PubMed Health⌕ Search

Biomedical subjects

M S Pinzur

Publications and source records attributed to M S Pinzur.

At least 19 recordsLinked to original sources
PubMed1992

Transcutaneous oxygen as a predictor of wound healing in amputations of the foot and ankle.

Thirty-eight amputations of the foot and ankle were performed in patients with peripheral vascular insufficiency over a 20-month period. Amputation level selection was based on clinical examination, a minimum ankle-brachial index of 0.5 as a measure of vascular supply, serum albumin of 3.0 gm/dl as a measure of tissue nutrition, and a total lymphocyte count of 1500 as a measure of immunocompetence. Transcutaneous oxygen tension was measured at the midfoot and ankle levels prior to surgery. Thirty-two of 38 patients (84.2%) healed their amputation wounds. When the transcutaneous oxygen tension was greater than 30 mm Hg, 24 of 26 patients (92.3%) healed. When the value was below 30 mm Hg, only eight of 12 patients healed. When the propensity to support wound healing is factored out, with patients having the metabolic capacity to heal an amputation wound in the foot and ankle, it appears that transcutaneous oxygen tension is an accurate measure of vascular inflow to support amputation wound healing.

Adult↗
PubMed1992

Energy demands for walking in dysvascular amputees as related to the level of amputation.

Cardiac function and oxygen consumption were measured in 25 patients who underwent amputation for peripheral vascular disease (PVD), and in five similarly aged control patients with PVD. Five patients at each of the midfoot, Syme's, below-, through-, and above-knee amputation levels and the five controls were measured at rest, normal walking speed, and maximum walking speed on a treadmill. At normal walking speed, all of the patients functioned at approximately 80% of their cardiac capacity. Normal walking speed and cadence decreased and oxygen consumption per meter walked increased with more proximal amputation. The ratio of cardiac function and oxygen consumption at normal walking speed as compared with at rest increased with more proximal amputation, and the capacity to increase walking speed and oxygen consumption lessened. Our results suggest that peripheral vascular insufficiency amputees function at a level approaching their maximum functional capacity. At more proximal amputation levels, the capacity to walk short or long distances is greatly impaired.

Amputation, Surgical↗
PubMed1992

Multidisciplinary preoperative assessment and late function in dysvascular amputees.

During a three-year period, 95 adults were treated by lower-extremity amputations for peripheral vascular insufficiency. A multidisciplinary team for presurgical evaluation determined all to be potentially independent walkers with a prosthesis. Patients were graded for level of independent walking before amputation and again at a minimum two-year follow-up examination using a seven-level functional grading system. Seventy-six of 90 patients (84%) ambulated within one functional level of their preamputation status. This return to preamputation level of function was maintained whether comparing preamputation functional level or surgical amputation level. Prosthetic use increased and the use of walking aids decreased with increased functional ambulation levels, but did not correlate with surgical levels. Peripheral vascular insufficiency patients can maintain walking independence. Multidisciplinary presurgical evaluation helps selection of the amputation level and correct prosthetic limb fitting.

Adult↗
PubMed1992

Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis. An amputation of the back of the foot.

Twelve patients who had a large ulceration over the heel were managed with a partial calcanectomy, in lieu of a below-the-knee amputation, after unsuccessful non-operative treatment of the ulcer. Only patients who had an ankle-arm index (the ratio of blood pressure at the ankle to the brachial blood pressure) of more than 0.45, a transcutaneous PO2 of more than twenty-eight millimeters of mercury (3.7 kilopascals), a level of albumin of more than 3.0 grams per deciliter (thirty grams per liter), and a total lymphocyte count of more than 1500 were managed with a partial calcanectomy. The primary diagnosis was diabetes in seven patients, peripheral vascular disease in three, quadriplegia in one, and myelodysplasia in one. The duration of follow-up averaged thirty-three months and ranged from seven to sixty-four months. The wound healed after the partial calcanectomy in ten of the twelve patients. Nine of these ten patients maintained the level of mobility that they had had preoperatively. (One patient was unable to walk because he was quadriplegic before the operation). The wound did not heal in two patients, and those patients ultimately had a below-the-knee amputation and a decrease of one grade on the scale that was used to evaluate walking ability.

Adult↗
PubMed1991

Flexor origin release and functional prehension in adult spastic hand deformity.

Eighteen adult patients with spastic hand deformities underwent release of the flexor-pronator origin and step-cut lengthening of the flexor pollicis longus to improve prehensile hand function. The goal of surgery was to provide active grasp release in order to improve hand function. Using a previously published grading scale, patients were graded before and after operation. At follow-up after an average of 35 months (range 24-64 months), all had improved by at least two functional levels.

Adolescent↗
PubMed1991

Loading of the contralateral foot in peripheral vascular insufficiency below-knee amputees.

Seven ambulatory peripheral vascular insufficiency below-the-knee amputees underwent gait analysis to determine the local pressures on seven prominent plantar regions in their remaining limb. Patients occupied significantly less stance phase time on their remaining limbs. Peak, mean, and total pressures measured at each of the seven prominent areas was decreased as compared with laboratory age and sex matched controls. The results of this study suggest that the risk of contralateral limb amputation surgery is related to systemic peripheral vascular insufficiency or local factors, and not increased loading of the remaining contralateral "limb-at-risk."

Aged↗
PubMed1991

Syme's two-stage amputation in insulin-requiring diabetics with gangrene of the forefoot.

Thirty-five insulin-requiring adult diabetic patients underwent 38 Syme's Two-Stage amputations for gangrene of the forefoot with nonreconstructible peripheral vascular insufficiency. All had a minimum Doppler ischemic index of 0.5, serum albumin of 3.0 gm/dl, and total lymphocyte count of 1500. Thirty-one (81.6%) eventually healed and were uneventfully fit with a prosthesis. Regional anesthesia was used in all of the patients, with 22 spinal and 16 ankle block anesthetics. Twenty-seven (71%) returned to their preamputation level of ambulatory function. Six (16%) had major, and fifteen (39%) minor complications following the first stage surgery. The results of this study support the use of the Syme's Two-Stage amputation in adult diabetic patients with gangrene of the forefoot requiring amputation.

Adult↗
PubMed1991

Dynamic electromyography in active and limited walking below-knee amputees.

Walking electromyography was performed in 12 below-knee amputees, who were amputated for peripheral vascular insufficiency. All were at least 1 year post-surgery and had no problems with the fit of their prostheses. Seven were community walkers and five were limited household ambulators. The quadriceps and hamstring muscles exhibited electrical activity during 60% and 64.7% of the gait cycle, respectively, in the active walkers, compared with 44.6% and 53.8% in the limited walkers. Quadriceps muscle activity was initiated almost 10% earlier in the active walkers, while hamstring muscle initiation was similar in both groups. The active walkers were able to maintain quadriceps and increase hamstring muscle activity to compensate for their absent ankle motors, while the limited walkers showed decreased activity in both muscle group. The results of this preliminary study suggest that the dysvascular limited walking below-knee amputee does not use the quadriceps and hamstring muscles for propulsion during walking, and does not appear to reap the benefits of knee joint preservation.

Aged↗
PubMed1991

Preventing heel ulcers: a comparison of prophylactic body-support systems.

Five commercially available body-support systems used in the prevention of decubitus heel ulcers were objectively compared for their capacity to dissipate or decrease pressure concentration at the most prominent posterior aspect of the heel in bedridden, insensate patients. The Foot Drop Stop, a foam heel suspender, completely eliminated contact between the heel and the bed, and it was the most successful in decreasing pressure concentration. The space boot and foam heel protectors were far more successful than sheepskin rugs or polyester heel protectors, which provided little protection to the prominent heel.

Equipment and Supplies↗
PubMed1990

Torsional malunion of a femur fracture: diagnosis and treatment.

Angulatory malunion and overgrowth deformity following skeletal traction or hip spica treatment of pediatric femoral shaft fractures have been reported often. Torsional deformity following such fractures is less common. Accurate diagnostic measurement and the value of treatment are controversial issues. We present a case of symptomatic torsional deformity, describe a method for accurate calculation of the magnitude of the deformity, and discuss treatment guidelines.

Child↗
PubMed1990

Tips of the trade #26. Treatment of amputation residual limb ulcers with a hydroactive dressing and continued weight bearing.

This paper discusses treatment methods for amputation residual limb (stump) ulcers and infected or failed-amputation wounds. Local wound care and abstinence from prosthetic limb use and weight bearing have been found effective in the treatment of decubitus ulcers, as has the use of occlusive hydroactive dressings such as DuoDERM (ConvaTec, Princeton, NJ). DuoDERM application and prosthetic socket modification have been found useful for the treatment of decubitus ulcers in ambulatory patients. The techniques of, and benefits obtained from, DuoDERM therapy are explored; we conclude that the relief of local wound pressure and shear forces obtained with this therapy generally enhances ambulation capacity.

Amputation Stumps↗
PubMed1989

A safe, pre-fabricated, immediate postoperative prosthetic limb system for rehabilitation of below-knee amputations.

Thirty-eight below-knee amputees were treated with a commercially available pneumatic prosthetic limb system, applied immediately postoperatively, that would allow immediate weight bearing following lower extremity amputation. Thirty-four limbs were amputated for peripheral vascular insufficiency and four were amputated due to trauma. Weight bearing was initiated an average of 4.7 days following surgery and patients were discharged with a non-removable temporary prosthesis at an average of 8.9 days. Thirty-three healed and were uneventfully fit with standard below-knee prosthetic limbs. Three required revision to the above-knee level. In a controlled setting, early weight bearing in the peripheral vascular insufficiency patient can be initiated with a low risk of local wound complication.

Adult↗
PubMed1989

Complications following midfoot amputation in neuropathic and dysvascular feet.

A review of 64 midfoot amputations performed between 1980 and 1985 revealed that complications occurred in 42% of the series. These included early wound dehiscence and late re-ulceration after the patient began walking again. By providing aggressive management and appropriate local revisions, 84% of the original group's limbs were salvaged at a functionally significant level. These findings underscore the fact that midfoot amputation requires diligent immediate and long-term follow-up if an acceptable success rate is to be achieved.

Amputation, Surgical↗
PubMed1989

Axial loading studies of unstable intertrochanteric fractures of the femur.

An experimental four-part unstable intertrochanteric (IT) femoral fracture was created with either a large or small posteromedial fragment (PMF). Sixty-eight adult embalmed femoral anatomic specimens were fractured and subjected to axial loading after fixation. The maximum load prior to failure for femora from the same anatomic specimen was compared to differentiate between different methods of fixation. In the presence of the large PMF variation, anatomic reduction and fixation allowed the femur to resist an average maximum load 57% greater than identical fractures with the fragment excluded. Fixation of the small PMF increased construct strength by an average of 17% over no fixation. The PMF is the keystone to mechanical stability for IT fractures of the femur. When anatomic reduction is possible, its fixation becomes progressively more critical as its size increases.

Aged↗
PubMed1988

Brachioradialis to finger extensor tendon transfer to achieve hand opening in acquired spasticity.

Four patients with adult acquired spastic hemiplegic hand disorders had brachioradialis to extensor digitorum communis tendon transfer to establish motor balance and improve prehensile hand function. All of the patients had volitional control of the wrist and finger flexors without control of the finger extensors, producing a dynamic hand deformity in which the patients could initiate grasp without release. Dynamic electromyography in these patients revealed electrical activity of the brachioradialis muscle during active elbow extension, making a seemingly "out-of-phase" muscle available for "in-phase" tendon transfer. At follow-up, ranging from 26 to 36 months (average of 30.2 months), all four patients improved three functional levels. Translated to functional capacity all of the patients had no functional capacity before operation and good assistive prehension afterward.

Adult↗
PubMed1988

Limb salvage in infected lower extremity gangrene.

Four diabetic patients with gangrene of the forefoot and infection ascending above the ankle were treated with open amputation of the foot combined with open fasciotomy and debridement of the involved proximal muscle compartments. All four patients healed their wounds and returned to their premorbid community ambulation status. The management and indications in these unusual patients are discussed.

Adult↗