Overcoming severe calcified lower extremity artery in lower limb salvage operation by using the Fogarty catheter and vein graft

Microsurgery ◽  
2021 ◽  
Author(s):  
Dong Yeon Kim ◽  
Yesol Kim ◽  
Suk‐Ho Moon
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Lower Limb ◽  
Vein Graft ◽  
Fogarty Catheter ◽  
Salvage Operation

Association of clinical characteristics with decision making in patients with severe lower extremity trauma

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Lower Limb ◽  
Patient Management ◽  
Treatment Time ◽  
Emergency Department Admission ◽  
Stump Closure ◽  
Limb Trauma ◽  
Lower Limb Trauma

Severe lower limb trauma represents a challenge for both the emergency department physicians and the surgeons. These injuries are associated with significant incidence of limb loss and it is not uncommon for the treating physician to make the hard decision between limb salvage, amputation or stump closure for a patient in critical condition. Our aim was to evaluate the epidemiology of traumatic lower extremity amputations and to analyze the factors which may have effect on patient resuscitation, limb salvage and efficient patient management. Patients who were admitted to our institution’s emergency department for traumatic lower extremity amputation over an 8 years’ period (2012 to 2020) were retrospectively analyzed. Patient files with the possibility of severe lower limb trauma and mangled extremity were retrieved and analyzed using ICD codes recorded/registered during the emergency department admission. Mean time from emergency admission to transfer to operating theater was 184,5 minutes. Replantation of the amputate was performed in 4 patients (19%). 25% of the amputations at the ankle level (1 out of 4) and 37.5% of the transtibial amputates (3 out of 8) were replanted. A multidisciplinary approach is necessary in every aspect of patient management; however, this does not justify a delay in treatment. Time spent during conclusion of necessary consultations does not have negative effects on patient outcome as long as patient is closely monitored and resuscitated in the emergency department.

Limb Salvage and Amputation in Survivors of Pediatric Lower-Extremity Bone Tumors: What Are the Long-Term Implications?

2002 ◽  
Vol 20 (22) ◽  
pp. 4493-4501 ◽  
Author(s):  
Rajaram Nagarajan ◽  
Joseph P. Neglia ◽  
Denis R. Clohisy ◽  
Leslie L. Robison
Keyword(s):  
Quality Of Life ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Lower Limb ◽  
Bone Tumors ◽  
Pediatric Patients ◽  
Population Based ◽  
Surgical Approaches

ABSTRACT: The past four decades have seen tremendous progress in the treatment of pediatric and adolescent cancers. As a consequence, there are increasing numbers of adult childhood cancer survivors. This has prompted investigation into the long-term consequences of cancer treatments. One group that merits special study is the survivors of lower-extremity bone tumors. Their function and quality of life may depend in part on both the surgery and the age at which it was performed. Comparisons between studies are difficult because small numbers of patients and the use of varying research designs and methods have limited research in this area. The purpose of this article is to review the major surgical approaches to lower-limb bone tumors and their impact on pediatric patients. The results show that survival is equivalent between amputation and limb salvage. Complications occur more frequently in limb salvage. The long-term outcomes of those undergoing amputation and limb salvage have not been found to be substantially different in regard to quality of life. In conclusion, prospective long-term follow-up of pediatric patients with lower-limb tumors is needed to (1) determine in a uniform manner the long-term complications, quality of life, and functionality of this population and describe differences within this patient population based on age at diagnosis and surgical procedure, (2) identify areas of concern that are amenable to intervention, and (3) provide clinicians and future patients a better understanding of the surgical options.

Lower Extremity Limb Salvage with Cross Leg Pedicle Flap, Cross Leg Free Flap, and Cross Leg Vascular Cable Bridge Flap

2018 ◽  
Vol 34 (07) ◽  
pp. 522-529 ◽  
Author(s):  
Oscar Manrique ◽  
Sarah Bishop ◽  
Pedro Ciudad ◽  
Kian Adabi ◽  
Jorys Martinez-Jorge ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Hospital Stay ◽  
Limb Salvage ◽  
Lower Limb ◽  
Average Length ◽  
Donor Site ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Tissue Loss ◽  
Pedicle Flap

Background Lower extremity salvage following significant soft tissue loss can be complicated by lack of recipient vessel for free tissue transfer. We describe our experience in lower limb salvage for patients with no recipient vessels with the use of pedicle, free and cable bridge flaps. Methods A retrospective review from 1985 to 2017 of patients undergoing lower limb salvage using a contralateral pedicle cross leg (PCL) flaps, free cross leg (FCL) flaps, or free cable bridge (FCB) flaps was conducted. Demographics, etiology of the reconstruction, type of flap used, donor-site vessels, defect size, operating time, time of pedicle division, length of hospital stay, time to ambulation, and complications were analyzed. Results A total of 53 patients (48 males and 5 females) with an average age of 35 years (range, 29–38 years) were identified. The etiology for the reconstruction was trauma in 52 patients and oncological resection in 1 patient. There were 18 PCL, 25 FCL, and 10 FCB completed. The recipient vessels for all flaps were the posterior tibial artery and vein. The average operating room times for PCL, FCL, and FCB flaps were 4, 9, and 10 hours, respectively. The average length of hospital stay was 5 weeks and average time to ambulation was 4 weeks. The average follow-up time was 7.5 years (range, 3–12 years). Complications encountered were hematoma (six), prolonged pain (six), total flap loss (two), reoperation (five), and infection (four). Limb salvage rates were 96.2%. Conclusion When ipsilateral limb vessels are not available, and other reconstructive options have been exhausted, cross leg flaps can be a viable option for limb salvage in the setting of extensive defects.

scholarly journals Functional Prognosis after Limb Salvage Operation for Malignant Bone Tumors of the Lower Extremity.

1992 ◽  
Vol 41 (2) ◽  
pp. 479-482
Author(s):  
Kenji Fukuda ◽  
Takao Kurogi ◽  
Shigeru Kuwahara ◽  
Naoya Tajima
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Bone Tumors ◽  
Malignant Bone Tumors ◽  
Salvage Operation

Lower Limb Salvage Using Patent-Specific 3D-Printed Titanium Cage Following Severe Left Ankle Traumatic Partial Amputation: A Pediatric Case Report

2020 ◽  
pp. 193864002095481
Author(s):  
Todd Dow ◽  
Dani Lowe ◽  
Joel Morash
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Lower Limb ◽  
Salvage Surgery ◽  
Patient Specific ◽  
Limb Salvage Surgery ◽  
Partial Amputation ◽  
Retrograde Nail ◽  
3D Printed

Background Patients with large bony defects of the ankle who wish to avoid amputation have limited surgical intervention options for limb salvage. Each of these interventions are technically complex and present significant risk for complications. The use of a patient-specific 3D-printed titanium cage in conjunction with a tibiotalocalcaneal (TTC) arthrodesis using a retrograde nail is another management option. This case adds to the scarce published literature on this technique. Case presentation This report presents the case of a 16-year-old female who suffered a traumatic partial amputation of her left distal lower extremity following an all-terrain-vehicle accident that resulted in a 10.0 × 10.0 cm skin laceration and a 5-cm subsegmental bony loss of the distal tibia. She was successfully treated using a patient-specific 3D-printed titanium truss cage in conjunction with a TTC arthrodesis using a retrograde nail. Conclusions The decision to amputate or attempt limb salvage in a severely injured lower limb is still a topic of active debate. However, literature has shown that patients who undergo limb salvage surgery have better psychological health outcomes and equivalent functional outcomes as patients who have undergone amputation. Therefore, research on techniques that optimize and advance limb salvage surgery is needed. As the numerous potential benefits and limitations of patient-specific 3D-printed implants are assessed throughout the field of orthopedics, further research and cost-analysis will be required. Cases such as the one presented add to the limited existing literature of patient-specific 3D-printed implant for treatment of large distal lower extremity bony defects. Levels of Evidence Level V (Case Report)

Limitations of body mass index for counseling individuals with unilateral lower extremity amputation

2016 ◽  
Vol 41 (2) ◽  
pp. 186-193 ◽  
Author(s):  
Alexandra P Frost ◽  
Tracy Norman Giest ◽  
Allison A Ruta ◽  
Teresa K Snow ◽  
Mindy Millard-Stafford
Keyword(s):  
Body Mass Index ◽  
Lower Extremity ◽  
Health Risk ◽  
Body Mass ◽  
Body Fat ◽  
Lower Limb ◽  
Dual Energy ◽  
Limb Loss ◽  
Percent Body Fat ◽  
X Ray

Background: Body composition is important for health screening, but appropriate methods for unilateral lower extremity amputees have not been validated. Objectives: To compare body mass index adjusted using Amputee Coalition equations (body mass index–Amputee Coalition) to dual-energy X-ray absorptiometry in unilateral lower limb amputees. Study design: Cross-sectional, experimental. Methods: Thirty-eight men and women with lower limb amputations (transfemoral, transtibial, hip disarticulation, Symes) participated. Body mass index (mass/height2) was compared to body mass index corrected for limb loss (body mass index–Amputee Coalition). Accuracy of classification and extrapolation of percent body fat with body mass index was compared to dual-energy X-ray absorptiometry. Results: Body mass index–Amputee Coalition increased body mass index (by ~ 1.1 kg/m2) but underestimated and mis-classified 60% of obese and overestimated 100% of lean individuals according to dual-energy X-ray absorptiometry. Estimated mean percent body fat (95% confidence interval) from body mass index–Amputee Coalition (28.3% (24.9%, 31.7%)) was similar to dual-energy X-ray absorptiometry percent body fat (29.5% (25.2%, 33.7%)) but both were significantly higher ( p < 0.05) than percent body fat estimated from uncorrected body mass index (23.6% (20.4%, 26.8%)). However, total errors for body mass index and body mass index–Amputee Coalition converted to percent body fat were unacceptably large (standard error of the estimate = 6.8%, 6.2% body fat) and the discrepancy between both methods and dual-energy X-ray absorptiometry was inversely related ( r = −0.59 and r = −0.66, p < 0.05) to the individual’s level of body fatness. Conclusions: Body mass index (despite correction) underestimates health risk for obese patients and overestimates lean, muscular individuals with lower limb amputation. Clinical relevance Clinical recommendations for an ideal body mass based on body mass index–Amputee Coalition should not be relied upon in lower extremity amputees. This is of particular concern for obese lower extremity amputees whose health risk might be significantly underestimated based on body mass index despite a “correction” formula for limb loss.

Infra-popliteal deep venous thrombi and the risk of symptomatic pulmonary embolism in hospitalized patients

Vascular ◽  
2011 ◽  
Vol 19 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Saadi Alhalbouni ◽  
Anil Hingorani ◽  
Alexander Shiferson ◽  
Natalie Marks ◽  
Enrico Ascher
Keyword(s):  
Pulmonary Embolism ◽  
Lower Extremity ◽  
Retrospective Review ◽  
Lower Limb ◽  
Hospitalized Patients ◽  
Symptomatic Pulmonary Embolism ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hospital Patients ◽  
Made In

Infra-popliteal veins include the tibial and peroneal veins, as well as the soleal and gastrocnemial veins collectively known as the calf muscle veins (CMVs). Acute infra-popliteal deep venous thrombi (DVTs) are often considered insignificant with regard to the risk of pulmonary embolism (PE). A retrospective review of 4035 consecutive lower extremity venous duplex scans were made in 3146 hospital patients at our Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL)-accredited vascular lab. Seven hundred sixteen (17.7%) duplex scans were positive for acute DVTs, and 112 (2.8%) were associated with PEs. The breakdown of positive duplexes for acute DVTs was as follows: 202 (28.2%) isolated femoral-popliteal DVTs with PE in 23 (11.4%), 304 (42.5%) isolated infra-popliteal DVTs with PE in 24 (7.9%) and 210 (29.3%) multilevel DVTs involving both vein segments (femoral-popliteal and infra-popliteal) with PE in 38 (18.1%). Of the 304 isolated acute infra-popliteal DVTs, 207 (68.1%) were isolated CMV DVTs with evidence of PE in 12 (5.8%). No statistically significant difference ( P = 0.27) in the risk of PE between isolated femoral-popliteal and isolated infra-popliteal DVTs was noted. A significant number of patients (5.8%) with isolated CMV DVTs developed PE. Lower limb venous scans for DVTs should evaluate the infra-popliteal veins. Hospitalized patients with infra-popliteal DVTs should receive anticoagulation.

Impact of Interdisciplinary System-Wide Limb Salvage Advisory Council on Lower Extremity Major Amputation

2021 ◽  
Author(s):  
Mehdi H. Shishehbor ◽  
Tarek A. Hammad ◽  
Tonia J. Rhone ◽  
Ahmad Younes ◽  
Norman Kumins ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Major Amputation ◽  
Advisory Council
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