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1.
Bone Joint J ; 102-B(7): 912-917, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600140

RESUMO

AIMS: It has been generally accepted that open fractures require early skeletal stabilization and soft-tissue reconstruction. Traditionally, a standard gauze dressing was applied to open wounds. There has been a recent shift in this paradigm towards negative pressure wound therapy (NPWT). The aim of this study was to compare the clinical outcomes in patients with open tibial fractures receiving standard dressing versus NPWT. METHODS: This multicentre randomized controlled trial was approved by the ethical review board of a public sector tertiary care institute. Wounds were graded using Gustilo-Anderson (GA) classification, and patients with GA-II to III-C were included in the study. To be eligible, the patient had to present within 72 hours of the injury. The primary outcome of the study was patient-reported Disability Rating Index (DRI) at 12 months. Secondary outcomes included quality of life assessment using 12-Item Short-Form Health Survey questionnaire (SF-12), wound infection rates at six weeks and nonunion rates at 12 months. Logistic regression analysis and independent-samples t-test were applied for secondary outcomes. Analyses of primary and secondary outcomes were performed using SPSS v. 22.0.1 and p-values of < 0.05 were considered significant. RESULTS: A total of 486 patients were randomized between January 2016 and December 2018. Overall 206 (49.04%) patients underwent NPWT, while 214 (50.95%) patients were allocated to the standard dressing group. There was no statistically significant difference in DRI at 12 months between NPWT and standard dressing groups (mean difference 0.5; 95% confidence interval (CI) -0.08 to 1.1; p = 0.581). Regarding SF-12 scores at 12 months follow-up, there was no significant difference at any point from injury until 12 months (mean difference 1.4; 95% CI 0.7 to 1.9; p = 0.781). The 30-day deep infection rate was slightly higher in the standard gauze dressing group. The non-union odds were also comparable (odds ratio (OR) 0.90, 95% CI 0.56 to 1.45; p = 0.685). CONCLUSION: Our study concludes that NPWT therapy does not confer benefit over standard dressing technique for open fractures. The DRI, SF-12 scores, wound infection, and nonunion rates were analogous in both study groups. We suggest surgeons continue to use cheaper and more readily available standard dressings. Cite this article: Bone Joint J 2020;102-B(7):912-917.


Assuntos
Bandagens , Fraturas Expostas/terapia , Traumatismos da Perna/terapia , Tratamento de Ferimentos com Pressão Negativa/métodos , Fraturas da Tíbia/terapia , Adulto , Desbridamento , Avaliação da Deficiência , Feminino , Humanos , Masculino , Irrigação Terapêutica
3.
Plast Reconstr Surg ; 145(5): 1292-1301, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332555

RESUMO

BACKGROUND: Severe lower extremity injuries are challenging to treat. The aspects of limb salvage and amputation most important to patients are not well-defined. This study's aim is to develop a conceptual framework for a patient-reported outcome instrument for lower extremity trauma patients, by defining issues and concepts most important to this patient population. METHODS: This is an interpretative description of transcripts collected from semistructured qualitative interviews at a single institution. High-energy lower extremity trauma patients were recruited by means of purposeful sampling to maximize variability. Thirty-three participant interviews were needed to reach content saturation. These participants were aged 19 to 79 years; 21 were men (63.6 percent); participation was after reconstruction [n= 15 (45.5 percent)], after amputation [n = 11 (33.3 percent)], or after amputation after failed reconstruction [n = 7 (21.2 percent)]. Interviews were recorded, transcribed, and coded line-by-line. Concepts were labeled with major and minor themes and refined through a process of constant comparison. Analysis led to the development of a conceptual framework and item pool to inform the development of a patient-reported outcome measure. RESULTS: In total, 2430 unique codes were identified and used to generate the conceptual framework covering 10 major themes: appearance, environment, finances, physical, process of care, prosthesis, psychological, sexual, social, and treatment. CONCLUSIONS: This study establishes a comprehensive set of concepts, identifying what is most important to severe lower extremity trauma patients. These findings can be used to inform and focus research and clinical care, and provides the framework to develop a lower extremity trauma-specific patient-reported outcome instrument: the LIMB-Q.


Assuntos
Amputação/psicologia , Traumatismos da Perna/cirurgia , Salvamento de Membro/psicologia , Preferência do Paciente , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Amputação/estatística & dados numéricos , Estudos de Coortes , Estudos de Avaliação como Assunto , Feminino , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/diagnóstico , Salvamento de Membro/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Reoperação/psicologia , Reoperação/estatística & dados numéricos , Falha de Tratamento , Adulto Jovem
4.
Medicine (Baltimore) ; 99(14): e19684, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243406

RESUMO

BACKGROUND: Fracture is a common disease; many factors affect fracture healing. Recent studies have confirmed that hydrogen sulfide (H2S) plays an essential role in bone formation, but most of these studies are drawing conclusions based on animal experiment; whether H2S could promote fracture healing in patients is still unclear. We aim to investigate the change of serum H2S in fracture patients, and analyze its effort on fracture healing. METHODS: This is a single-center, prospective cohort study. Patients with spinal or limb fracture will be recruited. Patient's serum and urine will be collected at baseline for examination (serum H2S, ß-CTX, OC, PINP, 25-OH-VitD3, S-CTX, urinary calcium, and urinary creatinine). All patients will be followed-up for 24 months in outpatients settings, the image of X-ray or CT will be reviewed and fracture healing will be judged by 2 experienced orthopedic physicians. The difference in serum parameters especially H2S will be compared between patients with fracture healed within 9 months and those with fracture unhealed at 9 months. DISCUSSION: Results of the trial could provide insight into influence of H2S on fracture healing. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of School of Medicine UESTC & Sichuan Provincial People's Hospital Ethics Committee. All the participants will be asked to provide written informed consent before data collection. The findings of the study will be published in peer-reviewed journals and will be presented at national or international conferences.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas Ósseas/sangue , Sulfeto de Hidrogênio/sangue , Traumatismos do Braço/sangue , Fraturas Ósseas/urina , Humanos , Sulfeto de Hidrogênio/urina , Traumatismos da Perna/sangue , Osteogênese/fisiologia , Estudos Prospectivos , Fraturas da Coluna Vertebral/sangue
5.
Emerg Med Clin North Am ; 38(2): 499-522, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336337

RESUMO

Abdominal and extremity complaints are common in the emergency department (ED) and, because of their frequency, clinical vigilance is vital in order not to miss the timely diagnosis of occult or delayed emergencies. Such emergencies, if not timely managed, are sources of significant patient morbidity and mortality and may expose ED physicians to possible litigation. Each patient complaint yields to a nuanced approach in diagnostics and therapeutics that can lead physicians toward the ruling in or out of the correct high-risk diagnosis. This article discusses the approach and risk management of this high-risk subset of abdominal and extremity diagnoses.


Assuntos
Dor Abdominal/etiologia , Traumatismos do Braço/diagnóstico , Serviço Hospitalar de Emergência , Traumatismos da Perna/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/terapia , Traumatismos do Braço/terapia , Humanos , Traumatismos da Perna/terapia , Imperícia , Gestão de Riscos
6.
Plast Reconstr Surg ; 145(3): 608e-616e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097331

RESUMO

BACKGROUND: Various surgical techniques exist for lower extremity reconstruction, but limited high-quality data exist to inform treatment strategies. Using multi-institutional data and rigorous matching, the authors evaluated the effectiveness and cost of three common surgical reconstructive modalities. METHODS: All adult subjects with lower extremity wounds who received bilayer wound matrix, local tissue rearrangement, or free flap reconstruction were retrospectively reviewed (from 2010 to 2017). Cohorts' comorbidities and wound characteristics were balanced. Graft success at 180 days was the primary outcome; readmissions, reoperations, and costs were secondary outcomes. RESULTS: Five hundred one subjects (166 matrix, 190 rearrangement, and 145 free flap patients) were evaluated. Matched subjects (n = 312; 104/group) were analyzed. Reconstruction success at 180 days for matrix, local tissue rearrangement, and free flaps was 69.2 percent, 91.3 percent, and 93.3 percent (p < 0.001), and total costs per subject were $34,877, $35,220, and $53,492 (p < 0.001), respectively. Median length of stay was at least 2 days longer for free flaps (p < 0.0001). Readmissions and reoperations were greater for free flaps. Local tissue rearrangement, if achievable, provided success at low cost. Free flaps were effective with large, traumatic wounds but at higher costs and longer length of stay. Matrices successfully treated older, obese patients without exposed bone. CONCLUSIONS: Lower extremity reconstruction can be performed effectively using multiple modalities with varying degrees of success and costs. Local tissue rearrangement and free flaps demonstrate success rates greater than 90 percent. Bilayer wound matrix-based reconstruction effectively treats a distinct patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Retalhos de Tecido Biológico/transplante , Traumatismos da Perna/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Pele Artificial , Adulto , Idoso , Amputação/economia , Amputação/estatística & dados numéricos , Sulfatos de Condroitina/uso terapêutico , Colágeno/uso terapêutico , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/economia , Sobrevivência de Enxerto , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/economia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Reoperação/economia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Transplante de Pele/efeitos adversos , Transplante de Pele/economia , Transplante de Pele/instrumentação , Resultado do Tratamento
7.
Plast Reconstr Surg ; 145(3): 813-822, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097330

RESUMO

BACKGROUND: Little is known about the efficacy of newer skin substitute scaffolds to reconstruct complex lower extremity wounds. The investigators present a multihospital experience of reconstructive surgeons utilizing collagen-GAG bilayer wound matrix in lower extremity soft-tissue reconstruction with the goals to (1) characterize a suitable patient population, (2) categorize failures to optimize patient selection, and (3) determine wound factors affecting success. METHODS: Subjects underwent collagen-GAG-based lower extremity wound reconstruction from May of 2010 to June of 2017. The primary outcome variable was 180-day graft success, defined as eventual split-thickness skin grafting after bilayer wound matrix application; failure was defined as inadequate wound bed for split-thickness skin grafting, requirement for vascularized tissue transfer, or eventual amputation. Eligible subjects had at least one lower extremity wound and were at least 18 years old. Exclusion criteria included third-degree burn wounds or failure to follow up for at least 60 days postoperatively. Predictor variables included demographics, medical comorbidities, perioperative characteristics, postoperative complications, and cost-related data for each hospitalization. RESULTS: There were 147 subjects with 191 wounds. Mean patient age was 60.1 years (range, 21.0 to 95.6 years), and mean body mass index was 30.5 kg/m (range, 14.4 to 64.7 kg/m). Average wound size was 73.1 ± 137.7 cm, with 49.0 percent of subjects receiving adjunct postoperative negative-pressure wound therapy. Seventy percent of wounds were successfully healed at 180 days. Most were localized between the knee and ankle (50.8 percent) or foot (46.1 percent). Tendon exposure (p < 0.05), bone exposure (p < 0.01), and bone excision (p < 0.04) were associated with reconstructive failure. CONCLUSIONS: The authors present the largest reported multihospital, multidisciplinary experience with collagen-GAG wound matrix for lower extremity reconstruction. Tendon and/or bone exposure and socioeconomic factors were associated with failure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Amputação/estatística & dados numéricos , Traumatismos da Perna/terapia , Transplante de Pele/instrumentação , Pele Artificial , Lesões dos Tecidos Moles/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colágeno/administração & dosagem , Terapia Combinada/efeitos adversos , Terapia Combinada/instrumentação , Feminino , Seguimentos , Glicosaminoglicanos/administração & dosagem , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/estatística & dados numéricos , Fatores de Risco , Transplante de Pele/efeitos adversos , Fatores Socioeconômicos , Retalhos Cirúrgicos/transplante , Falha de Tratamento , Cicatrização , Adulto Jovem
8.
BMC Infect Dis ; 20(1): 104, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019500

RESUMO

BACKGROUND: Vibrio spp. are aquatic bacteria that are ubiquitous in warm estuarine and marine environments, of which 12 species are currently known to cause infections in humans. So far, only five human infections with V. harveyi have been reported. CASE PRESENTATION: A 26-year old patient was transferred to our center by inter-hospital air transfer from Mallorca, Spain. Seven days before, he had suffered a complete amputation injury of his left lower leg combined with an open, multi-fragment, distal femur fracture after he had been struck by the propeller of a passing motorboat while snorkeling in the Mediterranean Sea. On admission he was febrile; laboratory studies showed markedly elevated inflammatory parameters and antibiotic treatment with ampicillin/sulbactam was initiated. Physical examination showed a tender and erythematous amputation stump, so surgical revision was performed and confirmed a putrid infection with necrosis of the subcutaneous tissue and the muscles. Tissue cultures subsequently grew V. harveyi with a minimal inhibitory concentration (MIC) of 16 mg/L for ampicillin, and antibiotic treatment was switched to ceftriaxone and ciprofloxacin. Throughout the following days, the patient repeatedly had to undergo surgical debridement but eventually the infection could be controlled, and he was discharged. CONCLUSIONS: We report the first human infection with V. harveyi acquired in Spain and the second infection acquired in the Mediterranean Sea. This case suggests that physicians and microbiologists should be aware of the possibility of wound infections caused by Vibrio spp. acquired in the ocean environment, especially during hot summer months. Since Vibrio spp. preferentially grow at water temperatures above 18 °C, global warming is responsible for an abundance of these bacteria in coastal waters. This will likely lead to a worldwide increase in reports of Vibrio-associated diseases in the future.


Assuntos
Amputação Traumática/complicações , Traumatismos da Perna/cirurgia , Infecção da Ferida Cirúrgica/microbiologia , Vibrio/genética , Adulto , Antibacterianos/uso terapêutico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Navios/instrumentação , Espanha , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/etiologia , Vibrio/efeitos dos fármacos , Vibrio/isolamento & purificação , Vibrioses/microbiologia
9.
Int J Sports Med ; 41(3): 196-202, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31935775

RESUMO

This study aimed to assess prevalence and incidence of chronic exertional compartmental syndrome as well as functional outcomes after surgery in elite Nordic skiers. An exhaustive list of 294 elite Nordic skiers from the French national teams between 1994 and 2014 was analyzed through their individual medical files in order to identify cases of chronic exertional compartmental syndrome. Eighteen athletes had confirmed diagnosis and performed a structured interview to identify factors associated with chronic exertional compartmental syndrome and surgery outcomes. The prevalence was 6.1% and the incidence 13 per 1000 skier-years. Biathletes had a higher prevalence than cross-country skiers (OR=0.40, p=0.08). Free-technique skiing and roller-skiing were the main conditions inducing symptoms. All injured athletes had bilateral surgery and 94% of them reported no more or sporadic leg pain after. Almost 90% resumed competition at the same or higher level than prior surgery. Compare to previous studies, the incidence rate of chronic exertional compartmental syndrome is higher in French elite Nordic skiers. The higher prevalence in biathletes and the trigger during free-technique skiing suggest a contribution of this technique to this disease. This study also confirmed that surgery was an efficient therapeutic solution without compromising athletes' career.


Assuntos
Síndromes Compartimentais/epidemiologia , Traumatismos da Perna/epidemiologia , Resistência Física/fisiologia , Esqui/lesões , Síndromes Compartimentais/cirurgia , França/epidemiologia , Humanos , Incidência , Traumatismos da Perna/cirurgia , Prevalência , Estudos Retrospectivos , Resultado do Tratamento
10.
J Strength Cond Res ; 34(1): 26-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31490423

RESUMO

O'Connor, S, McCaffrey, N, Whyte, EF, and Moran, KA. Can a standardized visual assessment of squatting technique and core stability predict injury? J Strength Cond Res 34(1): 26-36, 2020-This study examined whether a standardized visual assessment of squatting technique and core stability can predict injury. Male adolescent and collegiate Gaelic players (n = 627) were assessed using the alternative core/trunk stability push-up test and a developed scoring system for the overhead squat and single-leg squat (SLS) that examined both overall impression and segmental criteria. A single summative score from the overall impression scores of all 3 tests was calculated. Sustained injuries were examined over a season. Results indicated that the single summative score did not predict those that sustained a lower-extremity injury, trunk injury, or whole-body injury, and receiver operating characteristic curves were also unable to generate an optimal cutoff point for prediction. When segmental criteria were included in multivariate analyses, the tests were able to predict whole-body injury (p < 0.0001) and lower-extremity injury (p < 0.0001). However, although specificity was high (80.6%, 76.5%), sensitivity of the models was low (40.2%, 44.2%). The most common score was "good" for the overhead squat (46.4%) and SLS (47.6%), and "good" and "excellent" for the alternative core stability push-up test (33.5%, 49.1%), with "poor" core stability increasing the odds of sustaining a lower-extremity injury (odds ratio = 1.52 [0.92-2.51]). The findings suggest that although segmental scoring could be incorporated by strength and conditioning coaches and clinicians, they should be used predominantly as a preliminary screening tool to highlight players requiring a more thorough assessment.


Assuntos
Músculos Abdominais/fisiologia , Traumatismos da Perna/diagnóstico , Força Muscular , Medição de Risco/métodos , Adolescente , Atletas , Humanos , Extremidade Inferior/lesões , Masculino , Postura , Curva ROC , Sensibilidade e Especificidade , Tronco/lesões , Adulto Jovem
11.
Phys Ther ; 100(2): 332-345, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-31588514

RESUMO

BACKGROUND: Physical activity is increasingly recognized as an important marker of functional recovery following fracture. OBJECTIVE: The objectives of this study were to measure sedentary behavior and physical activity 2 weeks and 6 months following fracture and to determine associated demographic and injury factors. DESIGN: This was an observational study. METHODS: Two weeks and 6 months following fracture, 83 adults who were 18 to 69 years old and had upper limb (UL) or lower limb (LL) fractures wore an accelerometer and an inclinometer for 10 days. We calculated sitting time, steps, moderate-intensity physical activity (MPA), and vigorous-intensity physical activity and conducted linear mixed-effects multivariable regression analyses to determine factors associated with temporal changes in activity. RESULTS: At 6 months versus 2 weeks after fracture, participants sat less, took more steps, and engaged in more MPA. Participants with LL fractures sat 2 hours more, took 66% fewer steps, and engaged in 77% less MPA than participants with UL fractures. Greater reductions in sitting time were observed for participants in the youngest age group and with LL fractures, participants with high preinjury activity, and participants who were overweight or obese. For steps, greater improvement was observed for participants in the youngest and middle-aged groups and those with LL fractures. For MPA, greater improvement was observed for middle-aged participants and those with LL fractures. LIMITATIONS: Although this study was sufficiently powered for the analysis of major categories, a convenience sample that may not be representative of all people with musculoskeletal trauma was used. CONCLUSIONS: Working-age adults with LL fractures had lower levels of physical activity 6 months after fracture than those with UL fractures. Older adults showed less improvement over time, suggesting that they are an important target group for interventions aimed at regaining preinjury activity levels.


Assuntos
Traumatismos do Braço/fisiopatologia , Exercício Físico , Fraturas Ósseas/fisiopatologia , Traumatismos da Perna/fisiopatologia , Recuperação de Função Fisiológica , Comportamento Sedentário , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Estudos Prospectivos , Postura Sentada , Fatores de Tempo , Adulto Jovem
12.
J Trauma Acute Care Surg ; 88(2): 197-206, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31804418

RESUMO

BACKGROUND: Traumatic popliteal arterial injury (TPAI) is associated with a risk of both limb loss and long-term morbidity due to prolonged ischemia and the often-associated musculoskeletal injuries. Long-term functional outcome following this injury has not been adequately studied. We evaluated patients with TPAI to determine if there was an improvement in functional outcome over time. We hypothesized that both the initial severity of ischemia and the associated injuries limited the ability of patients to improve functional outcome. METHODS: Patients with TPAI for 20 years were identified. All patients had at least a 2-year follow-up. Functional outcomes were measured using the Boston University Activity Measure for Post-Acute Care to assess basic mobility (BM) and daily activity (DA). Multiple linear regression, adjusted for age, severity of injury and shock, operative complexity, associated injuries, ischemic time, and length of follow-up were used to identify predictors of functional outcome after TPAI. RESULTS: A total of 214 patients were identified: 123 penetrating (57%) and 91 blunt (43%). Overall mortality was 1.9% (all in-hospital), and amputation occurred in 10%. Of the 210 survivors, follow-up was obtained in 145 patients (69%). Median follow-up was 9.2 years (interquartile range, 5.7-15.7 years). Mean Activity Measure for Post-Acute Care scores for BM and DA were 78 and 75, respectively, both signifying mild impairment (normal, >84). Multiple linear regression failed to identify increasing length of follow-up as a predictor of improved functional outcomes. Only age, lower extremity fracture, and ischemic time were identified as predictors of decreased BM and DA. CONCLUSION: Increasing age, lower extremity fracture, and prolonged ischemic time worsened long-term functional outcomes. Functional outcome did not improve over time, suggesting that maximal recovery may be achieved within the first 2 years postinjury. Thus, early and effective revascularization remains the only potentially modifiable risk factor for improving functional outcomes following TPAI. LEVEL OF EVIDENCE: Prognostic, level III.


Assuntos
Amputação/estatística & dados numéricos , Procedimentos Endovasculares , Isquemia/cirurgia , Traumatismos da Perna/cirurgia , Extremidade Inferior/irrigação sanguínea , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Isquemia/etiologia , Isquemia/mortalidade , Traumatismos da Perna/complicações , Traumatismos da Perna/mortalidade , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/lesões , Artéria Poplítea/cirurgia , Prognóstico , Sobreviventes/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
13.
Plast Reconstr Surg ; 145(1): 164e-171e, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881626

RESUMO

BACKGROUND: Although venous thrombosis is a leading cause of flap failure, the majority of lower extremity free flap planning is centered on arterial system evaluation. Preoperative identification of relevant abnormality in lower extremity venous systems by means of duplex ultrasound may aid in the diagnosis of clinically important abnormality that could affect lower extremity flap outcomes. METHODS: Between November of 2014 and August of 2017, 57 patients underwent preoperative lower extremity venous duplex imaging and free tissue transfer for lower extremity wounds. A retrospective review was performed to describe lower extremity venous pathologic findings, relevant patient demographic data, comorbid conditions, and outcomes. Discovery of venous abnormality helped guide recipient vein selection. RESULTS: Fifty-seven consecutive patients underwent 59 free flap operations to treat chronic lower extremity wounds. Venous duplex ultrasonography detected venous insufficiency (defined as >0.5 second of reflux) in 23 patients (39.0 percent), including 16 (27.2 percent) with deep thigh reflux, six (10.2 percent) with superficial calf reflux, and four (6.78 percent) with deep calf reflux. Deep venous thrombosis was found in four patients (6.78 percent) and treated with anticoagulation. The flap success rate was 98.3 percent. Five patients (8.47 percent) progressed to amputation. At a mean follow-up time of 15.1 ± 9.51 months (range, 1.67 to 35.2 months), 53 patients (89.8 percent) were able to continue community ambulation. CONCLUSIONS: Lower extremity venous duplex testing before free tissue transfer may be useful for optimizing flap recipient vessel selection and for detecting potentially unknown venous abnormality. Development of free flap planning protocols incorporating preoperative vascular imaging is important to achieving good functional outcomes in this comorbid patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Rejeição de Enxerto/prevenção & controle , Traumatismos da Perna/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Insuficiência Venosa/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Humanos , Incidência , Perna (Membro)/irrigação sanguínea , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Ultrassonografia Doppler Dupla , Veias/diagnóstico por imagem , Insuficiência Venosa/complicações , Insuficiência Venosa/epidemiologia , Trombose Venosa/complicações , Trombose Venosa/epidemiologia , Adulto Jovem
14.
Emerg Med Clin North Am ; 38(1): 143-165, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757247

RESUMO

Knee and leg injuries are extremely common presentations to the emergency department. Understanding the anatomy of the knee, particularly the vasculature and ligamentous structures, can help emergency physicians (EPs) diagnose and manage these injuries. Use of musculoskeletal ultrasonography can further aid EPs through the diagnostic process. Proper use of knee immobilizers can also improve long-term patient outcomes.


Assuntos
Gerenciamento Clínico , Emergências , Traumatismos do Joelho/diagnóstico , Articulação do Joelho/diagnóstico por imagem , Procedimentos Ortopédicos/métodos , Humanos , Traumatismos do Joelho/terapia , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/terapia
15.
Emerg Med Clin North Am ; 38(1): 31-59, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757254

RESUMO

Approximately one-third of children sustain a fracture before the age of 16 years; however, their unique anatomy and healing properties often result in a good outcome. This article focuses on the diagnosis and management of pediatric extremity injuries. The article describes the anatomic features and healing principles unique to children and discusses pediatric upper and lower extremity fractures and presents evidence-based and standard practice for their management. Finally, the article describes the conditions under which emergency physicians are likely to miss pediatric fractures by highlighting specific examples and discussing the general factors that lead to these errors.


Assuntos
Traumatismos do Braço/diagnóstico , Emergências , Serviço Hospitalar de Emergência , Fraturas Ósseas/diagnóstico , Traumatismos da Perna/diagnóstico , Procedimentos Ortopédicos/métodos , Radiografia/métodos , Traumatismos do Braço/terapia , Criança , Gerenciamento Clínico , Fraturas Ósseas/terapia , Humanos , Traumatismos da Perna/terapia
16.
Scand J Med Sci Sports ; 30(1): 174-184, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31494970

RESUMO

BACKGROUND: Calf muscle strain injuries (CMSI) show consistent rates of prevalence and re-injury in elite Australian Football players. An epidemiological evaluation is warranted to better understand the clinical presentation and recovery of CMSI. PURPOSE: First, to describe the epidemiology of CMSI in elite Australian Football players. Second, to determine if recovery following injury is different according to: (a) injury type (index vs re-injury); (b) muscle injured (soleus vs gastrocnemius); and (c) mechanism of injury (running-related activity vs non running-related activity). STUDY DESIGN: Descriptive epidemiological. METHODS: Data retrieved from the Soft Tissue injury Registry of the Australian Football League were analyzed. Sixteen clubs submitted data on CMSI from 2014 to 2017. Data included: player characteristics, training and match history at the time of injury, MRI, and the time to reach recovery milestones. RESULTS: One hundred and eighty-four CMSI were included (149 index injuries; 35 re-injuries). Soleus injuries were most prevalent (84.6%). Soleus injuries took 25.4 ± 16.2 days to return to play, whereas gastrocnemius injuries took 19.1 ± 14.1 days (P = .097). CMSI sustained during running-related activities took approximately 12 days longer to recover than injuries sustained during non running-related activities (P = .001). Compared to index injuries, re-injuries involved older players (P = .03) and significantly more time was taken to run at >90% of maximum speed, return to full training, and return to play (P ≤ .001). Almost all of the observed re-injuries involved soleus (91.4%). CONCLUSION: Soleus injuries are more prevalent than gastrocnemius injuries in elite Australian Football players. Prognosis appears to be influenced by clinical factors, with CMSI sustained during running-related activities and re-injuries needing more time to recover.


Assuntos
Traumatismos em Atletas/epidemiologia , Futebol Americano/lesões , Traumatismos da Perna/epidemiologia , Músculo Esquelético/lesões , Entorses e Distensões/epidemiologia , Adolescente , Adulto , Atletas , Austrália , Humanos , Imagem por Ressonância Magnética , Corrida/lesões , Adulto Jovem
17.
J Foot Ankle Surg ; 58(6): 1273-1275, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31679680

RESUMO

Replantation of the lower leg has controversial indications, but it may be considered in carefully selected patients. Although the function of prosthetic lower legs has been improved in recent decades, leg salvage remains a laudable goal. We present the case of a 7-year-old child who sustained a traumatic amputation at the level of the middle tibia with loss of the middle portion of the lower leg. We performed successful replantation, and tibia lengthening was performed starting 10 days after replantation and lasted 6 months.


Assuntos
Amputação Traumática , Alongamento Ósseo , Traumatismos da Perna/cirurgia , Desigualdade de Membros Inferiores/cirurgia , Perna (Membro)/cirurgia , Reimplante , Criança , Fixadores Externos , Fraturas Ósseas/cirurgia , Humanos , Desigualdade de Membros Inferiores/etiologia , Masculino , Músculo Esquelético/lesões , Músculo Esquelético/cirurgia , Nervo Fibular/lesões , Nervo Fibular/cirurgia , Transplante de Pele , Tíbia/lesões , Tíbia/cirurgia , Nervo Tibial/lesões , Nervo Tibial/cirurgia
18.
Pan Afr Med J ; 33: 243, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692679

RESUMO

Coverage of loss of skin substances on the lower third of the leg is a challenging problem. This is due to adjacent soft tissues impairment, shortage of local vascularization and bone exposure. We conducted a retrospective study of a series of 9 cases of skin coverage of the lower third of the leg treated at the University Hospital Hassan II of Fez from 2016 to 2018. This study aims to highlight the characteristic of the loss of skin substances on the lower third of the leg, while emphasizing the difficulty of management.


Assuntos
Traumatismos da Perna/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Feminino , Humanos , Traumatismos da Perna/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele/patologia , Lesões dos Tecidos Moles/patologia , Adulto Jovem
19.
Handchir Mikrochir Plast Chir ; 51(6): 453-463, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698488

RESUMO

BACKGROUND: The gastrocnemius and soleus muscle flaps are the most commonly used transfer flaps to treat lower limb severe lesions. The use of the muscle as coverage tissuemay incur in functionality loss and motor control deficits. The aim of this study is to assess whether functional deficits are present during gait, posture and heel rise test (HRT). METHOD: From 2008-2013 we treated 9 patients suffering from complex injury of the lower third of the leg (Gustilo III B). A population of 9 patients (group A) was examined after reconstruction with a soleus muscle flap. The results were compared with a control population (group B: 9 patients). Each patient performed at least 3 gait tests at a fast pace, 2 posture tests and 2 HRT on an inclined plane. RESULTS: Gait parameters for group A: Spatio-temporal parameters such as step length, cadence were reduced compared to the homolateral leg (p < 0.05). The initial double support phase was shorter in relation to the final phase and the first peak in the vertical ground reaction component was reduced compared to the contralateral leg.Posture for the group A: the mediolateral excursion (during open- and closed-eyes test) and the related mean velocity (in the open-eyes test) were significantly lower compared to the control group (p < 0.05).HRT for group A: the number of rises and relative height and angular excursion were reduced in the operated leg in relation to the control group (p < 0.05) and to the contralateral leg. CONCLUSION: The patients treated with the soleus muscle used as tissue defect coverage completely recovered the ability to walk but showed some deficits in kinetic parameters during the body weight-loading phase. During gait prolonged muscle activity compared to controls was observed. The absence of soleus (group A) revealed no significant alterations in postural control. However, the HRT remained the most relevant test to measure patients' performance when treated with soleus flap in relation to the control group.


Assuntos
Traumatismos da Perna , Músculo Esquelético , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Traumatismos da Perna/cirurgia , Extremidade Inferior , Músculo Esquelético/cirurgia , Músculo Esquelético/transplante , Terapia de Salvação , Retalhos Cirúrgicos , Resultado do Tratamento
20.
Curr Sports Med Rep ; 18(11): 416-420, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702723

RESUMO

Hamstring muscle injuries (HMI) are common among athletes. HMI can take many months to years to resolve. Often, athletes do not report complete resolution with typical conservative therapy. We present several cases of athletes who presented with chronic hamstring injuries that resolved immediately after being treated with an ultrasound-guided fascial hydrodissection procedure. Following the procedure and graded rehabilitation protocol, athletes reported resolution of pain and tightness in addition to increased performance and a quicker return to play.


Assuntos
Traumatismos em Atletas/cirurgia , Dissecação/métodos , Músculos Isquiossurais/lesões , Traumatismos da Perna/cirurgia , Lesões dos Tecidos Moles/cirurgia , Adolescente , Adulto , Atletas , Feminino , Humanos , Masculino , Ultrassonografia
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