Characteristics and main clinical outcomes of patients undergoing transtibial amputation

Objective: To analyse the epidemiological profile of patients undergoing transtibial amputation (TTA) of the lower limb, including the prosthetic fitting rate, the degree of patient satisfaction, and postoperative complications. Methods: This retrospective study was designed to analyse the epidemiological profile of patients undergoing TTA from 2012 through 2016. Prosthetic fitting rate, degree of satisfaction, and postoperative complications were analysed. Results: The sample included 68 patients, of whom 42 were male (62.7%), with a mean age of 50.3 years. Of the participants, 61.2% had finished elementary school only, and 46.2% were white. The most common reason for amputation was chronic osteomyelitis, which was present in 53.7% of participants. A prosthesis was fitted in 89.6% of patients, with most (78.3%) adapting to it well. Of the participants, 40.3% experienced postoperative complications, and mortality was 21.9%. Regarding satisfaction, 76.1% of patients were not satisfied with the surgical outcome. Conclusion: Patients who underwent TTA were most commonly white males of approximately 50 years of age; the most prevalent comorbidities were systemic arterial hypertension and diabetes mellitus, and the most frequent reason for amputation was chronic osteomyelitis. Patient dissatisfaction was significantly associated with age (>60 years old) and depression. The prosthetic fitting rate and adaptation to the prosthesis were directly related to patient satisfaction. Level of Evidence IV; Therapeutic Studies; Case Series.

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Epidemiological profile of patients undergoing surgical treatment of ankle fractures in a tertiary hospital

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2018.v12.809 ◽

2018 ◽

Vol 12 (3) ◽

Author(s):

Cleiton Francisco Piccini ◽

Gaston Endres ◽

João Marcus Do Prado ◽

Mateus Breitenbach Scherer

Keyword(s):

Postoperative Complications ◽

Case Series ◽

Tertiary Hospital ◽

High Energy ◽

Ankle Fractures ◽

Definitive Treatment ◽

Level Of Evidence ◽

Early Postoperative Complications ◽

The Mean ◽

Epidemiological Profile

Objective: To evaluate the epidemiological profile of ankle fractures treated surgically in a tertiary hospital.Methods: A retrospective epidemiological study was performed. The medical records of patients with ankle fractures who underwent surgery between January and December 2017 were reviewed. The parameters assessed included age, gender, injured side, exposure (open vs closed), Arbeitsgemeinschaft für steosynthesefragen (AO) fracture classification, trauma mechanism, time to definitive treatment, and early postoperative complications. Results: The male gender was predominant (64.6%). Twenty-two fractures (50%) resulted from traffic accidents, 16 (36.4%) of which involved a motorcycle. The mean age of these patients was 28.25 years. The AO 44-B ankle fracture was the most common injury (70.4%). Eight (18.2%) wereopen fractures. The mean time to definitive treatment was 5.9 days. Early postoperative complications occurred in two patients (4.5%). Conclusion: Ankle fractures treated in a tertiary hospital affect young victims of high-energy accidents, mainly involving motorcycles. Level of Evidence IV; Therapeutic Studies; Case Series.

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Applications of Medical Tattooing: A Systematic Review of Patient Satisfaction Outcomes and Emerging Trends

Aesthetic Surgery Journal Open Forum ◽

10.1093/asjof/ojab015 ◽

2021 ◽

Author(s):

Stacie J Becker ◽

Jeffrey E Cassisi

Keyword(s):

Patient Satisfaction ◽

Medical Condition ◽

Case Series ◽

Outcome Data ◽

Future Research ◽

Health Service Provider ◽

Level Of Evidence ◽

Case Examples ◽

Areola Complex ◽

Clinical Series

Abstract Background Medical tattooing is often applied in the context of plastic, aesthetic, and reconstructive surgery to help achieve the best cosmetic outcome. Objectives This article reviews various conditions that medical tattooing have been empirically studied in terms of patient satisfaction outcomes; makes practice recommendations; and suggests future directions for research. Methods This review was performed following the PRISMA guidelines. Studies were included if the tattooing application was associated with a medical condition and if outcome data was provided using at least a case series methodology. Where no cohort or clinical series exist, case examples are used from the literature and the author’s practice to illustrate emerging medical tattooing applications that need further evaluation. Results Eighteen studies met the inclusion criteria and were applied to the following conditions: baldness, vitiligo, scars from incisions, lacerations or burns, and nipple areola complex reconstruction following breast surgery. Conclusions The application of medical tattooing has shown high levels of patient satisfaction across various conditions. The practice recommendation grade is “B” or recommend since the level of evidence for these interventions ranged from III to IV according to the ASPS guidelines. This means clinicians can consider this treatment alternative, but they should be alert to new information and be sensitive to patient preferences. Recommendations are made for reporting future research including clearly describing procedural details, identifying the professional performing the procedure, increased use of standardized outcome measures, and that satisfaction ratings be assessed by someone independent of the health service provider. Further research using RCT methodology with waitlist controls is needed.

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Antibiotic Impregnated Cement Spacer for Salvage of Diabetic Osteomyelitis

Foot & Ankle International ◽

10.3113/fai.2012.0213 ◽

2012 ◽

Vol 33 (3) ◽

pp. 213-219 ◽

Cited By ~ 15

Author(s):

Eyal A. Melamed ◽

Eli Peled

Keyword(s):

Case Series ◽

Severe Infection ◽

Diabetic Patients ◽

Skin Closure ◽

Cement Spacer ◽

Retrospective Case ◽

Level Of Evidence ◽

Patient Dissatisfaction ◽

Extensive Debridement ◽

Antibiotic Release

Background: Florid infection and osteomyelitis of the forefoot in patients with diabetic neuropathy often requires minor amputation, with risk of subsequent reulceration, reamputation, and patient dissatisfaction. We investigated use of an antibiotic-impregnated cement spacer (ACS) to release antibiotic locally to resolve residual infection and to fill the cavity created by debridement. Methods: We report 23 cases of osteomyelitis and associated severe infection of forefoot joints in 20 consecutive patients, age 60.3 ± 13.4 years. Antibiotic-impregnated cement, extensive meticulous debridement, and ACS placement to fill the gap were employed in all cases. Deep cultures were taken routinely. Fixation with Kirschner wires was used as necessary. Mean followup was 21.2 ± 10.2 months. A successful result was resolution of infection and wound healing to full skin closure without amputation. Results: Of 23 cases, 21 (91.3%) healed and two required toe amputation. ACS was left permanently in 10 patients, removed with arthrodesis in six, and removed without arthrodesis in five. One patient recovered but subsequently underwent transtibial amputation due to infection of a different site. Conclusion: Severe infection associated with osteomyelitis of the foot in diabetic patients was successfully treated with extensive debridement and use of ACS, which filled the void created by debridement. Amputation was avoided in most patients. This procedure allowed extensive debridement through filling large voids with ACS, with prolonged antibiotic release. Level of Evidence: IV; Retrospective Case Series

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Patient Satisfaction Following Inverted-T and Short-Scar Mammaplasty as Measured by the Breast Evaluation Questionnaire 55

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa236 ◽

2020 ◽

Cited By ~ 2

Author(s):

Gisela Hobson Pontes ◽

Fernando Sérgio Mendes Carneiro Filho ◽

Luis Alejandro Vargas Guerrero ◽

Carolina Takahashi Rodrigues Pinto ◽

Fernando Serra-Guimarães

Keyword(s):

Patient Satisfaction ◽

Statistical Significance ◽

Patient Comfort ◽

Level Of Evidence ◽

Evaluation Questionnaire ◽

Patients Satisfaction ◽

Implant Placement ◽

Degree Of Satisfaction ◽

Short Scar ◽

General Appearance

Abstract Background Mastopexy combined with silicone implant placement is one of the most frequently performed plastic surgeries. Various techniques have been developed to increase the degree of patient satisfaction after surgery. The goal is to give the breasts a harmonious shape, generating the smallest scars possible. The Breast Evaluation Questionnaire 55 (BEQ 55) was developed in 2006 as a tool for assessing the satisfaction and comfort of patients with the general appearance of their breasts. Objectives The objective of this study was to compare the degree of satisfaction of patients undergoing mastopexy by the inverted-T technique vs the short-scar technique by the BEQ 55. Methods The BEQ 55 was administered pre- and postoperatively to 200 patients who underwent mastopexy performed by the first author between October 2013 and September 2017. One hundred patients underwent the short-scar technique, and 100 patients underwent the inverted-T technique. Results The first analysis used descriptive statistics. Relative frequencies were used to track the responses corresponding to each technique. There was an increase in the level of patient comfort and satisfaction with breast appearance after surgery in both groups. The short-scar technique was shown to be superior, with statistical significance (P < 0.05) found for the questions evaluating comfort with overall appearance naked, comfort with breast appearance naked, and satisfaction with breast appearance. Conclusions Both techniques improved the patients’ satisfaction and comfort with their breasts. When the short-scar technique was used, patients were more comfortable with their breast appearance and with their overall appearance naked. Level of Evidence: 4

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Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States

Foot & Ankle International ◽

10.1177/1071100719855049 ◽

2019 ◽

Vol 40 (10) ◽

pp. 1140-1148 ◽

Cited By ~ 14

Author(s):

Spenser J. Cassinelli ◽

Stephanie Chen ◽

Timothy P. Charlton ◽

David B. Thordarson

Keyword(s):

Patient Satisfaction ◽

Case Series ◽

Retrospective Chart Review ◽

The United States ◽

Reoperation Rate ◽

Hallux Rigidus ◽

Level Of Evidence ◽

Physical Dysfunction ◽

Magnetic Resonance Imaging Mri

Background: The aim of this study was to determine the early outcomes and complications following the implantation of a hydrogel synthetic cartilage implant (SCI, Cartiva) for the treatment of hallux rigidus by a single surgeon. Methods: A retrospective chart review was performed of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and April 2018 by a single surgeon. Demographic information, radiographic assessment, and concomitant operative procedures performed were evaluated for all patients. Postoperatively, PROMIS physical function (PF) and pain interference (PI) scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Sixty-four SCIs were implanted in 60 patients. Follow-up averaged 18.5 months (range 12-30 months). Results: 14% (9/64) of patients were very satisfied, 28% (18/64) satisfied, 20% (13/64) neutral, 11% (7/64) unsatisfied, and 27% (17/64) very unsatisfied with their outcome. In addition, 45% of patients underwent additional procedures at the time of SCI, and 23% had a history of surgery on the hallux before implantation. PROMIS PF scores averaged 42 and PROMIS PI scores averaged 60. Overall, 63% completed PROMIS PI, 66% completed PROMIS PF, and 100% completed a satisfaction survey. In addition, 30% (19/64) underwent magnetic resonance imaging (MRI) postoperatively due to pain. There was a 20% reoperation rate, which included an 8% rate of conversion to arthrodesis. Conclusion: Synthetic cartilage implantation yielded neutral patient satisfaction, mild pain, and physical dysfunction at early follow-up. We believe patient selection and counseling regarding early postoperative limitations are important before proceeding with SCI. Level of Evidence: Level IV, case series.

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Outcomes of Nitinol Compression Staples in Tarsometatarsal Fusion

Foot & Ankle Orthopaedics ◽

10.1177/2473011420944904 ◽

2020 ◽

Vol 5 (3) ◽

pp. 247301142094490

Author(s):

Carissa C. Dock ◽

Katie L. Freeman ◽

J. Chris Coetzee ◽

Rebecca Stone McGaver ◽

M. Russell Giveans

Keyword(s):

Patient Satisfaction ◽

Case Series ◽

Fusion Rate ◽

Perioperative Outcomes ◽

Wound Complications ◽

Retrospective Case ◽

Level Of Evidence ◽

Patient Satisfaction Score ◽

Foot Function

Background: Tarsometatarsal (TMT) arthrodesis is commonly performed in the management of midfoot arthritis, trauma, or deformity. The purpose of this study was to collect aggregate data (demographic, surgical, and perioperative outcomes) on patients who previously had a TMT fusion with BME compression staples. Methods: Sixty-six patients underwent TMT fusion with BME compression staples. Outcomes included demographics, surgical information, the Veterans Rand VR-12 Health Survey, Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), Revised-Foot Function Index (FFI-R), Ankle Osteoarthritis Scale (AOS), patient satisfaction survey scores, radiographic fusion rate, level of pain reduction, and complications. Sixty-six patients (68 feet) were analyzed (59 females) with an average age of 64 years (range, 18-83). The mean latest follow-up was 35.9 (range, 6-56.6 months). Results: The average surgical time was 38.1±14.3 minutes (range, 11-75). All outcomes improved significantly ( P < .001) from preoperative to latest follow-up except for the VR-12 Mental and Physical score. The average time to fusion determined by radiographs was 8.4 weeks (range, 6.1-46.1 weeks). Wound complications were not seen. Indications for subsequent surgeries (26.5%, 18/68 feet) in this current study included pain (n = 14), broken staples, and nonunion (n = 3). Conclusions: The fusion rate in this study, 89.7%, was similar to values reported in the literature. The patient satisfaction score of 81.9 at latest follow-up is consistent with patient satisfaction for other methods of fusion. Level of Evidence: Level IV, retrospective case series.

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Postoperative Complications and Patient Satisfaction After Abdominal Etching: Prospective Case Series of 25 Patients

Aesthetic Plastic Surgery ◽

10.1007/s00266-019-01558-4 ◽

2019 ◽

Vol 44 (3) ◽

pp. 830-835 ◽

Cited By ~ 1

Author(s):

Jeremy Niddam ◽

Barbara Hersant ◽

Celine Aboud ◽

Dana Sawan ◽

Mounia SidAhmed-Mezi ◽

...

Keyword(s):

Patient Satisfaction ◽

Postoperative Complications ◽

Case Series ◽

Prospective Case Series

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Primary Total Knee Arthroplasty: Correlation between Preoperative Radiographic Severity of Arthritis and Postoperative Patient Satisfaction

The Journal of Knee Surgery ◽

10.1055/s-0040-1710384 ◽

2020 ◽

Author(s):

Katie Rooks ◽

Devon Houdek ◽

Haron Obaid ◽

William Dust

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Retrospective Chart Review ◽

Level Of Evidence ◽

Radiographic Severity ◽

Patient Reported ◽

Degree Of Satisfaction ◽

Total Knee

AbstractPredicting postoperative outcomes following total knee arthroplasty (TKA) is important for patient selection. This study focuses on patient-reported outcomes and satisfaction in relation to preoperative radiographic arthritis severity. A retrospective chart review of 420 TKAs was performed. Patient satisfaction was determined using a structured telephone survey with questions focused on degree of satisfaction whether they would have surgery again and their ability to kneel. The radiographic severity of the arthritis of the tibiofemoral joint was graded by a musculoskeletal radiologist using the Kellgren–Lawrence grading scale. The patellofemoral compartment was graded using the scale described by Jones et al. Those grouped as severe arthritis had an overall satisfaction rate of 96% (76% fully satisfied and 20% partially satisfied) compared with 82% of the time (64% fully satisfied and 18% partially satisfied) if their arthritis was mild. Postoperatively 51% of TKA patients were able to kneel. Univariate logistic regression showed an association between higher rates of satisfaction and male gender (p = 0.053), severity of preoperative radiographic arthritis (p = 0.034) those who would have surgery again (p ≤ 0.0001) and those able to kneel (p = 0.005). Patients should be informed preoperatively that if their arthritis is only mild radiographically, their outcomes are less predictable. There should also be a discussion surrounding kneeling and activities patients do, which may require kneeling, as many are unable to kneel postoperatively. The Level of Evidence for the study is III.

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Influence of Complications and Revision Surgery on Fulfillment of Expectations in Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100720985231 ◽

2021 ◽

pp. 107110072098523

Author(s):

Bopha Chrea ◽

Jonathan Day ◽

Jensen Henry ◽

Elizabeth Cody ◽

Scott Ellis ◽

...

Keyword(s):

Patient Satisfaction ◽

Pain Management ◽

Postoperative Complications ◽

Postoperative Complication ◽

Foot And Ankle ◽

Level Of Evidence ◽

Initial Surgery ◽

Ankle Surgery ◽

Patient Reported ◽

The Impact

Background: Fulfillment of patients’ expectations following foot and ankle surgery has been previously studied, and shown to be an effective modality in assessing patient-reported outcomes (PROs). Although this assessment has been shown to correlate well with patient satisfaction and other validated PROs, the impact of postoperative complications on fulfillment of expectations is unknown. The aim of this study is to therefore investigate the impact of postoperative complications on fulfillment of patients’ expectations. Methods: Preoperatively, patients completed a validated Foot and Ankle Expectations Survey consisting of 23 questions encompassing domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. Chart review was performed to identify patient demographics, comorbidities, pain management, and postoperative complications, which were classified as minor (infection requiring antibiotics) or major (return to operating room for revision, deep infection). FP in patients with a complication was compared to patients who did not experience a complication. In addition, the Foot and Ankle Outcomes Score (FAOS), satisfaction, and Delighted-Terrible scale (how they would feel if asked to spend the rest of their life with their current foot/ankle symptom) were collected at final follow-up. Of the 271 patients (mean age 55.4 years, 65% female), 31 (11.4%, mean age 53.6, 58% female) had a postoperative complication: 25 major (19 revisions, 6 deep infections requiring irrigation and debridement), 4 minor (4 superficial infections requiring antibiotics), and 2 major and minor (revision and superficial infection). Average time from complication to completion of fulfillment survey was 15 (±3.6) months. The groups were similar in diagnoses. Results: Complications were associated with significantly worse FP (0.69 ± 0.45 vs 0.86 ± 0.40, P = .02). Having a complication significantly correlated with worse satisfaction, Delighted-Terrible scale, and FP ( P < .001). FAOS domains were similar between groups preoperatively; postoperatively, patients without complications had significantly higher Activities of Daily Living and Quality of Life scores ( P < .05). Demographically, there was no difference in age, sex, body mass index, Charlson Comorbidity Index, depression/anxiety, or pain management between the 2 groups. Conclusion: Our data suggests that postoperative complications following foot and ankle surgery were associated with worse patient-reported fulfillment of their operative expectations even after recovery from the initial surgery and complication. This finding is independent of preoperative expectations, and correlates with patient satisfaction with their procedure. Therefore, while patient-perceived fulfillment following foot and ankle surgery is multifactorial, the incidence of a postoperative complication negatively impacts fulfillment as well as satisfaction following surgery. Level of Evidence: Level II, prospective comparative series.

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Patient Satisfaction Following Hallux Rigidus Treatment With a Synthetic Cartilage Implant

Foot & Ankle Specialist ◽

10.1177/19386400211001993 ◽

2021 ◽

pp. 193864002110019

Author(s):

Wonyong Lee ◽

Carol Wang ◽

Dan Prat ◽

Keith L. Wapner ◽

Wen Chao ◽

...

Keyword(s):

Patient Satisfaction ◽

Functional Outcomes ◽

Corticosteroid Injection ◽

Sport Activity ◽

Case Series ◽

Hallux Rigidus ◽

Lower Percentage ◽

Level Of Evidence ◽

Patient Reported

Background There remains no clear consensus on patient satisfaction and functional outcomes following synthetic cartilage implant (SCI) implantation for hallux rigidus. The purpose of this study was to review our experience at a single academic institution using an SCI for treatment of hallux rigidus. Methods A retrospective review was performed of patients who underwent the SCI procedure for treatment of hallux rigidus between January 2017 and May 2019. Functional outcomes were evaluated using Patient-Reported Outcome Measures Informational System (PROMIS)-10 scores as well as a survey investigating patient satisfaction, self-reported clinical improvement, and changes in sporting ability. Patients were divided into satisfied versus unsatisfied subgroups, and between-group differences in preoperative variables and complications were reviewed. A total of 90 patients (96 implants) were included in this study. The mean follow-up time was 26.4 months. Results In all, 81.2% of patients reported that their foot was “much improved” (55.2%) or “improved” (26.0%) since undergoing the SCI procedure, whereas a slightly lower percentage, 74.0%, stated that they were “extremely satisfied” (41.7%) or “satisfied” (32.3%) at final follow-up. Patients were able to tolerate higher impact sporting activities after the procedure, and 75.0% of patients stated they would have the same surgery again. PROMIS-10 T-scores averaged 54.2 points for physical health and 57.4 points for mental health. Only 2.1% of patients required conversion to arthrodesis. Significant differences between the satisfied versus unsatisfied subgroups were found in preoperative corticosteroid injection use (21.1% vs 41.1%, respectively; P = .029) and preoperative VAS pain score (8.2 vs 7.1, respectively; P = .036). Conclusion The SCI procedure can be a viable option for treating hallux rigidus with high satisfaction overall, increased sport activity levels, and a very low revision rate. However, maximizing patient satisfaction may require more careful consideration of preoperative prognosticators and extensive patient counseling to ensure realistic expectations for recovery time and individual outcome. Level of Evidence: Level IV: Retrospective case series

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