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1.
Foot Ankle Clin ; 27(3): 655-670, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36096557

RESUMO

Severe diabetic foot infections (DFI) are both limb threatening and life threatening and associated with negative impact on health-related quality of life. Most severe DFIs require surgical intervention, and the goal of treatment should be preservation of limb function in addition to eradication of infection. Minor amputations are required in approximately 40% and major amputations in approximately 20% of patients. Significant risk factors for lower extremity amputation included male gender, smoking, previous amputation, osteomyelitis, peripheral artery disease, retinopathy, severe infections, gangrene, neuroischemic diabetic foot infections, leukocytosis, positive wound cultures, and isolation of gram-negative bacteria.


Assuntos
Diabetes Mellitus , Pé Diabético , Osteomielite , Amputação , Diabetes Mellitus/cirurgia , Pé Diabético/complicações , Pé Diabético/cirurgia , Humanos , Salvamento de Membro , Masculino , Osteomielite/complicações , Osteomielite/cirurgia , Qualidade de Vida
2.
BMC Surg ; 22(1): 333, 2022 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-36071411

RESUMO

BACKGROUND: Amputation is still the most common therapy for patients suffering from osteosarcoma in Myanmar, despite the fact that limb salvage surgery e.g. Borggreve-Van Nes-Winkelmann rotationplasty for malignant tumors located within the distal femur or proximal tibia is the current state-of-the-art reconstructive procedure. A safe and reliable operation technique is crucial in order to perform a complex surgical procedure like the rotationplasty in lower-middle income economies with limited infrastructure and resources. The authors present seven cases of patients with osteosarcomas that received a Borggreve-Van Nes-Winkelmann rotationplasty with an evaluation of the procedures focusing on safety and sustainability. METHODS: From 2019 until 2020, seven young patients with osteosarcomas of the distal femur or proximal tibia were treated with Borggreve-Van Nes-Winkelmann rotationplasties in the Orthopaedic Hospital in Mandalay, Myanmar. As modification of the standard procedure the dissection and subsequent clamping of the femoral artery in order to minimize blood loss as well as the formation of an adipocutaneous flap that minimizes swelling and decreases the pressure on the vessels were successfully performed. This modified procedure resembles a safe and simplified surgical technique that is feasible under the circumstances of lower-middle income economies with good outcomes. RESULTS: All patients showed good functional and aesthetic results. One of the seven patients needed secondary wound closure due to wound dehiscence. CONCLUSIONS: A simplified and safe operation technique for the performance of the Van Nes-Borggreve rotationplasty was adapted to the given constraints in lower-middle income economies and proved to be successful. Trial registration All patients approved to participate in the study and have given consent to publication.


Assuntos
Neoplasias Ósseas , Neoplasias Femorais , Osteossarcoma , Neoplasias Ósseas/cirurgia , Países em Desenvolvimento , Neoplasias Femorais/cirurgia , Humanos , Salvamento de Membro/métodos , Osteossarcoma/cirurgia
3.
J Med Vasc ; 47(3): 116-124, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36055680

RESUMO

OBJECTIVE: Demonstrate that simplified ERICVA (Valladolid Critical Limb Ischaemia Risk Scale) is useful in predicting amputation in chronic limb-threatening ischemia (CLI) after one year of revascularization. METHODS: A retrospective cohort study was performed. We analyzed the medical records of 93 patients over the age of 35 with the diagnosis of CLI who were treated in the Department of Internal Medicine, Orthopedics or in the Cardiovascular Surgery Unit of the Víctor Lazarte Echegaray Hospital and the High Complexity Virgen de La Puerta Hospital during the period 2015-2018. The simplified ERICVA score was determined in patients before surgical and endovascular revascularization. We included 31 patients who scored 2 or more points in the exposed group and 62 patients who scored less than 2 points in the group not exposed to amputation risk. The collected data was analyzed with the statistical program SPSS where the Relative Risk and significance was obtained with Pearson's Chi-square. The multivariate analysis was also carried out in order to obtain the adjusted relative risk. RESULTS: It was identified that the simplified ERICVA score greater than or equal to 2 points was more frequent in those who underwent amputation (90.3%) compared to patients who did not undergo amputation (4.8%), increasing the risk of amputation in those patients with CLI who underwent revascularization (RR: 18.67, P<0.001). It was also possible to identify that within the group of patients that showed a high risk of amputation according to the ERICVA scale, they had a higher risk of major amputation (RR: 9.32, P<0.001) as opposed to the risk of minor amputation (RR: 1, 89, P=0.193). Among the items of the simplified ERICVA scale, the preoperative neutrophil-lymphocyte ratio and hematocrit were significantly higher in the group of amputated patients (P<0.001). In addition, it was possible to identify that the score greater than or equal to 2 was independently associated with the risk of amputation in patients revascularized with CLI (RR: 13.5, P<0.001). CONCLUSION: In our patient population, the simplified ERICVA scale is useful in predicting major and minor amputation in critical limb ischemia after revascularization. The present data showed that the patients who had a simplified ERICVA score greater than or equal to 2 had a higher risk of major amputation compared to the risk of minor amputation. However, it is important to highlight that the impact on the prediction of minor amputation is greater because in some circumstances major amputation can appear as a complication of CLI.


Assuntos
Procedimentos Endovasculares , Doença Arterial Periférica , Amputação , Isquemia Crônica Crítica de Membro , Procedimentos Endovasculares/efeitos adversos , Humanos , Isquemia/diagnóstico , Isquemia/cirurgia , Salvamento de Membro , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
PLoS One ; 17(9): e0274786, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36121827

RESUMO

PURPOSE: This single-center, prospective cohort study aimed to compare the patient-reported outcomes one year after injury between limb salvage and amputation and to elucidate whether amputation contributes to early recovery of functionality and quality of life. METHODS: We included 47 limbs of 45 patients with severe open fractures of the lower limb and categorized them into limb salvage and amputation groups. Data on patient-reported outcomes one year after injury were obtained from the Database of Orthopaedic Trauma by the Japanese Society for Fracture Repair at our center. Patients' limbs were evaluated using the lower extremity functional scale and Short-Form 8. Early recovery was assessed using functionality and quality-of-life questionnaires. RESULTS: Of the 47 limbs, 34 limbs of 34 patients were salvaged, and 13 limbs of 11 patients were amputated. Significant differences were noted between the limb salvage and amputation groups in terms of the lower extremity functional scale scores (mean: 49.5 vs. 33.1, P = 0.025) and scores for the mental health component (mean: 48.7 vs. 38.7, P = 0.003), role-physical component (mean: 42.2 vs. 33.3, P = 0.026), and mental component summary (mean: 48.2 vs. 41.3, P = 0.042) of the Short-Form 8. The limb salvage group had better scores than the amputation group. CONCLUSIONS: As reconstruction technology has advanced and limb salvaging has become possible, the focus of studies should now be based on the perspective of "how the patient feels;" hence, we believe that the results of this study, which is based on patient-reported outcomes, are meaningful.


Assuntos
Salvamento de Membro , Qualidade de Vida , Amputação , Humanos , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Estudos Retrospectivos
5.
Stem Cell Res Ther ; 13(1): 462, 2022 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-36068595

RESUMO

Critical limb ischemia (CLI), the terminal stage of peripheral arterial disease (PAD), is characterized by an extremely high risk of amputation and vascular issues, resulting in severe morbidity and mortality. In patients with severe limb ischemia with no alternative therapy options, such as endovascular angioplasty or bypass surgery, therapeutic angiogenesis utilizing cell-based therapies is vital for increasing blood flow to ischemic regions. Mesenchymal stem cells (MSCs) are currently considered one of the most encouraging cells as a regenerative alternative for the surgical treatment of CLI, including restoring tissue function and repairing ischemic tissue via immunomodulation and angiogenesis. The regenerative treatments for limb ischemia based on MSC therapy are still considered experimental. Despite recent advances in preclinical and clinical research studies, it is not recommended for regular clinical use. In this study, we review the immunomodulatory features of MSC besides the current understanding of different sources of MSC in the angiogenic treatment of CLI subjects and their potential applications as therapeutic agents. Specifically, this paper concentrates on the most current clinical application issues, and several recommendations are provided to improve the efficacy of cell therapy for CLI patients.


Assuntos
Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Terapia Baseada em Transplante de Células e Tecidos , Isquemia Crônica Crítica de Membro , Humanos , Isquemia/terapia , Salvamento de Membro , Transplante de Células-Tronco Mesenquimais/métodos , Resultado do Tratamento
6.
J Surg Oncol ; 126(5): 906-912, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36087079

RESUMO

There have been enormous advances in the treatment of bone tumors over the past half-century. The most notable of these has been the transition from amputation as the standard of care to limb salvage surgery. This transition is the result of advances in imaging techniques, accurate diagnosis, systemic therapies (including chemotherapy), and prosthetic design for the reconstruction of musculoskeletal defects. Advances have also been made in the management of benign and metastatic bone tumors.


Assuntos
Neoplasias Ósseas , Amputação , Neoplasias Ósseas/cirurgia , Extremidades/cirurgia , Humanos , Salvamento de Membro , Terapia de Salvação
7.
Technol Cancer Res Treat ; 21: 15330338221124696, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36128851

RESUMO

Osteosarcoma, one of the common malignant tumors in the skeletal system, originates in mesenchymal tissue, and the most susceptible area of occurrence is the metaphysis with its abundant blood supply. Tumors are characterized by highly malignant spindle stromal cells that can produce bone-like tissue. Most of the osteosarcoma are primary, and a few are secondary. Osteosarcoma occurs primarily in children and adolescents undergoing vigorous bone growth and development. Most cases involve rapid tumor development and early blood metastasis. In recent years, research has grown in the areas of molecular biology, imaging medicine, biological materials, applied anatomy, surgical techniques, biomechanics, and comprehensive treatment of tumors. With developments in molecular biology and tissue bioengineering, treatment methods have also made great progress, especially in comprehensive limb salvage treatment, which significantly enhances the quality of life after surgery and improves the 5-year survival rate of patients with malignant tumors. This article provides a review of limb salvage, immunotherapy, gene therapy, and targeted therapy from traditional amputation to neoadjuvant chemotherapy, providing a reference for current clinical treatments for osteosarcoma.


Assuntos
Produtos Biológicos , Neoplasias Ósseas , Osteossarcoma , Adolescente , Produtos Biológicos/uso terapêutico , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/patologia , Neoplasias Ósseas/terapia , Criança , Humanos , Salvamento de Membro , Osteossarcoma/tratamento farmacológico , Osteossarcoma/terapia , Qualidade de Vida
8.
Mo Med ; 119(2): 122-124, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36036025

RESUMO

The University of Missouri's Limb Preservation Center is a multi-disciplinary team helping patients with acute and chronic traumatic limb injuries, especially when faced with the difficult decision of limb preservation versus amputation. The team focuses on acute trauma and the chronic effects of a prior failed treatment, including possible amputation. This approach results in improved care, outcomes, and a decrease in failed treatment plans for patients. New advances in amputation techniques also provides better outcomes for patients.


Assuntos
Amputação , Salvamento de Membro , Humanos , Equipe de Assistência ao Paciente , Estudos Retrospectivos , Resultado do Tratamento
9.
Anticancer Res ; 42(9): 4619-4626, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36039442

RESUMO

BACKGROUND/AIM: This study aimed to retrospectively investigate clinical outcomes after tumor resection surgery and discuss reconstruction methods and postoperative complications. PATIENTS AND METHODS: We analyzed the clinical outcomes, such as graft survival and prognosis, of nine patients with bone and soft-tissue tumors of the extremities with major vascular invasion who underwent limb-sparing surgery with vascular reconstruction between January 2006 and December 2020. RESULTS: The primary tumor was malignant in eight cases and intermediate in one case, with a mean postoperative follow-up duration of 52.1 months. A total of 10 vascular reconstructions (arterial in eight patients and both arterial and venous in one) were performed with autologous vein grafts in four cases and synthetic grafts in five cases. Graft occlusion was observed in two cases reconstructed with the great saphenous vein measuring >200 mm in length, and the 5-year arterial patency rate was 8/9. Only one case showed local recurrence, and at 5 years, local control was achieved in eight out of nine patients. Limb-sparing was achieved in all cases and the 5-year overall and disease-free survival rates were 77.8%. Postoperative complications occurred in six patients and wound-related complications were improved by re-surgery, while the others were controlled by conservative treatment. CONCLUSION: Limb-sparing tumor resection surgery with vascular reconstruction has favorable clinical and oncological outcomes. Most postoperative complications related to this surgery can be controlled by conservative treatment, except for wound-related complications. In reconstructions with autologous vein grafts of a length exceeding 200 mm, the graft occlusion rate may increase, and synthetic grafts may be recommended.


Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Extremidades/patologia , Humanos , Salvamento de Membro/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Veia Safena/patologia , Veia Safena/transplante , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Resultado do Tratamento
10.
Ann Surg ; 276(3): 532-538, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35972512

RESUMO

INTRODUCTION: The 6-hour threshold to revascularization of an ischemic limb is ubiquitous in the trauma literature, however, contemporary evidence suggests that this threshold should be less. This study aims to characterize the relationship between the duration of limb ischemia and successful limb salvage following lower extremity arterial trauma. METHODS: This is a cohort study of the United States and UK military service members injured while serving in Iraq or Afghanistan between 2003 and 2013. Consecutive patients who sustained iliac, femoral, or popliteal artery injuries, and underwent surgery to attempt revascularization, were included. The association between limb outcome and the duration of limb ischemia was assessed using the Kaplan-Meier method. RESULTS: One hundred twenty-two patients (129 limbs) who sustained iliac (2.3%), femoral (56.6%), and popliteal (41.1%) arterial injuries were included. Overall, 87 limbs (67.4%) were successfully salvaged. The probability of limb salvage was 86.0% when ischemia was ≤1 hour; 68.3% when between 1 and 3 hours; 56.3% when between 3 and 6 hours; and 6.7% when >6 hours ( P <0.0001). Shock more than doubled the risk of failed limb salvage [hazard ratio=2.42 (95% confidence interval: 1.27-4.62)]. CONCLUSIONS: Limb salvage is critically dependent on the duration of ischemia with a 10% reduction in the probability of successful limb salvage for every hour delay to revascularization. The presence of shock significantly worsens this relationship. Military trauma systems should prioritize rapid hemorrhage control and early limb revascularization within 1 hour of injury.


Assuntos
Traumatismos da Perna , Lesões do Sistema Vascular , Amputação , Estudos de Coortes , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Traumatismos da Perna/cirurgia , Salvamento de Membro/métodos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Artéria Poplítea , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Lesões do Sistema Vascular/cirurgia
11.
Surg Clin North Am ; 102(4): 551-565, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35952687

RESUMO

The potentially curative treatment of sarcoma is negative margin wide resection, the clinical tumor with an en bloc margin of surrounding tissue potentially contains microscopic tumor. Planned margins should be 1 to 2 cm but can be less for oncologically equivalent barrier tissues or to preserve an adjacent critical structure. Tumor spillage should be avoided. The role of radiation and/or chemotherapy should be discussed before surgery, as there are potential benefits to preoperative administration. An isolated local recurrence is potentially curable. Amputation is rarely necessary and should only be pursued after other limb salvage treatment options have been considered.


Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Amputação , Extremidades/patologia , Extremidades/cirurgia , Humanos , Salvamento de Membro , Margens de Excisão , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia
12.
Cardiovasc Interv Ther ; 37(4): 635-640, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35941316

RESUMO

Revascularization plays an important role in the treatment of chronic limb-threatening ischemia. Evaluation of hemodynamic compromise in the lower extremity is required to optimize the treatment strategy for each patient. A variety of methods have been reported to detect arterial obstruction or impaired foot perfusion. This article reviews each method, clarifying features and limitations.


Assuntos
Salvamento de Membro , Doença Arterial Periférica , Amputação , Isquemia Crônica Crítica de Membro , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Salvamento de Membro/métodos , Extremidade Inferior , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/cirurgia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
14.
AIDS ; 36(12): 1717-1724, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35848583

RESUMO

OBJECTIVE: With antiretroviral therapy, people with HIV (PWH) are developing age-related diseases, including peripheral arterial disease (PAD). This study examined frequency and outcomes of peripheral vascular intervention (PVI) and primary amputation in PWH. DESIGN: We used the National Inpatient Sample (NIS) database to examine demographics, comorbidities, and temporal trends among PVI and primary amputation admissions by HIV status from 2012 to 2018. METHODS: Inverse probability of treatment weighting was used to calculate adjusted odds of in-hospital death and amputation. Cost of hospitalization and length of stay were compared by HIV status and revascularization approach. RESULTS: Of the 347 824 hospitalizations for PVI/amputation, 0.6% were PWH, which was stable over time. PWH had more renal and hepatic disease, whereas uninfected individuals had more traditional PAD risk factors. 55.2% of HIV+ admissions were endovascular compared with 49.3% in HIV- admissions, and 28.9% of the HIV+ admissions were elective compared with 42.1% among HIV-. HIV status did not impact amputation following PVI. In-hospital death was similar between groups following PVI or primary amputation. PWH had lower costs of hospitalization and a trend towards shorter hospital stays. CONCLUSION: Although PWH are developing more age-related chronic illnesses, the number of PAD-associated procedures has remained flat. Despite being younger with fewer traditional PAD risk factors, PWH had higher rates of unplanned PVI admissions and endovascular revascularization but similar in-hospital outcomes. These findings suggest PWH have different risk factors for PAD and are likely underdiagnosed and undertreated, whereas those who are treated have similar outcomes to the general population.


Assuntos
Procedimentos Endovasculares , Infecções por HIV , Doença Arterial Periférica , Amputação , Procedimentos Endovasculares/efeitos adversos , Infecções por HIV/complicações , Mortalidade Hospitalar , Humanos , Salvamento de Membro , Doença Arterial Periférica/complicações , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
J Bone Joint Surg Am ; 104(18): 1659-1666, 2022 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-35809001

RESUMO

BACKGROUND: Functional outcomes are commonly reported in studies of patients undergoing limb-salvage surgery for the treatment of musculoskeletal tumors; however, interpretation requires knowledge of the smallest amount of improvement that is important to patients: the minimally important difference (MID). We established the MIDs for the Musculoskeletal Tumor Society Rating Scale-93 (MSTS-93) and Toronto Extremity Salvage Score (TESS) for patients with bone tumors undergoing lower-extremity endoprosthetic reconstruction. METHODS: This study was a secondary analysis of the recently completed PARITY (Prophylactic Antibiotic Regimens in Tumor Surgery) study. We used MSTS-93 and TESS data from this trial to calculate (1) the anchor-based MIDs with use of an overall function scale and a receiver operating characteristic curve analysis and (2) the distribution-based MIDs based on one-half of the standard deviation of the change scores from baseline to the 12-month follow-up and one-half the standard deviation of baseline scores. RESULTS: Five hundred and ninety-one patients were available for analysis. The Pearson correlation coefficients for the association between changes in MSTS-93 and TESS scores and changes in the external anchor scores were 0.71 and 0.57, indicating high and moderate correlations. The anchor-based MID was 12 points for the MSTS-93 and 11 points for the TESS. Distribution-based MIDs were larger: 16 to 17 points for the MSTS-93 and 14 points for the TESS. CONCLUSIONS: Two methods for determining MIDs for the MSTS-93 and TESS for patients undergoing lower-extremity endoprosthetic reconstruction for musculoskeletal tumors yielded quantitatively different results. We suggest the use of anchor-based MIDs, which are grounded in changes in functional status that are meaningful to patients. These thresholds can facilitate responder analyses and indicate whether significant differences following interventions are clinically important to patients. LEVEL OF EVIDENCE: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Neoplasias Ósseas , Sistema Musculoesquelético , Antibacterianos , Neoplasias Ósseas/cirurgia , Humanos , Salvamento de Membro/métodos , Extremidade Inferior/cirurgia , Sistema Musculoesquelético/cirurgia
16.
BMC Cancer ; 22(1): 781, 2022 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-35842696

RESUMO

BACKGROUND: The high rate of aseptic loosening of cemented stems has led to their frequent use in endoprosthetic reconstruction. However, problems, such as stem breakage and stress shielding at the insertion site, remain. The Japanese Musculoskeletal Oncology Group (JMOG) has developed Kyocera Modular Limb Salvage System (KMLS) cementless stems with a unique tapered press-fit and short fixation design. This study aimed to clarify the short-term postoperative outcomes of this prosthesis and validate the stem design. METHODS: One hundred cases of KMLS cementless stems (51 male patients; median age, 49 years; mean follow-up period, 35 months), with a minimum follow-up of 2 years, for the proximal femur (PF), distal femur (DF), and proximal tibia were prospectively registered for use. Prosthesis survival, complication rates, postoperative functional, and radiographical evaluation were analyzed. Complications or failures after insertion of the KMLS endoprostheses were classified into five types and functional results were analyzed according to the MSTS scoring system at postoperative 1 year. The diaphyseal interface and anchorage were graded by the ISOLS system at postoperative 2 years. RESULTS: The overall prosthesis survival rates at 2 and 4 years were 88.2 and 79.6%, respectively. The prosthesis-specific survival rate excluding infection and tumor recurrence was 90.2 and 87.9%, respectively. Younger age (p = 0.045) and primary tumor (p = 0.057) were associated with poor prognosis of prosthesis-specific survival excluding infection and tumor recurrence. Complications were observed in 31 patients, 13 patients underwent revision surgery. The mean MSTS functional score at 1 year postoperatively was 68%. Early implant loosening was significantly more common in the DF (p = 0.006) and PF/DF straight stem (p = 0.038). The ISOLS radiographic evaluation at 2 years after surgery revealed good bone remodeling and anchorage in most cases (bone remodeling: 90% / excellent and good, anchorage: 97% / excellent and good). CONCLUSIONS: Tumor endoprosthesis long-term fixation to the diaphysis of the lower extremity remains challenging. The KMLS cementless stem with a unique tapered press fit design showed good short-term results in maintaining bone stock. To prevent early loosening, a curved stem should be used in PF and DF, but long-term follow-up is necessary.


Assuntos
Salvamento de Membro , Falha de Prótese , Humanos , Japão , Salvamento de Membro/métodos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
17.
Iowa Orthop J ; 42(1): 89-96, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35821918

RESUMO

Background: High energy, lower extremity trauma is associated with longstanding pain and functional limitations. The clinical decision to proceed with early amputation or limb salvage is often controversial. This study was designed to compare differences in complications, costs, and clinical outcomes of below knee amputation (BKA) performed early after injury or after attempted limb salvage in a hospital with standardized prosthetic care following amputation. Methods: This is a retrospective comparative study of subjects who underwent BKA for a traumatic injury at a single level 1 trauma center and received standardized prosthetic care from a single manufacturer from 1999-2016 with minimum 2-year post-amputation follow up. Outcomes collected included demographics, surgical management, unplanned re-operations, and hospital and prosthetic cost data 2 years from time of injury. Results: Overall, 79 subjects met criteria. Early amputation (EA) was defined by median duration between injury and amputation (6 weeks) with 41 subjects in the EA group and 38 subjects in the late amputation (LA) group. Subjects in the EA group were more likely to have open fractures, high energy mechanism, and less likely to have medical comorbidities. Post-amputation infection was common in both groups (17/41 (42%) vs 17/38 (45%), p=0.77). Subjects undergoing EA were more likely to require unplanned post-amputation revision, 22/41 (54%) versus 10/38 (27%), p=0.017. Hospital costs and prosthetics/orthotics costs from the time of injury to two years following amputation were comparable, with mean hospital EA costs $136,044 versus LA costs $125,065, p=0.38. Mean prosthetics/orthotics costs of EA subjects were $33,252 versus LA costs $37,684, p=0.59. Conclusion: Unplanned post-amputation revision surgeries were more common when BKA was performed early after trauma. Otherwise, outcomes and cost were comparable when amputation was performed early versus late. Level of Evidence: IV.


Assuntos
Amputação , Traumatismos da Perna , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/complicações , Traumatismos da Perna/cirurgia , Salvamento de Membro , Estudos Retrospectivos
18.
Stem Cell Res Ther ; 13(1): 345, 2022 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-35883198

RESUMO

Peripheral arterial disease is atherosclerotic occlusive disease of the lower extremity arteries and afflicts hundreds of millions of individuals worldwide. Its most severe manifestation is chronic limb-threatening ischemia (Petersen et al. (Science 300(5622):1140-2, 2003)), which is associated with severe pain at rest in the limbs, which progresses to necrosis, limb amputation, and/or death of the patient. Consequently, the care of these patients is considered a financial burden for both patients and health systems. Multidisciplinary endeavors are required to address this refractory disease and to find definitive solutions that lead to improved living conditions. Revascularization is the cornerstone of therapy for preventing limb amputation, and both open vascular surgery and endovascular therapy play a key role in the treatment of patients with CLI. Around one-third of these patients are not candidates for conventional surgical treatment, however, leading to higher amputation rates (approaching 20-25% at one year) with high morbidity and lower quality of life. Advances in regenerative medicine have enabled the development of cell-based therapies that promote the formation of new blood vessels. Particularly, mesenchymal stem cells (MSCs) have emerged as an attractive therapeutic agent in various diseases, including CLI, due to their role in tissue regeneration and immunomodulation. This review discusses the characteristics of MSCs, as well as their regenerative properties and their action mechanisms on CLI.


Assuntos
Salvamento de Membro , Células-Tronco Mesenquimais , Isquemia Crônica Crítica de Membro , Humanos , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento
20.
Niger J Clin Pract ; 25(7): 1192-1195, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35859483

RESUMO

Traumatic near total amputation of the hand with major vascular injury may lead to loss of the hand with dire consequences to the patient. A prompt attempt at salvaging the hand is key to prevent the untoward consequences. In addition, the awareness of the possibility of salvage in our environment should be spread among health care personnel as well as the need for multispecialty approach to the management. We report 2 patients with near total unilateral amputation of their hands proximal to the wrist who underwent salvage procedures.


Assuntos
Amputação Traumática , Salvamento de Membro , Amputação , Amputação Traumática/cirurgia , Humanos , Salvamento de Membro/métodos , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
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