Lower limb reconstruction for malignant bone tumours in children

Malignant bone tumours of the lower limb represent the majority of cases in both osteosarcoma and Ewing sarcoma in the growth period. Surgical treatment represents a key element of treatment. Different localizations and age groups require a differentiated surgical approach. Life and limb salvage are first on the list of treatment goals, followed by functional and cosmetic considerations. This review article delivers and discusses current surgical treatment strategies and outcomes for lower limb malignant bone tumours in children.

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Percutaneous Management of Enterocutaneous Fistulae and Abscess–Fistula Complexes

Digestive Disease Interventions ◽

10.1055/s-0038-1660452 ◽

2018 ◽

Vol 02 (02) ◽

pp. 131-140 ◽

Cited By ~ 4

Author(s):

Abigail Erickson ◽

Chaitanya Ahuja ◽

Romulo Vea ◽

Guillermo Sangster ◽

Horacio D'Agostino ◽

...

Keyword(s):

Surgical Treatment ◽

Percutaneous Drainage ◽

Treatment Options ◽

Management Strategies ◽

Treatment Strategies ◽

Review Article ◽

Abdominal Abscesses ◽

Percutaneous Catheter

AbstractAbscess–fistula complexes and enterocutaneous fistulae are due to postoperative, spontaneous, and inflammatory etiologies. Conservative, percutaneous, endoscopic, and surgical treatment options are available options. Interventional radiologists have an array of different treatment strategies, often starting with percutaneous drainage of associated intra-abdominal abscesses. This review article details different percutaneous management strategies, focusing on percutaneous catheter strategies for abscess-fistula complexes along with tract closures strategies for enterocutaneous fistulae.

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Surgical treatment strategies for secondary peritonitis: Outcome in 278 patients

Gastroenterology ◽

10.1016/s0016-5085(01)81992-2 ◽

2001 ◽

Vol 120 (5) ◽

pp. A401-A401

Author(s):

M BOERMEESTER ◽

E BELT ◽

B LAMME ◽

M LUBBERS ◽

J KESECIOGLU ◽

...

Keyword(s):

Surgical Treatment ◽

Treatment Strategies ◽

Secondary Peritonitis

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Free Flaps in Complex Lower Limb Reconstruction - 2-Year Experience

Journal of Reconstructive Microsurgery ◽

10.1055/s-0034-1374005 ◽

2014 ◽

Vol 30 (S 01) ◽

Author(s):

Horácio Zenha ◽

Carla Diogo ◽

Sara Ramos ◽

Susana Pinheiro ◽

Ricardo Carvalho ◽

...

Keyword(s):

Lower Limb ◽

Free Flaps ◽

Limb Reconstruction ◽

Lower Limb Reconstruction

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Treatment Strategies Against Diabetic Foot Ulcer: Success so far and Road Ahead

Current Diabetes Reviews ◽

10.2174/1573399816999201102125537 ◽

2020 ◽

Vol 16 ◽

Author(s):

Ankit Awasthi ◽

Sachin Kumar Singh ◽

Bimlesh Kumar ◽

Monica Gulati ◽

Rajesh Kumar ◽

...

Keyword(s):

Lower Limb ◽

Diabetic Foot ◽

Treatment Strategies ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

Current Status ◽

Limb Amputation ◽

Bibliographic Databases ◽

Inflammatory Phase

Background: Diabetic foot ulcer (DFU) is one of the leading complications of type-2 diabetes mellitus. It isassociated with neuropathy and peripheral arterial disease of the lower limb in patients with diabetes. Basically, there are four stages of wound healing namely hemostasis phase, inflammatory phase, proliferative phase and maturation phase. In case of DFU, all these stages are disturbed which lead to delay in healing and consequently to lower limb amputation. Traditionally the dosage forms like tablets, creams, ointments, gels and capsules have been used for the treatment of diabetic foot ulcer from many years. Introduction: In this review the global prevalence as well as etiopathogenesis related to diabetic foot ulcer has been discussed. Potential role of various synthetic and herbal drugs as well as their conventional dosage form for the effective management of diabetes foot ulcer has been highlighted. Methods: Structured search of bibliographic databases for previously published peer-reviewed research papers was explored and data was culminated in terms of various approaches that are used for the treatment of diabetic foot ulcer. Results: About 142 papers including both, research and review articles, were included in this review in order to produce a comprehensive as well as readily understandable article. A series of herbal and synthetic drugs have been discussed along with their current status of treatment in terms of dose and mechanism of action. Conclusion: DFU has become one of the most common complications in patients having more than ten years of diabetes. Hence, understanding the root cause and its successful treatment is a big challenge because it depends upon multiple factors such as judicious selection of drug as well as proper control of blood sugar level. Most of the drugs that have been used so far either belong to the category of antibiotics, antihyperglycaemics or, they have been repositioned. Moreover, in clinical practice, much focus has been given towards dressings that have been used to cover the ulcer. The complete treatment of DFU is still a farfetched dream to be achieved and it is expected that a combination therapy of herbal and synthetic drug with multiple treatment pathway could be able to overcome the disease.

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Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease—A Review with Different Treatment Strategies

International Journal of Angiology ◽

10.1055/s-0040-1709504 ◽

2020 ◽

Vol 29 (03) ◽

pp. 143-148

Author(s):

Ranjit Kumar Nath ◽

Siva Subramaniyan ◽

Neeraj Pandit ◽

Deepankar Vatsa

Keyword(s):

High Risk ◽

Peripheral Arterial Disease ◽

Femoral Artery ◽

Lower Limb ◽

Treatment Strategies ◽

Arterial Disease ◽

Retrograde Approach ◽

Femoral Access ◽

Antegrade Approach ◽

Peripheral Arterial

AbstractTranspedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.

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An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia

BMC Neurology ◽

10.1186/s12883-021-02197-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Naureen Keric ◽

Darius Kalasauskas ◽

Sophia L. Kreth ◽

Martin B. Glaser ◽

Harald Krenzlin ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Complication Rate ◽

Age Groups ◽

Treatment Strategies ◽

The Elderly ◽

Outcome Analysis ◽

Neurovascular Compression ◽

Duration Of Symptoms ◽

Ganglion Gasseri

Abstract Background Trigeminal neuralgia (TN) is a severe pain condition and the most common facial neuralgia. While microvascular decompression (MVD) presents an excellent treatment in neurovascular compression cases, percutaneous thermocoagulation (PT) of the ganglion Gasseri is an alternative option. This study aimed to evaluate post-operative complication rate and outcome of both treatment strategies related to the patient’s age. Methods The medical records of all patients with the diagnosis of trigeminal neuralgia undergoing an MVD or PT of the ganglion Gasseri (between January 2007 and September 2017) were reviewed to determine the efficacy and the complication rate of both methods in regard to the patient’s age. Results Seventy-nine patients underwent MVD surgery and 39 a PT. The mean age of patients in the MVD group was 61 years and 73 years in the PT group. There were 59 (50%) female patients. Nerve-vessel conflict could be identified in 78 (98.7%) MVD and 17 (43.6%) PT patients on preoperative MRI. Charlson comorbidity index was significantly higher in PT group (2.4 (1.8) versus 3.8 (1.8) p < 0.001). The Barrow pain score (BPS) at the last follow-up demonstrated higher scores after PT (p = 0.007). The complication rate was markedly higher in PT group, mostly due to the facial hypesthesia (84.6% versus 27.8%; p < 0.001). Mean symptom-free survival was significantly shorter in the PT group (9 vs. 26 months, p < 0.001). It remained statistically significant when stratified into age groups: (65 years and older: 9 vs. 18 months, p = 0.001). Duration of symptoms (OR 1.005, 95% CI 1.000–1.010), primary procedure (OR 6.198, 95% CI 2.650–14.496), patient age (OR 1.033, 95% CI 1.002–1.066), and postoperative complication rate (OR 2.777, 95% CI 1.309–5.890) were associated with treatment failure. Conclusion In this patient series, the MVD is confirmed to be an excellent treatment option independent of patient’s age. However, while PT is an effective procedure, time to pain recurrence is shorter, and the favorable outcome (BPS 1 and 2) rate is lower compared to MVD. Hence MVD should be the preferred treatment and PT should remain an alternative in very selected cases when latter is not possible but not in the elderly patient per se.

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Canadian Trends in Free Flap Management for Microsurgical Lower Limb Reconstruction

Plastic Surgery ◽

10.1177/22925503211019602 ◽

2021 ◽

pp. 229255032110196

Author(s):

Michelle Bonapace-Potvin ◽

Alexander Govshievich ◽

Laurent Tessier ◽

Mihiran Karunanayake ◽

Dominique Tremblay ◽

...

Keyword(s):

Lower Limb ◽

Free Flaps ◽

Online Questionnaire ◽

Limb Reconstruction ◽

Changing Practice ◽

Current State ◽

Lower Limb Reconstruction ◽

Tumor Extirpation ◽

Based Medicine ◽

Previous Training

Introduction: Free tissue transfers have become a mainstay in lower limb salvage, allowing safe and reliable reconstruction after trauma, tumor extirpation, and complex wounds. The optimal perioperative (PO) management of these flaps remains controversial. This study aims to assess the current state of practice among Canadian microsurgeons. Methods: Sixty-four Canadian microsurgeons were approached to complete an online questionnaire regarding their PO management of fasciocutaneous free flaps used for lower limb reconstruction. Trends in dangling timing and duration, use of venous couplers, compressive garments, thromboprophylaxis, and surgeons’ satisfaction with their protocol were assessed. Results: Twenty-eight surgeons responded. Fifty-seven percent did not have a specific mobilization protocol. Dangling was mainly initiated on postoperative days 5 to 6 (44%). The most common protocol duration was 5 to 6 days (43%). The concern for prolonged venous pooling was the main reason for delay of dangling (71%). Compressive garments were placed routinely by 12 surgeons (43%) with 20% starting before dangling, 46% with dangling, and 33% after dangling. Venous couplers were routinely used by 24 surgeons (85.7%). Trends in management were influenced by previous training in 53.6% of cases (vs evidence-based medicine 7.1%). Although 89.3% were satisfied with their approach, 92.8% would consider changing practice if higher-level evidence was available. Conclusions: The majority of Canadian microsurgeons initiate dangling early and utilize venous couplers. However, the use of compressive garments is limited. Trends in management are largely based on personal experience. Nearly all surgeons would consider changing their practice if higher-level evidence was available.

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