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PubMed1995

[Compositive treatment of acute deep vein thrombosis of lower extremity].

Fourteen patients with acute deep vein thrombosis of lower extremity (DVT) were treated with composite methods including thrombectomy (iliofemoral venous thrombectomy and ascending venous thrombectomy), thrombolytic and anticoagulant therapy. Follow-up for 2-27 months (average 11.5 months) showed excellent and good results in 78.6%, and the morbidity of post-thrombotic syndrome only 21.4%. The remarkable results were due to opening of occlusive vein of the lower extremities by thrombectomy, which could make thrombolytics effective and reduce the dose of thrombolytics to prevent bleeding complication. Ascending venous thrombectomy could not only remove the venous thrombi of the lower extremities but also protect the deep venous valves and reduce the morbidity of postthrombotic syndrome. Additionally, to reach a satisfied therapy, lesion in iliac vein, such as anatomical compression, stenosis, occlusion, diaphragm and so on, shall be managed as well. Otherwise, DVT shall be recurrent.

Adult↗

PubMed2005

Use of the extended-pedicle vastus lateralis free flap for lower extremity reconstruction.

BACKGROUND: Soft-tissue coverage in the lower extremity usually requires a flap with a long pedicle, low donor-site morbidity, and versatility in terms of shape and volume. The extended-pedicle free vastus lateralis muscle flap has previously been described for head and neck cancer, and it fulfills these requirements. METHODS: Twelve patients with lower extremity defects underwent reconstruction with an ipsilateral free vastus lateralis muscle flap. The flap included a segment of the distalmost part of the muscle, distal to the entry point of the motor nerve to the vastus lateralis, based on the descending branch of the lateral femoral circumflex vessels. Up to 20 cm of vascular pedicle with a large caliber was obtained. In three cases, a combined distal vastus lateralis and anterolateral thigh flap was used as a chimeric flap. RESULTS: All flaps were successful. Infection developed in two cases and required flap reelevation and new wound debridement. There was no substantial subjective donor-site morbidity. CONCLUSIONS: Elevation of the flap can be performed with the patient in the supine position and is extremely fast and straightforward, without the added difficulty of anatomical variation or extensive intramuscular vascular dissection. The pedicle is long and of large caliber. Although the series is short, the authors conclude that this is a useful free flap for lower extremity reconstruction.

Adult↗

PubMed1991

[Treatment of chronic ischemia of the lower extremities with complex herbal preparation].

Chronic ischemia of the lower extremities with atherosclerosis background is being manifested by intermittent claudication. For treating the intermittent claudication many drugs are used, which may give rise to therapeutical side effects. In 50 patients with diagnosed arteriosclerosis affecting the lower extremities in II stage according to Fontain, a vegetable preparation PADMA-28 was applied for 16 weeks. A marked, statistically significant elongation of the claudication distance was achieved. That was measured, under standardized condition, on an ergometer-treadmill. Moreover, there was also a decrease in the index of blood platelets aggregation, a drop in the level of cholesterol, triglycerides, total lipids, beta lipoproteins, and an increase in ++alpha lipoproteins. Also 50 patients were receiving placebo for 16 weeks, but no positive results were observed in comparison with preparation PADMA-28. The studies were carried out by the method of double blind test, the latter was accomplished by randomized method. Observation, the performed biochemical examinations did not reveal any undesirable effect. Drug tolerance was excellent. The positive influence of the drug may result from summed action of components contained in the preparation namely: bioflavonoides, salicylates, valepotriates, tannins, phenol acids, ethereal oils and esters of acids. PADMA-28 may be a useful adjuvant to therapeutic methods with regard to chronic ischemia of the lower extremities in II stage, according to Fontain.

Arteriosclerosis Obliterans↗

PubMed2005

[Application of bridged free latissimus dorsi musculo-cutaneous flap on the soft tissue defects in lower extremities].

OBJECTIVE: To evaluate the effect of bridged free latissimus dorsi musculo-cutaneous flap on repairing of soft tissue defect in the lower extremity. METHODS: Seven patients with extensive soft tissue defects in the lower extremities were enrolled in the clinical investigation. The defects were all repaired with bridged free latissimus dorsi musculo-cutaneous flaps. The condition of the blood vessels in the flaps and the healthy extremities was examined with ultrasound Doppler before the operation to assure the blood circulation of grafted flap. After debridement, the flap was designed in accordance with the size and the depth of the wound. Then the transplantation of the flaps were done. The operative indication and points for attention were summarized thereafter. RESULTS: All the 7 flaps survived. All patients recovered well with satisfactory function and external appearance, except flap reduction was done in 2 patients due to undue thickness of the flaps. Indications for operation: (1) Patients with anterior or posterior tibial artery injury in the injured lower extremity in which arterial transplantation was not possible to allow the free transplantation of a skin flap. (2) The injury was extensive and deep, with the injurious condition of the blood vessels indeterminable and no healthy artery could be found for anastomosis with a donor artery. (3) No vascular injury could be identified in the contralateral healthy extremity. Points for attention included that the blood supply of the flap to be transferred should be adequate, and the survival of the flap after division of the pedicle should be assured. The length of the flap to be transferred should be longer by 10% than the distance between the site of transplantation in the lower extremities and the donor area; and the donor area should be larger by 20% than the recipient area. The skin area of the flap to be transferred should be broad enough avoid tension so that there would be no pressure on the blood vessels. Pay attention to the blood supply of the flap after operation, and the recipient limb should be properly immobilized. CONCLUSION: The repair of extensive soft tissue defect in the lower extremity with bridged free latissimus dorsi musculo-cutaneous flap could be satisfactory. Proper wound management, broad flap, stable immobilization were the pivotal points for the success of the operation.

Adolescent↗

PubMed1998

Lower-extremity functioning in older Mexican Americans and its association with medical problems.

OBJECTIVE: To describe lower-extremity functioning in community-dwelling older Mexican Americans and to examine its relationship with medical problems. DESIGN: Cross-sectional analyses of survey and performance-based data obtained in a population-based study employing area probability sampling. SETTING: Households within selected census tracts of five Southwestern states: Arizona, California, Colorado, New Mexico, and Texas. PARTICIPANTS: A total of 2873 Mexican Americans aged 65 years and older. MEASUREMENTS: A multidimensional questionnaire assessing demographic, sociocultural, and health variables. Standardized tests of lower-extremity physical functioning included measures of standing balance, repeated chair stands, walking, and an overall summary measure. RESULTS: Regression analyses revealed that being more than age 75 and female, having arthritis diabetes, visual impairments, or being obese or underweight were all significantly associated with performance on both individual and summary tests of lower-extremity functioning. In separate regression analyses, the total number of medical conditions was also associated with performance. CONCLUSIONS: The likelihood of predicting performance or inability to complete tests of lower-extremity functioning was greatest for those aged 80 and older, those with arthritis or diabetes, and those with three or more medical conditions. Because of the high prevalence of diabetes in Mexican Americans, documentation of the association of diabetes with performance-based tests of lower-extremity functioning may help guide early interventions targeted to prevent progression to more severe limitations or disability.

Activities of Daily Living↗

PubMed2003

Does subintimal angioplasty have a role in the treatment of severe lower extremity ischemia?

OBJECTIVE: Subintimal angioplasty (SIA) has been advocated to treat long segment lower extremity arterial occlusions, but many question its value. We evaluated the role of SIA in a group of patients with severe lower extremity arterial occlusive disease. METHODS: During a 2.5-year period, 39 patients with arterial occlusions (median length, 8 cm; range, 2 to 31 cm) were treated on an intention-to-treat basis with SIA. Twenty-five patients had gangrene, five had rest pain, and nine had disabling (<one block) claudication. There were 24 superficial femoral, two superficial-femoral-popliteal, four popliteal, two popliteal-tibial, five tibial, and two external iliac artery lesions. With fluoroscopic guidance, via a prograde common femoral artery puncture (n = 29) or a contralateral common femoral artery puncture (n = 9), a subintimal dissection plane was created across the occlusion with a standard guidewire and catheter. The arterial lumen was reentered distal to the occlusion, and the recanalized segment balloon was dilated. All patients were followed prospectively with arterial duplex scan. RESULTS: SIA was technically successful in 34 of 39 patients (87%). All five failures were from an inability to reenter the patent lumen distally. These five patients underwent successful bypasses that in no case were more distal than would have been required before SIA. In the 34 technically successful SIAs, pain completely resolved (14/14) and areas of gangrene (21/25) healed. The cumulative patency rate in patients who underwent successful SIA was 74% +/- 10% at 12 months. The mean increase in ankle-brachial index after SIA was 0.34 (range, 0.1 to 0.69). There were two distal embolic events, successfully treated surgically (n = 1) or with catheter-directed techniques (n = 1). Three patients underwent subsequent bypass, and the remaining five patients remain asymptomatic. CONCLUSION: SIA is feasible and can be effective in some patients with lower extremity arterial occlusions and threatened limbs. These results, plus SIA's many advantages, support an increasing role for it in the treatment of lower extremity arterial occlusive disease.

Aged↗

PubMed2000

Peripheral nerve vein wrapping for intractable lower extremity pain.

HYPOTHESIS/PURPOSE: The purpose of this study was to determine the effectiveness of lower extremity peripheral nerve vein wrapping procedures in the management of patients with intractable lower extremity pain. The hypothesis was that nerve insulation through vein wrapping is effective in treating symptoms related to adhesive neuralgia, but not those secondary to intraneural damage. METHODS: We retrospectively reviewed 25 consecutive patients whose intractable chronic lower extremity peripheral neuralgia had been treated with revision neurolysis and vein wrapping. The 14 women and 11 men had an average age of 39 years (range, 21 to 53 years). Vein wrapping was performed using a saphenous vein autograft in 19 patients and a fetal umbilical vein in six patients. The average length of follow-up after vein wrapping was 24 months (range, 12 to 63 months). Assessment of pain and dysfunction was on a scale of 0 (no pain/dysfunction) to 10 (severe enough to prompt request for amputation and required use of a wheelchair). RESULTS: Pain scores improved from a preoperative average of 8.7 points (range, 6 to 10 points) to a postoperative average of 4.6 points (range, 0 to 10 points); dysfunction improved from a preoperative average of 7.3 points (range, 3 to 10 points) to a postoperative average of 4.4 points (range, 0 to 9 points). Although 17/25 patients were satisfied with the procedure, only 14/25 stated they would undergo the surgery again. All eight patients who exhibited no improvement had preoperative and intraoperative evidence of an idiopathic etiology and/or intraneural damage. Preoperatively, 18/25 patients could not work; postoperatively, that number improved to 8/25. CONCLUSIONS: Vein wrapping of lower extremity peripheral nerves is most effective in relieving symptoms related to adhesive neuralgia and less beneficial in the presence of intraneural damage. Although symptoms are rarely relieved completely, vein wrapping typically results in a substantial improvement in symptoms related to scar entrapment of peripheral nerves.

Adult↗

PubMed1992

Identifying diabetic patients at high risk for lower-extremity amputation in a primary health care setting. A prospective evaluation of simple screening criteria.

OBJECTIVE: To evaluate prospectively a risk categorization scheme for lower-extremity problems that incorporates the Semmes-Weinstein 5.07 monofilament and a simple exam to stratify patients who were followed in a primary-care setting into risk groups for plantar ulceration and lower-extremity amputation. RESEARCH DESIGN AND METHODS: Patients with diabetes in a well-defined American-Indian population were stratified into four risk categories based on sensation status to the 5.07 monofilament, the presence of foot deformity, and a history of lower-extremity events (amputation or ulceration): category 0, sensate; category 1, insensate; category 2, insensate with deformity; and category 3, history of lower extremity events. Patients were followed prospectively for lower extremity events and changes in sensation status. RESULTS: We gave screening exams to 358 (88%) of 406 individuals with diabetes in the community. The distribution of patients for risk categories 0, 1, 2, and 3 was 74.3, 8.4, 4.5, and 13%, respectively. Over a 32-mo follow-up period, 41 patients developed ulcerations, and incidence rates correlated positively with increasing risk category (P less than 0.00001). All 14 amputations occurred in risk groups 2 and 3. CONCLUSIONS: These data suggest that the risk categorization described here may have a role in identifying patients at risk for lower extremity events who are followed in a primary-care setting.

Amputation, Surgical↗

PubMed1997

[Neurological CPC.57. An 80-year-old woman with four years history of muscle atrophy involving lower extremities predominantly on the right side].

We report an 80-year-old woman with progressive muscular atrophy predominantly involving her right lower extremity. She was well until 1992 (75 years of age) when she noted an onset of weakness in her right leg which had got progressively worse. She was admitted to our service in July 1994. On admission, general physical examination was unremarkable. She was alert and well oriented without dementia. Higher cerebral functions were normal. Cranial nerves also appeared intact. She dragged her right leg in walking. Mild to moderate weakness (2/5 to 4/5) was noted in muscles in her right lower extremity more in the distal part. Deep tendon reflexes were within normal limits, and the plantar response was flexor bilaterally. Sensation was intact. Laboratory examinations were also unremarkable except for slight increase in CK which was 470 IU/l. CSF was also normal. EMG revealed neurogenic changes in the lower extremities. She was admitted to Aoki Hospital on October 21, 1994, by that time, her weakness in the right lower extremity had gotten worse in that the muscle strength of the right extensor hallucis longus was 0 and tibialis anterior 2; muscle atrophy was also prominent in her right leg; the right ankle jerk could not be elicited. In the subsequent course, weakness and atrophy appeared in her left lower extremity, however, upper extremities and cranial nerves had never been affected. Babinski sign was always negative. In February 1996, she developed delusional ideation of self persecution, and showed difficulty in communication with medical staffs. She developed fever of 38.7 degrees C on June 13, 1996 expired on the next day. The patient was discussed in a neurological CPC, and the chief discussant arrived at the conclusion that the patient had a form of spinal muscular atrophy. Opinions were divided between ALS and spinal muscular atrophy. Post-mortem examination revealed marked loss of anterior horn neurons in the lumbar area with astrogliosis. Bunina bodies were seen in some of the remaining neurons. No myelin pallor was noted in the pyramidal tracts, however, atrophy and loss of Betz cells were noted in the motor cortex. Other cortical areas were unremarkable. The neuropathologist arrived at the conclusion that the patient had ALS. This patient was unique in that she had asymmetric atrophy and weakness limited to the lower extremities. This is quite unusual as ALS of four years duration. In addition, the patient developed some mental change which was thought to represent dementia by some participants. But no clear morphologic changes were seen to account for her mental change.

Aged↗

PubMed1996

The quality of life of the limb-threatened patient after lower-extremity revascularization.

There is limited research evaluating the quality of life after lower-extremity revascularization surgery. Nursing is concerned not only with survival and decreased morbidity, but also with the whole patient. An impact analysis survey was used to investigate whether patients perceived their quality of life to be improved after they underwent lower-extremity revascularization surgery. The Medical Outcomes Study-36 (MOS-36, 1990) survey was used to help us assess the patients' overall perceptions after lower-extremity revascularization surgery. The MOS-36 has a scale that measures life health concepts and a health-transition item. The purpose of this study was to determine the effect of lower-extremity revascularization on the quality of life in limb-threatened patients. The study examined quality of life as an outcome after revascularization.

Aged↗

PubMed2005

[Autologous peripheral blood stem cells transplantation in treatment of 62 cases of lower extremity ischemic disorder].

OBJECTIVE: To observe the clinical efficacy of autologous peripheral blood stem cells (PBSC) transplantation in 62 cases with ischemic lower extremity disorder. METHODS: Totally 62 patients with 34 cases of diabetic foot and 28 cases of various lower extremity ischemic disorders received recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) 450 - 600 microg/d by hypodermic injection for 5 days to mobilize stem cells. On the sixth day, PBSC were collected by COBE 6.1 Spectra Version with an amount of 82 - 148 ml; the number of mononuclear cells (MNC) is (718.2 - 224.6) x 10(9)/L. CD34+ cells were tested. The PBSC were injected into the ischemic lower extremity and foot intramuscularly at 3 cm x 3 cm distance. The clinical and laboratory findings were monitored from first day to 24th week. RESULTS: In 62 patients with PBSC transplantation, free of severe pain was found in 54 cases (87.1%) from 7 to 30 days, improvement of foot cool feeling in 56 patients (90.3%) from 7 to 30 days, improvement of foot ulcer in 16 cases (40.0%) from 4 to 16 weeks. Ankle/brachial index (ABI) increased in 12 cases (34.3%), TcPO2 improved in 26 cases (42.3%). Digital subtraction angiographic scores were performed in 5 patients after 8 - 12 weeks, there was formation of new collateral vessels. No related complication or adverse effect was observed except in 2 patients with diabetic foot and cerebral infarction exacerbation of symptoms during the process of stem cells mobilization in all process. CONCLUSION: Autologous PBSC transplantation might be a safe and effective method for lower extremity ischemic disorder. It could improve the quality of life of many patients as amputation of lower extremity or foot might be avoided.

Adult↗

PubMed1987

Upper vs lower extremity functional loss in neuromuscular disease.

Functional rating scales have been developed for evaluation of upper extremity (UE) and lower extremity (LE) function in Duchenne muscular dystrophy (DMD). The Vignos scale is accepted for LE function and the Brooke scale for UE evaluation. The assumption that UE functional loss parallels LE loss has never been tested. Furthermore, there are no studies examining the relationship between UE/LE strength. This study tests the hypothesis that UE/LE strength and functional losses are parallel in DMD and other neuromuscular disorders. Vignos grades, Brooke grades, and manual muscle test scores were determined for 27 patients with DMD, 10 patients with fascioscapulohumeral muscular dystrophy (FSH), 24 patients with myotonic muscular dystrophy (MMD) and 29 patients with other (Becker's dystrophy and limb-girdle syndrome) proximal myopathies (PM). Spearman correlation coefficients were calculated for UE vs LE functional grade and strength scores and subjected to significance analysis. While all correlations were statistically significantly different from zero (p less than 0.01), all were also significantly different from one (p less than 0.01), none representing perfect equivalence. Coefficients of determination indicated that a maximum of 86% (FSH) of variation in UE rank could be explained purely by observing LE rank. While there is a significant relationship between UE/LE strength and functional grade, these measurements were not found to be entirely equivalent. Therefore, while measures of lower body function or strength might be used as a substitute for UE measurements in drug trials in which global effects are expected, the two measurements are not equivalent when evaluating an individual's clinical status.

Child↗

PubMed2000

Axial alignment of the lower extremity in Chinese adults.

BACKGROUND: The restoration of normal axial alignment of the lower extremity is important to surgeons who perform reconstructive surgery of the knee. However, data on the normal alignment of the lower extremity in Chinese adults are not available. METHODS: The axial alignment of the lower extremity in twenty-five adult male and twenty-five adult female volunteers of southern Chinese origin was measured on weight-bearing radiographs of the entire lower limb. The mean age was twenty-four years for the male volunteers and twenty-three years for the female volunteers. The results were compared with those of two similar studies of white volunteers in the United States. RESULTS: The medial inclination of the tibial plateau in the Chinese subjects (mean and standard deviation, 5.4 +/- 2.5 degrees for women and 4.9 +/- 2.3 degrees for men) was greater than the commonly reported 3 degrees. The extremities of the Chinese women were found to have a mean of 2.2 +/- 2.5 degrees of varus alignment, and those of the Chinese men had a mean of 2.2 +/- 2.7 degrees of varus alignment. CONCLUSIONS: Compared with the white subjects described in the studies by Moreland et al. and Hsu et al., the Chinese subjects had significantly larger medial inclination of the knee joint (knee-joint obliquity) (p < 0.005) and the female Chinese subjects had significantly more varus alignment of the lower extremity (p < 0.025). CLINICAL RELEVANCE: Five degrees of external rotation of the femoral component, instead of the commonly reported 3 degrees, may be required to obtain a rectangular flexion gap in total knee arthroplasty in Chinese patients. The racial difference in the knee-joint obliquity may contribute to the racial difference in the ratio of knee osteoarthritis to hip osteoarthritis. Additional studies are necessary to confirm this relationship.

Adult↗

PubMed2000

[Hemodynamics of the lower extremities in patients with decubitus ulcers using the ultrasonic Doppler method].

Our clinical experience indicates that decubitus ulcers with tissue loss/necrosis extending beyond the subcutaneous fat in aged patients are liable to become refractory and that most of these patients experience a cold feeling/cyanosis in the lower extremities. In order to determine the relationship between the severity of the decubitus ulcers and the hemodynamics in the lower extremities, we conducted a blood flow test using the ultrasonic Doppler method on the lower extremities in patients. Sixty-eight inpatients (38 men, 30 women, with an average age of 80.5 +/- 7.6 years old) were selected. B-mode tomographs were obtained with an ultrasonic diagnostic apparatus. The power Doppler method was used to measure blood flow rate, vascular lumen diameter, and intravascular blood flow at the dorsalis pedis artery, posterior tibial artery, peroneal artery furcation, and femoral artery. The subjects were divided into three groups: patients without decubitus ulcers; patients with mild to moderate decubitus ulcers of IAET Classification grade I-III; and patients with severe decubitus ulcers (IAET Classification grade IV), and the measurements were compared among the groups. The results revealed a tendency for the vascular lumen to become narrowed and intravascular blood flow to be reduced at all sites as decubitus ulcers increased in severity and showed the hemodynamics in the lower extremities to be particularly poor in the severe group. We measured the hemodynamics in the lower extremity with the ultrasonic Doppler method from the viewpoint of decubitus ulcer prevention and found differences in blood flow in the lower extremities according to the severity of decubitus ulcers. A reduction in blood flow in the lower extremities is considered to indirectly indicate a susceptibility to decubitus ulcers and to serve as a sign of its exacerbation. We consequently considered the test to be useful and concluded that deterioration of hemodynamics due to the progress of arteriosclerosis is one of the causes of decubitus ulcer exacerbation.

Aged↗

PubMed2004

The epidemiology of lower-extremity disease in veterans with diabetes.

OBJECTIVE: To describe the epidemiology of lower-extremity complications of diabetes in veterans who are users of the Department of Veterans Affairs (VA). RESEARCH DESIGN AND METHODS: Hospital discharge records for care provided in all VA hospitals in 1998 were obtained. All hospitalizations for lower-extremity ulceration, peripheral vascular procedures, and amputation were analyzed using frequency tables. A diabetes denominator was defined as a veteran with at least three ambulatory care visits with at least one diabetes diagnosis code. Age-specific and total age-adjusted rates of discharge with ulceration, vascular procedures, and amputation were calculated. RESULTS: Veterans with diabetes comprised over half of all hospitalizations for lower-extremity ulceration, one-third of all hospitalizations for peripheral vascular procedures, and two-thirds of all hospitalizations for amputation. The age-specific discharge rate per 1,000 diabetic persons for age 0-64 years, 65-74 years, and 75 years and older for ulceration were 28.4, 31.0, and 37.9; for vascular procedures, the rates were 3.5, 4.4, and 4.4; and for amputation, the rates were 7.3, 9.0, and 10.0, respectively. CONCLUSIONS: Veterans with diabetes comprise a significant proportion of hospitalizations for lower-extremity ulceration, peripheral vascular bypass, and amputation. Age-specific rates of diabetic amputation in veterans are lower than U.S. rates.

Adult↗

PubMed2004

Refinements of free tissue transfer for optimal outcome in lower extremity reconstruction.

Advances in microsurgery have revolutionized the management of severe lower extremity soft tissue injuries. However, the final optimal result, such as cosmesis, is only of secondary concern as limb salvage is the ultimate goal in reconstruction. In a continuous effort to obtain the best possible outcome for patients, several refinements of free tissue transfers in lower extremity reconstruction have been made. Over the past 2 years, 14 patients (8 males: 6 females; ages 14 to 65 years) underwent lower extremity reconstructions with free muscle flaps (7 gracilis, 3 rectus abdominus, and 4 latissimus dorsi) and split-thickness skin grafts for various soft tissue defects. All patients have obtained excellent cosmetic and reconstructive outcomes with an average of 1-year follow-up. Based on our results, the following refinements are recommended: (1) selection of donor muscle flap appropriate to the size and contour requirements of the defect; (2) meticulous flap inset into the defect; and (3) if necessary, final flap debulking by tangential excision for optimal contouring.

Adolescent↗

PubMed2006

The thoracodorsal artery perforator flap with a vascularized scapular segment for reconstruction of a composite lower extremity defect.

High-energy trauma resulting in a composite defect of the lower extremity confronts the microvascular surgeon with more difficulties than do free flap reconstruction elsewhere in the body, since the choice of distant recipient vessels is particularly difficult. Combining principles of perforator flap surgery with those of composite tissue transfer, we designed a thoracodorsal artery perforator flap with a vascularized bone segment from the scapula for reconstruction of a composite lower extremity defect in a patient following a paragliding accident. This is the first report on the application of a composite thoracodorsal artery perforator flap with vascularized scapula in lower extremity reconstruction. Among its multiple advantages, such as preservation of latissimus dorsi function, it is a good tool for one-stage reconstruction of traumatic composite lower extremity defects because its low donor site morbidity and long vascular pedicle enables anastomosis placement outside the zone of injury.

Humans↗

PubMed2006

Mechanical contribution of the fibula to torsion stiffness in the lower extremity.

The role of the fibula in rotational stability of the lower extremity, taking into account the intact knee joint and tibia, to the best of our knowledge, has not been investigated. A cadaver study was designed to determine the torque transfer down the lower extremity, with and without the fibula. Six fresh, frozen human cadaver legs were used. The knee joint was left intact and the foot disarticulated. An external rotation up to 5 degrees , coupled with axial compression, was applied to the femur passing through the knee joint in extension and down the lower extremity to the fixed distal end, where torque (N m) was measured via a load cell. Each specimen was further tested with the fibula, cut 4 cm from the distal end, and finally with the entire fibula disarticulated at the proximal end and removed. To achieve 5 degrees rotation, torques reached 1.82 N m (SD, 0.66 N m). When the fibula was cut, the torque reduced a small yet significant amount of 5%. With the entire fibula removed, the torque reduction was significant and more pronounced at 11%. The fibula provided a small yet significant role in torsion stability. From this study, where the biomechanical characteristics of the fibula is explicated, it is hoped that this information will have use in further understanding the biomechanical role of the fibula, especially, in relation to the altered mechanics associated with lower limb pathology involving a deficient fibula.

Aged↗