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1.
PLoS One ; 15(9): e0239236, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936828

RESUMO

PURPOSE: A considerable number of diabetic foot ulcer (DFU) patients require amputation every year, which worsens their quality of life, aggravates the social burden, and shortens their life expectancy. Considering these negative effects, it is important to explore the relative risk factors affecting amputation in DFU patients. METHODS: The PubMed, SCIE and Embase databases were comprehensively searched for prospective or retrospective studies published before October 31, 2019. All English language studies involving DFU patients were included, and RevMan 5.3 software was used to analyse the data. RESULTS: This meta-analysis includes 21 studies involving 6505 participants, including 2006 patients who required a lower limb amputation. The following variables were associated with an increased risk of amputation: male sex (odds ratios (OR) = 1.30, 95% confidence interval (CI) = 1.16~1.46, P<0.00001), smoking history (OR = 1.19, 95% CI = 1.04~1.35, P = 0.009), a history of foot ulcers (OR = 2.48, 95% CI = 2.00~3.07, P<0.00001), osteomyelitis (OR = 3.70, 95% CI = 3.02~4.53, P<0.00001), gangrene (OR = 10.90, 95% CI = 5.73~20.8, P<0.00001), a lower body mass index (mean difference IV (MD) = -0.88, 95% CI = -1.30~-0.47, P<0.0001), and a higher white blood cell count (MD = 2.42, 95% CI = 2.02~2.82, P<0.00001). However, age (MD = 1.24, 95% CI = -0.45~2.93, P = 0.15), type of diabetes (OR = 0.96, 95% CI = 0.61~1.52, P = 0.86), hypertension (OR = 1.19, 95% CI = 0.96~1.47, P = 0.12), and HbA1c level (MD = 0.02, 95% CI = -0.28~0.33, P = 0.87) were not associated with amputation in patients with DFU. CONCLUSIONS: Our meta-analysis identified several risk factors for amputation in DFU patients, including the male sex, a smoking history, a history of foot ulcers, osteomyelitis, gangrene, a lower body mass index, and a higher white blood cell count. Once gangrene occurs, the risk of amputation rapidly increases.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Pé Diabético/cirurgia , Úlcera do Pé/cirurgia , Extremidade Inferior/cirurgia , Amputação/métodos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/etiologia , Pé Diabético/fisiopatologia , Úlcera do Pé/fisiopatologia , Humanos , Extremidade Inferior/fisiopatologia , Qualidade de Vida , Fatores de Risco
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(8): 945-950, 2020 Aug 15.
Artigo em Chinês | MEDLINE | ID: mdl-32794660

RESUMO

Ilizarov first reported the tibial transverse transport (TTT) for limb regeneration and functional reconstruction. The law of tension-stress could activate and enhance the regenerative potentials of living tissues, leading to growth or regeneration of muscles, fascia, blood vessels, and nerves simultaneously. Ilizarov discovered the phenomenon of rich vascular network formation during distraction osteogenesis process, but he did not apply this technique purposely to reconstruct microcirculation. Chinese orthopedic surgeons first used the TTT to treat lower extremity vascular lesions and diabetic foot ulcers. At present, some small sample clinical studies showed that the TTT could reconstruct microvascular network in the lower limbs of diabetic foot and promote the healing of foot ulcers. The use of TTT could significantly reduce the overall risk of diabetic foot complication especially the amputation risk. This expert consensus is initiated by the Chinese Association of Orthopaedic Surgeons (CAOS), Taskforce Group of Tibial Cortex Transverse Transport Technique for the Treatment of Diabetic Foot Ulcers. This expert consensus provides clear recommendations for indications, contraindications, principles for surgical procedures, preoperative and postoperative management, which maximize the success rate for TTT surgery in treatment of severe diabetic foot ulcers.


Assuntos
Pé Diabético , Úlcera do Pé , Amputação , Consenso , Diabetes Mellitus , Pé Diabético/cirurgia , Úlcera do Pé/cirurgia , Humanos , Tíbia
4.
Ann Vasc Surg ; 68: 384-390, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32278873

RESUMO

BACKGROUND: In the context of chronic limb-threatening ischemia, the prognostic impact of angiosome-targeted revascularization and of the status of the pedal arch are debated. METHODS: This series includes 580 patients who underwent endovascular (n = 407) and surgical revascularization (n = 173) of the infrapopliteal arteries for chronic limb-threatening ischemia associated with foot ulcer or gangrene. The risk of major amputation after infrapopliteal revascularization was assessed by a competing risk approach. A subanalysis was made separately for patients who underwent endovascular or open surgical revascularization. RESULTS: At 2 years, survival was 65.1% and leg salvage was 76.1%. Multivariable competing risk analysis showed that C-reactive protein ≥10 mg/dL, diabetes, rheumatoid arthritis, increased number of affected angiosomes, and the incomplete or total absence of pedal arch compared with complete pedal arch (CPA) were independent predictors of major amputation after infrapopliteal revascularization. Multivariable analysis showed increasing risk estimates of major amputation in patients with incomplete (subdistribution hazard ratio [SHR], 2.131; 95% confidence interval [95% CI], 1.282-3.543) and no visualized pedal arch (SHR, 3.022; 95% CI, 1.553-5.883) compared with CPA. Pedal arch was important even if angiosome-targeted revascularization was achieved: Angiosome-directed revascularization in presence of CPA had a lower risk of major amputation (adjusted SHR, 0.463; 95% CI, 0.240-0.894) compared with angiosome-directed revascularization without CPA. In the subanalysis, among patients who underwent endovascular revascularization, CPA (SHR, 0.509; 95% CI, 0.286-0.905) and angiosome-targeted revascularization (SHR, 0.613; 95% CI, 0.394-0.956) were associated with a lower risk of major amputation. CONCLUSIONS: Competing risk analysis showed that a patent pedal arch had significant impact on leg salvage and that the subset of patients undergoing endovascular procedure may most benefit of an angiosome-targeted revascularization.


Assuntos
Amputação , Procedimentos Endovasculares/efeitos adversos , Úlcera do Pé/cirurgia , Pé/irrigação sanguínea , Isquemia/cirurgia , Doença Arterial Periférica/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Amputação/mortalidade , Doença Crônica , Procedimentos Endovasculares/mortalidade , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/mortalidade , Úlcera do Pé/fisiopatologia , Gangrena , Humanos , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/mortalidade
5.
Ann Vasc Surg ; 62: 375-381, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31445090

RESUMO

BACKGROUND: Lower-limb revascularization surgery, especially when performed using the great saphenous vein, predisposes patients to major surgical trauma on initially ischemic tissue. Vein harvest wounds (VHWs) after infrainguinal revascularization heal slowly. This study's aim was to assess the factors associated with VHW healing after infrainquinal bypass surgery for critical limb ischemia (CLI). METHODS: A retrospective patient record study was conducted. All patients with CLI who underwent infrainguinal bypass surgery with autologous vein graft between January 1, 2015, and December 31, 2017, in the Turku University Hospital, were included. Follow-up data were collected until February 28, 2018. The following data was collected from the patient files; risk factors, ankle-brachial indices (ABIs), systolic toe pressures (STPs), the presence of an ischemic ulcer, VHW dehiscence, and the time when the VHW was completely healed. Procedures with outflow vessels at either popliteal or tibial artery were analyzed separately. Descriptive and univariate statistical analyses were performed. RESULTS: Altogether, 195 patients were operated on for CLI, of whom 133 (68.2%) patients had ischemic ulcers. The mean follow-up time was 535.0 days (range 3.0-1143.0 days). The mean ABI improvement was 0.49 (P = 0.00), and STP improvement, 39.9 mm Hg (P = 0.00). The median time taken when VHW was healed was 48.0 days (95% confidence interval [CI], 39.4-56.6) in patients without ischemic ulcers and 82.0 days (95% CI, 59.7-104.3) in patients with ischemic ulcers, P = 0.03. VHW in patients who underwent popliteal artery bypass (62 days, 95% CI, 12.9-93.0) healed faster than VHW in those who underwent tibial artery bypass (132 days, 95% CI, 48.0-93.0), P = 0.02. Risk factors and the preoperative or postoperative ABIs or STPs had no effect on VHW healing time. CONCLUSIONS: VHW healing was remarkably slower after revascularization surgery in patients with an ischemic foot ulcer than in those without ischemic ulcers.


Assuntos
Úlcera do Pé/cirurgia , Isquemia/cirurgia , Doenças Vasculares Periféricas/cirurgia , Veia Safena/transplante , Coleta de Tecidos e Órgãos , Enxerto Vascular/métodos , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/fisiopatologia , Humanos , Isquemia/diagnóstico , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Coleta de Tecidos e Órgãos/efeitos adversos , Transplante Autólogo , Resultado do Tratamento , Enxerto Vascular/efeitos adversos
6.
J Foot Ankle Surg ; 59(1): 27-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882144

RESUMO

Ray resection is frequently performed in cases of infection or ischemia, but the literature is scarce concerning its outcome as a definitive treatment. In this retrospective cohort study, we reviewed our cohort with transmetatarsal ray resection with a mean follow-up of 36.3 months. Reulcerations, transfer ulcers, and reamputations were determined. Risk factor analysis for revision surgery was conducted. Among 185 patients, 71 (38.4%) had revision surgery within a mean of 1.4 ± 2.6 years (range 2 days to 12.9 years), 22 (11.9%) had major amputations, 49 (26.5%) had minor amputations, 11 (5.9%) had same-ray reulceration, 40 (21.6%) had transfer ulceration, and 2 (1.1%) had both reulceration and transfer ulceration. Occurrence of a postoperative ulcer was statistically significantly associated with revision surgery (p < .01). In conclusion, metatarsal ray resection is a reasonable treatment option in cases of forefoot ischemia or infection to prevent major amputation but fails in 11.9%, and reulceration is associated with further revisions, making ulcer prevention paramount.


Assuntos
Amputação , Úlcera do Pé/cirurgia , Ossos do Metatarso/cirurgia , Osteomielite/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Úlcera do Pé/etiologia , Úlcera do Pé/patologia , Gangrena/etiologia , Gangrena/cirurgia , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Osteomielite/patologia , Reoperação , Resultado do Tratamento
7.
J Surg Res ; 250: 232-238, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31870563

RESUMO

BACKGROUND: Surgical outcomes may differ between low-volume and experienced hospitals. We sought to identify characteristics of remote patients-those living more than 50 miles from an experienced center-who underwent leg amputations for peripheral artery disease (PAD) and foot complications at low-volume and experienced hospitals and identify regions of Texas where such patients live. MATERIALS AND METHODS: Publicly available Texas hospitalization data from 2004 through 2009 were used to identify patients with PAD who underwent leg amputation for foot complications, including foot ulcers, foot infections, and gangrene. Geocoding was used to further identify a subset of remote patients and to estimate distances from zip code of residence to hospital in which care was received. RESULTS: Among all leg amputations, 850 (18.6%) were performed on patients classified as remote, and 3723 (81.4%) were performed on patients classified as nonremote. Compared with nonremote patients, remote patients were more often categorized as white and more frequently received Medicare and/or Medicaid. Of the subset of remote patients, those at low-volume hospitals were older, were less often categorized as Hispanic, more often had Medicaid coverage, were also more frequently admitted through the emergency department, and often had a foot infection compared with those at experienced centers. Geospatial analysis identified five concentrated geographic areas of remote patients who live more than 50 miles from an experienced center. CONCLUSIONS: These findings suggest travel distance may at least influence, if not constrain, the choice of hospital for patients with PAD and foot complications. Efforts to decrease leg amputations among remote patients should be focused on five specific geographic areas of Texas.


Assuntos
Amputação/estatística & dados numéricos , Úlcera do Pé/cirurgia , Gangrena/cirurgia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Doença Arterial Periférica/cirurgia , Adolescente , Adulto , Idoso , Feminino , Úlcera do Pé/complicações , Geografia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/estatística & dados numéricos , Análise Espacial , Texas , Transportes/estatística & dados numéricos , Enxerto Vascular/estatística & dados numéricos , Adulto Jovem
8.
Rev. bras. cir. plást ; 34(4): 497-503, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047912

RESUMO

Introdução: A úlcera plantar por hanseníase é uma lesão no pé resultante da falta de sensibilidade plantar. O objetivo é descrever o tratamento realizado em portadores de úlceras plantares por hanseníase. Métodos: Estudo de prontuários de portadores de úlcera plantar atendidos no Hospital Sarah em Brasília, de 2006 a 2016, quanto ao sexo, idade, etiologia, localização e tratamento. Resultados: Foram atendidos 27 pacientes, 17(62,96%) homens e 10 (37,04%) mulheres, procedentes de Goiás e DF, na faixa etária de 41 a 60 anos (40,74%). Todos necessitaram de um ou mais procedimentos cirúrgicos. Conclusão: Observou-se maior frequência no sexo masculino, grau avançado, localizadas no primeiro artelho. Todos necessitaram de procedimentos cirúrgicos e não cirúrgicos, evoluindo com cicatrização completa da ferida, amputação transtibial em um caso e de artelhos em sete casos, e 90% dos casos apresentaram recorrência da úlcera após um ano.


Introduction: Leprosy-induced plantar ulcers result from a lack of plantar sensitivity. Objective: This study aimed to describe the treatment provided to patients with leprosy-induced plantar ulcers. Methods: We retrospectively reviewed the medical records of patients with plantar ulcers treated at Sarah Hospital in Brasilia from 2006 to 2016 and collected information about sex, age, etiology, location, and treatment. Results: A total of 27 patients (17 [62.96%] men, 10 [37.04%] women; 40.74% were aged 41­60 years) were treated from Goiás and the Federal District. All required ≥1 surgical procedure. Conclusion: A higher frequency of advanced grade was observed in men, primarily on the first toe. All needed surgical and non-surgical procedures and achieved complete wound healing. Transtibial amputation was required in 1 case and toe amputation in 7 cases; 90% patients developed ulcer recurrence after 1 year.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Reabilitação , Terapêutica , Tratamento Terciário , Registros Médicos , Úlcera do Pé , Hanseníase , Reabilitação/métodos , Reabilitação/estatística & dados numéricos , Terapêutica/métodos , Terapêutica/estatística & dados numéricos , Tratamento Terciário/métodos , Tratamento Terciário/estatística & dados numéricos , Registros Médicos/normas , Registros Médicos/estatística & dados numéricos , Úlcera do Pé/cirurgia , Úlcera do Pé/complicações , Úlcera do Pé/terapia , Hanseníase/cirurgia , Hanseníase/complicações , Hanseníase/terapia
9.
J Foot Ankle Surg ; 58(6): 1067-1071, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31679660

RESUMO

Heel ulcers have a significant impact on lower-extremity morbidity and confer high risk of major amputations. Treating these ulcers is difficult because of poor tissue coverage and the bony os calcis, often leading to proximal amputation. This case series shows the vertical contour calcanectomy (VCC) as a surgical alternative in functional limb salvage. Sixteen feet (14 patients) with recalcitrant heel wounds who underwent VCC were identified. The minimum follow-up time for inclusion was 1 year. Body mass index, diabetes, renal disease, peripheral vascular disease, lymphedema/venous insufficiency, smoking status, Charcot, amputation, vascular intervention, wound recurrence, reoperation rate, and ambulatory status were evaluated. The average follow-up time was 27.1 months (range 13.5 to 51.1). At 1 year of follow-up, 56% of heel wounds (9 of 16) treated with the VCC remained closed. An average of 1.44 subsequent surgeries were required per patient. Baseline or improved ambulatory status was achieved in 69% of patients (9 of 14) at 1-year follow up and 100% of patients (8 of 8) at 2-year follow up. The overall rate of major amputation was 19%. The long-term ambulatory status of patients treated with the VCC shows promise. The VCC should be considered as an alternative, reliable, surgical limb salvage tool for heel ulcerations.


Assuntos
Calcâneo/cirurgia , Úlcera do Pé/cirurgia , Calcanhar/cirurgia , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , District of Columbia/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
J Foot Ankle Surg ; 58(6): 1072-1076, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31679661

RESUMO

Limited reconstructive options exist for soft tissue defects of the foot and ankle because of a lack of surrounding tissue. Although microsurgical free flaps have become a popular treatment modality for this anatomic region, pedicled muscle flaps can provide robust coverage of small foot wounds with significantly less donor site comorbidity. One such muscle is the abductor hallucis, which can be used as a proximally based turnover flap to cover medial hindfoot defects. However, complete distal disinsertion of the muscle may lead to loss of support over the medial arch and first metatarsophalangeal joint, leading to pes planus and hallux valgus. In this case report, we describe a modified technique of a split abductor hallucis turnover flap for a young patient with a chronic, traumatic medial heel wound complicated by calcaneal osteomyelitis. By preserving part of the muscle's distal tendinous attachment, this technique allows for adequate soft tissue coverage while maintaining long-term biomechanical function.


Assuntos
Úlcera do Pé/cirurgia , Retalhos de Tecido Biológico , Músculo Esquelético/transplante , Ferimentos Penetrantes Produzidos por Agulha/complicações , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Feminino , Úlcera do Pé/diagnóstico , Úlcera do Pé/etiologia , Humanos , Imagem por Ressonância Magnética , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Radiografia
11.
J Foot Ankle Surg ; 58(6): 1171-1176, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31679669

RESUMO

Total transmetatarsal amputation (TMA) can be an option for foot salvage in gangrene, sepsis, or infected necrosis. However, the literature concerning predictive outcome factors and bacterial sampling is scarce. To identify potential associations between revision surgery and underlying bacteria or other preoperative selection criteria, we reviewed all patients with TMA who were treated at our institution. We compared the patients with remissions with surgical revisions. Among 96 adult patients with TMA (105 amputations), 42 required a revision surgery (40%), 18 had a further minor proximal surgical reamputation (17%) and 18 had a major proximal surgical reamputation (14%). In group comparisons, a previous infection with Staphylococcus aureus was protective with a lower revision risk (4/26 with revision surgery vs 22/26 without revisions; p = .03). This was the opposite for postoperative persistent soft tissue or bone infections (p < .01) and delayed wound healing (p < .01), which were positively associated with a revision risk. The American Society of Anesthesiologists Score, sex, age, body mass index, diabetes, polyneuropathy, chronic renal failure, dialysis, peripheral arterial disease, smoking status, and antibiotic regimen did not influence this revision risk. These results must be interpreted cautiously because no multiple variable calculations could be conducted as a result of the paucity of cases and confounding could not be evaluated sufficiently. TMA is an option to prevent major amputations, but it may be associated with a subsequent revision risk of 40% in adult patients. In our cohort study, persistent postamputation infection and delayed wound healing were associated with revision. However, no preoperative selection criteria were found that lead to revision surgery except for an infection with Staphylococcus aureus, which protected against revision surgery.


Assuntos
Amputação , Pé/cirurgia , Ossos do Metatarso/cirurgia , Reoperação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Pé Diabético/cirurgia , Feminino , Úlcera do Pé/cirurgia , Gangrena/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/cirurgia , Infecções dos Tecidos Moles/cirurgia , Cicatrização
12.
Adv Skin Wound Care ; 32(12): 1-4, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31764150

RESUMO

Thromboangiitis obliterans, or Buerger disease, is a rare nonatherosclerotic segmental inflammatory vasculitis that generally affects young tobacco smokers. Although no surgical treatment is available, the most effective way to halt the disease's progress is smoking cessation. In this case report, a 29-year-old smoker showed up to emergency department with gangrene of his fifth left toe and extensive plantar ulceration. After investigative angiography, he was diagnosed with Buerger disease. On November 2017, he underwent fifth left toe amputation and hyperbaric therapy. Five months after amputation, the patient was rehospitalized because of surgical wound dehiscence, wide ulceration, and pain. He was treated with lipofilling using the Coleman technique. Two weeks after the fat grafting procedure, the patient suspended pain control medication, and after 2 months, the surgical wound was almost healed. Fat grafting (lipofilling) is mostly used in plastic surgery; it offers regenerative effects, with minimal discomfort for the patient. This case report demonstrates a successful alternative use of lipofilling for this unique condition and opens up new options for use of this technique in other fields.


Assuntos
Tecido Adiposo/transplante , Amputação/métodos , Úlcera do Pé/cirurgia , Fumar/efeitos adversos , Tromboangiite Obliterante/cirurgia , Cicatrização/fisiologia , Adulto , Angiografia/métodos , Terapia Combinada/métodos , Serviço Hospitalar de Emergência , Seguimentos , Úlcera do Pé/etiologia , Úlcera do Pé/fisiopatologia , Sobrevivência de Enxerto , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Medição de Risco , Índice de Gravidade de Doença , Tromboangiite Obliterante/diagnóstico por imagem , Tromboangiite Obliterante/etiologia , Dedos do Pé/fisiopatologia , Dedos do Pé/cirurgia , Resultado do Tratamento
13.
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
14.
Chin J Traumatol ; 22(4): 202-206, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31239218

RESUMO

Calcaneovalgus foot deformities are present in up to 35% of patients with lumbar spina bifida. Resultant heel weight bearing causes complications include those associated with pressure ulcers. Early surgical reconstruction is advocated to prevent deformity progression and rigidity. Several surgical techniques in paediatric populations have been described, but there remains a paucity of literature regarding reconstruction of chronic calcaneovalgus feet in adults. This case report describes our experience using the Ilizarov technique in the reconstruction of an adult presenting with chronic calcaneovalgus feet. This is a 34-year-old lady with myelomeningocoele spina bifida of lumbar level 5 who presented with a history of multiple admissions for cellulitis and infections of bilateral heel pressure sores. Rigid calcaneovalgus deformities of both feet (45° on the right, 40° on the left) were noted on clinical examination and radiological investigations. Reconstruction with an Ilizarov frame allowed for gradual correction of both soft tissue and bone, correcting heel weight bearing ambulation, with the aim of preventing further complications from infected heel ulcers. While the correction of bony deformities is crucial, management of chronically contracted soft tissue must not be overlooked. An Ilizarov frame requires both an experienced surgeon and a motivated patient, but it allows for accurate reconstruction of bony deformities, while allowing management of surrounding chronic soft tissue contractures with good functional outcome.


Assuntos
Pé Chato/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Doença Crônica , Feminino , Pé Chato/etiologia , Úlcera do Pé/etiologia , Úlcera do Pé/cirurgia , Humanos , Vértebras Lombares , Meningomielocele/complicações , Disrafismo Espinal/complicações , Resultado do Tratamento
15.
J Foot Ankle Res ; 12: 34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223342

RESUMO

Background: Lower extremity amputation (LEA) is a potential sequelae of diabetic foot ulceration (DFU) and is associated with huge morbidly and mortality. Low and middle income countries are currently at the greatest risk of diabetes-related complications and deaths. We sought to identify demographic, clinical and laboratory variables that significantly predict LEA in patients hospitalized for DFU. Methods: The Multi-center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study conducted between March 2016 and April 2017 in six tertiary healthcare institutions. We prospectively followed 336 diabetic patients hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. Patients were evaluated for neuropathy, peripheral arterial disease (PAD) and medical co-morbidities while relevant laboratory and imaging tests were performed. The study end-points were ulcer healing, LEA, duration of hospitalization and mortality. Here we present data on amputation. Results: One hundred and nineteen subjects (35.4%) underwent LEA during the follow-up period. Univariate predictors of LEA were ulcer duration more than 1 month prior to hospitalization (P <  0.001), PAD (P <  0.001), Wagner grade ≥ 4 (P <  0.001), wound infection (P 0.041), Proteinuria (P 0.021), leucocytosis (P 0.001) and osteomyelitis (P <  0.001). On multivariate regression, only three variables emerged as significant independent predictors of LEA and these include: ulcer duration more than 1 month (O.R. 10.3, 95% C.I. 4.055-26.132), PAD (O.R. 2.8, 95% C.I. 1.520-5.110) and presence of osteomyelitis (O.R. 5.6, 95% C.I. 2.930-10.776). Age, gender, diabetes type and duration, neuropathy, glycemic control and anemia did not predict LEA in the studied population. Conclusion: We identified duration of ulcer greater than 1 month, PAD, Wagner grade 4 or higher, proteinuria, leucocytosis, wound infection and osteomyelitis as the significant predictors of LEA in patients hospitalized for DFU. Prompt attention to these risk factors may reduce amputation rate among these patients.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/cirurgia , Úlcera do Pé/cirurgia , Extremidade Inferior/cirurgia , Adulto , Idoso , Pé Diabético/patologia , Feminino , Úlcera do Pé/etiologia , Úlcera do Pé/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária
16.
Int J Low Extrem Wounds ; 18(2): 129-134, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31111761

RESUMO

Although exostectomy for chronic midfoot plantar ulcers in Charcot foot is apparently effective, with healing rates of nearly 75%, a subset of patients develop recurrent ulceration and show an unstable foot position, especially after undergoing exostectomy confined to the lateral column. The reasons for this failure have not been investigated. The main objective of this study was to evaluate the early changes in radiographic alignment after an exostectomy in patients with Charcot neuropathic osteoarthropathy (rocker bottom) and plantar ulcer located in the lateral column. The present study evaluated retrospectively changes in radiographic alignment after an exostectomy in 12 Charcot feet (rocker bottom) with plantar ulcer located in the lateral column. Indication for plantar exostectomy was the treatment of ulcer affected by osteomyelitis. We evaluated the early changes in the alignment of the foot on weight-bearing lateral radiographs 6 months after exostectomy. Paired sample Wilcoxon test was used to calculate the differences between preoperative and postoperative measurements. Furthermore, the relationship between revision surgery and early changes in radiographic angular measurements was determined by using the Mann-Whitney U test. After exostectomy, the inclination of the calcaneal bone decreased (P = .003; r = 0.849) and declination of talus bone increased (P = .041; r = 0.589). The change in calcaneal inclination was associated with revision surgery (P = .042; r = 0.586). The present case series demonstrates that exostectomy procedure for the lateral column in patients with Charcot foot results in radiological changes in the hindfoot over the sagittal plane. The inversion of the calcaneal pitch angle suggests the possibility of further adverse events and the need for revision surgery.


Assuntos
Artropatia Neurogênica/cirurgia , Mau Alinhamento Ósseo/diagnóstico por imagem , Úlcera do Pé/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Cicatrização/fisiologia , Adulto , Artropatia Neurogênica/diagnóstico por imagem , Mau Alinhamento Ósseo/cirurgia , Calcâneo/fisiopatologia , Doença Crônica , Estudos de Coortes , Feminino , Úlcera do Pé/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Prognóstico , Radiografia/métodos , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Tálus/fisiopatologia , Resultado do Tratamento
17.
Foot (Edinb) ; 39: 45-49, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30965226

RESUMO

Often times, conservative treatment is unsuccessful in long-term resolution of recalcitrant verrucae plantaris lesions. In addition to being aesthetically displeasing, severe cases that are left untreated can be debilitating, often leading to chronic pain, gait abnormalities, and further cutaneous spread. Inoculation through implantation of verrucae plantaris into a muscle was previously postulated to provoke an immune response against the human papilloma virus, resulting in auto-immunization. The purpose of this study was to determine the rate of recurrence following two methods of treatment: A) Surgical removal and subsequent implantation of verruca plantaris into the contralateral abductor hallucis muscle belly and B) Surgical excision of verrucae plantaris. A retrospective chart review of 43 consecutive patients was performed. Group A was comprised of 25 patients who underwent surgical removal of verrucae plantaris followed by implantation of a biopsied specimen into the contralateral abductor hallucis muscle belly. Group B was comprised of 18 patients who underwent only surgical removal of the verrucae. The presence or absence of verrucous lesions was recorded at a post-operative follow-up at an average of 27.5 months. Correlations between recurrence of disease and age, sex, and medical comorbidities were evaluated. Our results suggest that implantation of verruca plantaris into the abductor hallucis muscle belly yields no significant difference in clinical recurrence rates when compared to surgical removal.


Assuntos
Úlcera do Pé/cirurgia , Terapia a Laser , Lasers de Gás/uso terapêutico , Verrugas/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
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
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