Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 431
Filtrar
1.
Vasc Endovascular Surg ; 53(7): 606-608, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272303

RESUMO

Hydrophilic polymer coatings are now widely applied to catheters and other intravascular devices used in neurovascular, cardiovascular, and peripheral vascular procedures. Emboli consisting of these materials have been previously identified in biopsies and autopsies following pulmonary infarction, stroke, gangrene, or death. We report a case involving a nonhealing foot ulcer that appeared following cardiac catheterization, stenting, and automatic implanted cardiac defibrillator (AICD) implantation in a patient without other evidence of significant peripheral artery disease. An 85-year-old woman with chronic atrial fibrillation, aortic valve stenosis, and coronary artery disease underwent coronary stenting and AICD implantation for ventricular tachycardia and syncope. She developed a toe ulcer shortly thereafter, which did not respond to standard treatment. A histological examination following amputation of the toe found amorphous basophilic material in capillaries adjacent to the edge of the ulcer, which was similar to material associated with hydrophilic polymer coatings. Ischemia and infarcts following endovascular procedures should not be presumed to result from thrombus or vascular disease, even if intravascular devices appear intact or properly placed after the procedure. To help establish the incidence of ischemia caused by hydrophilic polymer device coatings, if excision of ischemic or infarcted tissue after endovascular procedures using coated devices becomes necessary, the tissue should be evaluated microscopically. Surgeons should also consider the tolerance of distal organs to infarct or ischemia when selecting coated intravascular devices.


Assuntos
Materiais Revestidos Biocompatíveis/efeitos adversos , Embolia/etiologia , Úlcera do Pé/etiologia , Migração de Corpo Estranho/etiologia , Isquemia/etiologia , Polímeros/efeitos adversos , Dedos do Pé/irrigação sanguínea , Idoso de 80 Anos ou mais , Amputação , Angiografia , Biópsia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Fluxo Sanguíneo Regional , Dedos do Pé/cirurgia , Resultado do Tratamento
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(1): 23-27, 2019 01 15.
Artigo em Chinês | MEDLINE | ID: mdl-30644256

RESUMO

Objective: To evaluate the effectiveness of transverse tibial bone transport in treatment of diabetic foot ulcer. Methods: Between June 2014 and December 2017, 17 patients with diabetic foot ulcer were treated. There were 11 males and 6 females, with a median age of 57 years (range, 46-72 years). The duration of diabetes was 2.4-32.0 years (mean, 16.0 years). According to the Wagner grading criteria, 7 cases were rated as grade 2, 8 cases as grade 3, and 2 cases as grade 4. The CT angiography (CTA) showed the arterial occlusion or stenosis of varying degrees below knee joint. All cases were treated with transverse tibial bone transport. Bone transport started at 3 to 5 days after placing external fixator and lasted 14 days (1 mm per day), and then reverse transport started. The total transport time was 28-30 days. Results: All 17 patients were followed up 5-12 months (mean, 8.5 months). During transportation, 4 cases had screw orifice infection, and 3 cases had liquefaction and seepage. And other 15 cases ulcers healed and the healing time was 35-72 days (mean, 48 days). There were significant differences in visual analogue scale (VAS) scores, skin temperature, ankle brachial index (ABI) between before and after ulcer healed ( P<0.05). The CTA showed that the collateral circulation was established. The foot ulcer of 2 cases (Wagener grade 3 in 1 case and grade 4 in 1 case) still progressed after treatment, and amputation was performed. Conclusion: Transverse tibial bone transports has good effectiveness for diabetic foot ulcer.


Assuntos
Pé Diabético , Úlcera do Pé , Tíbia , Idoso , Pé Diabético/cirurgia , Feminino , Úlcera do Pé/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tíbia/cirurgia , Resultado do Tratamento , Cicatrização
4.
Ann Vasc Surg ; 51: 86-94, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29679687

RESUMO

BACKGROUND: To predict wound healing in patients with critical limb ischemia (CLI) is an ongoing issue. Current methods such as ankle-brachial index (ABI), color Doppler and transcutaneous oxygen pressure (TCPO2), and computed tomography angiography are lacking in demonstrating regional perfusion. Indocyanine green angiography (ICGA) has the potential to provide regional perfusion information lacking in other methods. This study was conducted to demonstrate successes of revascularization procedure in CLI patients based on ICGA data. METHODS: A total of 47 patients with grade 2 or grade 3 University of Texas Wound Classification System ischemic foot ulcer undergoing lower limb revascularization procedure were included in this study, from July 2014 to May 2016. ICGA with intravenous 0.1 mg/kg of 0.1% indocyanine green dye was performed before and after revascularization procedure. ICGA data maximum unit, blush time, and blush rate were compared between prerevascularization and postrevascularization data, along with ABI and TCPO2. RESULTS: Out of 47 patients (45 males and 2 females), 43 underwent endovascular revascularization and 4 underwent open procedure. Of all, 76.6% of patients were diabetic and 46.8% were hypertensive. Also, 31.9% had coronary artery disease, 21.2% had history of cerebrovascular disease, 23% had chronic kidney disease, and 74.4% were chronic smokers. A total of 37 patients' ulcer healed completely on follow-up with significant improvement (P < 0.05) in preoperative and postoperative ABI, TCPO2, and ICGA data. Ten patients' ulcer did not heal in the follow-up period. In those 10 patients, preoperative and postoperative ABI and TCPO2 improved, but ICGA data were not improved postoperatively (P > 0.05). CONCLUSIONS: ICGA is an evolving tool to quantify regional perfusion in CLI. ICGA parameters provide qualitative real-time visual images of perfusion in area of interest as well as quantitative information of perfusion.


Assuntos
Angiografia/métodos , Corantes Fluorescentes/administração & dosagem , Úlcera do Pé/diagnóstico por imagem , Verde de Indocianina/administração & dosagem , Isquemia/diagnóstico por imagem , Imagem de Perfusão/métodos , Cicatrização , Administração Intravenosa , Idoso , Velocidade do Fluxo Sanguíneo , Estado Terminal , Feminino , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Humanos , Isquemia/fisiopatologia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Ann Vasc Surg ; 51: 78-85, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29501595

RESUMO

BACKGROUND: Ischemic heel ulcerations are generally thought to carry a poor prognosis for limb salvage. We hypothesized that patients undergoing infrapopliteal revascularization for heel wounds, either bypass or endovascular intervention, would have lower wound healing rates and amputation-free survival (AFS) than patients with forefoot wounds. METHODS: A retrospective chart review was performed on patients who presented between 2006 and 2013 to our institution with ischemic foot wounds and infrapopliteal arterial disease and underwent either pedal bypass or endovascular tibial artery intervention. Data were collected on patient demographics, comorbidities, wound characteristics, procedural details, and postoperative outcomes then analyzed by initial wound classification. The primary outcome was major amputation or death. RESULTS: Three hundred ninety-eight limbs underwent treatment for foot wounds; accurate wound data were available in 380 cases. There were 101 bypasses and 279 endovascular interventions, with mean follow-up of 24.6 and 19.9 months, respectively (P = 0.02). Heel wounds comprised 12.1% of the total with the remainder being forefoot wounds; there was no difference in treatment modality by wound type (P = 0.94). Of 46 heel wounds, 5 (10.9%) had clinical or radiographic evidence of calcaneal osteomyelitis. Patients with heel wounds were more likely to have diabetes mellitus (DM) (P = 0.03) and renal insufficiency (P = 0.004). 43.1% of wounds healed within 1 year, with no difference by wound location (P = 0.30). Major amputation rate at 1 year was 17.8%, with no difference by wound location (P = 0.81) or treatment type (P = 0.33). One- and 3-year AFS was 66.2% and 44.0% for forefoot wounds and 45.7% and 17.6% for heel wounds, respectively (P = 0.001). In a multivariate analysis, heel wounds and endovascular intervention were both predictors of death; however, there was significant interaction such that endovascular intervention was associated with higher mortality in patients with forefoot wounds (hazard ratio 2.25, P < 0.001) but not those with heel wounds (hazard ratio 0.67, P = 0.31). CONCLUSIONS: Patients presenting with heel ulceration who undergo infrapopliteal revascularization are prone to higher mortality despite equivalent rates of amputation and wound healing and regardless of treatment modality. These patients may benefit from an endovascular-first strategy.


Assuntos
Amputação , Procedimentos Endovasculares/mortalidade , Úlcera do Pé/cirurgia , Calcanhar/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Artéria Poplítea/cirurgia , Artérias da Tíbia/cirurgia , Enxerto Vascular/mortalidade , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Intervalo Livre de Doença , Procedimentos Endovasculares/efeitos adversos , Feminino , Úlcera do Pé/diagnóstico , Úlcera do Pé/mortalidade , Humanos , Estimativa de Kaplan-Meier , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Artéria Poplítea/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Artérias da Tíbia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Cicatrização
6.
Foot Ankle Spec ; 11(3): 269-276, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29532742

RESUMO

Heel ulcerations are a significant burden of care in both hospital and long-term care settings. The presence of peripheral arterial disease as a contributing factor to delayed healing is often not recognized, resulting in prolonged healing and high patient morbidity and mortality. Formal vascular evaluation and intervention is often not performed as these patients can have palpable pedal pulses while having localized ischemia of the heel. As routine noninvasive vascular studies can be affected by medial calcinosis and collateralization and do not specifically assess tissue perfusion to the heel, a false sense of security of adequate perfusion for healing can result. Indocyanine green fluorescence angiography (ICGFA) allows for real-time visualization and objective assessment of site specific tissue perfusion not limited by the factors that can make routine noninvasive vascular studies unreliable or unobtainable. A retrospective medical record review of a subset of patients with chronic heel ulceration from a prospective institutional review board-approved study in which serial ICGFA was performed during their treatment course was performed. ICGFA was able to identify local heel ischemia and expedite vascular intervention. ICGFA should be considered as an additional vascular study in patients presenting with chronic, nonhealing heel ulcerations. LEVELS OF EVIDENCE: Level IV: Diagnostic, Case series.


Assuntos
Angiofluoresceinografia/métodos , Úlcera do Pé/diagnóstico por imagem , Calcanhar/irrigação sanguínea , Isquemia/cirurgia , Doença Arterial Periférica/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos de Coortes , Feminino , Seguimentos , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Calcanhar/diagnóstico por imagem , Calcanhar/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/cirurgia , Estudos Prospectivos , Qualidade de Vida , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
7.
Diabetes Care ; 41(4): 891-898, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29439130

RESUMO

OBJECTIVE: Diabetes is the leading cause of nontraumatic lower-limb amputations in the U.S., but no research has prospectively examined associations between limb-specific measurements and amputation risk among patients without foot ulcer. We investigated amputation risk by limb in relation to the same limb- and person-level factors. RESEARCH DESIGN AND METHODS: We conducted a 22-year prospective study among 1,461 male patients with diabetes without foot ulcer (mean age 62.4 years), with 2,893 lower limbs among subjects recruited between 1990 and 2002 from one Department of Veterans Affairs general internal medicine clinic. The following information was collected: demographic, lifestyle, and diabetes characteristics; visual acuity; kidney function (estimated glomerular filtration rate [eGFR]); and lower-limb measurements including presence of Charcot deformity, sensory neuropathy by 10-g monofilament, dorsal foot transcutaneous oximetry (TcPO2) at 44°C, and ankle-brachial index (ABI). RESULTS: Over 25,735 limb-years, 136 amputations occurred. A multivariable Cox model identified multiple independent risk factors: sensory neuropathy (hazard ratio 3.09 [95% CI 2.02-4.74]), ABI ≤0.5 vs. >0.9 to <1.3 (3.98 [2.31-6.85]), ABI ≥1.3 vs. >0.9 to <1.3 (2.20 [1.18-4.09]), 1-SD decrease in eGFR (1.18 [1.00-1.38]), poor vision (1.70 [1.05-2.73]), body weight in 21.4-kg increments (0.78 [0.61-0.98]), and age >70 years vs. <57 years (0.13 [0.04-0.38]). Although TcPO2 was not significantly associated with amputation overall, TcPO2 <26 mmHg significantly predicted a higher risk in the ABI ≥1.3 category. CONCLUSIONS: Arterial disease and neuropathy emerged as the only limb-specific risk factors for amputation, but these and several person-level factors may be amenable to prevention or treatment interventions to potentially reduce diabetic amputation risk.


Assuntos
Amputação , Pé Diabético/cirurgia , Úlcera do Pé/cirurgia , Extremidade Inferior/cirurgia , Idoso , Índice Tornozelo-Braço , Pé Diabético/patologia , Feminino , Seguimentos , Pé/cirurgia , Úlcera do Pé/patologia , Humanos , Extremidade Inferior/patologia , Masculino , Registros Médicos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
8.
Adv Skin Wound Care ; 31(2): 78-81, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29346148

RESUMO

BACKGROUND: Plantar foot reconstruction requires special consideration of both form and function. There are several fasciocutaneous flap options, each with indications and reservations. CASE STUDY: This case presents a new application of the vertical profunda artery perforator flap for definitive closure of a neuropathic foot ulcer in a young woman with spina bifida. The postoperative course was uneventful, and the flap survived completely. The surgical and donor sites were without wound recurrence at 5-month follow-up. DISCUSSION: Understanding the variability of foot flap options is important because of unique cases such as the one presented where the wound was caused by specific and less commonly observed foot anatomy. The specific choice to use the vertical profunda artery perforator flap for this patient and her neuropathic wound type was made based on its excellent flexibility, durability, and donor site appeal. CONCLUSIONS: The vertical profunda artery perforator flap has adequate surface area and bulk and a favorable pedicle length and caliber, can be thinned, and leaves a donor scar in a less conspicuous area than other popular free flaps for lower-extremity reconstruction. For these reasons, it should be considered a first-line therapy for free flap coverage of selected foot wounds.


Assuntos
Úlcera do Pé/cirurgia , Retalho Perfurante/irrigação sanguínea , Doenças do Sistema Nervoso Periférico/fisiopatologia , Placa Plantar/cirurgia , Cicatrização/fisiologia , Artérias/transplante , Feminino , Úlcera do Pé/diagnóstico , Sobrevivência de Enxerto , Humanos , Retalho Perfurante/transplante , Doenças do Sistema Nervoso Periférico/etiologia , Placa Plantar/fisiopatologia , Prognóstico , Medição de Risco , Disrafismo Espinal/complicações , Disrafismo Espinal/diagnóstico , Adulto Jovem
9.
J Nippon Med Sch ; 84(5): 237-240, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29142185

RESUMO

Congenital insensitivity to pain with anhidrosis (CIPA) syndrome is a neuropathy characterized by insensitivity to pain, impaired thermoregulation, anhidrosis, and mental retardation. A 9-year old boy with CIPA syndrome, underwent 2 operations for a calcaneal ulcer. During the first operation standard monitorization was performed. In the second operation, Bispectral Index (BIS) monitoring was added and temperature was monitored with an esophageal probe. In the first operation, in which anesthesia induction was applied with ketamine and midazolam, extremity movements with surgical stimuli were seen. Despite pain insensitivity, as extremity movements were seen with surgical stimuli, propofol was administered in the second operation. Throughout the operation, the BIS values varied from 19-58 and body temperature was measured as 36.1°C-36.9°C. In conclusion, despite the absence of pain sensitivity in CIPA syndrome cases, there is an absolute need for the administration of anesthesia in surgical procedures because of tactile hyperesthesia.


Assuntos
Anestesia , Calcâneo , Úlcera do Pé/cirurgia , Neuropatias Hereditárias Sensoriais e Autônomas/complicações , Hiperestesia/etiologia , Hiperestesia/prevenção & controle , Hipo-Hidrose/complicações , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Insensibilidade Congênita à Dor/complicações , Temperatura Corporal , Criança , Monitores de Consciência , Úlcera do Pé/complicações , Humanos , Ketamina , Masculino , Midazolam , Monitorização Intraoperatória , Propofol , Cirurgia de Second-Look , Síndrome
10.
Int J Low Extrem Wounds ; 16(4): 284-288, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29141466

RESUMO

Thrombocytopenia is an important medical condition to understand prior to performing procedures in the foot and ankle. We have set forth to highlight factors a physician should take into consideration before performing procedures in the thrombocytopenic patient. A retrospective cohort analysis at a large academic institution was undertaken utilizing a cohort discovery tool to discover incidence and management strategies for patients with foot-related conditions that require in-office procedures. We demonstrate that a full history and physical are important to guide treatment along with complete blood count testing prior to intervention. We included all patients at the institution that underwent a foot and ankle procedure in-office with podiatric surgery over 10 years where thrombocytopenia was demonstrable via complete blood count within 3 months of the procedure. Patients' charts were reviewed for 1 year following podiatric intervention and outcomes were recorded. The cohort reveals that patients with thrombocytopenia have many advanced comorbidities but performing procedures in this cohort is safe. Complications from procedures included erythrocyte transfusion, ulcer recurrence, need for formal surgical intervention, infection, falls, and death. We then provide a brief discussion about the etiology and management options available for thrombocytopenia.


Assuntos
Transfusão de Eritrócitos , Úlcera do Pé , Infecção , Podiatria/métodos , Complicações Pós-Operatórias , Trombocitose , Técnicas de Fechamento de Ferimentos , Contagem de Células Sanguíneas/métodos , Transfusão de Eritrócitos/métodos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Úlcera do Pé/sangue , Úlcera do Pé/complicações , Úlcera do Pé/mortalidade , Úlcera do Pé/cirurgia , Humanos , Infecção/diagnóstico , Infecção/etiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Recidiva , Estudos Retrospectivos , Trombocitose/complicações , Trombocitose/diagnóstico , Trombocitose/terapia , Estados Unidos/epidemiologia , Técnicas de Fechamento de Ferimentos/efeitos adversos , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos
11.
BMC Nephrol ; 18(1): 293, 2017 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-28886703

RESUMO

BACKGROUND: Adults on dialysis are at increased risk of foot ulceration, which commonly precedes more serious lower limb complications, including amputation. Limited data exist regarding the prevalence and factors associated with foot disease in this population. Hence, this study set out to investigate factors associated with foot ulceration and amputation in a dialysis cohort. METHODS: This study presents a cross-sectional analysis of baseline data from a multi-center prospective cohort study. We recruited 450 adults with end-stage renal disease on dialysis from multiple satellite and home-therapy dialysis units in Melbourne, Australia from January to December 2014. Data collection consisted of a participant interview, medical record review, health-status questionnaire and non-invasive foot examination. Logistic regression analyses were conducted to evaluate associations between screened variables and study outcomes. RESULTS: Mean age was 67.5 (SD, 13.2) years, 64.7% were male, 94% were on hemodialysis, median dialysis duration was 36.9 (IQR, 16.6 to 70.1) months, and 50.2% had diabetes. There was a high prevalence of previous ulceration (21.6%) and amputation (10.2%), 10% had current foot ulceration, and 50% had neuropathy and/or peripheral arterial disease. Factors associated with foot ulceration were previous amputation (OR, 10.19), peripheral arterial disease (OR, 6.16) and serum albumin (OR, 0.87); whereas previous and/or current ulceration (OR, 167.24 and 7.49, respectively) and foot deformity (OR, 15.28) were associated with amputation. CONCLUSIONS: Dialysis patients have a high burden of lower limb complications. There are markedly higher risks of foot ulceration and/or amputation in those with previous and/or current ulceration, previous amputation, peripheral arterial disease, lower serum albumin, and foot deformity. Although not a major risk factor, diabetes in men was an important effect modifier for risk of ulceration.


Assuntos
Amputação , Úlcera do Pé/epidemiologia , Úlcera do Pé/cirurgia , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/tendências , Estudos de Coortes , Estudos Transversais , Feminino , Úlcera do Pé/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Diálise Renal/tendências , Insuficiência Renal Crônica/complicações , Fatores de Risco
12.
Khirurgiia (Mosk) ; (9): 4-16, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28914827

RESUMO

AIM: To improve treatment of patients with grade IV chronic ischemia of lower extremities via endovascular angioplasty combined with surgical methods for suppurative-necrotic lesions of the feet. MATERIAL AND METHODS: 51 patients with grade IV chronic ischemia of lower extremities underwent endovascular interventions (balloon angioplasty, stenting). A total of 23 stents were deployed in 16 patients including 12 stents in superficial and common femoral arteries, 5 in popliteal artery, 6 in iliac artery. There were no stents in crural arteries. The most perspective artery for wound healing was preferred in case of revascularization below popliteal segment. Necrectomy was performed along with angioplasty in patients with suppurative-necrotic lesion of the feet followed by delayed reconstructive operations if it was necessary. RESULTS: Endovascular surgery for grade IV chronic ischemia of lower extremities was associated with good immediate results in most cases due to revascularization and organ-sparing interventions for suppurative lesions of the feet. Current endovascular methods allow to perform successful re-operations to restore blood flow in previously repaired arteries and implanted stents with restenosis or thrombosis.


Assuntos
Angioplastia com Balão/métodos , Arteriosclerose Obliterante , Procedimentos Endovasculares , Extremidade Inferior , Stents , Idoso , Angiografia/métodos , Arteriosclerose Obliterante/complicações , Arteriosclerose Obliterante/diagnóstico , Arteriosclerose Obliterante/cirurgia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Úlcera do Pé/etiologia , Úlcera do Pé/cirurgia , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Salvamento de Membro/métodos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Masculino , Necrose/etiologia , Necrose/cirurgia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Federação Russa , Resultado do Tratamento , Grau de Desobstrução Vascular , Cicatrização
13.
Wounds ; 29(7): E48-E50, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28759430

RESUMO

Diabetic foot ulcers (DFUs) are a severe and costly complication of diabetes and may result in foot amputation. CASE REPORT: A 69-year-old man with a 10-year history of type 2 diabetes, who was undergoing routine care for diabetes in the authors' clinic, developed a DFU of his right foot of 4 years' duration. The wound did not respond to conventional treatments, and imaging studies were normal. His 2 biopsies tested negative for malignancy. The DFU was fully removed surgically. Following surgical removal, squamous cell carcinoma (SCC) was diagnosed in the histologic study of the wound. CONCLUSION: Clinicians should consider a diagnosis of SCC in any chronic, nonhealing DFU. Early surgical resection of a chronic, nonhealing DFU may prevent development of SCC in an ulcer.


Assuntos
Adenocarcinoma in Situ/patologia , Carcinoma de Células Escamosas/patologia , Pé Diabético/patologia , Úlcera do Pé/patologia , Adenocarcinoma in Situ/cirurgia , Idoso , Carcinoma de Células Escamosas/cirurgia , Pé Diabético/complicações , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Resultado do Tratamento , Cicatrização
14.
Rev Col Bras Cir ; 44(2): 147-153, 2017 Mar-Apr.
Artigo em Inglês, Português | MEDLINE | ID: mdl-28658333

RESUMO

Objective: : to evaluate whether bacterial genus is a risk factor for major amputation in patients with diabetic foot and infected ulcer. Methods: : we conducted a case-control, observational study of 189 patients with infected ulcers in diabetic feet admitted to the Vascular Surgery Service of the Risoleta Tolentino Neves Hospital, from January 2007 to December 2012. The bacteriological evaluation was performed in deep tissue cultures from the lesions and amputation was considered major when performed above the foot'smiddle tarsus. Results: : the patients'mean age was 61.9±12.7 years; 122 (64.6%) were men. The cultures were positive in 86.8%, being monomicrobial in 72% of the cases. In patients with major amputation, Acinetobacter spp. (24.4%), Morganella spp. (24.4%), Proteus spp. (23.1%) and Enterococcus spp. (19.2%) were the most frequent types of bacteria. The most commonly isolated species were Acinetobacter baumannii, Morganella morganii, Pseudomonas aeruginosa and Proteus mirabilis. As predictors of major amputation, we identified the isolation of the generaAcinetobacter spp. and Klebsiella spp., serum creatinine ≥1.3mg/dl and hemoglobin <11g/dl. Conclusion: : the bacterial genera Acinetobacter spp. and Klebsiella spp. identified in infected ulcers of patients with diabetic foot were associated with a higher incidence of major amputation. Objetivo:: avaliar se gênero bacteriano é fator de risco para amputação maior em pacientes com pé diabético e úlcera infectada. Método:: estudo observacional do tipo caso-controle de 189 pacientes com úlcera infectada em pé diabético admitidos pelo Serviço de Cirurgia Vascular do Hospital Risoleta Tolentino Neves, no período de janeiro de 2007 a dezembro de 2012. A avaliação bacteriológica foi realizada em cultura de tecido profundo das lesões e a amputação foi considerada como maior quando realizada acima do médio tarso do pé. Resultados:: a média de idade dos pacientes foi 61,9±12,7 anos e 122 (64,6%) eram homens. As culturas foram positivas em 86,8%, sendo monomicrobianas em 72% dos casos. Nos pacientes com amputação maior, os gêneros de bactérias mais frequentes foram Acinetobacter spp. (24,4%), Morganella spp. (24,4%), Proteus spp. (23,1%) e Enterococcus spp. (19,2%) e as espécies mais isoladas foram Acinetobacter baumannii, Morganella morganii, Pseudomonas aeruginosa e Proteus mirabilis. Identificou-se como fatores preditivos para amputação maior o isolamento dos gêneros Acinetobacter spp. e Klebsiella spp.,e níveis séricos de creatinina ≥1,3mg/dl e de hemoglobina <11g/dl. Conclusão:: os gêneros bacterianos Acinetobacter spp. e Klebsiella spp. identificados nas úlceras infectadas dos pacientes com pé diabético associaram-se a maior incidência de amputação maior.


Assuntos
Amputação , Bactérias/classificação , Pé Diabético/microbiologia , Pé Diabético/cirurgia , Úlcera do Pé/microbiologia , Úlcera do Pé/cirurgia , Bactérias/isolamento & purificação , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
16.
PLoS One ; 12(5): e0177176, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28498862

RESUMO

OBJECTIVES: To investigate whether A) duration of ulcer before start of treatment in specialist health care, and B) severity of ulcer according to University of Texas classification system (UT) at start of treatment (baseline), are independent predictors of healing time. METHODS: This retrospective cohort study, based on electronic medical record data, included 105 patients from two outpatient clinics in Western Norway with a new diabetic foot ulcer during 2009-2011. The associations of duration of ulcer and ulcer severity with healing time were assessed using cumulative incidence curves and subdistribution hazard ratio estimated using competing risk regression with adjustment for potential confounders. RESULTS: Of the 105 participants, 45.7% achieved ulcer healing, 36.2% underwent amputations, 9.5% died before ulcer healing and 8.5% were lost to follow-up. Patients who were referred to specialist health care by a general practitioner ≥ 52 days after ulcer onset had a 58% (SHR 0.42, CI 0.18-0.98) decreased healing rate compared to patients who were referred earlier, in the adjusted model. High severity (grade 2/3, stage C/D) according to the UT classification system was associated with a decreased healing rate compared to low severity (grade1, stage A/B or grade 2, stage A) with SHR (95% CI) equal to 0.14 (0.05-0.43) after adjustment for referral time and other potential confounders. CONCLUSION: Early detection and referral by both the patient and general practitioner are crucial for optimal foot ulcer healing. Ulcer grade and severity are also important predictors for healing time, and early screening to assess the severity and initiation of prompt treatment is important.


Assuntos
Pé Diabético/patologia , Úlcera do Pé/patologia , Cicatrização/fisiologia , Idoso , Idoso de 80 Anos ou mais , Amputação , Pé Diabético/cirurgia , Feminino , Úlcera do Pé/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
17.
J Wound Care ; 26(5): 267-270, 2017 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-28475443

RESUMO

OBJECTIVE: The number of patients with foot gangrene caused by critical ischaemia and severe infection is increasing significantly in developed countries. The measurement of perilesional skin blood flow by skin perfusion pressure (SPP) is useful to select the appropriate treatment of gangrenous lesions, in that it is not affected by calcifications of blood vessels. However, the prognosis of a foot ulcer may also be affected by the level of blood sugar and infections. This study aimed to validate the use of SPP in cases of foot gangrene and ulcers in patients with and without diabetes mellitus (DM) and infection. METHOD: Clinical symptoms, ankle-brachial pressure index (ABPI) and SPP were assessed to evaluate the condition of each foot ulcer. Every foot ulcer was treated as independent, even if a participant had multiple ulcers. All ulcers for which we measured SPP were subject to the analysis. All ulcers were purely ischaemic in nature and were exclusively located on the foot or toes. RESULTS: Data were collected from 117 foot ulcers on 91 toes and feet from 65 patients. Almost all SPP values in healed cases were > 27 mmHg. There were three patients whose ulcers failed to heal by conservative treatments were complicated with severe infection. However, no effect of DM on the relationship between SPP values and prognosis was observed. Logistic regression analysis of all ulcers except for the 5 cases complicated with infection revealed that those with 30 mmHg or lower SPP values are likely to heal by conservative treatment with 23% or lower probability, whereas any ulcer with more than 50 mmHg SPP value and without severe infection may heal without the need for further operations with 80% or higher probability. CONCLUSION: The combination of SPP and careful evaluation of infection may be a good parameter to decide the appropriate treatment for ischaemic skin ulcers, regardless of the complication of DM.


Assuntos
Diabetes Mellitus , Pé Diabético/fisiopatologia , Doenças Vasculares Periféricas/fisiopatologia , Pele/irrigação sanguínea , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Índice Tornozelo-Braço , Pé Diabético/etiologia , Pé Diabético/cirurgia , Feminino , Pé/patologia , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Gangrena , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/cirurgia , Pressão , Prognóstico , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Adulto Jovem
18.
Int Wound J ; 14(1): 74-78, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26663492

RESUMO

The aim of the study was to investigate the relationship between the toe brachial index (TBI) and foot ulceration and amputation in older people. Two hundred and sixty-one participants meeting guidelines for lower limb vascular assessment had their toe and brachial blood pressure measured, medical records audited and signs and symptoms of peripheral arterial disease (PAD) recorded. Pearson's correlation and linear regression analyses were performed to determine the strength of relationships between variables. Significant correlations were found between the TBI and painful symptoms (r = -0·35, P < 0·05) and foot complications (r = -0·31, P < 0·05). After adjusting for traditional risk factors for foot complications, participants with a TBI <0·70 were 19 times more likely to have a history of foot wounds or amputation (odds ratio = 19·20, 95% confidence interval (CI): 2·36-155·96, P < 0·001) than those with higher TBI values (>0·70). This preliminary study supports a TBI threshold of 0·70 for PAD diagnosis and indicates that lower values are associated with painful symptoms, history of ulceration and amputation. Future longitudinal investigation of the predictive capacity is now warranted.


Assuntos
Amputação/estatística & dados numéricos , Índice Tornozelo-Braço , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Extremidade Inferior/fisiopatologia , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Anaerobe ; 42: 162-165, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27789247

RESUMO

We present the first case of a complicated foot infection caused by Fusobacterium russii in Austria. F. russii is highly associated with mammals such as cats and dogs. Our case underlines the difficulties in isolation and identification of anaerobes and the pitfalls in antimicrobial treatment of polymicrobial infections.


Assuntos
Úlcera do Pé/microbiologia , Antepé Humano/microbiologia , Infecções por Fusobacterium/microbiologia , Fusobacterium/isolamento & purificação , Infecções por Pasteurella/microbiologia , Infecções Estreptocócicas/microbiologia , Idoso , Anaerobiose , Animais , Antibacterianos/uso terapêutico , Gatos , Coinfecção , Úlcera do Pé/tratamento farmacológico , Úlcera do Pé/patologia , Úlcera do Pé/cirurgia , Antepé Humano/patologia , Antepé Humano/cirurgia , Fusobacterium/efeitos dos fármacos , Fusobacterium/genética , Infecções por Fusobacterium/tratamento farmacológico , Infecções por Fusobacterium/patologia , Infecções por Fusobacterium/cirurgia , Humanos , Masculino , Infecções por Pasteurella/tratamento farmacológico , Infecções por Pasteurella/patologia , Infecções por Pasteurella/cirurgia , Pasteurella multocida/efeitos dos fármacos , Pasteurella multocida/genética , Pasteurella multocida/isolamento & purificação , RNA Ribossômico 16S/genética , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/patologia , Infecções Estreptocócicas/cirurgia , Streptococcus/efeitos dos fármacos , Streptococcus/genética , Streptococcus/isolamento & purificação
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA