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1.
Wiad Lek ; 74(3 cz 1): 413-417, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813442

RESUMO

OBJECTIVE: The aim: To study the role and place of bone grafting in the formation of bone stump after amputation. PATIENTS AND METHODS: Materials and methods: 3 series of experiments were carried out on 44 rabbits with amputation of the thigh in the middle third and stump grafting using osteoplastic hermetic closure of the canal with a thin cortical plate (series I), closure of the canal with a spongy bone (series II), and loose closure of the canal with a cortical graft located at the entrance to the canal at an angle of 30° (ІІІ series). Observation period: 1, 3, 6 months. Histological examination method with vascular filling with 10% mascara-gelatin mixture. RESULTS: Results: In series I, in the majority of observations, a stump of a cylindrical shape with a bone locking plate of an osteon-beam structure and normalization of intraosseous microcirculation was formed. A slight displacement of the graft caused a violation of microcirculation. In series II, organotypic stumps were formed in all observations. In series III, incomplete closure of the bone marrow cavity led to sharp microcirculatory disorders and the course of the reparative process with pathological bone remodeling. CONCLUSION: Conclusions: The parameters of the favorable course of the reparative process and the formation of the organotypic bone stump are the safety of its cylindrical shape, the presence of a compact bone structure, normalization of intraosseous microcirculation.


Assuntos
Amputação , Arquivamento , Cotos de Amputação , Animais , Microcirculação , Coelhos , Coxa da Perna
2.
Bone Joint J ; 103-B(4): 769-774, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789468

RESUMO

AIMS: Complex fractures of the femur and tibia with associated severe soft tissue injury are often devastating for the individual. The aim of this study was to describe the two-year patient-reported outcomes of patients in a civilian population who sustained a complex fracture of the femur or tibia with a Mangled Extremity Severity Score (MESS) of ≥ 7, whereby the score ranges from 2 (lowest severity) to 11 (highest severity). METHODS: Patients aged ≥ 16 years with a fractured femur or tibia and a MESS of ≥ 7 were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (January 2007 to December 2018). Cases were grouped into surgical amputation or limb salvage. Descriptive analysis were used to examine return to work rates, three-level EuroQol five-dimension questionnaire (EQ-5D-3L), and Glasgow Outcome Scale-Extended (GOS-E) outcomes at 12 and 24 months post-injury. RESULTS: In all, 111 patients were included: 90 (81%) patients who underwent salvage and 21 (19%) patients with surgical amputation. The mean age of patients was 45.8 years (SD 15.8), 93 (84%) were male, 37 (33%) were involved in motor vehicle collisions, and the mean MESS score was 8.2 (SD 1.4). Two-year outcomes in the cohort were poor: six (7%) patients achieved a GOS-E good recovery, the mean EQ-5D-3L summary score was 0.52 (SD 0.27), and 17 (20%) patients had returned to work. CONCLUSION: A small proportion of patients with severe lower limb injury (MESS ≥ 7) achieved a good level of function 24 months post-injury. Further follow-up is needed to better understand the long-term trajectory of these patients, including delayed amputation, hospital readmissions, and healthcare utilization. Cite this article: Bone Joint J 2021;103-B(4):769-774.


Assuntos
Fraturas do Fêmur/cirurgia , Escala de Gravidade do Ferimento , Traumatismos da Perna/cirurgia , Fraturas da Tíbia/cirurgia , Amputação , Feminino , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Sistema de Registros , Vitória
3.
Angiol Sosud Khir ; 27(1): 24-32, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825725

RESUMO

AIM: The study was aimed at comparing efficacy of conventional conservative therapy and comprehensive treatment including a plasmid VEGF-165-gene therapy drug in 'no-option' chronic limb-threatening ischaemia with different prevalence of trophic ulcers and infection during a 1-year follow-up period. PATIENTS AND METHODS: A total of 101 patients (54% being men and 46% women, mean age 69 years) with 'no-option' chronic limb-threatening ischaemia underwent comprehensive conservative treatment. They were subdivided into 4 groups according to the WIFI classification: WIFI 130 (n=38), 131 (n=23), 230 (n=16), 231 (n=24). The control group patients (n=58) received standard treatment using a PGE1 analogue (Vasaprostan) and the study group patients (n=43) underwent standard conservative treatment (SCT) in combination with gene therapy. The end points of the study were as follows: major amputation rate, amputation-free survival, total mortality, and ulcer healing rate during a 1-year of follow up. RESULTS: Major amputation rate in the control and study groups amounted to 35 and 28% (p=0.48), respectively, with amputation-free survival of 53 and 63% (p=0.35), total mortality of 21 and 12% (p=0.23), ulcer healing rate of 31 and 51% (p=0.04), respectively. The WIfI classification made it possible to single out a subgroup of patients (WIfI combination 130) yielding other statistically significant results: major amputation rate 27% and 0% (p=0.03), amputation-free survival 59 and 94% (p=0.025), ulcer healing rate 50 and 88% (p=0.016), respectively. CONCLUSION: Using plasmid-based VEGF-165 gene therapy in the subgroup with the WIfI combination 130 decreases the major amputation rate (p=0.03), increases amputation-free survival (p=0.025) and promotes ulcer healing (p=0.016) compared with the standard therapy during 1-year follow up. No significant differences in the compared groups were revealed by all endpoints of the study for other combinations analysed. The total mortality rate in patients with limb-threatening ischaemia does not depend on either the initial severity of ulcer or the selcted methods of conservative treatment.


Assuntos
Tratamento Conservador , Salvamento de Membro , Idoso , Amputação , Feminino , Humanos , Isquemia/cirurgia , Estimativa de Kaplan-Meier , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Cicatrização
4.
Angiol Sosud Khir ; 27(1): 182-190, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825747

RESUMO

Peripheral artery disease is a common and acute social burden worldwide. The main method of treatment of PAD consists in open surgical or endovascular revascularization. However, despite steady growth of the number and quality of interventions, the incidence of lower-limb amputation still remains at a high level. Lower-limb amputation is a severe psychological blow for the patient and leads to significant deterioration of his or her quality of life, as well as has an extremely negative prognosis concerning the frequency of subsequent complications and survival. Consequences of amputations include not only severe disability but also an unfavourable prognosis of life, thus determining the necessity of adequate prevention of such events. Reconstructive and endovascular operations, as well as amputations are associated with a significant increase of the probability of the development of major adverse cardiovascular events, the frequency of repeat hospitalizations and, finally, the cost of treatment. Prescribing pathogenetically substantiated antithrombotic therapy is considered to be one of the methods to improve the results of surgical treatment and prognosis for the patient. Presented in the article is a literature review making it possible to assess the risks and consequences of amputations in patients with PAD, as well as to determine therapy capable of improving the prognosis.


Assuntos
Procedimentos Endovasculares , Doença Arterial Periférica , Amputação , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Salvamento de Membro , Extremidade Inferior , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/cirurgia , Prognóstico , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento
5.
Rev Med Liege ; 76(4): 262-267, 2021 Apr.
Artigo em Francês | MEDLINE | ID: mdl-33830690

RESUMO

Rotationplasty can be used as an alternative to amputation when conservative treatment is not possible, for example in malignant tumours of the knee. The principle of the operation is to rotate the lower leg through 180 ° after resection of the distal femur and in this way the ankle joint replaces the knee joint. This surgical technique, although complex, allows satisfactory carcinological resection with a functional outcome superior to amputation above the knee as well as a better quality-of-life. Patients do not develop phantom pain, neuroma or stump discomfort because it is not an amputation. In addition, they can actively control their knee and having proprioception and normal contact with the ground. This results in a coordinated, harmonious and elegant gait pattern similar to the normal population. Patients are more efficient in their activities of everyday life and sports. The major disadvantage is the particular aesthetic aspect and the psychological acceptance.


Assuntos
Artroplastia do Joelho , Neoplasias Ósseas , Amputação , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Rotação
6.
BMC Surg ; 21(1): 168, 2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33781250

RESUMO

BACKGROUND: This study aimed to assess a multidisciplinary team (MDT) meeting approach for the management of patients with complex extremity defects, analyze treatment recommendations, and evaluate factors influencing non-implementation. METHODS: All patients introduced to an MDT meeting for complex extremity defects from 2015 to 2017 were included in a retrospective cohort study. Patients' characteristics and defect causes were evaluated. Treatment recommendations (TR) of MDT meetings and subsequent implementation were reviewed (cohort with implementation of TR versus cohort with non-implementation of TR), and factors associated with non-adherence to recommendations were statistically analyzed using logistic regression. RESULTS: Fifty-one patients (41 male) with a mean age of 54 years were presented in 27 MDT meetings. Most of the patients (70%) suffered from reconstructive challenging or combined bone- and soft tissue defects, primarily located at the lower extremity (88%). Large skeletal defects, chronic osteomyelitis, and multi-fragmented fractures were present in 65% of cases. Forty-five percent of the patients suffered from peripheral vascular disease, necessitating surgical optimization. Of the 51 MDT decisions, 40 were implemented (78%; (32/40) limb salvage versus 22%; (8/40) limb amputation). Limb salvage was successfully achieved in 91% (29/32) of the cases. Failed limb salvages were due to flap failure (33%; 1/3), recurring periprosthetic joint infections (66%; 2/3) and concomitant reconstructive failure. Patients who underwent limb amputation, as recommended, showed proper stump healing and regained mobility with a prosthesis. Overall the MDT treatment plan was effective in 92.5% (37/40) of the patients, who adhered to the MDT treatment recommendation. In eleven patients (22%; 11/51), the MDT treatment was not implemented. MDT decisions were less likely to be implemented, if amputation was recommended (p = 0.029). CONCLUSIONS: MDT meetings represent a valid tool to formulate individualized treatment plans, avoiding limb amputation in most patients with severe extremity defects. Recommendation for limb amputation is less likely to be implemented than plans for limb salvage. TRIAL REGISTRATION: Retrospectively registered.


Assuntos
Amputação , Relações Interprofissionais , Salvamento de Membro , Equipe de Assistência ao Paciente , Comportamento Cooperativo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
7.
J Surg Oncol ; 123(5): 1328-1335, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33650694

RESUMO

BACKGROUND AND OBJECTIVES: This study compares long-term patient-reported outcomes between patients that underwent limb-salvage surgery with complex reconstruction by free or pedicled flap (LS) or amputation. Additionally, the need for revision surgery is compared. METHODS: A total of 43 patients were studied at a median follow-up of 9.54 years. Sixteen patients completed questionnaires regarding functional outcome and mental wellbeing. Functional outcomes were measured by using the Toronto Extremity Salvage Score (TESS), QuickDASH, and PROMIS Upper Extremity instruments. Mental wellbeing was assessed using the PROMIS Anxiety and Depression instruments. Revision surgery was assessed for the entire follow-up. RESULTS: The median TESS scores were 96.0 versus 71.7 (p = 0.034) and the PROMIS Upper Extremity scores were 50.1 versus 40.3 (p = 0.039) for the LS and amputation cohorts, respectively. No significant difference was found regarding symptoms of anxiety (52.7 vs. 53.8; p = 0.587) or depression (52.0 vs. 50.5; p = 0.745). Of the patients in the LS cohort 51.6% required at least one reoperation compared to 8.33% in the amputation cohort. CONCLUSIONS: LS surgery maintains functional benefits over amputation after almost a decade of follow-up. Still, mental wellbeing seems to be comparable between these patients, whereas LS procedures are associated with a sixfold increased need for reoperations.


Assuntos
Amputação/métodos , Salvamento de Membro/métodos , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Reoperação , Sarcoma/cirurgia , Extremidade Superior/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Sarcoma/patologia , Resultado do Tratamento
8.
Semin Vasc Surg ; 34(1): 38-46, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33757634

RESUMO

Peripheral artery disease (PAD) is the clinical manifestation of atherosclerosis that primarily affects peripheral arteries within the lower extremities. In this brief review, we describe the epidemiology and burden of disease of PAD within the United States, particularly among high-risk populations. Although the prevalence of PAD continues to increase and is typically higher among the elderly as well as men, women in lower socioeconomic strata are affected at rates two times that of men. Among racial/ethnic groups, Black and African-American patients both experience higher rates of disease as well as lower rates of access to preventative care. Moreover, despite an overall decrease in amputation rates among all patients with PAD, high-risk populations remain disproportionally affected. Specifically, patients in rural areas, African-American and Native-American patients, and those of low socioeconomic status carry the highest risk of amputation. Efforts to improve care among PAD patients should target these high-risk populations and offer comprehensive, evidence-based preventative care. Wide adoption and integration of these practices into comprehensive care models may help to mitigate amputation in the highest-risk populations. As our treatment pathways continue to evolve, we must place further emphasis on patient input and quality of life as we work toward continual improvement in the care of patients with PAD.


Assuntos
Doença Arterial Periférica/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Amputação , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/terapia , Prevalência , Fatores Raciais , Medição de Risco , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Estados Unidos/epidemiologia
9.
Semin Vasc Surg ; 34(1): 54-58, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33757636

RESUMO

Dysvascular amputations, defined as those secondary to the complications of peripheral arterial disease or diabetes mellitus, are the most common cause of lower extremity amputations. Despite recent advancements in diabetes mellitus treatments and the many modern innovations in endovascular therapies, the incidence of dysvascular lower extremity amputations has not improved. In this article, we will review the most recent epidemiological data on lower extremity amputations, discuss the latest recommendations from different medical societies for the prevention of limb loss, and explore the role of the vascular surgeon as part of a multidisciplinary team in providing comprehensive care for patients at risk of undergoing amputations for ischemic or diabetic complications. We will also discuss the importance of considering patient perspectives and patient-reported outcomes to better understand the impact of amputations on the patient experience.


Assuntos
Amputação , Salvamento de Membro , Extremidade Inferior/irrigação sanguínea , Assistência Centrada no Paciente , Doença Arterial Periférica/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologia , Procedimentos Cirúrgicos Vasculares
10.
Sultan Qaboos Univ Med J ; 21(1): e116-e119, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33777432

RESUMO

Objectives: This study aimed to discuss the different challenges faced while managing emergency vascular surgery cases during the COVID-19 pandemic and how these challenges were overcome. Methods: This study details 14 emergency cases that were managed during a period of one month from mid-March to mid-April at Sultan Qaboos University Hospital, Muscat, Oman. The cases included acute limb ischaemia, critical limb ischaemia, type B dissection of the thoracic aorta, thoraco-abdominal aneurysm, critical internal carotid artery stenosis, trauma, infected arteriovenous forearm loop graft and thrombosed arteriovenous fistulas. Results: Only one patient was confirmed to have COVID-19. Five were negative for COVID-19 while the remaining eight were not tested. Various strategies on how the vascular surgical team accommodated changes in hospital protocols and nationwide lockdown are discussed in detail. Conclusions: With the judicious use of personal protective equipment and consumable surgical and endovascular devices, communication with support services and other hospitals and implementation of triage protocols, it was possible to manage vascular surgery emergencies effectively.


Assuntos
/diagnóstico , Emergências , Encaminhamento e Consulta , Doenças Vasculares/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/métodos , Aneurisma Dissecante/terapia , Angioplastia/métodos , Aneurisma Aórtico/terapia , Derivação Arteriovenosa Cirúrgica , Estenose das Carótidas/terapia , Gerenciamento Clínico , Embolectomia/métodos , Feminino , Oclusão de Enxerto Vascular/complicações , Oclusão de Enxerto Vascular/terapia , Humanos , Isquemia/terapia , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Omã , Centros de Atenção Terciária , Extremidade Superior
11.
Bone Joint J ; 103-B(3): 430-439, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641410

RESUMO

Upper limb amputations, ranging from transhumeral to partial hand, can be devastating for patients, their families, and society. Modern paradigm shifts have focused on reconstructive options after upper extremity limb loss, rather than considering the amputation an ablative procedure. Surgical advancements such as targeted muscle reinnervation and regenerative peripheral nerve interface, in combination with technological development of modern prosthetics, have expanded options for patients after amputation. In the near future, advances such as osseointegration, implantable myoelectric sensors, and implantable nerve cuffs may become more widely used and may expand the options for prosthetic integration, myoelectric signal detection, and restoration of sensation. This review summarizes the current advancements in surgical techniques and prosthetics for upper limb amputees. Cite this article: Bone Joint J 2021;103-B(3):430-439.


Assuntos
Amputados/reabilitação , Membros Artificiais/tendências , Desenho de Prótese/tendências , Implantação de Prótese/tendências , Extremidade Superior/cirurgia , Amputação , Cotos de Amputação/inervação , Humanos , Osseointegração , Sensação , Extremidade Superior/inervação
12.
Bone Joint J ; 103-B(3): 553-561, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641415

RESUMO

AIMS: The aims of the study were to analyze differences in surgical and oncological outcomes, as well as quality of life (QoL) and function in patients with ankle sarcomas undergoing three forms of surgical treatment, minor or major limb salvage surgery (LSS), or amputation. METHODS: A total of 69 patients with ankle sarcomas, treated between 1981 and 2017 at two tumour centres, were retrospectively reviewed (mean age at surgery: 46.3 years (SD 22.0); 31 females (45%)). Among these 69 patients 25 were analyzed prospectively (mean age at latest follow-up: 61.2 years (SD 20.7); 11 females (44%)), and assessed for mobility using the Prosthetic Limb Users Survey of Mobility (PLUS-M; for amputees only), the Toronto Extremity Salvage Score (TESS), and the University of California, Los Angeles (UCLA) Activity Score. Individual QoL was evaluated in these 25 patients using the five-level EuroQol five-dimension (EQ-5D-5L) and Fragebogen zur Lebenszufriedenheit/Questions on Life Satisfaction (FLZ). RESULTS: Of the total number of patients in the study, 22 (32%) underwent minor LSS and 22 (32%) underwent major LSS; 25 underwent primary amputation (36%). Complications developed in 26 (38%) patients, and were more common in those with major or minor LSS in comparison to amputation (59% vs 36% vs 20%; p = 0.022). A time-dependent trend towards higher complication risk following any LSS was present (relative risk: 0.204; 95% confidence interval (CI) 0.026 to 1.614; p = 0.095). In the prospective cohort, mean TESS was higher following minor LSS in comparison to amputation (91.0 vs 67.3; p = 0.006), while there was no statistically significant difference between major LSS and amputation (81.6 vs 67.3; p = 0.099). There was no difference in mean UCLA (p = 0.334) between the three groups (p = 0.334). None of the items in FLZ or EQ-5D-5L were different between the three groups (all p > 0.05), except for FLZ item "self-relation", being lower in amputees. CONCLUSION: Complications are common following LSS for ankle sarcomas. QoL is comparable between patients with LSS or amputation, despite better mobility scores for patients following minor LSS. We conclude that these results allow a decision for amputation to be made more easily in patients particularly where the principles of oncological surgery would otherwise be at risk. Cite this article: Bone Joint J 2021;103-B(3):553-561.


Assuntos
Amputação , Tornozelo , Salvamento de Membro/métodos , Qualidade de Vida , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Áustria/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia
13.
Vasc Health Risk Manag ; 17: 69-76, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33692625

RESUMO

Purpose: To determine if further endovascular infrapopliteal angioplasty in combination with femoropopliteal revascularization improves the clinical outcomes regarding major amputation rate, rate of secondary interventions, and mortality in diabetic type-II patients presented with critical lower limb ischemia (CLI). Patients and Methods: This is a retrospective study in which all type-II diabetic patients with CLI at King Abdullah University Hospital between October 2015 and September 2019 were identified. Patients with concomitant femoropopliteal and infrapopliteal vessels atherosclerotic lesions (total occlusion or more than 50% stenosis) who received successful endovascular treatment were included. Patients were divided into 2 groups. Group-I included patients treated for femoropopliteal segment alone, while Group-II included patients treated for both femoropopliteal and infrapopliteal segments. The outcomes of the two groups were compared regarding major amputation rate, rate of secondary interventions, and mortality. In addition, demographic data, atherosclerotic lesions distributions and cardiovascular risk factors were also collected and analyzed. Results: In all, 90 patients (65 males and 25 females) with a mean age of 67.5±12 years were included. In Group-I; 44 patients (48.9%) were included (36 males and 8 females) with a mean age of 67±12 years. In group-II; 46 patients (51.1%) were included (29 males and 17 females) with a mean age of 68±13 years. The major amputation rate was higher and statistically significant in Group-I (38.6% vs 17.4%, p-value = 0.034). However, the secondary interventions and the mortality rates showed no statistically significant differences (56.8% vs 39.1%, p-value = 0.139) and (22.7% vs 28.3%, p-value = 0.632), respectively. Conclusion: Endovascular infrapopliteal angioplasty in combination with femoropopliteal revascularization in diabetic type-II patients with CLI improves the clinical outcome regarding major amputation rate. However, there were no significant differences regarding the rate of secondary interventions and the mortality rate.


Assuntos
Diabetes Mellitus Tipo 2 , Angiopatias Diabéticas/terapia , Procedimentos Endovasculares , Artéria Femoral , Isquemia/terapia , Artéria Poplítea , Idoso , Idoso de 80 Anos ou mais , Amputação , Estado Terminal , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/diagnóstico por imagem , Angiopatias Diabéticas/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Jordânia/epidemiologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
J Spec Oper Med ; 21(1): 120-123, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33721320

RESUMO

As a result of the increasing use and application of military tourniquets in civilian settings, it is necessary to evaluate the size and effectiveness of the equipment on patients that differ from the military-aged population for whom the devices have been primarily created. This case report describes the application of a tourniquet on a pediatric patient while also profiling a common situation in which the Combat Application Tourniquet GEN 7 (C-A-T Resources) might be used in civilian care systems. The case is that of a 14-month-old child who suffered a limb amputation secondary to a road accident in Italy and the ensuing life-saving treatment. The intervening nurse at the scene had been trained on the use of hemorrhage-control devices through the American College of Surgeons "Stop the Bleed" campaign.


Assuntos
Militares , Torniquetes , Idoso , Amputação , Criança , Hemorragia/terapia , Humanos , Lactente , Itália
15.
Saudi Med J ; 42(2): 166-169, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33563735

RESUMO

OBJECTIVES: To avoid hospital spread of Coronavirus-2019 (COVID-19) and to analyze out of hospital outcomes after amputation. METHODS: Prospective analysis of data obtained from 60 diabetic patients in 2020 was performed at Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina. Personal protection equipment included double surgical mask, glasses, disposable surgical coats, and surgical masks for patients. Swabs were used to take samples from wounds. We randomly divided patients in 2 groups of 30 patients each. In pre-operative treatment, we used local anesthesia lidocaine hydrochloride 2% (Belupo, Koprivnica, Croatia) in group A and systemic analgesia intravenous tramadol chloride 100 mg intravenous (Krka, Novo Mesto, Slovenia) in group B. Wounds were surgically treated each day and heal spontaneously. Periodical control exams were performed. RESULTS: Wound healing did not present any statistically significant differences between groups (group A: 69±21.97 and B: 61±22.13 days, t=-1.22; p=0.11). No statistically significant differences (p<0.05) between groups A and B in wound healing regarding to gender or cigarette use was noted. CONCLUSION: No significant differences in amputation treatment between the 2 comparative groups were noted. No confirmed COVID-19 infections in medical staff who performed surgical interventions or in treated patients were detected.


Assuntos
Amputação , Pé Diabético/cirurgia , Controle de Infecções/métodos , Assistência Perioperatória/métodos , Bósnia e Herzegóvina/epidemiologia , /epidemiologia , Pé Diabético/complicações , Feminino , Humanos , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Masculino , Pandemias , Equipamento de Proteção Individual , Estudos Prospectivos , Resultado do Tratamento , Cicatrização
16.
Medicine (Baltimore) ; 100(7): e24791, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607836

RESUMO

RATIONALE: Despite significant advances in surgical techniques and implants, the clinical outcome of high-energy pilon fractures remains unsatisfactory, which continues to represent numerous challenges for orthopedic trauma surgeons. PATIENT CONCERNS: A 62-year-old man injured his right ankle after falling from a 3 m high place. There were no open wounds or other complications. DIAGNOSES: According to the X-ray and CT scans, the patient was diagnosed with pilon fracture (type AO-43-C2) and lateral malleolus fracture of the right limb. INTERVENTIONS: The patient was initially treated with calcaneal traction upon admission to a primary hospital. Five days after the injury, the patient underwent open reduction and internal fixation (ORIF) of the fracture and vacuum sealing drainage (VSD) for wound closure. OUTCOMES: The patient presented to our hospital on the 9th day after the first ORIF operation because of critical ischemia of the affected foot and distal lower leg. Blood circulation did not improve after a series of salvage treatments, and below-knee amputation was ultimately performed. LESSONS: This is a rare case of complete ischemic necrosis following ORIF surgery of a closed pilon fracture due to iatrogenic damage. Standardized treatment that strictly follows the guidelines, instructions, or expert consensus should be promoted in this kind of complicated pilon fracture.


Assuntos
Amputação/métodos , Fraturas do Tornozelo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Redução Aberta/efeitos adversos , Fraturas da Tíbia/cirurgia , Angiografia Digital , Fraturas do Tornozelo/complicações , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/etiologia , Fraturas da Tíbia/complicações , Lesões do Sistema Vascular/etiologia
17.
BMC Infect Dis ; 21(1): 231, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639872

RESUMO

BACKGROUND: Capnocytophaga canimorsus is a Gram-negative capnophilic rod and part of dogs/cats' normal oral flora. It can be transmitted by bites, scratches, or even by contact of saliva with injured skin. Asplenic patients and patients with alcohol abuse are at particular risk for fulminant C. canimorsus sepsis. However, also immunocompetent patients can have a severe or even fatal infection. This is the first case of a severe C. canimorsus infection in an immunocompromised host complicated by acute renal cortical necrosis with a "reverse rim sign" in contrast-enhanced computed tomography on hospital admission. CASE PRESENTATION: We report the case of a 44-year functionally asplenic patient after an allogeneic stem cell transplantation, who presented with septic shock after a minor dog bite injury 4 days prior. Because of abdominal complaints, epigastric pain with local peritonism, and radiological gallbladder wall thickening, an abdominal focus was suspected after the initial work-up. The patient underwent emergent open cholecystectomy, but the clinical suspicion of abdominal infection was not confirmed. Septic shock was further complicated by cardiomyopathy and disseminated intravascular coagulation. As a causative pathogen, C. canimorsus could be isolated. The clinical course was complicated by permanent hemodialysis and extensive acral necrosis requiring amputation of several fingers and both thighs. CONCLUSION: We present a severe case of a C. canimorsus infection in a functionally asplenic patient after a minor dog bite. The clinical course was complicated by septic shock, disseminated intravascular coagulation, and the need for multiple amputations. In addition, the rare form of acute renal failure - bilateral acute renal cortical necrosis - was visible as "reverse rim sign" on computed tomography scan. This case is an example of the potential disastrous consequences when omitting pre-emptive antibiotic therapy in wounds inflicted by cats and dogs, particularly in asplenic patients.


Assuntos
Mordeduras e Picadas/complicações , Mordeduras e Picadas/microbiologia , Capnocytophaga , Infecções por Bactérias Gram-Negativas/complicações , Necrose do Córtex Renal/microbiologia , Adulto , Amputação , Animais , Antibacterianos/uso terapêutico , Mordeduras e Picadas/terapia , Capnocytophaga/isolamento & purificação , Capnocytophaga/patogenicidade , Coagulação Intravascular Disseminada/microbiologia , Coagulação Intravascular Disseminada/patologia , Coagulação Intravascular Disseminada/terapia , Cães , Feminino , Infecções por Bactérias Gram-Negativas/patologia , Infecções por Bactérias Gram-Negativas/terapia , Humanos , Hospedeiro Imunocomprometido , Infecções Intra-Abdominais/etiologia , Infecções Intra-Abdominais/microbiologia , Infecções Intra-Abdominais/terapia , Necrose do Córtex Renal/etiologia , Necrose do Córtex Renal/terapia , Choque Séptico/microbiologia , Choque Séptico/terapia , Suíça
18.
Medicine (Baltimore) ; 100(3): e24364, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546072

RESUMO

ABSTRACT: Lower limb amputation (LLA) is still a health issue requiring rehabilitation and long-term care even in industrial societies. Several studies on subjects with LLA have been focused on the efficacy of rehabilitation and factors influencing the use of prosthesis. However, literature data on the recovery of ability to walk outdoors, and thus to participate in social life in this population is limited.To investigate potential correlations between socio-demographic and clinical factors, and the use of the prosthesis for indoor and/or outdoor walking referred to as community ambulation (CA) in subjects with LLA.An observational cohort study on 687 LLA subjects was conducted. Socio-demographic and clinical characteristics of 302 subjects who received similar rehabilitative treatment with respect to the standard protocol were collected by a telephone survey with a structured questionnaire. The CA recovery, in terms of patient's autonomy and participation, assessed by Walking Handicap Scale, was considered as the main outcome.The univariate analysis demonstrated statistical significant positive correlation between CA and gender (χ2 = 3.901, P = .048); amputation level (χ2 = 24.657, P < .001); pre-LLA (χ2 = 6.338, P = .012) and current work activity (χ2 = 25.192, P < .001); prosthesis use (χ2 = 187.037, P < .01); and time from LLA (r = 0.183, P < .001); increasing age was negatively correlated with the outcome (r = -0.329, P < .001), while pain intensity was not significant. Being male (75.4%); trans-tibial (TT) amputation level (9.79%); working before (3.81%) and after LLA (7.68%); and the prosthesis use (24.63%) increased the probability of CA recovery. Multivariate binary logistic regression analysis confirmed that the prosthesis use (P < .001) and TT amputation level (P = .042) are predictors of a positive outcome (Walking Handicap Scale 4-6).These findings highlight the importance of the use of prosthesis in people with LLA for the restoration of a good capacity of participation (CA), especially in subjects with TT amputation level. The identification of predictive factors may help tailor-made rehabilitation approaches addressing an earlier reintegration to social life.


Assuntos
Amputação/reabilitação , Extremidade Inferior/lesões , Caminhada/fisiologia , Idoso , Amputação/métodos , Amputados/reabilitação , Estudos de Coortes , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Saúde Pública
19.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563693

RESUMO

A 54 year-old man was admitted after being found on the floor of his home, thought to have been there for approximately 5 days. He was diagnosed with a non-ST elevation myocardial infarction and bilateral cerebral ischaemic infarcts, as well as an acute kidney injury driven by rhabdomyolysis. The following day, bilateral lower limb ischaemia was observed. A full body CT angiogram revealed a complete thromboembolic shower with bilateral arterial occlusion in the lower limbs, bilateral pulmonary emboli, a splenic infarct and mesenteric ischaemia. An echocardiogram revealed a large thrombus in the left ventricle as the likely thromboembolic source. Bilateral lower limb amputations were recommended, commencing a complex discussion regarding the best course of management for this patient. The discussion was multifaceted, owing to the patient's lack of capacity, and input from multiple teams and the patient's relatives was required. Both ethical and clinical challenges arise from this case of a thromboembolic shower.


Assuntos
Tromboembolia/diagnóstico por imagem , Tromboembolia/terapia , Amputação , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/terapia , Biomarcadores/sangue , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/terapia , Angiografia por Tomografia Computadorizada , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/terapia , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/terapia , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/terapia , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/terapia
20.
Science ; 371(6530): 678-679, 2021 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-33574201

Assuntos
Amputação
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