EXPERIENCE OF SOFT TISSUES REPAIR IN SEVERE INJURIES OF LOWER LIMBS

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.

Download Full-text

Body composition inPan paniscuscompared withHomo sapienshas implications for changes during human evolution

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1505071112 ◽

2015 ◽

Vol 112 (24) ◽

pp. 7466-7471 ◽

Cited By ~ 24

Author(s):

Adrienne L. Zihlman ◽

Debra R. Bolter

Keyword(s):

Body Composition ◽

Muscle Mass ◽

Human Evolution ◽

Soft Tissues ◽

Pan Paniscus ◽

Homo Sapiens ◽

The Body ◽

Lower Limbs ◽

Relative Mass ◽

Human Form

The human body has been shaped by natural selection during the past 4–5 million years. Fossils preserve bones and teeth but lack muscle, skin, fat, and organs. To understand the evolution of the human form, information about both soft and hard tissues of our ancestors is needed. Our closest living relatives of the genusPanprovide the best comparative model to those ancestors. Here, we present data on the body composition of 13 bonobos (Pan paniscus) measured during anatomical dissections and compare the data withHomo sapiens. These comparative data suggest that both females and males (i) increased body fat, (ii) decreased relative muscle mass, (iii) redistributed muscle mass to lower limbs, and (iv) decreased relative mass of skin during human evolution. Comparison of soft tissues betweenPanandHomoprovides new insights into the function and evolution of body composition.

Download Full-text

Reconstruction problems in emergency treatments of severe injuries of the lower limbs. (Italian)

Plastic & Reconstructive Surgery ◽

10.1097/00006534-197805000-00060 ◽

1978 ◽

Vol 61 (5) ◽

pp. 801

Author(s):

Ernesto P. Caronni ◽

G. Girardi ◽

Z. Martini ◽

O. Visentin

Keyword(s):

Lower Limbs ◽

Severe Injuries

Download Full-text

Clear cell sarcoma of the nuchal region with metastasis in stomach

Archive of oncology ◽

10.2298/aoo1104076t ◽

2011 ◽

Vol 19 (3-4) ◽

pp. 76-78

Author(s):

Dragana Tegeltija ◽

Aleksandra Lovrenski ◽

Milana Panjkovic ◽

Slavica Knezevic-Usaj ◽

Zivka Eri ◽

...

Keyword(s):

Malignant Melanoma ◽

Soft Tissues ◽

Clear Cell ◽

Neck Region ◽

Surgical Excision ◽

Clear Cell Sarcoma ◽

Lower Limbs ◽

Medical Attention ◽

Cell Sarcoma ◽

Complete Surgical Excision

Clear cell sarcoma/malignant melanoma of soft parts is a rare malignant tumor that originates from the neural crest. It is most common in young men in the lower limbs, grows slowly in the form of deep localized nodes around the tendons, fascia, and aponeurosis. Prognosis is poor, local recurrences and metastases are common. We present a case of a 53-year-old patient who sought medical attention due to the presence of a tumefaction in the nuchal neck region, followed by pain, heightened sensitivity, and numbness in his right hand. After excision, histological examination, and application of immunohistochemical and histochemical methods, malignant melanoma of soft tissues was diagnosed. Fourteen months after the excision of the neck tumor, a metastatic stomach disease was diagnosed. Larger tumors with necrosis, expressed pleomorphisam, and increased mitotic activity give metastases before local recurrence. Diagnosis is set using immunohistochemical methods after surgical excision of the tumor and the prognosis of the disease depends on the size of tumor and complete surgical excision.

Download Full-text

Epidemiology, clinical features, and histopathology of sarcomas managed in a Haitian cancer clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e23515 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e23515-e23515

Author(s):

Joseph Bernard ◽

Thierry Alcindor ◽

Lynn Gabrielle Alexis ◽

Doukens Patrick Gilbert ◽

Vincent DeGennaro

Keyword(s):

Overall Survival ◽

Mortality Rate ◽

Head And Neck ◽

Clinical Features ◽

Soft Tissues ◽

Soft Tissue Sarcomas ◽

Presentation Rate ◽

Dermatofibrosarcoma Protuberans ◽

Lower Limbs ◽

Anatomical Site

e23515 Background: Sarcomas are among the least described cancers diagnosed in Haiti. Suboptimal surgery and the unavailability of radiation therapy make their management challenging. The main objective of this study was to present the epidemiology, clinical features and histopathology of sarcomas in the Haitian setting. Methods: A seven-year retrospective study was conducted in the cancer program of Innovating Health International (IHI). We included all patients with clinical or histological diagnosis of sarcoma enrolled from January 1, 2014 to December 31, 2020. Date of first visit, age, gender, stage, anatomical site, histology, outcome as of December 31, 2020 and date of death were the main variables selected for this chart review. Mortality rate and overall survival were also evaluated. Results: One hundred and twenty-two (122) patients with sarcomas were diagnosed and treated during the study period. Their mean age was 43.3 years [range: 15-88] and the sample was 62.3% women and 37.7% men. 49.2% of the patients were less than 40 years of age. Among the cases of sarcomas, 86.9% were soft tissue sarcomas and 13.1% bone sarcomas. The lower limbs (36.9%), abdomen (14.8%), head and neck (13.1%), upper limbs (12.3%) and breasts (7.4%) were the most common locations of the sarcomas. 81% of abdominal/pelvic sarcoma cases (n=21) were in women. The most common histological types (n=94) were fibrosarcoma (15.2%), liposarcoma (10.9%), dermatofibrosarcoma protuberans (8.7%), malignant histiocytofibroma (6.5%), rhabdomyosarcoma (5.4%) and gastrointestinal stromal tumor (5.4%). 19.6% of the patients had metastatic disease. The mortality rate for the study period was 53.3% and 17.2% of the patients were lost to follow-up. The median overall survival was 7.2 months for the cohort and 18.4 months for the treated patients (n=70). Conclusions: The sarcomas seen in this Haitian medical clinic mainly affect the soft tissues of limbs, abdomen and head and neck. There is a strong predominance of female patients and about half of the patients are aged less than 40. Despite a low metastatic presentation rate, the prognosis is poor, likely reflecting both the aggressiveness of this group of diseases and the disparities of outcomes between high-income and low-and-middle-income countries.

Download Full-text

Doppler Comparative Measurements in the Reconstruction of Limbs with Flaps and Grafts

Macedonian Medical Review ◽

10.1515/mmr-2017-0011 ◽

2017 ◽

Vol 71 (1) ◽

pp. 56-63

Author(s):

Boro Dzonov ◽

Lazo Noveski ◽

Suzana Nikolovska ◽

Elizabeta Zhogovska

Keyword(s):

Blood Flow ◽

Reconstructive Surgery ◽

Soft Tissues ◽

Continuous Wave ◽

Power Doppler ◽

Lower Limbs ◽

Reconstructive Procedures ◽

Significant Difference ◽

Doppler Color

Abstract Doppler technique was first described by the Australian physicist and mathematician Christian Doppler. Doppler effect is defined as a reflection of high frequency sound waves of different frequency when they come in contact with the movable structure in the blood vessel. Waves that go to transducers are coded red, while waves that move away from the transducer are coded blue. Doppler main types can be classified as following: continuous wave (CW) Doppler, spectral Doppler, color Doppler and Power Doppler color. The study was realizedat the University Clinic for Plastic and Reconstructive Surgery. It is a randomized prospective study. During the study two groups of 30 patientseach were formed. Each patient was required a permission for reconstructive surgery procedure and an informed consent for participation in the study. For all patients a specially designed questionnaire (non-standardized) was filled out. 1. First (I) group of patients treated with flaps. In this group a type of reconstructive technique with skin or complex flapshas been applied. 2. Second group (II) of patients treated with grafts (split thickness grafts). In this group applied reconstruction comprised application of skin grafts with partial thickness. The study included patients with defects of the skin and soft tissues, whohad an indication for reconstructive surgery procedure. Exclusion criteria of patients for participation in the study were: children under 14 years of age, adults over 75 years, people with systemic diseases that can affect the results of reconstructive intervenetions and patients who have without periosteum bone-like surface defect as contraindication for skin grafting. The results of the reconstructive procedures according to the objectives set were investigated clinically into three time periods: preoperative, postoperative day 7 and day 30 postoperatively. The following investigations were carried out: determination of the circulation levels by means of Doppler; determination of the levels of limbs circulation is distal to the site of reconstruction in the pre-and postoperative period (day 7 and day 30); For the evaluation of blood flow the following parameters were used: • PSV-Peak systolic velocity • PI - Pulsatility index RI - Resistance indexPI and RI were calculated using the formula: • PI = PSV - EDV / Vmean • RI = PSV - EDV / PSV EDV indicates the flow velocity in late diastole and V mean, the average speed of blood flow through the artery. By assessment of arterial status before and after surgery through the analysis ofvascular waves at different locations of the vascular tree of the upper and lower extremities, we registered significant difference between the two examined groups, which speaks in favor of the use of flaps in reconstruction of the lower limbs.

Download Full-text

Fracture and Complete Dislocation of the Thoracic or Lumbosacral Spine

Neurosurgery ◽

10.1227/00006123-197908000-00009 ◽

1979 ◽

Vol 5 (2) ◽

pp. 250-253 ◽

Cited By ~ 17

Author(s):

Richard H. Jackson ◽

Ronald G. Quisling ◽

Arthur L. Day

Keyword(s):

Soft Tissues ◽

Lateral Displacement ◽

Spinal Fracture ◽

Open Reduction Internal Fixation ◽

Fracture Site ◽

Neurological Dysfunction ◽

Fracture Dislocation ◽

Lumbosacral Spine ◽

Severe Injuries ◽

Severe Fracture

Abstract Severe fracture/dislocation of the thoracic (T) or lumbar (L) spine is usually associated with complete neurological dysfunction below the level of injury. Three cases of severe spinal fracture/dislocation are presented in this report. Two of these patients suffered only partial neurological deficit, which improved after open reduction, internal fixation, and bone fusion. Severe fracture/dislocation of the T or L spine may be quite obvious on lateral roentgenograms. Occasionally, however, the fracture site may be obscured by the overlying shoulders, hips, or soft tissues. If no lateral displacement is evident on anteroposterior (AP) films, a false impression of normal alignment may be given, as was the case in two of our patients. A careful interpretation of the AP view will provide the diagnosis in such cases. The subtle AP radiographic changes suggesting fracture/dislocation of the T or L spine are detailed. The mode of injury, physical findings, prognosis, and surgical treatment of such severe injuries are also briefly reviewed.

Download Full-text

Snoring as main symptoms of peripheral primitive neuroectodermal tumor in oropharynx:a case report with review of literature

10.21203/rs.3.rs-847261/v1 ◽

2021 ◽

Author(s):

Xin-xiang Ma ◽

Chuan-xin Zhang ◽

Yi-fan Ren ◽

Yu-lin Zhang ◽

Ji-ai Zheng

Keyword(s):

Primitive Neuroectodermal Tumor ◽

Soft Tissues ◽

Wilms Tumor ◽

Smooth Muscle Actin ◽

S100 Protein ◽

Neuroectodermal Tumor ◽

Lower Limbs ◽

Peripheral Primitive Neuroectodermal Tumor ◽

Magnetic Resonance Imaging Mri ◽

Histology And Immunohistochemistry

Abstract IntroductionIn children, snoring is often associated with hypertrophied tonsils and adenoids. There was a case in a girl who did not suffer from hypertrophy adenoids, but from a peripheral primitive neuroectodermal tumor (pPNET) in the oropharynx. pPNET often occurs in the deep soft tissues of the trunk, paravertebral, lower limbs and retroperitoneum. It is rarely located in children's oropharynx and makes snoring.Patient concernsWe report a case of a 4-years-old girl who complained of slurred speech and snoring. Her serum showed normal results, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mass lesion in oropharynx. By using histology and immunohistochemistry, cluster of differentiation 99 (CD99), vimentin, friend leukemia integration 1 (FLI-1), integrase interactor-1 and α-smooth muscle actin were positive, but epithelial membrane antigen, erythroblast transformation-specific (ETS) related gene (ERG), NK homeobox 2.2, Wilms’ tumor 1 and S100-protein were negative. And the rearrangement of the Ewing sarcoma breakpoint region 1 (EWSR1) gene was proved in the test of fluorescent.DiagnosisShe was diagnosed as a peripheral primitive neuroectodermal tumor.Interventions and outcomeThe girl had been treated with surgery and chemotherapy. She has been well for 24 months without any signs of disease.ConclusionIn children who snore, we should not only think of hypertrophied adenoids, but also the possibility of pPNETs in oropharynx. CT scan or MRI should be conducted in time, as well as histology and immunohistochemistry to avoid misdiagnosis.

Download Full-text

The Dynamic Behaviour of the Floor of a Surrogate Vehicle Under Explosive Blast Loading

Journal of Materials Science Research ◽

10.5539/jmsr.v5n2p59 ◽

2016 ◽

Vol 5 (2) ◽

pp. 59 ◽

Cited By ~ 1

Author(s):

Nicolas Newell ◽

William Neal ◽

Thanyani Pandelani ◽

David Reinecke ◽

William G Proud ◽

...

Keyword(s):

Numerical Models ◽

Lower Limbs ◽

High Rate ◽

Improvised Explosive Devices ◽

Severe Injuries ◽

Know How ◽

Axial Forces ◽

Models Of Injury ◽

Improvised Explosive ◽

Explosive Devices

<p class="1Body">Improvised Explosive Devices have been the signature weapon in the recent conflicts in Iraq and Afghanistan. High-rate axial forces exerted by the vehicle floor to the lower limbs of occupants have been the cause of severe injuries. In order to gain a greater understanding of the mechanisms of these injuries so that countermeasures can be developed, one is required to know how the vehicle floor behaves; therefore, the purpose of this study was to characterise the behaviour of a vehicle floor surrogate to a range of explosive loads. Explosive loads between 1 and 6 kg TNT were detonated beneath a vehicle floor surrogate resulting in peak floor velocities between 5.8 and 80.5 m/s reached in a time between 0.10 and 3.13 ms. The data can now be used to (a) test numerical models of blast and its interaction with structures for validity, and (b) ensure that the velocity profiles replicated in a laboratory environment to understand human tolerance to injury are relevant to the blast process. These will ensure that preventive measures are developed based on realistic physical and numerical models of injury.</p>

Download Full-text

POTENTIAL AND PERSPECTIVES OF INDIRECT REVASCULARIZATION IN TREATMENT OF LOWER LIMBS CRITICAL ISCHEMIA

Novosti Khirurgii ◽

10.18484/2305-0047.2021.4.490 ◽

2021 ◽

Vol 29 (4) ◽

pp. 490-503

Author(s):

S.N. Yaroshkin ◽

◽

S.A. Sushkou ◽

L.A. Fralou ◽

◽

...

Keyword(s):

Blood Flow ◽

Soft Tissues ◽

Lower Limbs ◽

Cochrane Library ◽

Muscular Tissue ◽

Critical Ischemia ◽

Actual Problem ◽

Scientific Database ◽

Slow Development ◽

Indirect Revascularization

This review was undertaken by a literature search of the International scientific database PubMed and Cochrane library. The review highlights the issues and perspectives of indirect revascularization in the patients with lower limbs critical ischemia. The study revealedthat lower limbs critical ischemia remains the actual problem ofangiosurgery, despite of the widespread introduction of angioplasty and open vascular reconstruction. However, angioplasty and bypass surgery revascularization cannot be performed in some category of patients, so that the further improvement of indirect revascularization techniques has been of great interesttoresearchers. The severity of the ischemic process is determined not only by the mechanical blood flow restriction but also by the angiogenic potential of the surrounding soft tissues, foremost muscular one. Therefore, in the case of technical irreparability of the main blood flow it remains possible to preserve the limb by creating new vascular networks in the muscular tissue. Revascularizing osteotrepanation of the lower limb bones is considered to be theoptimal variant to achieve this result. The discontent of clinical outcomes occurred due to the slow development of the angiogenic effect, which in critical ischemia is fraught with loss of a limb until the maximal angiogenesis is reached. In recent years, cell therapyhas become a very promising and advanced scientific research topic. So that its methods have been actively introduced into practice; they are easily combined with revascularizing osteotrepanation and are able significantly accelerate angiogenesis induced by surgical bone injury. In this regard, there is reason to believe that curative effect increases when revascularising osteotrepanation is combined with cell therapy, including the use of bone marrow aspirates.

Download Full-text