SEARCH · PubMed Health

Results for “Lower Extremity”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources

PubMed1995

Microsurgical reconstruction of the lower extremity using the 3M microvascular coupling device in venous anastomoses.

Microsurgical reconstruction of the lower extremity presents a difficult problem to plastic surgeons; the rate of failure is higher than any other anatomical site. We reviewed our recent experience with lower extremity microsurgical reconstruction using the 3M vascular coupling device. We believe the excellent patency rate of the coupler may minimize the well-described problem of venous thrombosis in this challenging group of patients. This study involves a consecutive series of 11 patients who presented for reconstructive microsurgery of the lower extremity at NYU Medical Center hospitals between June 1 and September 1, 1994. Ten of 11 patients had free flap transfer to traumatic lower extremity injuries, whereas the remaining reconstruction was in a diabetic individual with a chronic wound. Fifteen microvascular venous anastomoses were performed; all but 1 was performed using the 3M coupler. Our experience with 11 patients, involving 14 mechanically coupled venous anastomoses, demonstrated successful use of the coupler. No intraoperative or postoperative vascular complications occurred. The overall success rate of the 3M coupler for venous anastomoses was 100%, and all microvascular free flaps were successful. We recommend using the 3M coupling device for venous anastomoses during reconstructive microsurgery of the lower extremity. Our series demonstrates the safety and effectiveness of the 3M coupler in this challenging group of patients. In addition, a secondary benefit of the 3M coupler is a significant reduction in operative time.

Adolescent↗

PubMed2003

Comparison of changes in upper and lower extremity impairments and disabilities after stroke.

The aims of this study were to determine if the changes in impairment and disability measures for the upper and lower extremities were equivalent during the post-stroke rehabilitation period and whether the rates of change were maintained 6 months after discharge from rehabilitation. A prospective cohort study design was used. One-hundred-and-thirty-two people who had sustained a stroke and who were enrolled in an intensive functional rehabilitation programme were recruited. Upper and lower extremity impairments and disabilities were evaluated at admission, at discharge from rehabilitation and 6 months later. During active rehabilitation, the changes in both extremities were smaller for the impairment measures (standardized response mean (SRM), 0.37-0.63) than the disability measures (SRM, 0.76-1.05). While the changes in upper and lower extremities were equivalent for impairment measures, they were larger in the lower extremity for disability measures, indicating that the rate of functional improvement was faster in the lower extremity during active rehabilitation. After discharge, however, while the rate of motor recovery in the lower extremity dropped (SRM, 0.54-0.18), it was maintained in the upper extremity (SRM, 0.45 and 0.42). Present findings indicate that functional (disability) measures improve faster than impairment measures in both extremities during the active rehabilitation period and suggest that motor recovery occurs at a different rate in the upper and lower extremities, with that of the upper extremity occurring later and extending into the period after discharge from active rehabilitation.

Aged↗

PubMed1998

Photothermal removal of telangiectases of the lower extremities with the PhotodermVL.

BACKGROUND: Telangiectases of the lower extremities have been refractory to permanent ablation by photothermal coagulation. In addition, adverse effects often occur because of nonselective absorption of the light by the overlying skin. OBJECTIVE: This study was performed to determine the effectiveness and the incidence of adverse effects associated with the PhotodermVL in the treatment of telangiectases, less than 0.4 mm in diameter, of the lower extremities. METHODS: Seventy-two patients were treated, each at one treatment site, by means of a treatment protocol designed by ESC Medical Systems, Ltd., the developer and manufacturer of the PhotodermVL. RESULTS: Complete, or almost complete, clearance of telangiectases was observed in 10% of patients. No improvement occurred in 56% of treated telangiectases, and 25% had partial clearing. Adverse effects were common, including scarring in 21% of patients. CONCLUSION: The PhotodermVL provided a low rate of success in the treatment of telangiectases on the lower extremities. Treatment was associated with a high rate of adverse effects.

Adolescent↗

PubMed1999

Walker inlet-closure strap for unsteady patients with lower-extremity amputations.

Some patients with lower-extremity amputations who use a walker fall backwards after advancing too far forward into the walker's base of support. In a pilot study of 14 patients with unilateral lower-extremity amputations who stepped into the forward two thirds of the walker base, this problem was corrected by using a knee-high elastic strap to close the open posterior "inlet" of the walker. Without the strap, the stance-phase position of the leading ankle was in the forward third of the walker base for 8 subjects and in the middle third for 6. With the walker strap, the ankle position was in the middle third for one subject, in the posterior third for 6, and at or behind the walker inlet for 7 (p < .0002). This simple intervention appears to correct the potentially dangerous behavior of stepping too far into the walker base.

Accidental Falls↗

PubMedDate not supplied

Get the LEAD out: noninvasive assessment for lower extremity arterial disease using ankle brachial index and toe brachial index measurements.

Lower extremity arterial disease affects approximately one third of individuals 66 years of age and older and has a high risk for nonhealing wounds, infection, and limb loss. Much wound care is given by or under the direction of nurses. Therefore, the assessment and management of these patients presents many opportunities and challenges. Assessment is the cornerstone of effective care, but traditional methods of lower extremity arterial assessment, such as pulse palpation and pain history, are insufficient to determine the presence and extent of ischemia. Recently published national guidelines for assessment and management of patients with lower extremity wounds have recommended using noninvasive tests such as the ankle brachial index and toe brachial index to rule out lower extremity arterial disease, which complicates wound healing. However, the ankle brachial index can be falsely elevated in patients with diabetes and renal failure because of calcification of the arteries, which causes them to be incompressible. In these situations, it has been advised to obtain a toe pressure or toe brachial index because digital arteries are usually less affected by calcification. There is a paucity of data about the knowledge of principles and performance of the ankle brachial index/toe brachial index by nurses, particularly in the United States, using pocket-sized portable Doppler equipment. Therefore, the purpose of this article is to provide an overview and synthesis of relevant studies and published expert opinion regarding noninvasive arterial assessment using ankle brachial and toe brachial indexes as a basis for developing protocols for performing the tests and identifying gaps in research where further investigation is needed.

Ankle↗

PubMed1987

Acute and definitive management of traumatic osteocutaneous defects of the lower extremity.

Twenty-two lower extremity osteocutaneous defects resulting from high-energy trauma were managed from the onset of injury to rehabilitation by a collaborative effort between orthopedic and plastic surgeons. Emergency debridement of devitalized soft tissue and bone, external fracture stabilization, and serial debridements prepared the wound for closure with predominantly free-muscle transfers performed an average of 17 days (range 3 to 43 days) after injury. Cancellous or vascularized fibula grafting, depending on defect size, was performed an average of 9 weeks (range 6 to 16 weeks) after muscle flap closure. In this group of patients, whose average injury severity score was 18 (range 9 to 45) and whose average segmental bone defect was 8 cm (range 3 to 18 cm), the average time after injury to full weight bearing was 61 weeks (range 39 to 120 weeks). The early infection rate was 14 percent. Two extremities were amputated. There have been no chronic infections. Follow-up has ranged from 9 to 34 months.

Adolescent↗

PubMed1996

Percutaneous vs modified phemister epiphysiodesis of the lower extremity.

Epiphysiodesis of the lower extremity for limb-length discrepancy has been performed on 24 patients by both the modified Phemister and a percutaneous method. The primary complication of epiphysiodesis by both methods was continued growth of the physeal plate (12% and 15%, respectively). Failure of epiphysiodesis was attributed to young skeletal age at surgery in three of five cases. Closer attention to physeal ablation and close follow up should prevent this complication. No angular deformities resulted in any patient. During 16 proximal fibular procedures, there were no neurologic complications. The percutaneous method is preferred due to ease of surgical procedure, minimal incisions, limited disability to the normal extremity, and equal results.

Adolescent↗

PubMed2000

The management of lower-extremity diabetic ulcers.

Lower-extremity ulcers occur in approximately 15% of the estimated 16 million Americans with diabetes. The most important risk factors are neuropathy, ischemia, and poor glycemic control. Early identification of the patient at risk, patient education, and implementation of preventive measures are keys to curtailing morbidity and mortality. Diabetic foot care clinics allow enhanced patient accessibility to health care and improved quality of care. Novel treatment options have expanded the alternatives available to clinicians treating these difficult and prevalent wounds.

Ambulatory Care Facilities↗

PubMedDate not supplied

Lower extremity peripheral nerve assessment.

Lower extremity peripheral nerve function is essential for normal mobility and protection of the feet and legs from further trauma. The common causes of such injuries predispose the patient to a more serious injury and prolonged morbidity. It is therefore essential that a careful assessment be done as often as necessary to protect the patient from complications that may cause long-term disability.

Emergency Medical Services↗

PubMedDate not supplied

Prevention of post-operative complications in the lower-extremity amputee.

Eighty lower-extremity amputation patients were randomly divided into two groups: one that ambulated (A) early (48 to 72 hours) and one that did not (NA). Group A patients used an immediate, post-operative, pneumatic splinting device. The two groups were compared as to the incidence of wound and constitutional post-operative complications, with the A group showing significantly fewer. As in previous studies, the A group continued toward quicker and more successful rehabilitation.

Amputation, Surgical↗

PubMed1977

Reconstructive arterial surgery for ischemic lower extremities.

Patients with ischemic lower extremities who are to indergo arterial reconstruction must be carefully selected. A careful history and physical examination will disclose the point of obstruction and the degree of ischemia. Arteriography is essential for the determination of runoff adequancy below the point of obstruction and for selection of the best site for distal anastomosis. Various potential routes for bypass graft have been discussed and some of the factors that determine the procedure ultimately chosen have been presented. Types of graft materials currently enjoying popularity have been listed and the general techniques of operation have been outlined.

Aorta, Abdominal↗

PubMed1995

Rehabilitation of the lower extremity.

Rehabilitation of the lower extremities has fallen into two basic categories known as open and closed kinetic chain activities. Closed kinetic chain exercises are functional exercises specific to sport movement patterns. Exercises performed with a variety of equipment may be classified as closed kinetic chain. Program development should include a variety of functional exercises using variable volumes and intensities of resistance for maximum results.

Athletic Injuries↗

PubMed2003

The surgical management of pediatric fractures of the lower extremity.

The majority of pediatric fractures of the lower extremity can and should be treated with closed reduction, immobilization, and close follow-up. However, there is an ongoing debate in the orthopaedic community regarding the exact role of surgical management in the treatment of pediatric fractures. In the past 2 decades, surgical management of certain fractures provided markedly better results than closed management. In certain cases, such as those requiring anatomic realignment of the physis or articular surface, there are clear indications for surgical management. Increasingly, however, surgical management is being used to maintain optimal alignment, to allow early motion, or to facilitate mobilization of children with a lower extremity fracture. For many types of fractures, both nonsurgical and surgical methods have yielded good results and have vocal advocates. Certain technical advances, such as the use of flexible intramedullary fixation and bioreabsorbable implants, have further increased enthusiasm for surgical management of pediatric fractures of the lower extremity.

Adolescent↗

PubMed1986

Free vascularized flaps for lower extremity reconstruction.

Large wounds of the lower extremity, particularly distal to the knee, have been difficult to cover by traditional means such as skin grafts, local flaps, cross-leg flaps and jump flaps. These wounds, particularly when associated with fractures and osteomyelitis, have frequently resulted in amputation of the lower extremity. Microvascular surgical techniques have allowed the transfer of large flaps of skin and/or muscle from a remote site of the body to the defect in the leg for soft tissue coverage and additional blood supply to the defect. Although these techniques are more tedious and require longer operating times, they usually shorten the patient's hospital stay, heal the wounds faster and shorten disability time. With wider experience, improved techniques and greater microsurgical skill, lower limbs with large defects due to trauma or tumor resection can be salvaged and reconstructed with acceptable risks and minimal donor site morbidity.

Adult↗

PubMed2003

Lower extremity neurological evaluation of the older patient.

The phrase "lower extremity neurological evaluation" is a misnomer. The evaluation focuses on deficits that manifest in the lower extremity, but the expert knowledge of the competent examiner may indicate that the cause is remote from the lower limbs. Moreover, the skilled examiner must evaluate the patient in toto to determine the etiology of any abnormalities manifesting in the lower extremities. For these reasons and others, the neurological evaluation of the older patient is of particular importance and should be performed routinely.

Aged↗

PubMed1996

The relationship between static lower extremity measurements and rearfoot motion during walking.

Despite the fact that clinicians regularly perform static lower extremity measurements on their patients, to date, little research has been published supporting their ability to predict dynamic rearfoot motion. The abilities of static measurements to predict dynamic foot motion could have important implications considering the fact that excessive rearfoot motion has been associated with various injuries of the lower extremity. The purpose of this study, therefore, was to determine if static lower extremity measurements could be used to predict the magnitude of rearfoot motion during walking. Rearfoot motion of each lower extremity was measured from videotape in 27 healthy young adult subjects with a mean age of 26.1 years. In addition, 17 static measurements were measured and recorded bilaterally for each subject. The results of a multiple regression analysis indicated that the only variable that was able to predict maximum rearfoot pronation was the "difference in navicular height" (r2 = .17). None of the 17 measurements were found to predict time to maximum pronation. These results indicate that static measurements of the lower extremity and foot are poor predictors of dynamic rearfoot motion as measured by maximum pronation or time to maximum pronation in healthy individuals without severe foot deformities.

Adult↗

PubMed1989

Diagnostic imaging of lower extremity trauma.

Traumatic injuries to the lower extremity are a common occurrence in today's society and may result in significant morbidity and mortality if not appropriately treated. Adequate radiographic evaluation is crucial to the assessment of these injuries. This article reviews the radiographic features and imaging approaches to the commonly encountered injuries of the lower extremity.

Femoral Fractures↗

PubMed2007

Assessing functional mobility in survivors of lower-extremity sarcoma: reliability and validity of a new assessment tool.

BACKGROUND: Reliability and validity of a new tool, Functional Mobility Assessment (FMA), were examined in patients with lower-extremity sarcoma. FMA requires the patients to physically perform the functional mobility measures, unlike patient self-report or clinician administered measures. PROCEDURE: A sample of 114 subjects participated, 20 healthy volunteers and 94 patients with lower-extremity sarcoma after amputation, limb-sparing, or rotationplasty surgery. Reliability of the FMA was examined by three raters testing 20 healthy volunteers and 23 subjects with lower-extremity sarcoma. Concurrent validity was examined using data from 94 subjects with lower-extremity sarcoma who completed the FMA, Musculoskeletal Tumor Society (MSTS), Short-Form 36 (SF-36v2), and Toronto Extremity Salvage Scale (TESS) scores. Construct validity was measured by the ability of the FMA to discriminate between subjects with and without functional mobility deficits. RESULTS: FMA demonstrated excellent reliability (ICC [2,1] >or=0.97). Moderate correlations were found between FMA and SF-36v2 (r = 0.60, P < 0.01), FMA and MSTS (r = 0.68, P < 0.01), and FMA and TESS (r = 0.62, P < 0.01). The patients with lower-extremity sarcoma scored lower on the FMA as compared to healthy controls (P < 0.01). CONCLUSION: The FMA is a reliable and valid functional outcome measure for patients with lower-extremity sarcoma. This study supports the ability of the FMA to discriminate between patients with varying functional abilities and supports the need to include measures of objective functional mobility in examination of patients with lower-extremity sarcoma.

Amputation, Surgical↗