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At least 55 records · Page 3Linked to original sources
PubMed1998

Diagnosis and treatment of chronic lower extremity ischemia.

Chronic lower extremity ischemia is due to progressive atherosclerosis of the aorto-iliac and/or infrainguinal arteries. This disease process is of great importance as millions of patients are affected by lower extremity arterial occlusive disease. Most of these patients are asymptomatic but a growing number of them are symptomatic, with complaints ranging from mild claudication to gangrene. The increasing number of patients affected by lower extremity atherosclerosis is, in part, due to the 'graying' of the general population and to the medical improvements of the past three decades that have allowed patients with generalized atherosclerosis to survive longer. Fortunately, the diagnosis and management of peripheral arterial occlusive disease has also significantly progressed leading to improved graft patency, limb salvage rates, and quality of life for patients.

Aorta↗
PubMedDate not supplied

Use of topical recombinant human platelet-derived growth factor-BB (becaplermin) in healing of chronic mixed arteriovenous lower extremity diabetic ulcers.

Lower extremity ulcers cause significant morbidity and mortality in patients with diabetes. The primary factors that contribute to the development of this type of ulcer are peripheral neuropathy and peripheral vascular disease, which are often accompanied by infection. Lower extremity diabetic ulcers are chronic and difficult to treat, in part due to underlying pathologic conditions in individuals with diabetes that can contribute to impaired wound healing. This article reports the author's experience with treatment of chronic lower extremity ulcers of mixed etiologies with recombinant human platelet-derived growth factor--BB [rhPDGF-BB, REGRANEX (becaplermin) Gel 0.01%] in a patient with multiple risk factors including long-standing insulin-dependent type 2 diabetes.

Administration, Topical↗
PubMed1990

Outpatient or short-stay skin grafting with early ambulation for lower-extremity burns.

Lower-extremity burns and skin grafts to these wounds have traditionally required extended hospitalization. We have used early tangential excision of the burn wounds and application of an Unna boot to fresh skin grafts in an attempt to shorten the hospitalization for such patients. Over a six-month period, 9 patients were treated with Unna boots to fresh skin grafts on the lower extremity. The average hospital stay was 0.9 days (range, 0 to 3 days). Graft take was 85% to 100%; no regrafting was required. Ambulation was begun 24 hours postoperatively. The technique described is a safe, effective, and inexpensive alternative to prolonged immobilization and hospitalization in patients with lower-extremity skin grafts.

Ambulatory Care↗
PubMed2002

Simultaneous toe-to-hand transfer and lower extremity amputations for severe upper and lower limb defects: the use of spare parts.

From 1995 to 2000, five microvascular toe-to-hand transfers were performed in three children who were simultaneously undergoing lower extremity amputations. Their ages at time of transfer ranged from 4 to 10 years and the types of lower extremity amputation included toe amputation, foot amputation and through-knee amputation. The resulting toe-to-hand transfers included three great toe-to-thumb transfers and one combined great and second toe-to-hand transfer. The toe-to-hand transfers were all successful and all the lower extremity amputations healed without complications. In all cases, improved hand function and lower extremity function was noted by the families. These unique cases represent the ultimate use of spare parts in congenital hand surgery.

Amputation, Surgical↗
PubMed1988

[Primary reconstruction in extremity saving resection of the lower extremity].

Limb sparing procedures have become possible in many cases of tumor resections of the lower extremity by using the new free-tissue transplantation technique. In some cases the stump can be elongated. Forty-four patients were treated for soft tissue sarcoma of the lower extremity. In only one case conventional amputation was necessary. In all other cases the limb was saved by primary reconstruction. In four cases a distalisation of the stump was achieved.

Adult↗
PubMed1997

Neurotization of motor nerves innervating the lower extremity by utilizing the lower intercostal nerves.

An animal model in the rat was developed to study the reinnervation of ventral roots contributing to lower-extremity nerves by use of intercostal nerves. Intercostal nerves and distal cauda equina roots were anastomosed, using a collagen tube and microsurgical technique. Most experimental animals could lift their previously paralyzed legs and could walk with a severe limp by 9 months postoperatively. Recordings of nerve action potentials (NAPs) and muscle action potentials (MAPs) indicated that the intercostal and sciatic nerves had some functional connections. Histologic analysis 12 months after repair demonstrated axonal regeneration extending from the intercostal nerves to and down lumbar ventral roots. Most of the regenerated fibers were moderately well-myelinated. Connections between the neurons of the anterior horn cells in the lower thoracic spinal cord and the reinnervated sciatic nerve were confirmed by retrograde tracer, using fast blue.

Action Potentials↗
PubMed1998

Infection in the ischemic lower extremity.

Infections in the lower extremity of the patient with ischemia can cover a broad spectrum of different diseases. An understanding of the particular pathophysiologic circumstances in the ischemic extremity can be of great value in understanding the natural history of the disease and the potential complications that may occur. Optimizing blood flow to the extremity by using revascularization techniques is important for any patient with an ischemic lower extremity complicated by infection or ulceration. Infections in the ischemic lower extremity require local débridement and systemic antibiotics. For severe infections, such as necrotizing fasciitis or the fetid foot, more extensive local débridement and even amputation may be required. Fundamentals of managing prosthetic graft infection require removing the infected prosthesis, local wound débridement, and systemic antibiotics while attempting to preserve viability of the lower extremity using autogenous graft reconstruction.

Amputation, Surgical↗
PubMedDate not supplied

[Ablative and extremity salvage tumor surgery of the lower extremity--a 10 year comparison].

AIM: The treatment of choice for local tumor control was amputation in the 1970's. Nowadays, limb salvage procedures have become the new standard, implicating that limb salvage surgery results in a better quality of life. This study attempts to prove this hypothesis. METHOD: In total, 102 patients who survived longer than ten years after tumor treatment of the lower extremities were investigated, of these, 71 patients underwent ablative procedures compared to 31 patients with limb salvage surgery. Operative revisions, education level, and occupational situation were evaluated in both groups. To analyze the outcome of every patient regarding functional results, quality of life, life contentment, and social parameters, the functional evaluation system of the Muskulo-Skeletal-Tumor Society (MSTS), the Freiburger Life-Contentment-Questionnaire (FLZ) and the Quality of Life Questionnaire (QLQ-C-30) of the European Organization of Research and treatment of Cancer (EORTC) were used. RESULTS: Patients treated with a limb salvage procedure underwent more surgical revisions (p < 0.000). Educational level and occupational situation showed no difference in both groups. Functional results reached similar levels in both groups (74.6% vs. 73.8%). Life contentment and Quality of Life measurements showed good results in both groups. The FLZ-questionnaire showed significantly better results for the ablative group in some items. CONCLUSION: The type of surgical local therapy of lower extremity tumors has no measurable effect on quality of life according to long-term follow-up in lower extremity tumors. In cases with a risk of inadequate margins when performing limb salvage surgery, an ablative procedure should be preferred.

Activities of Daily Living↗
PubMedDate not supplied

Broken bones: common pediatric lower extremity fractures--Part III.

Lower extremity injuries and fractures occur frequently in young children and adolescents. Nurses are often one of the first healthcare providers to assess a child with an injury or fracture. Although basic fracture care and principles can be applied, nurses caring for these young patients must have a good understanding of normal bone growth and development as well as common mechanisms of injury and fracture patterns seen in children. Similar to many of the injuries in the upper extremity, fractures in the lower extremity in children often can be treated nonoperatively with closed reduction and casting. However, this article will also review several lower extremity fractures that frequently require surgical intervention to obtain a precise anatomical reduction. Common mechanisms of injury, fracture patterns, and current management techniques will be discussed. Teaching strategies and guidelines that will enable nurses and nurse practitioners to confidently educate parents, families, and other providers caring for these young patients will be reviewed.

Adolescent↗
PubMed2004

Survival after lower-extremity amputation.

BACKGROUND: Lower extremity amputation has long been considered an end-of-life event and it is unclear if survival after amputation has improved over time. STUDY DESIGN: A retrospective cohort comprised from a statewide, hospital discharge database was used to determine if survival after amputation improved with time. The cohort included all patients (older than 18 years) with nontraumatic, lower extremity amputations (1987 to 2000). Survival analysis was used to determine the adjusted hazard ratio of survival as it related to the era of amputation. RESULTS: A total of 13,807 patients (mean age +/- SD, 67 +/- 15, 58.5% men) underwent amputation. The gender and age standardized frequency of amputation remained essentially stable, with a 0.01% increase per year (95% CI, 0.006-0.01%). During followup, 49.2% (6,795/13,807) of patients died, with significantly (p < 0.001) worse outcomes for more proximal levels of amputation. After controlling for potential confounders, including age, gender, level of amputation, comorbid illness, emergency status of procedure, hospital type, and payer of the procedure, patients undergoing amputation in more recent years (1995 to 2000) had a 28% lower hazard of dying (hazard ratio 0.72 [95% CI, 0.67-0.77%) during the study period than those undergoing operation before 1995. Thirty-day survival did not improve by era (p = 0.2), although 1- and 5-year survival after amputation was significantly greater for all levels of amputation (p < 0.001). CONCLUSIONS: Although 30-day survival associated with amputation has remained stable in the state of Washington over the past 14 years, longterm survival after amputation has improved considerably with time. The reasons underlying this improvement should be explored so that further gains may be achieved.

Aged↗
PubMed1986

Methysergide-induced lower extremity arterial insufficiency.

Lower extremity arterial insufficiency, a relatively common complication of ergotamine ingestion, is a rare complication of methysergide therapy for migraine headaches. Methysergide causes one of two typical angiographic patterns: intra-abdominal extrinsic compression of the aorto-iliac vessels in patients with retroperitoneal fibrosis, or marked diffuse bilateral spasm of the superficial femoral arteries in those without retroperitoneal fibrosis. We report a patient with methysergide-induced bilateral lower extremity arterial spasm and review the relevant literature. When one of the above arteriographic patterns is recognized, methysergide ingestion should be considered as a possible etiology.

Female↗
PubMed1999

Upper extremity augmentation of lower extremity kinetics during countermovement vertical jumps.

Twenty-five volleyball players (14 males, 11 females) were videotaped (60 Hz) performing countermovement vertical jumps with and without an arm swing. Ground reaction force and video-based coordinate data were collected simultaneously. The resultant joint force and torque at the hip, knee, ankle and shoulder for two trials per subject per condition were computed and normalized. Average kinematic, resultant joint force and torque data were compared using repeated-measures analysis of variance. Larger values were recorded for the vertical velocity of the centre of mass at take-off in the jumps with (mean 2.75, s = 0.3 m.s-1) versus without (mean 2.44, s = 0.23 m.s-1) an arm swing. The jumps with no arm swing produced larger torques at the hip during the first third of the propulsive phase (from zero to maximum vertical velocity of the centre of mass). During the final two-thirds of the propulsive phase, the arm swing augmented hip extensor torques by slowing the rate of trunk extension and placing the hip extensor muscles in slower concentric conditions that favoured the generation of larger forces and resultant joint torques. During the first two-thirds of the propulsive phase, knee extensor torque increased by 28% in the jumps with an arm swing, but maintained a relatively constant magnitude in the jumps with no arm swing.

Adult↗
PubMed1992

Accuracy of lower extremity arterial duplex mapping.

We performed lower extremity arterial duplex mapping from the aortic bifurcation to the ankle in 150 consecutive patients evaluated for aortic and lower extremity arterial reconstruction and compared lower extremity arterial duplex mapping in a blinded fashion to angiography. On the basis of history, physical examination, and four-cuff segmental Doppler pressures individual lower extremities were classified as normal, isolated aortoiliac disease, infrainguinal disease, and multilevel inflow and outflow disease. For vessels proximal to the tibial arteries, lower extremity arterial duplex mapping was analyzed for its ability to insonate individual arterial segments, detect a 50% or greater stenosis, and distinguish stenosis from occlusion. In the tibial arteries lower extremity arterial duplex mapping was evaluated for its ability to visualize tibial vessels and to predict interruption of tibial artery patency from origin to ankle. Lower extremity arterial duplex mapping visualized 99% of arterial segments proximal to the tibial vessels, with overall sensitivities for detecting a 50% or greater lesion ranging from 89% in the iliac vessels to 67% at the popliteal artery. Stenosis was successfully distinguished from occlusion in 98% of cases. In the tibial vessels lower extremity arterial duplex mapping was better at visualizing anterior tibial and posterior tibial artery segments (94% and 96%) than peroneal artery segments (83%), (p less than 0.001). Overall sensitivities for predicting interruption of tibial artery patency were 90% for the anterior tibial, 90% for the posterior tibial, and 82% for the peroneal. Clinical disease category did not influence in a major way the accuracy of lower extremity arterial duplex mapping in either above-knee or below-knee vessels.

Aged↗