable and has endweight-bearing capabilities. This has permitted the fitting of an endweight-bearing, total contact, fully extended, below knee prosthesis that appears to offer significant improvement in ease of use and normality of gait pattern over standard patellar tendon-bearing prostheses.
Assuntos
Amputação Cirúrgica/métodos , Membros Artificiais , Traumatismos da Perna/cirurgia , Retalhos Cirúrgicos , Tíbia/cirurgia , Adulto , Amputação Cirúrgica/reabilitação , Fenômenos Biomecânicos , Marcha , Humanos , Perna (Membro) , Traumatismos da Perna/reabilitação , Masculino , Pessoa de Meia-Idade , Movimento , Tíbia/lesõesRESUMO
One hundred and sixty patients have been studied in a controlled trial of two drugs which have been in combination to prevent postoperative-deep-vein thrombosis. Both the drugs, dipyridamole (Persantin) and aspirin, were given by mouth from the evening before operation and for seven days after operation. The radioactive fibrinogen test was used to diagnose thrombosis. Of the 85 patients in the control group 24 developed thrombosis (28%). Twelve out of 85 patients (14%) in the test group were found to have thrombosis. Similar significant differences in incidence were found in the various subgroups.
Assuntos
Aspirina/uso terapêutico , Dipiridamol/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Tromboflebite/prevenção & controle , Adulto , Idoso , Aspirina/administração & dosagem , Ensaios Clínicos como Assunto , Dipiridamol/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agregação Plaquetária , Cintilografia , Tromboflebite/diagnósticoAssuntos
Fibrinogênio/metabolismo , Rejeição de Enxerto , Transplante de Rim , Injúria Renal Aguda/metabolismo , Animais , Anuria/etiologia , Hidronefrose/metabolismo , Isótopos de Iodo , Rim/metabolismo , Ratos , Ratos Endogâmicos , Obstrução da Artéria Renal/metabolismo , Trombose/etiologia , Trombose/metabolismo , Transplante HomólogoAssuntos
Aspirina/uso terapêutico , Dipiridamol/uso terapêutico , Tromboflebite/prevenção & controle , Adulto , Dextranos/uso terapêutico , Quimioterapia Combinada , Feminino , Fibrinogênio/metabolismo , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Agregação Plaquetária/efeitos dos fármacos , Complicações Pós-OperatóriasRESUMO
In a study of 52 patients admitted into the coronary intensive care unit the incidence of deep-vein thrombosis was measured with the (125)I-fibrinogen test. Of these patients 31 were eventually confirmed to be suffering from acute myocardial infarction. This preliminary study showed that in patients with a confirmed infarct who were not treated with anticoagulants the incidence of deep-vein thrombosis was 38% and in those treated it was 5.5%. In patients who were "severely ill" from whatever the cause there was a high incidence of deep-vein thrombosis (68%).