scholarly journals Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

2021 ◽  
Author(s):  
Pablo S. Corona ◽  
Carla Carbonell-Rosell ◽  
Matías Vicente ◽  
Jordi Serracanta ◽  
Kevin Tetsworth ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Functional Outcomes ◽  
Local Flap ◽  
Tissue Loss ◽  
Functional Score ◽  
Limb Salvage Rate ◽  
Soft Tissue Loss ◽  
Infection Eradication ◽  
Salvage Rate

Abstract Introduction Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. Materials and methods A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. Primary outcomes: limb salvage rate and infection eradication. Secondary outcomes: patient functional outcomes and satisfaction. Results Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm2 (6–600) and 5.4 cm (1–23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were “very satisfied” with the treatment outcome. Conclusion A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.

Surgical and endovascular hybrid approach in peripheral arterial disease of the lower limbs

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 417-422 ◽  
Author(s):  
Anouk Grandjean ◽  
Katia Iglesias ◽  
Céline Dubuis ◽  
Sébastien Déglise ◽  
Jean-Marc Corpataux ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Hybrid Approach ◽  
Arterial Disease ◽  
Early Mortality ◽  
Secondary Patency ◽  
Limb Salvage Rate ◽  
Peripheral Arterial ◽  
Salvage Rate

Abstract. Background: Multilevel peripheral arterial disease is frequently observed in patients with intermittent claudication or critical limb ischemia. This report evaluates the efficacy of one-stage hybrid revascularization in patients with multilevel arterial peripheral disease. Patients and methods: A retrospective analysis of a prospective database included all consecutive patients treated by a hybrid approach for a multilevel arterial peripheral disease. The primary outcome was the patency rate at 6 months and 1 year. Secondary outcomes were early and midterm complication rate, limb salvage and mortality rate. Statistical analysis, including a Kaplan-Meier estimate and univariate and multivariate Cox regression analyses were carried out with the primary, primary assisted and secondary patency, comparing the impact of various risk factors in pre- and post-operative treatments. Results: 64 patients were included in the study, with a mean follow-up time of 428 days (range: 4 − 1140). The technical success rate was 100 %. The primary, primary assisted and secondary patency rates at 1 year were 39 %, 66 % and 81 %, respectively. The limb-salvage rate was 94 %. The early mortality rate was 3.1 %. Early and midterm complication rates were 15.4 % and 6.4 %, respectively. The early mortality rate was 3.1 %. Conclusions: The hybrid approach is a major alternative in the treatment of peripheral arterial disease in multilevel disease and comorbid patients, with low complication and mortality rates and a high limb-salvage rate.

Injectable Soft Tissue Nano/Micro Fillers for Facial Reconstruction

2021 ◽  
Vol 17 (1) ◽  
pp. 1-17
Author(s):  
Yue Pan ◽  
Ying Hao ◽  
Yao Xiao ◽  
Kun Shi ◽  
Ying Qu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Facial Reconstruction ◽  
Soft Tissue Augmentation ◽  
Tissue Loss ◽  
Competitive Performance ◽  
Filling Materials ◽  
Tissue Augmentation ◽  
Soft Tissue Loss ◽  
Injectable Fillers ◽  
Micro Fillers

Soft Tissue augmentation is a way to restore lost tissue and also a way to reshape confidence for patients who suffer from soft tissue loss. Materials that can realize such a function are called soft tissue fillers. Among the large number of fillers, injectable fillers have attracted widespread attention in facial cosmetic fields due to their convenience and competitive performance. Meanwhile, there is a huge demand for better injectable soft tissue fillers in medical cosmetology market. This review introduces several fillers which were once used in clinical or are now still in use. Furthermore, we update recent improvements and progress on injectable filling materials hoping to contribute to its further developments.

scholarly journals Intravascular Shunt in Management of Limb Trauma- A Review

2021 ◽  
pp. 274-281
Author(s):  
Hashem Bark Awadh Abood ◽  
Abdulaziz Munahi Alanazi ◽  
Falah Bader Alhajraf ◽  
Wejdan Nawaf Mesfer Alotaibi ◽  
Bushra Saad Alghamdi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Patient Survival ◽  
Survival Rates ◽  
Tissue Loss ◽  
Vascular Injuries ◽  
Limb Trauma ◽  
Life Threatening ◽  
Arterial Insufficiency ◽  
Soft Tissue Loss

Vascular injuries to the upper or lower limb in the context of significant soft tissue loss, fractures, or other life-threatening injuries are associated with a high amputation rate. Complex extremity vascular injuries in which acute arterial insufficiency combined with severe or prolonged shocks are unacceptable because warm, warm, skeletal muscle time is often exceeded before adequate revascularization, and are associated with extended ischemia periods or fractures or soft tissue wounds. Revascularizing the limb is essential for the success of the limb rescue. Selective intravascular temporary shunting hence allows better overall care of the patient and can therefore be predicted to increase both limb rescue and patient survival rates. The aim of this article was to review and summarize results of previous literature regarding effectiveness on intravascular shunting as management of limb trauma as well as reviewing its potential complications.

Two-staged extensor tendon reconstruction for zone 6 extensor tendon loss of the fingers: indications, technique and results

2013 ◽  
Vol 40 (3) ◽  
pp. 276-280 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Soft Tissue ◽  
Extensor Tendon ◽  
Tissue Loss ◽  
Soft Tissue Coverage ◽  
Metacarpophalangeal Joints ◽  
Tendon Reconstruction ◽  
Car Accidents ◽  
Active Flexion ◽  
Palmaris Longus Tendon ◽  
Soft Tissue Loss

Over a 20-year period, six patients (19 tendons) underwent two-staged extensor tendon reconstruction using silicone rods followed by palmaris longus tendon grafts sutured proximally to the divided flexor carpi radialis tendon. All patients were young men (mean age, 22 years) who sustained the injury in car accidents. The soft tissue loss from the dorsum of the hand was associated with extensor tendon loss over the entire zone 6 with or without loss in zone 7. Primary soft tissue coverage was done elsewhere, and patients presented for secondary tendon reconstruction. All patients had supple metacarpophalangeal joints before reconstruction. After the two-staged tendon reconstruction, full or near-full active flexion at the metacarpophalangeal joints was obtained in all patients. However, minor extension lags (10°–15°) at the metacarpophalangeal joints were seen in 15 out of 19 reconstructed fingers.

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