Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

scholarly journals (A21) Injury Patterns of Blast Type Antipersonnel Land Mine Victims

2011 ◽  
Vol 26 (S1) ◽  
pp. s6-s6
Author(s):  
L. Dassanayake ◽  
A. Karunarathne ◽  
D. Munidasa
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Lower Limb ◽  
The Body ◽  
Lower Limbs ◽  
Severe Injuries ◽  
Land Mine ◽  
Limb Injuries ◽  
Tarsal Bones ◽  
Compound Fractures

Anti-personnel land mines are deployed in many regions of conflict around the world. A large number of civilians and militants are affected regularly due to the blasts of such mines. Once set, they remain as silent concealed killers for decades and challenge the safety of the civilians even during the times of peace. A descriptive study was carried out at the Anuradhapura Teaching Hospital during a six month period starting in July 2007. The total number of anti-personal land mine injuries admitted during this period was 89. In all cases, the body part primarily in contact with the mine had been a lower limb. Except for few occasions, extensive soft tissue damage associated with compound fractures necessitated some form of an amputation for those limbs in primary contact with the blast mines. Closed fractures of the calcareous, talus, and the tarsal bones were seen in two cases. Nearly two thirds of the patients sustained either soft tissue or bone injuries to the opposite lower limb. Twelve percent of the victims had compound fractures on the opposite tibia and fibula. Injuries to external genitalia were seen in 8% of the cases. Upper limb injuries were not rare and predominantly found on the contra lateral upper limb (17%). The majority of them were soft tissue injuries. Chest wall injuries were seen among 2% of the cases. Superficial facial injuries were seen among 7% of the cases. In one occasion a gingival injury was detected. Seven percent of the victims developed deterioration in level of consciousness. None of them clinically showed any external physical trauma to the head. In some instances, the Glasgow Coma Scale (GCS) was ranked as 7 in which tracheal intubation and ventilation were needed. It was evident in this study that the majority of the affected patients sustained severe injuries in both lower limbs in contrast to some of the previous available studies.

scholarly journals The Effect of Corrective Feedback Exercise on Knee Kinematics and EMG of Lower Limbs of Female Wushu Players

2021 ◽  
Author(s):  
Fahimeh Rashidi ◽  
Abdolrasoul Daneshjoo ◽  
Seyed Kazem Mousavi Sadati
Keyword(s):  
Lower Limb ◽  
Corrective Feedback ◽  
Exercise Group ◽  
T Test ◽  
Lower Limbs ◽  
Control Group ◽  
Limb Injuries ◽  
Significant Difference ◽  
Post Test ◽  
Feedback Correction

Introduction: Recent studies have examined the risk factors associated with lower limb injuries. This study aimed to explore the effect of 12 sessions of feedback corrective exercises on the kinematic indicators of the knee and the Electromyography Activity (EMG) of the muscles of the lower limbs of female wushu players. The present study has a quasi-experimental design with a pre-test/post-test design and a control group. Materials and Methods: In this study, 16 female wushu players were selected by the available sampling method and placed in two groups of exercise and control. The exercise group performed feedback correction exercises for 12 sessions. Before and after the knee varus exercises, we measured, pelvic drop, and EMG of the lower limb muscles of both groups     in the SLS movement. The independent two-sample t-test was used to examine intergroup differences and the two-group correlated t-test was used to compare intra group sizes. To analyze the statistical data, SPSS V. 23 was used (P≤0.05) Results: The results showed a significant difference in knee varus between the experiment group and the control group in the pre-test and there was a significant difference between the pelvic drop in the pre-test and post-test of the experiment group compared with the control. The angle of the knee varus in the exercise group showed a significant difference with the control group. The EMG results of the muscles in the pre-test and post-test were significantly different. Conclusion: Based on the findings of the present study, the feedback correction exercise may improve motion control in wushu players. It also improved neuromuscular weakness in the subjects. According to the results and based on less muscle activity during movements, this exercise will reduce fatigue and the risk of injury.

Mid-aortic syndrome: computed tomography angiography depicting extensive collateral circulation in an 11-year-old patient with thoracoabdominal aortic coarctation

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 132-135 ◽  
Author(s):  
Krohn ◽  
Gebauer ◽  
Hübler ◽  
Beck
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Intestinal Ischemia ◽  
Clinical Presentation ◽  
Lower Limbs ◽  
Upper Body ◽  
Descending Aorta ◽  
Before And After ◽  
Blood Pressures

The mid-aortic syndrome is an uncommon clinical condition characterized by severe narrowing of the descending aorta, usually with involvement of its renal and visceral branches, presenting with uncontrollably elevated blood pressures of the upper body, renal and cardiac failure, intestinal ischemia, encephalopathy symptoms and claudication of the lower limbs, although clinical presentation is variable. In this article we report the case of an eleven-year-old patient with the initial diagnosis of a mid-aortic syndrome and present the computed tomography angiography pictures and reconstructions before and after surgical therapy.

scholarly journals Unilateral and Bilateral Strength Asymmetry among Young Elite Athletes of Various Sports

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 683
Author(s):  
Maros Kalata ◽  
Tomas Maly ◽  
Mikulas Hank ◽  
Jakub Michalek ◽  
David Bujnovsky ◽  
...  
Keyword(s):  
Lower Limb ◽  
Elite Athletes ◽  
Lower Limbs ◽  
Knee Extensors ◽  
Young Athletes ◽  
Lower Limb Muscles ◽  
Significant Difference ◽  
Strength Asymmetry ◽  
Main Factor ◽  
Objective Type

Background and objective: Type of physical activity may influence morphological and muscular asymmetries in the young population. However, less is known about the size of this effect when comparing various sports. The aim of this study was to identify the degree of bilateral asymmetry (BA) and the level of unilateral ratio (UR) between isokinetic strength of knee extensors (KE) and flexors (KF) among athletes of three different types of predominant locomotion in various sports (symmetric, asymmetric and hybrid). Material and methods: The analyzed group consisted of young elite athletes (n = 50). The maximum peak muscle torque of the KE and KF in both the dominant (DL) and non-dominant (NL) lower limb during concentric muscle contraction at an angular velocity of 60°·s−1 was measured with an isokinetic dynamometer. Results: Data analysis showed a significant effect of the main factor (the type of sport) on the level of monitored variables (p = 0.004). The type of sport revealed a significant difference in the bilateral ratio (p = 0.01). The group of symmetric and hybrid sports achieved lower values (p = 0.01) of BA in their lower limb muscles than those who played asymmetric sports. The hybrid sports group achieved higher UR values (p = 0.01) in both lower limbs. Conclusions: The results indicate that sports with predominantly symmetrical, asymmetrical, and hybrid types of locomotion affected the size of the BA, as well as the UR between KE and KF in both legs in young athletes. We recommend paying attention to regular KE and KF strength diagnostics in young athletes and optimizing individual compensatory exercises if a higher ratio of strength asymmetry is discovered.

scholarly journals Audio-visual stimulation in conjunction with functional electrical stimulation to address upper limb and lower limb movement disorder

2016 ◽  
Vol 26 (2) ◽  
Author(s):  
Deepesh Kumar ◽  
Sunny Verma ◽  
Sutapa Bhattacharya ◽  
Uttama Lahiri
Keyword(s):  
Electrical Stimulation ◽  
Movement Disorder ◽  
Upper Limb ◽  
Functional Electrical Stimulation ◽  
Lower Limb ◽  
Neurological Disorders ◽  
Visual Stimulation ◽  
Lower Limbs ◽  
Lower Limb Movement ◽  
Rehabilitation Exercises

Neurological disorders often manifest themselves in the form of movement deficit on the part of the patient. Conventional rehabilitation often used to address these deficits, though powerful are often monotonous in nature. Adequate audio-visual stimulation can prove to be motivational. In the research presented here we indicate the applicability of audio-visual stimulation to rehabilitation exercises to address at least some of the movement deficits for upper and lower limbs. Added to the audio-visual stimulation, we also use Functional Electrical Stimulation (FES). In our presented research we also show the applicability of FES in conjunction with audio-visual stimulation delivered through VR-based platform for grasping skills of patients with movement disorder.

A modern-day solution to a 100-yearold problem: the use of a bespoke offloading brace in the rehabilitation of ‘Deck-Slap’ and other high-energy lower limb injuries

2014 ◽  
Vol 100 (3) ◽  
pp. 337-343
Author(s):  
MA Osborne ◽  
HL Jarvis ◽  
N Bennett ◽  
RD Phillip
Keyword(s):  
Axial Loading ◽  
Cost Effective ◽  
Armed Forces ◽  
High Energy ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Activity Levels ◽  
Prosthetic Devices ◽  
Functional Benefit ◽  
Limb Injuries

Abstract‘Deck-Slap’ is an injury pattern first described at the Battle of Jutland; it is still relevant today, with anti-vehicle mines a significant threat to Coalition troops. The effect of a device exploding beneath a vehicle produces a wave of high energy that is rapidly transmitted through the steel floor; this causes significant axial loading of lower limbs often resulting in severe fractures (notably of the calcaneum). Recent advancements in orthopaedic surgery have allowed for limbs that were destined for immediate amputation following significant trauma to be salvaged. However, despite intense rehabilitation, many of these salvaged limbs have subsequently gone on to delayed amputation, as functional outcomes are often poor. Technologically advanced prosthetic devices are available that afford good quality of life and allow for increased activity levels; these devices are, however, expensive to procure and maintain. This report describes a United Kingdom (UK) Armed Forces soldier who suffered a typical ‘deck-slap’ injury in Afghanistan with subsequent limb salvage. The use of the Bespoke Off-loading Brace (BOB) is discussed. The results presented here indicate that the biomechanical function of a patient with this type of injury improves when wearing the BOB. Further studies are needed to assess long-term clinical outcomes and the functional benefit of the device as a viable and cost-effective alternative to delayed limb amputation.

Computed tomographic angiography in stroke and high-risk transient ischemic attack: Do not leave the emergency department without it!

2018 ◽  
Vol 13 (7) ◽  
pp. 673-686
Author(s):  
Brett R Graham ◽  
Bijoy K Menon ◽  
Shelagh B Coutts ◽  
Mayank Goyal ◽  
Andrew M Demchuk
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Hemorrhagic Stroke ◽  
Computed Tomographic Angiography ◽  
Rapid Diagnosis ◽  
Vascular Lesions ◽  
Transient Ischemic Attacks ◽  
Computed Tomographic ◽  
Ischemic Attack ◽  
Tomographic Angiography

Stroke is a major cause of morbidity and mortality worldwide, and effective treatment requires rapid diagnosis and recognition of relevant vascular lesions. In this review we will discuss the usefulness and versatility of computed tomography angiography in the setting of stroke, be it ischemic or hemorrhagic, minor or disabling. Furthermore, we also highlight how we use computed tomography angiography in decision making in transient ischemic attacks, acute disabling ischemic stroke, and hemorrhagic stroke.

Measurement of Lingual Artery Using Ultrasound Versus Computed Tomography Angiography for Midline Glossectomy in Patients With Obstructive Sleep Apnea

2021 ◽  
pp. 000348942110626
Author(s):  
Chenhai Zheng ◽  
Lei Shi ◽  
Dengxiang Xing ◽  
Jie Qin ◽  
Peipei Ji ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Computed Tomography Angiography ◽  
Lingual Artery ◽  
Obstructive Sleep ◽  
Significant Difference

Objective: To clarify the differences in assessing the course of the lingual artery between lingual artery computed tomography angiography (CTA) and ultrasound (US). Methods: Twenty-six OSA patients were included in this study and accomplished lingual artery CTA and US, respectively. The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries on 3 measurement levels based on lingual artery CTA and US were compared. Results: The depths of the lingual arteries on 3 measurement levels by CTA were deeper than those by US ( P < .01). There was no significant difference in the distances between bilateral lingual arteries on 3 measurement levels between CTA and US ( P > .05). Conclusions: The parameters of lingual artery measured by lingual artery US were similar to or smaller than those measured by lingual artery CTA. Like lingual artery CTA, lingual artery US could be used as an effective method to ensure the safety of the operation.

scholarly journals Cross-Sectional Survey of Musculoskeletal Disorders in Workers Practicing Traditional Methods of Underground Coal Mining

2020 ◽  
Vol 17 (7) ◽  
pp. 2566
Author(s):  
Madiha Ijaz ◽  
Sajid Rashid Ahmad ◽  
Muhammad M. Akram ◽  
Steven M. Thygerson ◽  
Falaq Ali Nadeem ◽  
...  
Keyword(s):  
Coal Mining ◽  
Upper Limb ◽  
Lower Limb ◽  
Lower Limbs ◽  
Underground Mines ◽  
Upper Limbs ◽  
Underground Coal Mining ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
R Programming

Background: In subcontinental underground mines, coal mining is carried out manually and requires many laborers to practice traditional means of coal excavation. Each task of this occupation disturbs workers’ musculoskeletal order. In order to propose and practice possible ergonomic interventions, it is necessary to know what tasks (drilling and blasting, coal cutting, dumping, transporting, timbering and supporting, loading and unloading) cause disorder in either upper limbs, lower limbs, or both. Methods: To this end, R-programming, version R 3.1.2 and SPSS, software 20, were used to calculate data obtained by studying 260 workers (working at different tasks of coal mining) from 20 mines of four districts of Punjab, Pakistan. In addition, a Standard Nordic Musculoskeletal Questionnaire (SNMQ) and Rapid Upper Limb Assessment (RULA) sheet were used to collect data and to analyze postures respectively. Results: In multi regression models, significance of the five tasks for upper and lower limb disorder is 0.00, which means that task based prevalence of upper and lower limb disorders are common in underground coal mines. The results of the multiple bar chart showed that 96 coal cutters got upper limb disorders and 82 got lower limb disorders. The task of timbering and supporting was shown to be dangerous for the lower limbs and relatively less dangerous for the upper limbs, with 25 workers reporting pain in their lower limbs, and 19 workers reporting pain in their upper limbs. Documented on the RULA sheet, all tasks got the maximum possible score (7), meaning that each of these tasks pose a threat to the posture of 100% of workers. The majority of participants (182) fell in the age group of 26 to 35 years. Of those workers, 131 reported pain in the lower limbs and slight discomfort (128) in the upper limbs. The significance value of age was 0.00 for upper limb disorder and was 0.012 for lower limb disorder. Frequency graphs show age in direct proportion to severity of pain while in inverse proportion with number of repetitions performed per min. Conclusions: All findings infer that each task of underground coal mining inflicts different levels of disorder in a workers’ musculoskeletal structure of the upper and lower limbs. It highlighted the need for urgent intervention in postural aspects of each task.

scholarly journals The Comparison between Isokinetic Knee Muscles Strength in the Ipsilateral and Contralateral Limbs and Correlating with Function of Patients with Stroke

2019 ◽  
Vol 10 (04) ◽  
pp. 683-689
Author(s):  
Fayaz Khan ◽  
Haris Anjamparuthikal ◽  
Mohamed Faisal Chevidikunnan
Keyword(s):  
Lower Limb ◽  
Knee Flexion ◽  
Peak Torque ◽  
Lower Limbs ◽  
Isokinetic Strength ◽  
Isokinetic Dynamometer ◽  
Knee Strength ◽  
Torque Measurements ◽  
Significant Difference ◽  
Knee Muscle

Abstract Objective The aim of this study is to compare the isokinetic knee muscles peak torque measurements and proprioception between the affected and intact limbs of patients with stroke, in addition to finding the correlation between knee muscles strength and lower limb function. Methods Twelve patients with stroke (mean age 64.33 ± 6.140 years), with 3 to 7 months poststroke who can walk 25 feet independently without using or using assistive devices and full passive range of motion were included in the study. Biodex isokinetic dynamometer was used for measuring isokinetic strength at 90°/s, 120°/s, and 150°/s and isometric strength at 60°/s in both flexors and extensors of the knee, whereas proprioception was measured at 45°/s knee flexion, all for affected and intact limbs. Functional measurements were assessed using the Fugl-Meyer Assessment for Lower Limb scale and Barthel Index (BI). Results The differences shown were found to be statistically significant between affected and intact limbs in isokinetic 90°/s flexion (p = 0.005), extension (p = 0.0013), and isometric at 60°/s flexion (p < 0.0001) knee muscle strengths and also the proprioception (p = 0.05). Significant positive correlation was found between isokinetic affected side knee flexion at 90°/s (r = 0.903) with BI (r = 0.704). Conclusion There is a significant difference in peak torque measurements between affected and normal lower limbs of poststroke patients, as well as a significant correlation between the knee strength and lower limb functions. Furthermore, it can also be concluded that the differences in knee proprioception between the affected and intact limbs were shown to be significant.

Sign in / Sign up

Export Citation Format

Share Document