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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(11): 1380-1383, 2021 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-34779162

RESUMO

Objective: To analyze the characteristics of patients with secondary lower limb deformity of spina bifida based on the QIN Sihe Orthopedic Surgery Case Data, and provide the references for clinical research, diagnosis, and treatment. Methods: A clinical data of 1 012 patients with secondary lower limb deformity of spina bifida between October 12, 1986 and December 31, 2020 selected from QIN Sihe Orthopedic Surgery Case Data was retrospectively analyzed. Among them, 231 cases (22.83%) had undergone orthopedic surgery for lower extremity deformities in other hospitals. The gender, age at surgery, indicators related to spina bifida (deformity side, comorbidity, sensory disturbance level), and information related to surgery (operating time, surgical site, postoperative fixation method) were analyzed. Results: Of the 1012 patients, 457 were males and 555 were females. The age was 3-51 years at the time of surgery, with a median of 18.0 years; among them, the 15-30 years old group had the most patients, accounting for 53.16%. Most deformities involved both lower limbs (652 cases, 64.43%). There were 111 cases of ulcers in the weight-bearing area of the foot, 265 cases of gatism, 554 cases of sensory disturbance, and 85 cases of abnormal hair on the waist. From 2010 to 2019, there were significantly more patients undergoing surgery than before 2010, reaching 61.17%. Sensory disturbances mostly occurred in the ankle and foot. A total of 1 149 sites were treated with surgery, of which the most ankle joint deformities were corrected by surgery, accounting for 84.33%. The main fixation methods after orthopedic surgery were external fixation, including Ilizarov external fixation (442 cases), combined external fixation (315 cases), and plaster fixation (189 cases). Conclusion: Spina bifida can be secondary to severe deformities of the lower limbs, mainly in the ankles. Common complications include ulcers in the weight-bearing area, dysfunction of urine and feces, and sensory disturbances; external fixation is the main method of fixation after surgery.


Assuntos
Ortopedia , Disrafismo Espinal , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Fixação de Fratura , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Disrafismo Espinal/complicações , Disrafismo Espinal/cirurgia , Adulto Jovem
2.
J Coll Physicians Surg Pak ; 31(12): 1455-1458, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34794287

RESUMO

OBJECTIVE: To evaluate the effect of obesity on percutaneous thrombectomy (PT) results for the management of lower limb deep vein thrombosis (DVT). STUDY DESIGN: Retrospective cohort study. PLACE AND DURATION OF STUDY: Department of Cardiology, Avcilar Hospital, Istanbul, Turkey, between August 2020 and January 2021. METHODOLOGY: Patients who underwent PT for lower limb DVT were included. Patients' demographic characteristics, operative parameters, and postoperative outcomes were recorded in prospective manner. Patients were divided into two groups, as patients with body mass index (BMI) <30 kg/m2 (Group 1) and patients with BMI ≥30 kg/m2 (Group 2). The two groups were compared according to patient demographic properties, intraoperative results, and postoperative outcomes. RESULTS: Eventually, 62 patients were enrolled into the non-obese group and 30 patients had BMI ≥30 Kg/m2. Comparison of the groups demonstrated that the mean operation time and the mean fluoroscopy time were significantly higher in obese patients (121.5 min vs. 134.5, p = 0.017 and 19.8 min vs. 25.9 min, p = 0.006, respectively). In addition, the mean hospitalisation period and the mean ICU stay were significantly longer in patients with ≥30 kg/m2 (p = 0.025 and p = 0.007). Postoperative visual analog scale (VAS) score in the first hour was significantly higher in obese patients (2.4 vs. 3.0, p = 0.008). The presence of obesity did not have a significant effect on success and complication rates following PT (p = 0.368 and p = 0.646). CONCLUSION: Obesity prolonged operation time and fluoroscopy time during PT. Additionally, obesity was associated with significantly longer hospitalisation period, and ICU stay, and higher VAS score in the first hour following PT. Key Words: Complication, Deep vein thrombosis, Obesity, Percutaneous thrombectomy, Success, VAS score.


Assuntos
Trombose Venosa , Humanos , Extremidade Inferior/cirurgia , Obesidade/complicações , Estudos Prospectivos , Estudos Retrospectivos , Trombectomia , Resultado do Tratamento
3.
BMJ Case Rep ; 14(11)2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34725062

RESUMO

Substernal goitre is characterised by compressive symptoms of the airway and oesophagus. Chronic, progressive symptoms usually result in surgical removal. We report a rare presentation of substernal goitre in a male in his early 70s who suffered from severe bilateral lower extremity (LE) lymphoedema, resulting in immobility and nursing home placement, and left upper extremity lymphoedema. Our initial assessment led to a filariasis work-up, which was negative, due to the patient's prior 2-year residence in India and service overseas. Chest CT scan revealed an incidental substernal goitre extending posterior to the left innominate vein and aortic arch to the level of the left mainstem bronchus. The patient underwent a left hemithyroidectomy via cervical excision and sternotomy and had an uneventful recovery with resolution of lymphoedema and mobility. Despite extensive literature regarding clinical presentations of substernal goitre, severe lymphoedema of the LE is not a well-established association.


Assuntos
Bócio Subesternal , Edema/etiologia , Bócio Subesternal/complicações , Bócio Subesternal/diagnóstico por imagem , Bócio Subesternal/cirurgia , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Masculino , Estudos Retrospectivos , Tireoidectomia
4.
Ann Dermatol Venereol ; 148(4): 241-245, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34756482

RESUMO

BACKGROUND: Skin tumors commonly occur on the legs and are treated in first line by surgery. Several techniques are available to repair lower limb defects: secondary-intention healing, partial closure, primary closure with or without an s-plasty, or a skin graft. The lack of tissue laxity of the surrounding skin does not allow several local flaps (advancement, rotation, or transposition). Closing large skin defects at this site may be challenging. PATIENTS AND METHODS: We retrospectively reviewed a series of consecutive patients undergoing malignant tumor wide excision on lower limbs, with a keystone flap or its simplified technique (releasing incision) for closure of a skin defect. RESULTS: Twenty-five patients, 17 women and 8 men, ranging from 19 to 95 years old (mean age: 70 years) were included. Keystone flap reconstruction on the lower limbs was performed in 19 cases and the simplified technique in 6. The excised tumors were as follows: squamous cell carcinoma (n=6), basal cell carcinoma (n=9), melanoma (n=9) and Bowen's disease (n=1). Three local complications were observed. No cases of recurrence were observed. CONCLUSION: Keystone flap is a reliable surgical method for reconstruction of lower limb skin defects. Aesthetic results are better than when a skin graft is used, complications are uncommon, and prolonged operative time is avoided.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Adulto Jovem
5.
Rev Assoc Med Bras (1992) ; 67(7): 985-990, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34817511

RESUMO

OBJECTIVE: The aim of this study was to investigate the levels of physical activity (PA) and quality of life (QOL) in adults and elderly individuals with lower limb amputation (LLA). METHODS: This was a cross-sectional observational study. Participants completed three surveys as follows: a demographic survey, the International Physical Activity Questionnaire, and the World Health Organization Quality of Life. Thirty-six individuals with lower limb amputation were separated into two different groups as follows: Adults-lower limb amputation (n=12), composed of individuals with lower limb amputation who aged from 18-59 years, and Elderly-lower limb amputation (n=24), composed of individuals with lower limb amputation who aged 60 years and above. Statistical differences were determined as p<0.05. RESULTS: Age and number of individuals with a low level of functional independency were higher in the Elderly-lower limb amputation group (p<0.05). The International Physical Activity Questionnaire scores were reduced in the Elderly-lower limb amputation group (p<0.05). The Pearson's correlation test between low metabolic equivalent task (MET), time since amputation, and family income presented positive significant results in the Elderly-lower limb amputation (p<0.05). Adults-lower limb amputation just presents a positive significant correlation with the low family income (p<0.05). CONCLUSION: Elderly individuals with lower limb amputation are more susceptible to present negative health outcomes than adults with lower limb amputation.


Assuntos
Extremidade Inferior , Qualidade de Vida , Adulto , Idoso , Amputação , Estudos Transversais , Exercício Físico , Humanos , Extremidade Inferior/cirurgia
6.
West Afr J Med ; 38(9): 866-870, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34677040

RESUMO

BACKGROUND: Diabetic foot ulcer is an associated and an increasing problem among individuals with diabetes. The aim of the present study was to evaluate the risk factors for amputation in patients with diabetic foot ulcer as well as common causes of increasing mortality in these patients. METHODS: The design was an observational prospective study carried out between July 2015 and June 2018. The Demographic data of all patients with diabetic foot ulcer seen at Lagos University Teaching Hospital and Nigerian Navy Reference Hospital Lagos with their clinical signs and symptoms as well as basic laboratory results were documented. The ankle brachial index (ABI), history of neuropathy, nephropathy and the relationship between these and lower limb amputation and mortality were collected and analyzed. RESULTS: There were 539 patients with diabetic foot ulcer seen during the 3-year period. The mean age was 62 + 13.7. There was male preponderance with a ratio of 1.7:1. Patient with amputation more often had ABI <0.9. Male sex is a risk factor for amputation. Over 40.5% of the patients had grade I ulcer, 19.5% had grade II, while 22.3%, 12.3% and 5.4% had grade III, IV and V respectively. Amputations were performed in 144(26.7%) patients (48 minor, 96 major). Compared with patients without amputation, patients with amputation differed significantly concerning diabetes and its complications. Mortality rate was 11.8%.


Assuntos
Diabetes Mellitus , Pé Diabético , Idoso , Amputação , Pé Diabético/epidemiologia , Pé Diabético/cirurgia , Feminino , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Nigéria , Estudos Prospectivos , Fatores de Risco
7.
BMJ Open ; 11(10): e053599, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34615685

RESUMO

OBJECTIVE: Estimate the prevalence/incidence/number of major lower extremity amputations (MLEAs) in the UK; identify sources of routinely collected electronic health data used; assess time trends and regional variation; and identify reasons for variation in reported incidence/prevalence of MLEA. DESIGN: Systematic review and narrative synthesis. DATA SOURCES: Medline, Embase, EMcare, CINAHL, The Cochrane Library, AMED, Scopus and grey literature sources searched from 1 January 2009 to 1 August 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Reports that provided population-based statistics, used routinely collected electronic health data, gave a measure of MLEA in adults in the general population or those with diabetes in the UK or constituent countries were included. DATA EXTRACTION AND SYNTHESIS: Data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Instruments were performed by two reviewers independently. Due to considerable differences in study populations and methodology, data pooling was not possible; data were tabulated and narratively synthesised, and study differences were discussed. RESULTS: Twenty-seven reports were included. Incidence proportion for the general population ranged from 8.2 to 51.1 per 100 000 and from 70 to 291 per 100 000 for the population with diabetes. Evidence for trends over time was mixed, but there was no evidence of increasing incidence. Reports consistently found regional variation in England with incidence higher in the north. No studies reported prevalence. Differences in database use, MLEA definition, calculation methods and multiple procedure inclusion which, together with identified inaccuracies, may account for the variation in incidence. CONCLUSIONS: UK incidence and trends in MLEA remain unclear; estimates vary widely due to differences in methodology and inaccuracies. Reasons for regional variation also remain unexplained and prevalence uninvestigated. International consensus on the definition of MLEA and medical code list is needed. Future research should recommend standards for the reporting of such outcomes and investigate further the potential to use primary care data in MLEA epidemiology. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020165592.


Assuntos
Amputação , Extremidade Inferior , Adulto , Humanos , Incidência , Extremidade Inferior/cirurgia , Prevalência , Reino Unido/epidemiologia
8.
Microsurgery ; 41(8): 716-725, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34609025

RESUMO

BACKGROUND: Primary defatting is suggested as an effective and appealing technique for achieving flap thinning. There has been a long-standing concern regarding its potential adverse effects on flap perfusion, for which limited clinical evidence exists. This study aimed to investigate whether primary defatting negatively influences the outcomes of free perforator flap reconstruction. METHODS: Patients who underwent upper or lower extremity reconstruction using free perforator flaps between 2002 and 2020 were investigated. They were categorized into two groups according to whether they underwent primary defatting. The association of primary defatting with the development of perfusion-related complications was evaluated. RESULTS: A total of 421 patients were included in the analysis. Perfusion-related complications developed in 61 (14.5%) cases, including 12 cases (2.9%) of total flap loss. In total, 302 patients underwent primary defatting and 119 did not. The patients who underwent primary defatting had a higher body mass index (BMI), lower rate of comorbidities, and smaller harvested flaps than the controls. Both groups had similar rates of perfusion-related complications (13.9% vs. 16.0%, p = .589), including total flap loss (3.0% vs. 2.5%, p = .799). In the multivariate analyses, primary defatting was not associated with the development of perfusion-related complications (p = .957). In the subgroup analyses, the rate of perfusion-related complications did not differ between the two groups regardless of the BMI (≥25 or <25 kg/m2 ), comorbidities, and flap size (≥200, 100-200, or <100 cm2 ). CONCLUSIONS: Primary defatting does not appear to be associated with the development of perfusion-related complications in free perforator flap extremity reconstruction.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Extremidade Inferior/cirurgia , Perfusão , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
9.
Microsurgery ; 41(8): 734-742, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34636068

RESUMO

BACKGROUND: With severe vascular calcifications, vascular clamp application and utilizing the vessel for free flap recipient vessel becomes impossible. These obstacles can be overcome with the Fogarty catheter and vein graft. PATIENTS AND METHODS: When unclampable artery was encountered intraoperatively, a vein graft was used to make a clampable recipient site for six diabetic foot patients (ages from 42 to 80). The end of the Fogarty catheter was inserted into the proximal end of the vein graft and the transected calcified vessel in sequence, and the balloon of the catheter was used as an intraluminal tourniquet. The remaining end of the vein graft was connected to the distal vessel with a vascular clamp. RESULTS: Five short vein graft revascularization for segmental arterial occlusion, one long vein graft for recipient artery elongation was done (lengths from 2 to 13.8 cm). Three delayed, and two immediate anterolateral thigh flaps (sizes from 15 to 150 cm2 ) were performed, and one patient received vein graft revascularization surgery only. Postoperative vascular sonography of all six patients showed well-maintained patency. Minor flap marginal disruption occurred at two patients but healed with conservative care. Postoperative follow-up was done for 1-18 months (average 7.17). Limb salvage was achieved for five patients and all five free flaps survived. However, for one patient, arterial restenosis at popliteal artery a month later lead to major amputation. CONCLUSION: Using a Fogarty catheter and a vein graft may obtain perfect hemostasis during micro-anastomosis and achieve successful microvascular reconstruction in patients with severely calcified vessels.


Assuntos
Retalhos de Tecido Biológico , Salvamento de Membro , Cateteres , Humanos , Extremidade Inferior/cirurgia , Artéria Poplítea/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
10.
Angiol Sosud Khir ; 27(3): 173-179, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528603

RESUMO

The article is a review of literature dedicated to simultaneous open and endovascular (hybrid) operations in treatment of patients with chronic ischaemia of lower limbs. Despite good results of endovascular interventions, in many situations involvement of arteries below the inguinal fold and multilevel lesions are arguments in favour of performing an open operation. On the other hand, open multilevel interventions are accompanied by an increased risk of complications and mortality. Hybrid interventions appear to be a safe and efficient alternative combining advantages of two methods of treatment and making it possible to achieve an optimal outcome with a minimal surgical wound. Also discussed herein are the problems of terminology, indications for, techniques and results of treatment, providing a historical background, followed by analysing problem spots of using this technique and trends of development.


Assuntos
Isquemia , Extremidade Inferior , Artérias , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Salvamento de Membro , Extremidade Inferior/cirurgia , Resultado do Tratamento
11.
J Int Med Res ; 49(9): 3000605211045230, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34530632

RESUMO

The number of patients with heart failure with reduced ejection fraction (HFrEF) is increasing. These patients have a reduced cardiorespiratory reserve. Therefore, preoperative evaluation is essential to determine the best type of anaesthesia to use in patients with HFrEF. A 70-year-old man with HFrEF was scheduled to undergo debridement of skin necrosis due to thrombotic occlusion of the right common iliac artery. He had undergone wound dressing changes under local anaesthesia every other day for several months, and treatment for heart failure was on-going. A sciatic nerve and fascia iliaca compartment block was performed under ultrasound guidance because of the patient's cardiopulmonary function. After confirming adequate sensory blockage, surgery was performed without any haemodynamic instability or complications. Thereafter, debridement was performed twice more using the same block technique, and a skin autograft was also successfully performed. We successfully performed an ultrasound-guided sciatic nerve and fascia iliaca compartment block in a patient with HFrEF who was scheduled to undergo lower limb surgery. Peripheral nerve block is an alternative option for patients with HFrEF.


Assuntos
Insuficiência Cardíaca , Bloqueio Nervoso , Idoso , Anestésicos Locais , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/cirurgia , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Masculino , Nervo Isquiático , Volume Sistólico , Ultrassonografia de Intervenção
12.
Georgian Med News ; (316-317): 10-16, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34511436

RESUMO

Aim - analyze the results of surgical treatment of patients with diabetes mellitus (DM) with chronic critical lower limb ischemia (CCLLI) against the background of the combined stenotic-occlusive lesions (SOL) of the femoral arterial segment (FAS) and popliteo-tibial arterial segment (PTAS), considering the data of the intraoperative debitometry (ID). The results of surgical treatment of 97 patients with diabetes mellitus with CCLLI caused by combined SOL of FAS and PTAS arteries after 1 month and 12 months of treatment were analyzed. All patients were treated at the Vascular Surgery Center of the Clinical Hospital "Feofania" of State Directorate for Affairs, Kiev, Ukraine during 2014 - 2018yrs. All patients underwent femoro-popliteal bypass grafting without intervention on arteries of PTAS.According to the obtained results of the ID, the patients were divided into groups: group 1 - 32 patients with a debit of the shunt (SD) greater than 60 ml/min, group 2 - 35 patients with SD 30-60 ml/min, group 3 - 30 patients with SD lesser than 30 ml/min. In case of the femoro-popliteal shunt (FPS) thrombosis, performed repeated surgery as a hybrid revascularization (HR) - thrombectomy from the shunt and endovascular balloon angioplasty of the arteries of PTAS. The primary patency of the arterial reconstruction zone of the patients from group 1 after 1 month was 93.75% (30 of 32), after 12 months - 78.13% (25 of 32); group 2 - after 1 month it was 82.8% (29 out of 35), after 12 months - 68.57% (24 out of 35); group 3 - after 1 month it was 46.66% (14 out of 30), after 12 months - 23.33% (7 out of 30). Thrombosis of the femoropopliteal shunt (FPS) within 12 months was diagnosed in 41 (42.27%) of 97 patients, within these patients 1 month after primary shunting in 26 (63.41%), and during the next 11 months in 15 (36.59 %)cases.With repeated intervention on thrombosis ofFPSin form ofHR, secondary patency within 12 months was 78.05% (32 of 41 patients).Restoration of the outflow from the popliteal artery in one of the tibial arteries by HR was possible in 28 of 41 (68.29%) patients, within 12 months rethrombosis of the arterial reconstruction zone occurred in 8 patients (28.57%) - with secondary patency after 12 months of 71.43% (20 of 28 patients). The restoration of the outflow from the popliteal artery into two tibial arteries by HR was possible in 13 of 41 (31.71%) patients, from them rethrombosis of the FPS within 12 months occurred in 1 patient (7.69%) - the secondary patency within 12 months was 92.31% (12 of 13 patients). In the case of combined SOL of FAS and arteries of PTAS, reconstruction of FAS without intervention on the arteries of PTAS requires performing of ID with determining of SD. Performing of ID with determining of SD is an effective diagnostic technique that allows to formulate a differentiated approach to the tactics of surgical treatment of patients with diabetes mellitus with CCLLI, caused by the SOL of FAS and PTAS. The indicator which allows to restore the patency of FAS without intervention on the arteries of the PTAS is SD>60 ml/min; with SD 30-60 ml/min, the reconstruction of the arteries of the PTAS after the restoration of the patency of FAS can be delayed and performed as elective surgery at the second stage; with SD<30 ml/min, simultaneous reconstruction of FAS and PTAS arteries is required by performing HR or two-stage open arterial reconstruction. The HR is an effective method of blood circulation restoration in patients with diabetes mellitus with CCLLI, caused by a combined SOL of FAS and PTAS, and according to the results: the patency of the FPS within 12 months is 78.05% and does not significantly differ from the results of FAS reconstruction in 1st group of patients with SD>60 ml/min - where patency of the FPS within 12 months is 78.13% (p>0.05). In case of thrombosis of the FPS, thrombectomy from the shunt, supplemented by the restoration of the magistral blood flow from the popliteal artery into two tibial arteriesby the method of balloon angioplasty, demonstrates reliably better secondary patency of the femoropopliteal shunt after 12 months - 92.31% in comparison with the secondary patency of the FPS within 12 months after restoration of the magistral blood flow from the popliteal artery into one tibial artery - 71.43% (p<0.05).


Assuntos
Diabetes Mellitus , Artéria Poplítea , Humanos , Isquemia/cirurgia , Extremidade Inferior/cirurgia , Artéria Poplítea/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
13.
S Afr J Surg ; 59(3): 128a-128g, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34515432

RESUMO

BACKGROUND: Lower extremity amputations (LEAs) are most frequently due to diabetes mellitus (DM), a disease on the rise. The objective of this study was to determine the prevalence and aetiology of LEAs at Addington Hospital from 2013 to 2017 and to explore the physiotherapy referral practices and outcomes. METHODS: Retrospective study carried out at Addington Hospital, Durban. Patients who underwent LEAs were filtered from theatre registers and the hospital Meditech database. Data collected included patients' demographic profile, diabetic status, level of amputation, limb orientation, physiotherapy referral status, and rehabilitation outcomes. Physiotherapy files were scanned for the attendance of referred patients. Study endpoints were prevalence, diabetes status, referral status, compliance and rehabilitation outcomes. RESULTS: From 2013 to 2017, 1 028 LEAs in 843 patients were identified with single amputations (697) and multiple amputations (146). The median age was 61 (IQR 52-68) years, and the M:F ratio was 1.3:1. A total of 574 (68.1%) patients had DM. Seven hundred and thirty-eight (71.8%) amputations were as a result of DM. The level of amputations was below-knee (479; 46.6%), toectomy (236; 23%), above-knee (196; 19%) and trans-metatarsal (117; 11.4%). Only 148 patients (17.6%) were referred for physiotherapy, of which 91 (61.5%) attended. Mobility in those who attended rehabilitation was with a walking frame (51; 56%), crutches (29; 31.9%), prosthesis and crutches (7; 7.7%), and wheelchair-bound (4; 4.4%). CONCLUSION: Over half the amputations were associated with DM, which was also a risk factor for multiple amputations. Although referral and attendance for physiotherapy were very poor, mobility in those who attended was excellent, indicating a dire need to improve hospital referral pathways.


Assuntos
Amputação , Diabetes Mellitus , Hospitais , Humanos , Extremidade Inferior/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , África do Sul
14.
Spine (Phila Pa 1976) ; 46(20): 1363-1369, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34559748

RESUMO

STUDY DESIGN: Two fresh-frozen and six formalin-fixed cadavers were included in the study. OBJECTIVE: To ascertain whether transferring T9 or T11 ventral root (VR) to L2 VR and T10 or T12 VR to L3 VR in restoring lower limb function after spinal cord injury is anatomically feasible. SUMMARY OF BACKGROUND DATA: Lower limb paralysis impairs the quality of the life and places burden on the whole society. However, no significant improvement in this area was achieved during recent years. METHODS: In the present study, two fresh-frozen and six formalin-fixed cadavers were dissected to confirm the anatomical feasibility. A limited laminectomy was performed to expose the T9-L3 extradural nerve roots. T9 and T10 VR were anastomosed to L2 and L3 VR respectively, or T11 and T12 VR were anastomosed to L2 and L3 VR respectively. The pertinent distances between the donor and recipient nerves were measured and H&E staining was used to detect the axon number and cross-section area of each VR. RESULTS: The limited incision was performed to expose the T9-L3 nerve root. According to the anatomic landmark of dorsal root ganglion, each VR could be isolated from each extradural nerve root. The T9 or T11 VR needs sural nerve graft to be transferred to L2 VR, and T10 or T12 VR also needs a nerve bridge to connect to L3 VR. The nerve numbers of T9, T10, T11, T12, L2, and L3 VRs and the sural nerves were measured respectively. The cross-section areas of T9, T10, T11, T12, L2, and L3 VRs and sural nerves were measured respectively. CONCLUSION: Our study suggested that application of transferring T9 or T11 VR to L2 VR and T10 or T12 VR to L3 VR in restoring lower limb function is anatomically feasible.Level of Evidence: 5.


Assuntos
Traumatismos da Medula Espinal , Cadáver , Estudos de Viabilidade , Humanos , Extremidade Inferior/cirurgia , Raízes Nervosas Espinhais/cirurgia
15.
BMC Musculoskelet Disord ; 22(1): 798, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530793

RESUMO

BACKGROUND: We assessed predictive factors of patients with fractures of the lower extremities caused by trauma. We examined which factors are associated with an increased risk of failure. Furthermore, the predictive factors were set into context with other long-term outcomes, concrete pain and physical functioning. METHODS: We performed a prospective cohort study at a single level I trauma center. We enrolled patients with traumatic fractures of the lower extremities treated with internal fixation from April 2017 to July 2018. We evaluated the following predictive factors: age, gender, diabetes, smoking status, obesity, open fractures and peripheral arterial diseases. The primary outcome was time to failure (nonunion, implant failure or reposition). Secondary outcomes were pain and physical functioning measured 6 months after initial surgery. For the analysis of the primary outcome, we used a stratified (according fracture location) Cox proportional hazard regression model. RESULTS: We included 204 patients. Overall, we observed failure in 33 patients (16.2 %). Most of the failures occurred within the first 3 months. Obesity and open fractures were associated with an increased risk of failure and decreased physical functioning. None of the predictors showed an association with pain. Age, female gender and smoking of more than ≥ 10 package years increased failure risk numerically but statistical uncertainty was high. CONCLUSIONS: We found that obesity and open fractures were strongly associated with an increased risk of failure. These predictors seem promising candidates to be included in a risk prediction model and can be considered as a good start for clinical decision making across different types of fractures at the lower limbs. However, large heterogeneity regarding the other analyzed predictors suggests that "simple" models might not be adequate for a precise personalized risk estimation and that computer-based models incorporating a variety of detailed information (e.g. pattern of injury, x-ray and clinical data) and their interrelation may be required to significantly increase prediction precision. TRIAL REGISTRATION: NCT03091114 .


Assuntos
Fixação Interna de Fraturas , Fraturas Expostas , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Extremidade Inferior/cirurgia , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
16.
J Pak Med Assoc ; 71(9): 2163-2166, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34580507

RESUMO

OBJECTIVE: To assess the risk factors for lower limb amputations in diabetic patients presenting with foot ulcers. Methods: The analytical cross-sectional study was conducted at the Mayo Hospital, Lahore, Pakistan, from December 1, 2019, to May 31, 2020, and comprised patients of either gender having type 1 or type 2 diabetes and foot ulcers. The wounds were assessed according to Wagner wound staging and wound sepsis was evaluated in terms of local infection of the wound, leucocytosis and osteomyelitis of the bone. The glycaemic control of these patients was assessed on presentation by measuring glycated haemoglobin levels. Data was analysed using SPSS 26. RESULTS: Of the 135 patients, 82(60.7%) were males and 53(39.2%) were females. Majority patients 59(43.7%) were aged 50-60 years. All 135(100%) patients underwent some type of amputation. Of all the amputations, 91(67.4%) were done in patients with poor glycaemic control on presentation, and 56(41.5%) in those with stage 4 wound. Local wound infection, increased total leukocyte count and bone showing features of osteomyelitis were significantly associated with increased risk of lower extremity amputations (p<0.05). Conclusion: With proper glycaemic control and early presentation and treatment, majority of amputations could be avoided in diabetic patients with foot ulcers.


Assuntos
Diabetes Mellitus Tipo 2 , Pé Diabético , Amputação , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/epidemiologia , Pé Diabético/cirurgia , Feminino , Humanos , Extremidade Inferior/cirurgia , Masculino , Paquistão/epidemiologia , Centros de Atenção Terciária
17.
BMC Musculoskelet Disord ; 22(1): 769, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503484

RESUMO

BACKGROUND: Obesity is common in persons with a lower limb amputation, an amputation can also lead to further weight gain. Data regarding the prevalence of obesity in the Dutch population with a lower limb amputation are lacking. Furthermore, the impact of obesity on skin problems of the residual limb and the need of prosthetic repairs is unknown. The aim of this study was to determine the prevalence of obesity in Dutch persons with a lower limb amputation and to investigate the relationship between body weight, body mass index and skin problems of the residual limb and the frequency of prosthetic repairs. METHODS: A survey was performed among adults with a unilateral lower limb amputation due to any cause, and who are user of a prosthesis. The survey consisted of measurement of the subjects' body height and weight, a questionnaire which assessed self-reported skin problems in the previous month and factors potentially associated with these skin problems, and assessment of the frequency of visits to the orthopedic workshop. RESULTS: In total, 413 persons were enrolled. Of them, 39% (95 % confidence interval 35;44) were overweight and 28% (95% confidence interval 24;33) were obese. A total of 77% (95% confidence interval 73;81) reported one or more skin problems in the past month. Body weight and body mass index were neither associated with the presence of skin problems in general nor with the number of prosthetic repairs. Persons with severe skin problems had a slightly lower body mass index (26.6 kg/m2 vs. 28.0 kg/m2, p = 0.012). Persons with skin problems were younger than those without (difference in means 6.0 years (95% confidence interval 3.0;8.9)). CONCLUSIONS: Our findings show that obesity is common in the Dutch ambulant population with a lower limb amputation, with a prevalence being higher than in the general Dutch adult population. However, its negative impact on the presence of skin problems and the frequency of prosthetic repairs may be limited.


Assuntos
Amputação , Membros Artificiais , Índice de Massa Corporal , Pele/patologia , Adulto , Humanos , Extremidade Inferior/cirurgia , Países Baixos , Implantação de Prótese
19.
J Rehabil Med ; 53(11 (November)): jrm00237, 2021 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-34546378

RESUMO

OBJECTIVE: To evaluate the impact of a lower limb amputation for chronic pain and/or functional impairment on pain and participation in daily living activities and to assess the use of prostheses. To improve decision-making for this controversial treatment. DESIGN: Survey. SETTING: University hospital. SUBJECTS: Patients who had an amputation of a lower limb for chronic pain and/or functional impairment. RESULTS: Eighty-one percent of the patients were satisfied with the amputation and would decide to undergo an amputation again under the same conditions. Sixty-nine percent of the patients reported an improvement in pain, 69% an improvement in mobility, 75% in daily living activities, and 56% an improvement in sleep. Seventy-five percent of the patients used their prosthesis on a daily basis. CONCLUSION: Most patients who underwent an amputation in our hospitals for chronic pain and/or functional impairment of a lower limb were satisfied and reported an improvement in function and pain.


Assuntos
Membros Artificiais , Dor Crônica , Atividades Cotidianas , Amputação , Dor Crônica/cirurgia , Humanos , Extremidade Inferior/cirurgia
20.
Microsurgery ; 41(8): 792-801, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34569653

RESUMO

BACKGROUND: Microsurgical free tissue transfers are a mainstay of lower extremity reconstruction. Despite being a reliable source of soft tissue, complications do arise. Venous congestion is among the most common causes of flap failure in lower extremity reconstruction, an issue that is attributed to venous stasis and impaired venous return in this region. There remains significant debate whether dual venous drainage improves outcomes. The aim of this study was thus to compare one versus two venous anastomoses in lower limb free flap reconstruction. METHODS: A systematic review of Medline, EMBASE, EBSCO CINAHL, SCOPUS, Proquest Dissertations and Theses Global, Cochrane Library, and PROSPERO from inception to May 20, 2020, was conducted. Two independent reviewers screened titles and extracted data. Our primary outcome was total free flap necrosis. Secondary outcomes were partial flap necrosis, minor complications, flap reoperation, venous thrombosis, and amputation. Methodological quality was assessed using the MINORS criteria and level of evidence. RESULTS: Three-hundred and fourteen unique titles were identified. All studies were level VI evidence and had a mean MINORS score of 16.1/24. Seven studies (comprising 1499 patients, 910 single venous anastomoses, and 579 double venous anastomoses) met criteria for inclusion. The mean (SD) patient age was 46.5 (7.1) years. Double venous anastomoses did not reduce the rate of minor complications, flap takeback, venous thrombosis, total flap necrosis, or partial flap necrosis when compared to a single vein (all p > .05). CONCLUSION: In microvascular lower extremity reconstruction, two venous anastomoses did not reduce the rate of minor or major complications.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Anastomose Cirúrgica , Humanos , Extremidade Inferior/cirurgia , Microcirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
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