scholarly journals The vascular armamentarium explored-the ultimate goal achieved

2020 ◽  
Vol 7 (5) ◽  
pp. 1637
Author(s):  
Manoj Prabakar Ravichandran ◽  
Subrammaniyan Rathinavelpandian ◽  
Marunraj Gnanasekaran ◽  
Saravanan Balachandran
Keyword(s):  
Skin Grafting ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Vascular Surgeon ◽  
Interventional Radiological Procedure ◽  
Catheter Directed Thrombolysis ◽  
Split Skin Grafting ◽  
Peripheral Arterial ◽  
The Right ◽  
Split Skin

Peripheral arterial disease is one of the commonest causes for a limb being amputated most often, we present this case of medium vessel vasculitis with chronic threatening limb ischemia to make a note of our attempt to save her limb by multiple modalities which included medical management with steroids, immunosuppressants, pulsed cyclophosphamide, interventional radiological procedure of catheter directed thrombolysis with urokinase, surgical procedures like bypass, split skin grafting and minor amputations, implemented novel modalities like hyperbaric oxygen therapy. By exploring the armamentarium available, involving a multidisciplinary team which included vascular surgeon, rheumatologist, intervention radiologist, plastic surgeon, physiotherapist and aptly using the right modality at the right time we were able to ultimately achieve our goal of limb salvage.

scholarly journals Pyoderma Gangrenosum and High Titer Serum Aanti-CCP2 Antibodies

2012 ◽  
Vol 52 (185) ◽  
Author(s):  
S K Das ◽  
N Banerjee ◽  
S Khaskil ◽  
S S Mukherjee
Keyword(s):  
Pyoderma Gangrenosum ◽  
High Titer ◽  
Laboratory Finding ◽  
Skin Grafting ◽  
Neutrophilic Dermatosis ◽  
Split Skin Grafting ◽  
History Of ◽  
Inflammatory Bowel ◽  
The Right ◽  
Split Skin

Pyoderma gangrenosum is an uncommon ulcerative cutaneous neutrophilic dermatosis. In about 50 percent of cases, it is associated with systemic diseases like inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythromatosus, hematological diseases and various malignancies. There is no specific laboratory finding or histological features pathognomonic of pyoderma gangrenosum and it is often a diagnosis of exclusion. Here, we report an elderly female without history of any systemic disorders, presenting to us with extensive, bilaterally symmetrical, deep leg ulcers along with multiple superficial ulcers involving the right groin which was diagnosed as pyoderma gangrenosum. The only positive rheumatologic marker was serum anti-cyclic cittrulinated peptide2 antibody, which was found to be strongly positive. Dramatic response to systemic corticosteroid followed by successful split skin grafting was observed in our patient. Keywords: Anti cyclic cittrulinated peptide2, pyoderma gangrenosum, symmetric leg ulcer.

scholarly journals Transluminal Recanalization of Chronic Total Occlusion of Radial Artery Using Rendezvous Technique: A Case Report and Literature Review

2014 ◽  
Vol 4 ◽  
pp. 36 ◽  
Author(s):  
Mohammad Arabi ◽  
Ishtiaq Ahmed ◽  
Nabeel Qattan
Keyword(s):  
Radial Artery ◽  
Chronic Total Occlusion ◽  
Index Finger ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Total Occlusion ◽  
Hand Ischemia ◽  
Rendezvous Technique ◽  
Peripheral Arterial ◽  
The Right

Although endovascular management of lower extremity peripheral arterial disease (PAD) is well studied, little information exists regarding endovascular treatment of critical upper limb ischemia. We report a case of transluminal recanalization of right radial artery chronic total occlusion (CTO) using rendezvous technique in a patient with critical hand ischemia and dry gangrene of the right index finger.

scholarly journals 500 Tetraminos Flap

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Schrire ◽  
A Din ◽  
U Khan
Keyword(s):  
Skin Graft ◽  
Free Flap ◽  
Femoral Condyle ◽  
Computer Game ◽  
Skin Grafting ◽  
Free Flaps ◽  
Soft Tissue Defect ◽  
Split Skin Grafting ◽  
The Right ◽  
Split Skin

Abstract 30 year old male, who had been hit at 90mph whilst on a motorbike sustaining femoral, tibial and right foot open fractures. He underwent an open reduction and internal fixation (ORIF) of his right lateral femoral condyle, a right retrograde femoral nail, and ORIF of the tibia. He had 2 separate free flaps (a chimera scapular/parascapular and antero-lateral thigh-ALT) to his right lower leg, and split skin grafting to the remainder of the right lower limb. Upon regular post-operative review it was found that whilst healed the limb was showing a poor return of function and a major contributor was the lack of motion of the right knee joint. Patient had an excision of the split skin graft, with a quadriceps plasty, where the myofascial planes were released, and the contractures incised, with a chimeric scapular and parascapular free flap onto the defect. This resulted in coverage of large soft tissue defect with no need to skin graft donor sites and no functional implication of muscle harvest. Tetraminos in appearance, like the popular computer game, which has never before been described, compared with normal coverage, which would be latissimus dorsi free flap and graft.

Secondary medical prevention in patients with peripheral arterial disease - Prescriptions of vascular surgeons and medical doctors (angiologists) in a multidisciplinary vascular centre

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Klein-Weigel ◽  
Gutsche-Petrak ◽  
Wolbergs ◽  
Köning ◽  
Flessenkamper
Keyword(s):  
Peripheral Arterial Disease ◽  
Oral Anticoagulants ◽  
Arterial Disease ◽  
Disease Stage ◽  
Channel Blockers ◽  
Medical Doctors ◽  
Vascular Surgeon ◽  
Medical Prevention ◽  
Number Of Patients ◽  
Peripheral Arterial

Background: We compared medical secondary prevention in patients with peripheral arterial disease stage II (Fontaine) located in the femoro-popliteal artery managed by vascular surgeons and medical doctors / angiologists in our multidisciplinary vascular center. Patients and methods: We retrospectively analyzed demission protocols of in-hospital treatments between 01.01.2007 and 20.06.2008. Results: We surveyed 264 patients (54.2 % women; mean age 67.52 ± 8.98 yrs), 179 (67.8 %) primarily treated by medical doctors / angiologists and 85 (32.2 %) primarily managed by vascular surgeons. Medical doctors / angiologists treated more women (n = 109) than men (n = 34), (p = 0.002) and documented smoking and diabetes mellitus more often (p < 0.001) than vascular surgeons. Besides, patients had similar cardiovascular risk profiles and concomitant diseases, vascular surgeons prescribed 5.47 ± 2.26 drugs, medical doctors / angiologists 6.37 ± 2.67 (p = 0.005). Overall, 239 (90.5 %) patients were on aspirin, 180 (68.2 %) on clopidogrel, and 18 (6.9 %) on oral anticoagulants. Significantly more patients treated by medical doctors / angiologists received clopidogrel (169 versus 11; p < 0.001), significantly more surgical patients received oral anticoagulants (11 versus 7; p = 0.016). The number of patients without prescriptions for any antithrombotic therapy was 6 (6.9 %) in patients treated by vascular surgeons and 0 (0 %) in patients managed by medical doctors / angiologists (p = 0.001). Prescription-rates of β-blockers, ACE-inhibitors, Angiotensin II-antangonists, calcium channel blockers, and diuretics were statistically not different between the two disciplines, but statins were prescribed significantly more often by medical doctors / angiologists (139 versus 49; p < 0001). With the exceptions of Clopidogrel (women > men) and diuretics (men > women) we observed no gender-specific prescriptions. Conclusions: We observed high prescriptions rates of secondary medical prevention in patients primarily treated by medical doctors / angiologists and vascular surgeons. We believe that this result is highly influenced by our multidisciplinary approach. Nevertheless, efforts have to be made to raise vascular surgeon’s awareness of statin use and complete prescription of antithrombotic and antiplatelet drugs.

MANAGEMENT OF POST BURN CONTRACTURE OF NECK IN A TERTIARY BURN CARE CENTRE

2021 ◽  
pp. 33-35
Author(s):  
Nangineedi Nagaprasad ◽  
Karthik G B
Keyword(s):  
Surgical Planning ◽  
Skin Grafting ◽  
Burn Care ◽  
Split Skin Grafting ◽  
Contracture Release ◽  
Common Problems ◽  
A Prospective Study ◽  
Split Skin ◽  
Burn Contractures

Background: Post burn contracture is one of the most common problems in our country and usually seen in lower socio-economic people. Burn contractures of the neck can produce a signicant impact on quality of life by reducing a patient's ability to perform activities of daily living Methods: A prospective study was conducted with a sample size of 30 patients with post burn neck contracture conducted for a duration of 24 months. After meticulous surgical planning, patients underwent contracture release and split skin grafting/z-plasty followed by rigorous splintage and physiotherapy. Majority of the patients were in the age group of 11-30 years (63%).70% of the Results: patients sustained burns in the range of 21-40% and 80% were due to ame burns.46.66% (14) of patients had severe contracture while 13.33% (4) had extensive mento-sternal adhesions. 90% of the patients underwent release + SSG while 10% underwent z-plasty. Postoperatively cervico-mental angle of 100-120 degrees was achieved Skin grafting is a simple, reliable and safe operation however postoperative splinting is n Conclusion: ecessary. The use of skin grafts continues to deliver excellent results with adequate restoration of cervico-mental angle.

Split Skin Grafting

2016 ◽  
pp. 107-128
Author(s):  
Aziz Nather ◽  
Ting Fang Tan
Keyword(s):  
Skin Grafting ◽  
Split Skin Grafting ◽  
Split Skin

scholarly journals Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Chandan Noel Vincent ◽  
S Elango ◽  
Dinakar Rai ◽  
Sujith Kumar ◽  
Ajay Sivakumar
Keyword(s):  
Respiratory Failure ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Third Trimester ◽  
Distal Limb ◽  
Catheter Directed Thrombolysis ◽  
Ct Angiogram ◽  
Severe Infections ◽  
The Right

Introduction:Pregnancy is a physiologically hypercoagulable state and a coronavirus disease 2019 (COVID-19) infection adds to this burden by accentuating the coagulopathy. We report two cases of severe peri-partum COVID infection leading to extremity gangrene secondary to a pro-thrombotic coagulopathy. Case Report:A 37-year-old lady, day-2 postpartum, was brought with severe COVID infection & and respiratory failure. She developed progressive gangrene of the foot. A computed tomography (CT) angiogram confirmed the presence of thrombosis of the left external iliac & and common femoral artery. She was managed with catheter- directed thrombolysis and fasciotomy. The dry gangrene of the foot was managed with a Boyd’s amputation. At 1-year follow-up, she is ambulant with a healthy stump. Case Two: A 34-year-old lady, 36 weeks of gestation, presented with fulminant COVID infection with respiratory failure and pulmonary embolus. The lady developed gangrene of the B/L toes. A CT angiogram revealed thrombosis below the popliteal trifurcation in both limbs along with segmental pulmonary thrombo-embolism involving the right lung and multiple splenic infarcts. She succumbed to the overwhelming infection and sepsis. Discussion:The pathogenesis of coagulopathy in pregnant COVID patients is attributed to the hypercoagulable effect, which leads to thrombo-embolisms and limb ischemia following a cytokine storm syndrome in severe infections. To date, this is the first experience detailing distal limb gangrene in fulminant COVID infection in peri-partum women. Although, cases have been reported on distal limb gangrene in severe COVID infection among non-pregnant individuals. Conclusion:A multidisciplinary team must manage COVID infections in the third trimester. A prompt recognition of any forms of lethal coagulopathy and vigilant treatment will prevent loss of life. Keywords:Coronavirus diseaseCOVID, foot gangrene, pregnancy, coagulopathy.

Abstract P250: Incidence of Hospitalized Peripheral Arterial Disease and Critical Limb Ischemia: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Corey A Kalbaugh ◽  
Anna Kucharska-Newton ◽  
Laura Loehr ◽  
Elizabeth Selvin ◽  
Aaron R Folsom ◽  
...  
Keyword(s):  
Risk Factors ◽  
African Americans ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Baseline Characteristics ◽  
Peripheral Arterial

Introduction: Lower extremity peripheral arterial disease (PAD) affects between 12% and 20% of Americans over the age of 65. PAD compromises quality of life, contributes a high burden of disability and its related health care costs exceed $4 billion/year, yet this preventable CVD outcome remains understudied. Aims: Assess the incidence of hospitalized PAD, and of the most severe form of PAD, critical limb ischemia (CLI), in middle-aged men and women, and evaluate their risk factors in a bi-ethnic, population-based cohort. We hypothesized that incidence of hospitalized PAD and CLI are higher in African Americans, and that modifiable atherosclerosis risk factors in middle age predict these sequelae of PAD. Methods: We analyzed data from 13,865 participants from the Atherosclerosis Risk in Communities Study aged 45–64 without PAD at baseline (1987–89). Incident PAD and CLI events were identified using ICD-9 codes from active surveillance of all hospitalizations among cohort participants from 1987 through 2008. All estimates are incidence rates per 10,000 person-years; nominal statistical significance was achieved for all baseline characteristic comparisons reported. Results: There were 707 incident hospitalized PAD during a median of 18 years of follow-up (249,570 person-years). The overall age-adjusted incidence of PAD and limb-threatening CLI were 26.0 and 9.6 per 10,000 person-years, respectively. Incidence of hospitalized PAD was higher in African Americans than whites (34.7 vs. 23.2) and in men compared to women (32.4 vs. 26.7). Baseline characteristics associated with age-adjusted incident PAD (per 10,000 person-years) compared to their referent groups were diabetes (91.2 vs. 19.0), history of smoking (33.6 vs. 16.2), hypertension (42.6 vs. 18.6), coronary heart disease (81.4 vs. 24.1), and obesity (41.5 vs. 20.2). Incidence of CLI also was higher among African Americans (21.0 vs. 5.9) and in men (10.5 vs. 8.9 per 10,000 person-years). Baseline characteristics associated with incident CLI were similar to those for PAD. Conclusions: The absolute risk of hospitalized lower extremity PAD in this community-based cohort is of a magnitude similar to that of heart failure and of stroke. As modifiable factors are strongly predictive of the long-term risk of hospitalized PAD and CLI, particularly among African Americans, our results highlight the need for effective risk factor prevention and control.

Sign in / Sign up

Export Citation Format

Share Document