Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.150
Filtrar
1.
Isr Med Assoc J ; 23(1): 28-32, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443339

RESUMO

BACKGROUND: Patients with critical limb ischemia (CLI) involving the below-the-knee (BTK) arteries are at increased risk of limb loss. Despite improvement in endovascular modalities, it is still unclear whether an aggressive approach results in improved limb salvage. OBJECTIVES: To assess whether an aggressive approach to BTK arterial disease results in improved limb salvage. METHODS: A comparative study of two groups was conducted. Group 1 included patients treated between 2012 and 2014, primarily with transfemoral angioplasty of the tibial arteries. Group 2 included patients treated between 2015-2019 with a wide array of endovascular modalities (stents, multiple tibial artery and pedal angioplasty, retrograde access). Primary endpoint was freedom from amputation at 4 years. RESULTS: A total of 529 BTK interventions were performed. Mean age was 71 ± 10.6 years, 382 (79%) were male. Patients in group 1 were less likely to be taking clopidogrel (66% vs. 83%, P < 0.01) and statins (72 % vs. 87%, P < 0.01). Several therapeutic modalities were used more often in group 2 than in group 1, including pedal angioplasty (24 vs. 43 %, P = 0.01), tibial and pedal retrograde access (0 vs. 10%, P = 0.01), and tibial stenting (3% vs. 25%, P = 0.01). Revascularization of two or more tibial arteries was performed at a higher rate in group 2 (54% vs. 50%, P = 0.45). Estimated freedom from amputation at 40 months follow-up was higher in group 2 (53% vs. 63%, P = 0.05). CONCLUSIONS: An aggressive, multimodality approach in treating BTK arteries results in improved limb salvage.


Assuntos
Amputação , Angioplastia , Procedimentos Endovasculares , Isquemia , Perna (Membro) , Salvamento de Membro , Doença Arterial Periférica , Complicações Pós-Operatórias , Artérias da Tíbia , Idoso , Amputação/métodos , Amputação/estatística & dados numéricos , Angioplastia/efeitos adversos , Angioplastia/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Israel , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Salvamento de Membro/instrumentação , Salvamento de Membro/métodos , Salvamento de Membro/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Doença Arterial Periférica/complicações , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Stents , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/fisiopatologia , Artérias da Tíbia/cirurgia , Grau de Desobstrução Vascular
2.
BMC Infect Dis ; 20(1): 618, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32831039

RESUMO

BACKGROUND: Vibrio cholerae are oxidase-positive bacteria that are classified into various serotypes based on the O surface antigen. V. cholerae serotypes are divided into two main groups: the O1 and O139 group and the non-O1/non-O139 group. O1 and O139 V. cholerae are related to cholera infection, whereas non-O1/non-O139 V. cholerae (NOVC) can cause cholera-like diarrhea. A PubMed search revealed that only 16 cases of necrotizing fasciitis caused by NOVC have been recorded in the scientific literature to date. We report the case of a Japanese woman who developed necrotizing fasciitis caused by NOVC after traveling to Taiwan and returning to Japan. CASE PRESENTATION: A 63-year-old woman visited our hospital because she had experienced left knee pain for the past 3 days. She had a history of colon cancer (Stage IV: T3N3 M1a) and had received chemotherapy. She had visited Taiwan 5 days previously, where she had received a massage. She was diagnosed with septic shock owing to necrotizing fasciitis. She underwent fasciotomy and received intensive care. She recovered from the septic shock; however, after 3 weeks, she required an above-knee amputation for necrosis and infection. Her condition improved, and she was discharged after 22 weeks in the hospital. CONCLUSIONS: With the increase in tourism, it is important for clinicians to check patients' travel history. Clinicians should be alert to the possibility of necrotizing fasciitis in patients with risk factors. Necrotizing fasciitis caused by NOVC is severe and requires early fasciotomy and debridement followed by intensive postoperative care.


Assuntos
Fasciite Necrosante/terapia , Vibrioses/complicações , Vibrioses/terapia , Vibrio cholerae não O1/patogenicidade , Amputação , Cuidados Críticos , Diarreia/complicações , Fasciite Necrosante/diagnóstico , Feminino , Humanos , Japão , Perna (Membro)/cirurgia , Pessoa de Meia-Idade , Fatores de Risco , Choque Séptico/etiologia , Choque Séptico/microbiologia , Choque Séptico/terapia , Taiwan , Viagem , Vibrioses/diagnóstico
3.
PLoS One ; 15(6): e0233706, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32502157

RESUMO

Equinus deformity is one of the most common gait deformities in children with cerebral palsy. We examined whether estimates of gastrocnemius length in gait could identify limbs likely to have short-term and long-term improvements in ankle kinematics following gastrocnemius lengthening surgery to correct equinus. We retrospectively analyzed data of 891 limbs that underwent a single-event multi-level surgery (SEMLS), and categorized outcomes based on the normalcy of ankle kinematics. Limbs with short gastrocnemius lengths that received a gastrocnemius lengthening surgery as part of a SEMLS (case limbs) were 2.2 times more likely than overtreated limbs (i.e., limbs who did not have short lengths, but still received a lengthening surgery) to have a good surgical outcome at the follow-up gait visit (good outcome rate of 71% vs. 33%). Case limbs were 1.2 times more likely than control limbs (i.e., limbs that had short gastrocnemius lengths but no lengthening surgery) to have a good outcome (71% vs. 59%). Three-fourths of the case limbs with a good outcome at the follow-up gait visit maintained this outcome over time, compared to only one-half of the overtreated limbs. Our results caution against over-prescription of gastrocnemius lengthening surgery and suggest gastrocnemius lengths can be used to identify good surgical candidates.


Assuntos
Paralisia Cerebral/complicações , Pé Equino/etiologia , Pé Equino/cirurgia , Marcha , Músculo Esquelético/cirurgia , Criança , Humanos , Perna (Membro)/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos
5.
Cir. plást. ibero-latinoam ; 46(2): 197-206, abr.-jun. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-194724

RESUMO

INTRODUCCIÓN Y OBJETIVO: Las heridas complejas de pierna y pie representan un desafío para la Cirugía Plástica, más aún cuando se asocian a fracturas expuestas dada la escasa disponibilidad de tejido local y regional. En estos casos suele plantearse la indicación de colgajos microquirúrgicos. En nuestro medio, donde la infraestructura aún está en desarrollo y no siempre se cuenta con equipamiento, horas de bloque quirúrgico para cirugías prolongadas, personal de enfermería capacitado, y hay poca colaboración de los pacientes para la recuperación, es frecuente optar por colgajos fasciocutaneos y musculares pediculados para la reconstrucción de estos defectos a pesar de que también esté indicado un colgajo libre. El objetivo de este trabajo es mostrar nuestra experiencia en hospitalespúblicos de Montevideo, Uruguay, en reconstrucción de pierna y pie utilizando colgajos locorregionales con buenos resultados y tiempo de recuperación aceptable. MATERIAL Y MÉTODO: Realizamos un estudio descriptivo retrospectivo de 7 casos de diferentes opciones terapéuticas de colgajos locorregionales fasciocutáneos y musculares para cobertura de diferentes defectos complejos de pierna y pie, en el Hospital de Clínicas y en el Instituto Nacional de Ortopedia y Traumatología de Montevideo. Seleccionamos los casos dentro de las etiologías más frecuentes de heridas en esta topografía que requieren reconstrucción por Cirugía Plástica y representan el modelo de colgajo realizado en cada tipo de herida descrito (topografía, tamaño y tejidos expuestos). RESULTADOS: Presentamos 7 pacientes de entre 21 y 80 años de edad, en los que se realizaron colgajos musculares de gemelo interno, externo, hemitríceps, hemitríceps con tibial anterior, hemisoleo, fasciocutáneo de transposición y fasciocutáneo en isla sural. Los resultados fueron aceptables en cuanto a ausencia de complicaciones de los colgajos, no necesidad de revisiones y tiempo de recuperación de 2 a 6 meses. CONCLUSIONES: Los colgajos locorregionales descritos proporcionan cobertura satisfactoria en defectos complejos de pierna y pie cuando los colgajos microquirúrgicos, aún estando indicados, no pueden realizarse por déficit de material, infraestructura o personal de la salud, así como por falta de colaboración del paciente para la recuperación. Las opciones planteadas pueden formar parte del algoritmo terapéutico en centros que comparten la misma epidemiología y recursos que los nuestros


BACKGROUND AND OBJECTIVE: Complex leg and foot wounds represent a challenge for Plastic Surgery, and even more so when they are associated with exposed fractures, given the limited availability of local and regional tissue. In these cases, the indication of microsurgical flaps is usually considered. In our environment, where the infrastructure is still under development and equipment is not always available, neither hours of surgical block for prolonged surgeries, trained nursing personnel, added to the little collaboration of patients for recovery, it is frequent to opt for fasciocutaneous flaps and pedicled muscle flaps for reconstruction, even though a free flap is also indicated. The objective of this paper is to show our experience in public hospitals in Montevideo, Uruguay, in leg and foot reconstruction using locoregional flaps, with good results and acceptable recovery time. METHODS: We performed a retrospective descriptive study, in which 7 cases of different therapeutic options were described within the fasciocutaneous and muscular locoregional flaps to cover different complex leg and foot defects, from the Hospital de Clínicas and Instituto Nacional de Ortopedia y Traumatología in Montevideo, Uruguay. The cases were selected within the most frequent etiologies of wounds in this topography that require reconstruction by Plastic Surgery, and represents the flap model performed in each type of wound described (topography, size, exposed tissues). RESULTS: We present 7 patients between 21 and 80 years of age, in whom internal, external twin muscle flaps, hemitriceps, hemitriceps with anterior tibial, hemisoleous, transpositional fasciocutaneous, fasciocutaneous in sural island flaps were performed. The results were acceptable in terms of the absence of flap complications, the lack of flap reviews and based on the recovery time from 2 to 6 months. CONCLUSIONS: The locoregional flaps described provide satisfactory coverage in complex leg and foot defects when the microsurgical flaps, even when indicated, cannot be performed due to deficits in material, infrastructure or health personnel, as well as due to patient's lack of collaboration in recovery. The options proposed may be part of the therapeutic algorithm in centers that share the same epidemiology and resources as ours


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Retalhos Cirúrgicos/cirurgia , Perna (Membro)/cirurgia , Deformidades Congênitas do Pé/cirurgia , Hospitais Públicos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Ferida Cirúrgica/etiologia , Perna (Membro)/anormalidades , Uruguai , Microcirurgia , Estudos Retrospectivos , Reepitelização , Autoenxertos
6.
Cir. plást. ibero-latinoam ; 46(2): 207-210, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194725

RESUMO

Presentamos un caso de reconstrucción de extremidad inferior combinando revascularización arterial y un colgajo libre en un paciente de 72 años con enfermedad arterial oclusiva y defecto de cobertura con exposición ósea, mediante vascularización poplítea-pedia con bypass de safena y cobertura con colgajo libre de músculo recto abdominal. Debido a la ausencia de vasos receptores adecuados utilizamos el bypass como fuente de irrigación arterial y un injerto venoso entre la vena epigástrica donante y la vena poplítea como drenaje del colgajo. En pacientes que requieren reconstrucción extensa de partes blandas con enfermedad arterial oclusiva concomitante, el tratamiento combinado con revascularización quirúrgica y cobertura con colgajo libre está asociado a una alta tasa de salvamento de la extremidad y excelentes resultados funcionales. El colgajo libre de recto abdominal provee una adecuada cobertura y relleno de defectos tridimensionales, además de presentar ventajas en cuanto al tiempo de disección y el tamaño del pedículo. En casos de vasos receptores inadecuados, es posible utilizar el bypass como fuente arterial y un injerto venoso de drenaje a un vaso proximal


We present a case of lower extremity reconstruction combining bypass revascularization and free flap for soft tissue coverage in a 72-year-old diabetic man with lower extremity arterial occlusive disease and wide soft tissue defect with bone exposure, who was treated with a popliteal-pedal vein saphenous bypass and a free rectus abdominis muscle flap. The bypass was used as the arterial inflow to the flap and an interposition saphenous vein graft to the popliteal vein as the outflow vessel, due the absence of appropriate local venous receptor vessels. In patients with concomitant occlusive arterial disease, combined treatment with surgical revascularization and free flap coverage is associated with a high rate of limb salvage and excellent functional outcomes. The free rectus abdominis flap provides adequate coverage and filling of the defect, as well as advantages in terms of dissection time and donor vessel diameter. In cases of inadequate recipient vessels, it is possible to use the bypass conduit as an arterial inflow and another venous graft for outflow to a proximal vessel


Assuntos
Humanos , Masculino , Idoso , Extremidade Inferior/cirurgia , Retalhos de Tecido Biológico , Anastomose Cirúrgica , Procedimentos Cirúrgicos Reconstrutivos , Músculos/cirurgia , Isquemia/cirurgia , Lesões dos Tecidos Moles/cirurgia , Complicações do Diabetes , Doença Arterial Periférica/complicações , Perna (Membro)/cirurgia
7.
Eur J Vasc Endovasc Surg ; 60(2): 301-308, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32336620

RESUMO

OBJECTIVE: To compare outcomes between long posterior flap (LPF) and skew flap (SF) amputation over a 13 year period. METHODS: This was a retrospective observational cohort study. Consecutive patients undergoing a LPF or SF below knee amputation (BKA) over a 13 year period at one hospital were identified. Both techniques were performed regularly, depending on tissue loss and surgeon preference. The primary outcome was surgical revision of any kind. Secondary outcomes included revision to above knee amputation (AKA), length of hospital stay (LOS), and mortality. A smaller cohort of patients who were alive and unilateral below knee amputees were contacted to ascertain prosthetic use and functional status. RESULTS: In total, 242 BKAs were performed in 212 patients (125 LPF and 117 SF; median follow up 25.8 months). Outcomes for the two groups were equivalent for surgical revision of any kind (27 LPF vs. 31 SF; p = .37), revision to an AKA (18 LPF vs. 14 SF; p = .58), LOS (29 days for LPF vs. 28 days for SF; p = .83), and median survival (23.9 months for LPF vs. 28.8 months for SF; p = .89). Multivariable analysis found amputation type had no effect on any outcome. Functional scores from a smaller cohort of 40 unilateral amputees who were contactable demonstrated improved outcomes with the LPF vs. the SF (p = .038). CONCLUSION: Both techniques appear equivalent for rates of surgical residual limb failure. Functional outcomes may be better with the LPF.


Assuntos
Amputação , Perna (Membro)/cirurgia , Retalhos Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Amputação/mortalidade , Membros Artificiais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ajuste de Prótese , Recuperação de Função Fisiológica , Reoperação , Estudos Retrospectivos , Fatores de Risco , Retalhos Cirúrgicos/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
8.
Plast Reconstr Surg ; 145(5): 1302-1312, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332556

RESUMO

BACKGROUND: Limb salvage techniques using free tissue transfer in patients with chronic wounds caused by longstanding osteomyelitis, diabetes, and peripheral vascular disease are technically challenging. The longitudinal slit arteriotomy end-to-side anastomosis is the authors' preferred technique because it is the least invasive arteriotomy and is especially important for diseased recipient arteries. The authors reviewed highly comorbid patients who underwent free tissue transfer with this technique to understand the success rates, overall outcomes, and long-term limb salvage rates. METHODS: A retrospective review was performed to analyze outcomes of free tissue transfer using longitudinal slit arteriotomy end-to-side anastomosis between 2012 and 2018 performed by the senior surgeon (K.K.E.). RESULTS: One hundred fifteen free flaps were identified. Patients were, on average, 55.9 years old, with a body mass index of 29.2 kg/m. Comorbidities included osteomyelitis (83.5 percent), hypertension (60.9 percent), tobacco use (46.1 percent), diabetes (44.3 percent), peripheral vascular disease (44.3 percent), hypercoagulability (35.7 percent), and arterial calcifications (17.4 percent). Overall flap success was 93.0 percent; 27.8 percent required reoperation perioperatively because of complications. On univariate analysis, diabetes mellitus, hypertension, and hypercoagulability were significantly associated with eventual amputation (p < 0.05). Multivariate analysis showed that intraoperative thrombosis and take back was independently associated with flap failure. There was an overall limb salvage rate of 83.5 percent, and of those salvaged, 92.7 percent were ambulating without a prosthesis at a mean follow-up of 1.53 years. CONCLUSIONS: This is the largest series of longitudinal slit arteriotomy end-to-side anastomosis for patients undergoing free tissue transfer for limb-threatening defects in the compromised host. Overall flap success, limb salvage rates, and functional outcomes are high using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Artérias/cirurgia , Retalhos de Tecido Biológico/transplante , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Salvamento de Membro/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Doença Crônica/terapia , Estado Terminal/terapia , Pé Diabético/complicações , Pé Diabético/epidemiologia , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Perna (Membro)/cirurgia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/epidemiologia , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/epidemiologia , Resultado do Tratamento , Adulto Jovem
9.
Eur J Vasc Endovasc Surg ; 60(1): 88-96, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32312664

RESUMO

OBJECTIVE: Major lower limb amputation is an important cause of morbidity and mortality in the USA. Little is known about the prevalence of the various indications for amputation, or if these indications have changed over time. The purpose of this study was to assess the indications for major amputation over a 17 year period and to determine whether surgical indications have shifted over this time period. METHODS: A retrospective, population based analysis of patients undergoing major amputation between 2000 and 2016 was performed using the National Inpatient Sample. Surgical indications for major amputation were classified as chronic ischaemia, acute limb ischaemia (ALI), infection, oncological, trauma, other, or any combination of these indications. Prevalence rates of surgical indications were calculated using logistic regression. Prevalence differences across years were assessed using likelihood ratio tests to determine statistical significance. RESULTS: Of 1 002 119 weighted hospitalisations for patients undergoing major amputation during the study period, the majority had chronic ischaemia (72%) or infection (15%) as the primary indication for amputation. Patients were predominantly male (60%) and diabetic (61%). Renal insufficiency was the only measured comorbidity that changed significantly over time (from 6% to 39%), although changes in coding procedures are partially responsible for the increase. From 2000 to 2016, the proportion of amputations done for chronic ischaemia alone decreased from 60% to 40% (p < .001), while the proportion of amputations that included infection in the presence of chronic ischaemia nearly doubled from 20% to 40% (p < .001). Major amputation due to ALI, oncology, or trauma was stable across the study period. CONCLUSION: Surgical indications for major amputation have changed between 2000 and 2016. Infection related amputations increased significantly during the study period. Further evaluation and modification of treatment protocols for limb infection are crucial to decreasing infection related major limb amputation.


Assuntos
Amputação/estatística & dados numéricos , Perna (Membro)/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais
11.
Rev. Rol enferm ; 43(3): 210-218, mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193822

RESUMO

En la actualidad, la amputación es el tratamiento de elección en pacientes que cursan con una isquemia crítica de los miembros inferiores y se valora como inviable la revascularización. En este caso clínico, mediante la evidencia científica se ha elegido un tratamiento que ha conseguido el manejo coste-consecuente de la lesión, tratando los efectos adversos que han aparecido durante el proceso: la dehiscencia en sí y su causa, el edema. Todo ello, utilizando técnicas de educación para la salud y un buen abordaje de la evolución de la herida. Con la curación como finalidad, se han utilizado vendas de tracción corta en combinación con los Dispositivos de un solo Uso de Terapia de Presión Negativa (DSUTPN), lo cual permitió el correcto abordaje de las complicaciones secundarias al linfedema. Por todo lo expuesto, el objetivo principal de este caso clínico ha sido el cierre de la dehiscencia, planteando como objetivos secundarios la resolución del linfedema del muñón y el mantenimiento del muñón en condiciones óptimas para la adaptación de una prótesis ortopédica que mejore, de esta manera, la calidad de vida del paciente


Currently, amputation is the treatment of choice in patients with critical ischemia of the lower limbs and revascularization is considered as unfeasible. In this clinical case, by means of scientific evidence a treatment has been chosen that has achieved the cost-consistent management of the lesion. We have treated the adverse effects that have appeared during the process: dehiscence itself and its cause, edema. Also we have used health education techniques and a good approach to the evolution of the wound. With the cure as a purpose, short traction bandages have been used in combination with the Single-Use Negative Pressure Therapy Devices (DSUTPN), which allowed the correct approach to complications secondary to lymphedema. In conclusion, the main objective of this clinical case has been the closure of the dehiscence, proposing as secondary objectives the resolution of the lymphedema of the stump and the maintenance of the stump in optimal conditions for the adaptation of an orthopedic prosthesis thus improving the quality of life of the patient


Assuntos
Humanos , Masculino , Idoso , Deiscência da Ferida Operatória/enfermagem , Tratamento de Ferimentos com Pressão Negativa , Amputação/efeitos adversos , Perna (Membro)/cirurgia , Resultado do Tratamento , Necrose/cirurgia
14.
Sci Data ; 7(1): 21, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941889

RESUMO

Haptic based surgical simulations are popular training aids in medicine. Previously, surgical tool loads and motion were measured during cutting and needle insertion on non-human tissue and several haptic based simulations were developed to enhance surgical training. However, there was a lack of realistic foundational data regarding the mechanical responses of human tissue and tools during fundamental acts of surgery, i.e., cutting, suturing, retracting, pinching and indenting. This study used four recently developed surgical tools in a variety of procedures on a diverse set of cadaver leg specimens from human donors. The kinematics and kinetics of surgical tools were recorded along with topical three-dimensional strain during commonly performed surgical procedures. Full motion and load signatures of foundational surgical acts can also be used beyond the development of authentic visual and haptic simulations of surgery, i.e., they provide mechanical specifications for the development of autonomous surgical systems.


Assuntos
Perna (Membro)/cirurgia , Treinamento por Simulação , Instrumentos Cirúrgicos , Procedimentos Cirúrgicos Operatórios , Fenômenos Biomecânicos , Cadáver , Humanos , Cinética
16.
J Surg Oncol ; 121(1): 75-84, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31273800

RESUMO

BACKGROUND: Retroperitoneal lymphangiomatosis (RL) is a rare form of primary lymphedema featuring aberrant retroperitoneal lymphatic proliferation. It causes recurrent cellulitis, repeated interventions, and poor life quality. This study aimed to investigate proper diagnositc criteria and surgical outcomes for RL with extremity lymphedema. METHODS: Between 2012 and 2018, 44 primary lower-extremity lymphedema cases received lymphoscintigraphy, magnetic resonance imaging, and single-photon electron computed tomography to detect RL. RL patients underwent vascularized lymph node transfers (VLNT) for extremity lymphedema and intra-abdominal side-to-end chylovenous bypasses (CVB) for chylous ascites. Complications, CVB patency, and quality of life were evaluated postoperatively. RESULTS: Six RL patients (mean age of 30.3 years) had chylous ascites with five had lower-extremity lymphedema. All CVBs remained patent, though one required re-anastomosis, giving a 100% patency rate. Four unilateral and one bilateral extremity lymphedema underwent six VLNTs with 100% flap survival. Patients reported improved quality of life (P = 0.023), decreased cellulitis incidence (P = 0.041), and improved mean lymphedema circumference (P = 0.043). All patients resumed a normal diet and activity. CONCLUSIONS: Evaluating primary lower-extremity lymphedema patients with MRI and SPECT could reveal a 13.6% prevalence of RL and guide treatment of refractory extremity lymphedema. Intra-abdominal CVB with VLNT effectively treated RL with chylous ascites and extremity lymphedema.


Assuntos
Linfonodos/transplante , Linfangioma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Adulto , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/cirurgia , Linfangioma/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada de Emissão de Fóton Único , Adulto Jovem
17.
Eur J Orthop Surg Traumatol ; 30(2): 337-341, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31473822

RESUMO

BACKGROUND: Reverse sural flap (RSF) is commonly used for soft tissue reconstruction of distal leg and heel defects. The classic method of flap transfer is the single-staged cutaneous islanded reverse sural flap (SS-RSF). This method is associated with variable flap complications notably the venous congestion. The other form of flap transfer is the two-stage reverse sural flap (TS-RSF), in which the pedicle of the flap is exteriorized in the first stage. Flap division and re-inset are done in the second stage. The aim of this paper is to review the flap outcomes and complications among the SS-RSF and TS-RSF reconstruction of soft tissue defects in the distal leg and heel. METHODS: This is a retrospective chart review of RSF being operated in a tertiary care hospital. The duration of study was 1.5 years. Twelve RSFs (6 SS-RSF, 6 TS-RSF) were done for soft tissue defects in the distal leg and heel. Wounds of various etiologies (traumatic, chronic, non-healing ulcers) were reviewed. Trauma was the most common etiology with 8 out of 12 (66.7%) patients. Large wounds, donor site damage and patients with peripheral vascular disease were excluded from the study. RESULTS: Five out of six (83.3%) of TS-RSF healed uneventfully. However, 3 out of 6 (50%) of SS-RSF had partial flap necrosis. All complicated flaps healed well subsequently. No donor site complication was found in any of our patients. CONCLUSION: Pedicle exteriorization in TS-RSF eliminates the element of venous congestion and eventually flaps necrosis. Less technical expertise and minimal morbidity are additional advantages of TS-RSF. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Úlcera da Perna/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Criança , Feminino , Calcanhar/cirurgia , Humanos , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/patologia , Resultado do Tratamento , Cicatrização , Adulto Jovem
18.
Eur J Orthop Surg Traumatol ; 30(2): 359-365, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31560102

RESUMO

INTRODUCTION: The primary objective of this study is to determine whether time from injury to fasciotomy is associated with increased risk for death or limb amputation in patients with acute leg compartment syndrome. The secondary objective of this study is to identify other risk factors for death or limb amputation in patients with acute leg compartment syndrome. METHODS: In an institutional review board approved retrospective study, we identified 546 patients with acute compartment syndrome of 558 legs treated with fasciotomies from January 2000 to June 2015 at two Level I trauma centers. Our primary outcome measures were death and limb amputation during inpatient hospital admission. Electronic medical records were analyzed for patient-related factors and treatment-related factors. Bivariate analyses were used to screen for variables associated with our primary outcome measures, and explanatory variables with a p value below 0.05 were included in our multivariable logistic regression analyses. RESULTS: In-hospital death occurred in 6.6% and in-hospital limb amputation occurred in 9.5% of acute leg compartment syndrome patients. Neither death nor limb amputation was found to be associated with time from injury to fasciotomy. Multivariable logistic regression analyses showed that older age (p = 0.03), higher modified Charlson Comorbidity Index (p = 0.009), higher potassium (p = 0.02), lower hemoglobin (p = 0.002), and higher lactate (p < 0.001) were associated with death, and diabetes mellitus (p = 0.05), no compartment pressure measurement (p = 0.009), higher PTT (p = 0.03), and lower albumin (p = 0.01) were associated with limb amputation. CONCLUSIONS: Time to fasciotomy is not found to be associated with death or limb amputation in acute leg compartment syndrome. Death and limb amputation are associated with patient-related factors and injury severity. LEVEL OF EVIDENCE: Level III Prognostic.


Assuntos
Amputação/estatística & dados numéricos , Síndromes Compartimentais/mortalidade , Perna (Membro)/irrigação sanguínea , Doença Aguda , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/patologia , Síndromes Compartimentais/cirurgia , Fasciotomia/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Perna (Membro)/cirurgia , Traumatismos da Perna/complicações , Traumatismos da Perna/mortalidade , Traumatismos da Perna/patologia , Traumatismos da Perna/cirurgia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
20.
J Cardiovasc Surg (Torino) ; 61(4): 467-470, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30917649

RESUMO

BACKGROUND: Neuropathic pain often occurs after leg amputation. It is unclear why some patients suffer from pain and others do not. Intraoperative nerve handling might correlate with these pain syndromes. It is unknown which nerve handling techniques are currently used among surgeons and whether a specific technique is related to eliciting these pain syndromes. The aim of this study was to investigate the current surgical sciatic nerve management used among surgeons in the Netherlands. METHODS: A survey was carried out among Dutch surgeons. Additionally, surgical sciatic nerve management data were obtained from the surgical reports of transfemoral amputations that were performed in our hospital. RESULTS: Seventy-eight of the 102 online surveys were returned. Sharp transection without ligation was used most often (41.0%), followed by sharp transection after ligation (30.8%). There were 38 transfemoral amputations performed in our hospital. Sharp transection after ligation was most often used (55.3%), followed by transection with electrocautery (13.2%). CONCLUSIONS: All techniques of transecting the sciatic nerve are currently performed by Dutch surgeons. These results provide a solid basis to perform future studies to investigate whether a specific surgical technique is related to postamputation pain syndromes.


Assuntos
Amputação , Perna (Membro)/cirurgia , Neuralgia/etiologia , Neuralgia/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Nervo Isquiático/cirurgia , Adulto , Idoso , Eletrocoagulação , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Países Baixos , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA