Sural Flap Use for the Treatment of Wounds With Underlying Osteomyelitis: Graft Size a Predictor in Outcome, a Systematic Review

2017 ◽  
Vol 10 (6) ◽  
pp. 560-566 ◽  
Author(s):  
Sham Persaud ◽  
Anthony Chesser ◽  
Ryan Pereira ◽  
Adrianne Ross
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Weight Bearing ◽  
Successful Outcome ◽  
Graft Size ◽  
Sural Flap ◽  
Flap Failure ◽  
Significant Difference ◽  
Versatile Technique ◽  
Treatment Of Wounds

The sural flap procedure is a versatile technique that can be used to cover many types of defects about the lower extremity. The management of soft tissue defects of the lower extremity with underlying osteomyelitis is difficult. The goal for any of these patients is to create a biomechanically stable foot for weight-bearing purposes with no continued infection. Data were gathered using multiple databases from the years 2000 to 2016. Data were compiled looking at the number of subjects, age, comorbidities, number of complications, number of failures, and average flap size of complications/failures. A total of 110 patients were gathered using 5 separate articles. Twenty-two of the 110 patients had short-term complications. Flap failure was seen in 9/110 patients. A significant difference was noticed in flap size between flap failure and complication groups and nonfailure groups. The average flap size of patients who had some form of complication or failure was 51.87 cm2 in size. The average graft size for patients without complications during their recovery was 36.54 cm2. Within our study, the failure rate of 8.9% and complication rate of 13.7% are consistent with previous reports on sural perforator flaps. Last, with regard to the effect of flap size, there were significant differences between patients with a successful outcome and those who experienced complications or failures. Levels of Evidence: Therapeutic, Level III: Systematic review

scholarly journals One Versus 2 Venous Anastomoses in Free Flap Surgery: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 26 (2) ◽  
pp. 91-98
Author(s):  
Jennifer L. K. Matthews ◽  
Noor Alolabi ◽  
Forough Farrokhyar ◽  
Sophocles H. Voineskos
Keyword(s):  
Systematic Review ◽  
Free Flap ◽  
Meta Analysis ◽  
Venous Congestion ◽  
Flap Surgery ◽  
Flap Failure ◽  
Free Flap Surgery ◽  
Significant Difference ◽  
Reoperation Rates ◽  
Venous Flap

Background: The necessity of a second venous anastomosis in free flap surgery is controversial. The purpose of this systematic review is to determine whether venous flap failure and reoperation rates are lower when 2 venous anastomoses are performed. The secondary objective is to determine whether venous flap failure and reoperation rates are lower when the 2 veins are from 2 different drainage systems. Methods: A comprehensive search of the literature identified relevant studies. Investigators independently extracted data on rates of flap failure and reoperation secondary to venous congestion. A meta-analysis was performed; odds ratios (ORs) were pooled using a random-effects model and 95% confidence intervals (CIs). Results: Of 18 190 studies identified, 15 were included for analysis. The mean sample size was 287 patients (minimum = 102, maximum = 564). No statistically significant difference in venous flap failure was found when comparing 1 versus 2 venous anastomoses (OR: 1.35; 95% CI: 0.46-3.93). A significant decrease in reoperation rate due to venous congestion was shown (OR: 3.03; 95% CI: 1.64-5.58). The results favor using 2 veins from 2 different systems over veins from the same system (OR: 0.16; 95% CI: 0.02-1.27). Conclusions: There is low-quality evidence suggesting that the use of 2 venous anastomoses will lower the rate of reoperation due to venous congestion. There are insufficient data published to meaningfully compare outcomes of flaps with 2 venous anastomoses from different systems to flaps with anastomoses from the same system.

scholarly journals Postoperative Management of Lower Extremity Free Tissue Transfer: A Systematic Review

2018 ◽  
Vol 35 (01) ◽  
pp. 001-007 ◽  
Author(s):  
Carol Soteropulos ◽  
Jenny Chen ◽  
Samuel Poore ◽  
Catharine Garland
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Weight Bearing ◽  
Free Tissue Transfer ◽  
Postoperative Management ◽  
Venous Congestion ◽  
Evidence Based ◽  
Flap Survival ◽  
Randomized Controlled ◽  
Tissue Transfer

Background Free tissue transfer for lower extremity reconstruction is a safe and reliable option for a wide range of challenging wounds; however, no consensus exists regarding postoperative management. Methods A systematic review of postoperative management of lower extremity free tissue transfer was conducted using Medline, Cochrane Database, and Web of Science. Multicenter surveys, randomized controlled trials, cohort studies, and case series were reviewed. Results Fifteen articles investigating current protocols, flap physiology, and aggressive dangle protocols were reviewed. The following evidence-based conclusions were made: (1) Free tissue transfer to the lower extremity is unique due to altered hemodynamics and dependency during orthostasis. Free flap circulation is dependent on locally mediated responses and deprived of compensatory muscular and neurovascular mechanisms that prevent venous congestion in the normal extremity. (2) Compressive wrapping reduces venous congestion and edema and may induce ischemic conditioning, which can increase blood flow. (3) Dangle protocols vary widely in timing of initiation, frequency, and monitoring. Small volume studies examining aggressive mobilization protocols initiating early dependency have led to earlier ambulation and discharge, with no change in flap survival as compared with conservative protocols. (4) Weight bearing may begin after the completion of dangle protocol if no orthopedic injury is present. Conclusions Early initiation of a dangle protocol does not appear to negatively impact flap survival based on this systematic review. Compressive wrapping may be a useful adjunct. Many surgeons agree that clinical monitoring is sufficient; there is no consensus on the utility of adjunct monitoring techniques. Weight bearing may begin after completion of dangle protocol with close flap monitoring, if not prevented by orthopedic restrictions. By providing additional outflow vasculature to reduce venous congestion, flow-through anastomoses may eliminate the need for a dangle protocol. Further research, including large randomized controlled trials is still needed to establish high-level evidence-based conclusions.

scholarly journals Comparing Outcomes of Single Versus Double Venous Anastomosis in Free Flap Operation for Lower Extremity Defect Reconstruction: A Meta-Analysis

2021 ◽  
Vol 17 (1) ◽  
pp. 1-8
Author(s):  
Suhwan Kim ◽  
Kyeong-Tae Lee
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Meta Analysis ◽  
Anastomosis Group ◽  
Venous Congestion ◽  
Complication Rates ◽  
Flap Necrosis ◽  
Venous Anastomosis ◽  
Flap Failure ◽  
Significant Difference

Background: Free flap operation is a common procedure for reconstructing defects of the lower extremity. However, venous congestion often results in flap failure in lower extremity reconstruction. Dual-vein anastomosis, one proposed solution to overcome this problem, has been controversial in terms of its efficacy. The objective of this study was to perform a systematic review and meta-analysis to assess the effectiveness of dual venous anastomosis on venous congestion and flap failure of the lower extremities.<br/>Methods: PubMed/MEDLINE, Google Scholar base, and Embase were searched to identify relevant studies presenting complication rates for groups of patients who had undergone single venous or dual venous anastomosis in lower extremity reconstructions. The relative risks of the following complications between these two groups (single venous and dual venous anastomosis) were calculated: flap failure, flap necrosis, flap congestion, and take-back to operating room.<br/>Results: A total of eight articles and 1,434 flaps were included. Double venous anastomosis was performed for 607 flaps, and single anastomosis for 827 flaps. Etiologies of defects and types of flaps were diverse. There was no significant difference in venous congestion, flap necrosis, or flap failure between the groups with one versus two vein anastomoses. However, the dual venous anastomosis group displayed a trend toward decreasing flap-related complications.<br/>Conclusion: Although there was a trend toward decreasing flap-related complications in the double venous anastomosis group, dual venous anastomosis had no statistically significant protective effects in decreasing free flap failure in the leg.

scholarly journals Evaluation of the reliability of lower extremity alignment measurements using EOS imaging system while standing in an even weight-bearing posture

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Byung Woo Cho ◽  
Tae-Ho Lee ◽  
Sungjun Kim ◽  
Chong-Hyuk Choi ◽  
Min Jung ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Reliability Analysis ◽  
Weight Bearing ◽  
Lower Extremities ◽  
Tibial Rotation ◽  
Tibial Torsion ◽  
Good Reliability ◽  
Observer Reliability ◽  
Eos Imaging ◽  
Significant Difference

AbstractThis study aimed to analyze the reproducibility and reliability of the alignment parameters measured using the EOS image system in both limbs while standing with an even weight-bearing posture. Overall, 104 lower extremities in 52 patients were analyzed retrospectively. The patients stood with an even load over both lower extremities then rotated 15° in both directions. Two EOS images were acquired and 104 pairs of lower extremities were compared according to the position of the indexed lower extremities. Then, the inter-observer reliability of the EOS system and the inter-modality reliability between EOS and computed tomography (CT) were evaluated. Femoro-tibial rotation (FTR) and tibial torsion demonstrated a significant difference between the anterior and posterior positions of the indexed lower extremity. In the inter-observer reliability analysis, all values except for FTR and tibial torsion demonstrated good or very good reliability. In the anterior position, FTR demonstrated moderate, and tibial torsion demonstrated poor reliability. In the posterior position, both FTR and tibial torsion demonstrated poor reliability. In the reliability analysis between the three-dimensional (3D) EOS model and 3D CT images, all measurements of the femur demonstrated very good reliability, but measurements of the tibia did not. For the coronal and sagittal alignment parameters measured by the EOS 3D system with rotated standing posture, except for the measurement including tibial torsion., there were no significant difference for either position of the indexed extremities with high agreement between the observers as well as with the CT 3D model.

scholarly journals Evaluation of the Reliability of Lower Extremity Alignment Measurements Using EOS Imaging System While Standing in an Even Weight-Bearing Posture

2021 ◽  
Author(s):  
Byung Woo Cho ◽  
Tae-Ho Lee ◽  
Sungjun Kim ◽  
Chong-Hyuk Choi ◽  
Min Jung ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Imaging System ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Lower Extremities ◽  
Tibial Rotation ◽  
Tibial Torsion ◽  
Good Reliability ◽  
Eos Imaging ◽  
Significant Difference

Abstract Purpose: This study aimed to analyze the reproducibility and reliability of the alignment parameters measured using the EOS image system in both limbs while standing with an even weight-bearing posture.Methods: Overall, 104 lower extremities in 52 patients were analyzed retrospectively. The patients stood with an even load over both lower extremities then rotated 15° in both directions. Two EOS images were acquired and 104 pairs of lower extremities were compared according to the position of the indexed lower extremities. Then, the inter-observer reliability of the EOS system and the inter-modality reliability between EOS and computed tomography (CT) were evaluated.Results: Femoro-tibial rotation (FTR) and tibial torsion demonstrated a significant difference between the anterior and posterior positions of the indexed lower extremity. All values except for FTR and tibial torsion demonstrated good or very good reliability. In the anterior position, FTR demonstrated moderate, and tibial torsion demonstrated poor reliability. In the posterior position, both FTR and tibial torsion demonstrated poor reliability. In the reliability analysis between the three-dimensional (3D) EOS model and 3D CT images, all measurements of the femur demonstrated very good reliability, but measurements of the tibia did not.Conclusions: For the coronal and sagittal alignment parameters measured by the EOS 3D system with rotated standing posture, except for the measurement including tibial torsion., there were no significant difference for either position of the indexed extremities with high agreement between the observers as well as with the CT 3D model.

Copper Concentrations in Breast Cancer: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 27 (37) ◽  
pp. 6373-6383 ◽  
Author(s):  
Leila Jouybari ◽  
Faezeh Kiani ◽  
Farhad Islami ◽  
Akram Sanagoo ◽  
Fatemeh Sayehmiri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Breast Tissue ◽  
Reference Lists ◽  
Meta Analysis ◽  
Cancer Risks ◽  
Hair Samples ◽  
Significant Difference ◽  
Mean Differences ◽  
Very High

: Breast cancer is the most common neoplasm, comprising 16% of all women's cancers worldwide. Research of Copper (Cu) concentrations in various body specimens have suggested an association between Cu levels and breast cancer risks. This systematic review and meta-analysis summarize the results of published studies and examine this association. We searched the databases PubMed, Scopus, Web of Science, and Google Scholar and the reference lists of relevant publications. The Standardized Mean Differences (SMDs) between Cu levels in cancer cases and controls and corresponding Confidence Intervals (CIs), as well as I2 statistics, were calculated to examine heterogeneity. Following the specimens used in the original studies, the Cu concentrations were examined in three subgroups: serum or plasma, breast tissue, and scalp hair. We identified 1711 relevant studies published from 1984 to 2017. There was no statistically significant difference between breast cancer cases and controls for Cu levels assayed in any studied specimen; the SMD (95% CI) was -0.01 (-1.06 - 1.03; P = 0.98) for blood or serum, 0.51 (-0.70 - 1.73; P = 0.41) for breast tissue, and -0.88 (-3.42 - 1.65; P = 0.50) for hair samples. However, the heterogeneity between studies was very high (P < 0.001) in all subgroups. We did not find evidence for publication bias (P = 0.91). The results of this meta-analysis do not support an association between Cu levels and breast cancer. However, due to high heterogeneity in the results of original studies, this conclusion needs to be confirmed by well-designed prospective studies.

Is there Sex-related Outcome Difference According to oral P2Y12 Inhibitors in Patients with Acute Coronary Syndromes? A Systematic Review and Meta-Analysis of 107,126 Patients

2019 ◽  
Vol 17 (2) ◽  
pp. 191-203
Author(s):  
Oliver Brown ◽  
Jennifer Rossington ◽  
Gill Louise Buchanan ◽  
Giuseppe Patti ◽  
Angela Hoye
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndromes ◽  
Meta Analysis ◽  
Indirect Comparison ◽  
Bleeding Risk ◽  
Cardiovascular Death ◽  
P2y12 Inhibitors ◽  
Significant Difference ◽  
Coronary Syndromes ◽  
Randomised Controlled

Background and Objectives: The majority of patients included in trials of anti-platelet therapy are male. This systematic review and meta-analysis aimed to determine whether, in addition to aspirin, P2Y12 blockade is beneficial in both women and men with acute coronary syndromes. </P><P> Methods: Electronic databases were searched and nine eligible randomised controlled studies were identified that had sex-specific clinical outcomes (n=107,126 patients). Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated for a composite of cardiovascular death, myocardial infarction or stroke (MACE), and a safety endpoint of major bleeding for each sex. Indirect comparison analysis was performed to statistically compare ticagrelor against prasugrel. </P><P> Results: Compared to aspirin alone, clopidogrel reduced MACE in men (RR, 0.79; 95% CI, 0.68 to 0.92; p=0.003), but was not statistically significant in women (RR, 0.88; 95% CI, 0.75 to 1.02, p=0.08). Clopidogrel therapy significantly increased bleeding in women but not men. Compared to clopidogrel, prasugrel was beneficial in men (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02) but not statistically significant in women (RR, 0.94; 95% CI, 0.83 to 1.06; p=0.30); ticagrelor reduced MACE in both men (RR, 0.85; 95% CI, 0.77 to 0.94; p=0.001) and women (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02). Indirect comparison demonstrated no significant difference between ticagrelor and prasugrel in either sex. Compared to clopidogrel, ticagrelor and prasugrel increased bleeding risk in both women and men. </P><P> Conclusion: In summary, in comparison to monotherapy with aspirin, P2Y12 inhibitors reduce MACE in women and men. Ticagrelor was shown to be superior to clopidogrel in both sexes. Prasugrel showed a statistically significant benefit only in men; however indirect comparison did not demonstrate superiority of ticagrelor over prasugrel in women.

scholarly journals Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098207
Author(s):  
Sachin Allahabadi ◽  
Favian Su ◽  
Drew A. Lansdown
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Achilles Tendon ◽  
Sports Medicine ◽  
Direct Consequence ◽  
National Basketball Association ◽  
Return To Play ◽  
Level Of Evidence ◽  
Cartilage Injuries ◽  
Women's National Basketball Association

Background: Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited. Purpose: To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players. Study Design: Systematic review; Level of evidence, 4. Methods: A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded. Results: A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied. Conclusion: The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.

scholarly journals Impact of Somatosensory Training on Neural and Functional Recovery of Lower Extremity in Patients with Chronic Stroke: A Single Blind Controlled Randomized Trial

2021 ◽  
Vol 18 (2) ◽  
pp. 583
Author(s):  
Reem M. Alwhaibi ◽  
Noha F. Mahmoud ◽  
Mye A. Basheer ◽  
Hoda M. Zakaria ◽  
Mahmoud Y. Elzanaty ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Lower Extremity ◽  
Functional Recovery ◽  
Intervention Group ◽  
Chronic Stroke ◽  
Post Treatment ◽  
Control Group ◽  
Stroke Patients ◽  
Significant Difference ◽  
Group Post

Recovery of lower extremity (LE) function in chronic stroke patients is considered a barrier to community reintegration. An adequate training program is required to improve neural and functional performance of the affected LE in chronic stroke patients. The current study aimed to evaluate the effect of somatosensory rehabilitation on neural and functional recovery of LE in stroke patients. Thirty male and female patients were recruited and randomized to equal groups: control group (GI) and intervention group (GII). All patients were matched for age, duration of stroke, and degree of motor impairment of the affected LE. Both groups received standard program of physical therapy in addition to somatosensory rehabilitation for GII. The duration of treatment for both groups was eight consecutive weeks. Outcome measures used were Functional Independent Measure (FIM) and Quantitative Electroencephalography (QEEG), obtained pre- and post-treatment. A significant improvement was found in the FIM scores of the intervention group (GII), as compared to the control group (GI) (p < 0.001). Additionally, QEEG scores improved within the intervention group post-treatment. QEEG scores did not improve within the control group post-treatment, except for “Cz-AR”, compared to pretreatment, with no significant difference between groups. Adding somatosensory training to standard physical therapy program results in better improvement of neuromuscular control of LE function in chronic stroke patients.

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