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PubMedDate not supplied

Microvascular reconstruction of the lower extremity.

Microvascular reconstruction has revolutionized the care of the lower extremity oncology patient. Radical limb-sparing surgeries may now be performed with the reconstructive option of unlimited transfer of tissues from elsewhere in the body. In its infancy, free tissue transfer provided vascularized tissue for wound closure. Experience with microsurgery and creative thinking have now combined to address limb function and aesthetics. In oncologic surgery, limb salvage of a functional lower extremity is currently the rule, not the exception. Semin. Surg. Oncol. 19:272-281, 2000.

Humans↗

PubMed1976

Femorotibial bypass in the elderly for revascularization of the severely ischemic lower extremity.

In the elderly, revascularization of a severely ischemic lower extremity with occlusion of both femoral and popliteal arteries often can be achieved by surgical construction of a distal bypass to the tibial or peroneal arteries. An aggressive diagnostic and therapeutic approach is necessary, in an attempt to prevent recourse to primary amputation. Femoroperoneal or femorotibial bypass can be performed safely and is recommended in elderly patients with advanced ischemia of a lower extremity with absolute indications for surgical intervention, e.g., gangrene, gangrenous ulceration or rest pain. A significant number of limbs can be salvaged by this method. Although the mortality rate in the older age groups is predictably higher, the overall rate for this operation compares favorably with that for primary amputation.

Adult↗

PubMed1993

Acute arterial occlusion of the lower extremity.

Acute arterial occlusion of the lower extremity occurs when blood supply from the lower limbs is abruptly cut off. Prompt evaluation and treatment are required to prevent irreversible damage. Differentiation between embolic and thrombotic sources is needed to initiate appropriate therapy. Although different types of occlusion require similar preoperative and postoperative considerations, the specific treatments vary. With a thorough understanding of the causes, signs and symptoms, treatment, and nursing management of acute arterial occlusion, the nurse can assist in the prevention of potentially severe complications.

Arterial Occlusive Diseases↗

PubMed2004

A comparison of magnetic resonance angiography, contrast arteriography, and duplex arteriography for patients undergoing lower extremity revascularization.

The objective of this study was to compare magnetic resonance angiography (MRA), contrast arteriography (CA), and duplex arteriography (DA) for defining anatomic features relevant to performing lower extremity revascularizations. From March 1, 2001 to August 1, 2001, 33 consecutive inpatients with chronic lower extremity ischemia underwent CA, MRA, and DA before undergoing lower extremity revascularization procedures. The reports of these tests were compared prospectively and the differences in the aortoiliac segment, femoral-popliteal, and infrapopliteal segments were noted. The vessels were classified as mild disease (<50%), moderate disease (50-70%), severe disease (71-99%), and occluded. These studies and treatment plans based on these data were compared. During this time period, 11 patients were not able to undergo MRA and therefore were excluded from the study. Thirty-three patients were included in this study. These patients underwent 35 procedures, as 2 patients underwent bilateral procedures. The mean age of the 33 patients was 76+/-10 years (SD). Indications for the procedures included gangrene (20), ischemic ulcer (8), rest pain (4), and severe claudication (1). Patients' medical history included diabetes mellitus (25), hypertension (20), and end-stage renal disease (5). No differences were noted between intraoperative findings and CA in this series. Two of the three differences between DA and CA were felt to be clinically significant whereas 9 of the 12 differences between MRA and CA were felt to be clinically significant. On the basis of these data in this series, MRA does not yet seem to be able to obtain adequate data on infrapopliteal segments, at least not for this highly selected population. When severe tibial calcification or very low flow states are identified, CA may be necessary for patients undergoing DA.

Aged↗

PubMed1998

Is there a relationship between hypertension and lower-extremity contracture release in cerebral palsy?

Recent reports have suggested a relationship between release of lower-extremity contractures and the development of hypertension in cerebral palsy and poliomyelitis patients. A retrospective study was performed on 119 cerebral palsy patients who had undergone lower-extremity contracture releases. Temporary elevation of systolic blood pressure in the perioperative and intraoperative periods occurred in 46 patients (39%), and temporary elevation of diastolic blood pressure occurred in 14 patients (12%). Type of cerebral palsy, patient age, patient sex, type of anesthesia, and type of procedure were not significantly correlated with the temporary blood pressure elevations. No patient developed sustained elevation of systolic and diastolic blood pressure. We conclude that lower-extremity contracture release in pediatric patients is not associated with an increased incidence of postoperative hypertension.

Adolescent↗

PubMed1989

The association of lower extremity peripheral vascular disease in patients undergoing coronary bypass surgery.

The association of lower extremity peripheral vascular disease (PVD) in patients undergoing coronary artery bypass (CAB) has been studied in two groups of patients who have been operated upon between January and May 1987. Group 1 consists of 125 cases in which only resting ankle-arm pressure index (AAPI) were evaluated. Group 2 consists of 50 cases where both resting and after exercise AAPI were recorded. In total, 17 cases of one extremity and in 10 both lower extremity resting AAPI were below 0.9 (15.4%). In Group 2 comparison of resting and after exercise AAPI on both sides showed no statistically significant difference. However in Group 2, 13 cases (26%) had after exercise AAPI below 0.9 and in 26 (52%) cases after exercise AAPI were lower than the resting AAPI. This study showed that, although the coexistence of PVD in patients undergoing CAB is not as high as the coexistence of CAD in patients undergoing peripheral vascular procedures, this percentage can increase when the presence of PVD is evaluated with an exercise test whenever possible.

Adult↗

PubMed2002

[Revascularized osteo-trepanation in the treatment of chronic occlusion of the lower extremities arteries].

The results of operation of revascularized osteotrepanation (ROT) in complex of treatment of 43 patients with chronic occlusion of the lower extremities arteries were analyzed. Stable clinical effect after application of ROT in patients with the ischemia II stage persisted during 40 months, III stage--25 months, "high" amputation of lower extremity in patients with IV stage ischemia was performed in 3.5-7 months. ROT is operation of choice in patients with distal form of ischemia of lower extremity, as well as while presence of contraindications for performance of reconstructive operation on main arteries.

Arterial Occlusive Diseases↗

PubMed2002

A combination of heparin and an intermittent pneumatic compression device may be more effective to prevent deep-vein thrombosis in the lower extremities after laparoscopic cholecystectomy.

BACKGROUND: The purpose of this study was to clarify the effect of a combination of heparin and an intermittent pneumatic compression device on thrombogenesis and platelet activation in the upper and lower extremities after laparoscopy. METHODS: A blinded study was performed on 30 patients. Patients were randomly injected with either heparin or physiological saline solution (PSS) subcutaneously. The intermittent compression boot was used during surgery. Plasma D-dimer (D-D), a marker of thrombogenesis, and b-thromboglobulin (b-TG), a marker of platelet activation, were measured in the upper and lower extremities. RESULTS: In the heparin group, D-Ds in the upper and lower extremities increased significantly 24 h after surgery, but they were significantly lower than those of the PSS group. b-TG in the lower extremities of patients in the PSS group increased significantly 24 h after surgery. CONCLUSION: A combination of low-molecular-weight heparin and intermittent pneumatic compression may be more effective to prevent deep-vein thrombosis in the legs.

Adult↗

PubMed2000

Characteristics of nondisabled older persons who perform poorly in objective tests of lower extremity function.

OBJECTIVES: It has been suggested that nondisabled older persons with poor performance of lower extremity function are ideal targets for interventions of disability prevention. However, health-related factors associated with poor performance are largely unknown. Using data from a representative sample of nondisabled older persons, this study identifies the diseases and biological markers that characterize this group of the population. DESIGN AND PARTICIPANTS: A total of 3,381 persons aged 71 or older, interviewed and administered a battery of physical performance tests at the sixth annual follow-up of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), who reported no need for help in walking 1/4 mile or climbing stairs. MEASUREMENTS: Lower extremity performance was measured using a short battery of tests including assessment of standing balance, a timed 2.4-m walk, and timed test of rising 5 times from a chair. Chronic conditions were ascertained as self-report of a physician diagnosis. Data on previous hospitalizations were obtained from the Medicare database. Nonfasting blood samples were obtained and processed with standard methods. RESULTS: In a multivariate analysis, older age, female gender, higher BMI, history of hip fracture and diabetes, one or more hospital admissions for acute infection in the last 3 years, lower levels of hemoglobin and albumin, and higher leukocytes and gamma-glutamyl transferase were all associated independently with poor performance. CONCLUSIONS: Screening for older patients who are not disabled but have poor lower extremity performance selects a subgroup of the population with a high percentage of women, high prevalence of diabetes and hip fracture, and high levels of biological markers of inflammation. This group represents about 10% of the US population 70 to 90 years old. These findings should be considered in planning specifically tailored interventions for disability prevention in this subgroup.

Activities of Daily Living↗

PubMed1997

Injuries to the Distal Lower Extremity Syndesmosis.

Disruption of the distal syndesmosis of the lower extremity is most commonly associated with ankle fractures but can also occur without gross bone injury. Definitive management of these injuries remains controversial. The current indications for syndesmosis fixation are based on tibiotalar joint mechanics as determined in cadaveric and biomechanical studies, as well as radiologic evaluation and an understanding of the pertinent anatomy and the etiology of these injuries. Such data support the use of syndesmotic screws in selected fractures that include a disruption of the syndesmosis. However, definitive fixation recommendations for syndesmosis disruption with or without ankle fracture remain under investigation. Distal lower extremity syndesmosis sprains without fracture or subluxation consistently require longer recovery time than typical lateral sprains and can be associated with greater long-term disability.

Journal Article↗

PubMed2001

Lower extremity kinetics during stair ambulation in patients with and without patellofemoral pain.

OBJECTIVE: To compare lower extremity kinetics during stair ascent and descent in subjects with and without patellofemoral pain. DESIGN: A cross-sectional study utilizing a control group. BACKGROUND: The patellofemoral joint reaction force (the resultant force between the quadriceps muscle force and patellar ligament force) increases with quadriceps force and knee flexion angle. Consequently, patients with patellofemoral pain may employ compensatory strategies to minimize pain and reduce patellofemoral joint reaction forces during activity. METHODS: 10 individuals with a diagnosis of patellofemoral pain and 10 individuals without pain participated. Subject groups were matched on sex, age, height, and body mass. Anthropometric data, three dimensional kinematics, and ground reaction forces were used to calculate lower extremity sagittal plane moments (inverse dynamics) while subjects ascended and descended stairs at a self-selected pace. Differences in kinetic variables between groups were assessed using 2x2 (group x stair condition) analysis of variance. RESULTS: Subjects with patellofemoral pain had decreased peak knee extensor moments during stair ascent and descent. There were no group differences in peak hip, ankle, or support moments, however, subjects with patellofemoral pain had decreased cadence (descent) compared to controls. CONCLUSION: Subjects with patellofemoral pain had reduced peak knee extensor moments, suggesting that quadriceps avoidance was employed to reduce patellofemoral joint reaction forces. The lack of group differences in peak moments at the hip and ankle suggests that secondary compensation did not occur exclusively at the hip or ankle in this group of subjects with patellofemoral pain. RELEVANCE STATEMENT: Because stair ambulation is often used to evaluate the reproducibility of symptoms and to identify abnormal movement patterns indicative of patellofemoral pain, knowledge of lower extremity mechanics during stair negotiation is necessary to better characterize compensatory behavior in this population.

Adult↗

PubMed2001

Clinical characteristics of 500 consecutive patients presenting for laser removal of lower extremity spider veins.

BACKGROUND: Laser treatment for removal of lower extremity spider veins is emerging as a modality of choice in patients with small spider veins, those who have previously undergone sclerotherapy or vein stripping, and those refusing sclerotherapy. OBJECTIVE: To determine clinical characteristics of patients presenting for laser treatment of leg veins. METHODS: The clinical characteristics of 500 patients presenting for laser treatment of spider veins were evaluated to investigate characteristics leading to their development, and to characterize the type of patients presenting for laser treatment. RESULTS: Patients presenting for treatment range widely in age and have had spider veins for an average of 14 years. Both pregnancy and previous sclerotherapy were factors that contributed to the development or exacerbation of spider veins. CONCLUSION: As laser treatment of spider veins improves, this modality will play an increasing role in the management of lower extremity telangiectasias.

Adult↗

PubMed1997

Role of venous duplex imaging of the lower extremities in patients with fever of unknown origin.

BACKGROUND: Although a fever of unknown origin (FUO) is most often due to other causes, the few caused by pulmonary emboli, pelvic thrombophlebitis, or lower extremity venous thrombosis (DVT) present a diagnostic challenge. The purpose of this study was to evaluate the role of venous duplex imaging of the lower extremity in evaluating a large series of patients with FUO. This has not been reported previously in the English-language literature. METHODS: Medical records were analyzed of patients with FUO who were referred to the vascular laboratory for venous duplex imaging of the lower extremities to rule out DVT as a cause of their fever. A FUO was defined as a temperature of greater than 38.3 degrees C on several occasions for at least 3 weeks' duration that defied 1 week of hospital evaluation. DVT was considered as a probable cause of FUO if the following criteria were met: (1) a positive venous duplex image for acute DVT, (2) subsequent fever resolution within 7 days of anticoagulation therapy, and (3) a fever that was resistant to prior treatment. RESULTS: A total of 114 duplex examinations, gathered during a 2-year period, were analyzed. The 89 patients had a mean age of 58 years. Infections were the most common cause of FUO (57 of 89, 64%), and unknown causes constituted 19%. There were seven cases of DVT (8%), five (6%) of whom met the criteria for probable cause of FUO. The overall cost of venous duplex imaging examinations was $51,300 ($450 x 114 tests), with an average cost of $10,260 for each case of DVT detected as probable cause of FUO. CONCLUSIONS: Consistent with the literature, infections remain the most common cause of FUO; however, DVT was found to be a more common cause of FUO in our present series (6%). The cost of venous duplex imaging of the lower extremities in establishing DVT as a probable cause of FUO should be borne in mind when the work-up of these patients is planned.

Adult↗

PubMed2005

Modifying center of mass trajectory during sit-to-stand tasks redistributes the mechanical demand across the lower extremity joints.

OBJECTIVE: Sit-to-stand tasks are commonly facilitated by modifying the initial position of the center of mass relative to the feet. It was hypothesized that modifications in the center of mass trajectory during sit-to-stand tasks altered the total body momentum at seat departure and redistributed the lower extremity net joint moments. DESIGN: Between-task within-subject comparison was employed using a robust statistical method to accommodate for small sample size. METHODS: Six individuals performed four sit-to-stand tasks with systematic modifications in the initial center of mass position by varying the orientation of the lower extremity segments. The momentum of the center of mass and lower extremity net joint moments were quantified and compared. RESULTS: Reducing the horizontal center of mass displacement significantly reduced horizontal total body momentum required at seat departure. Sit-to-stand tasks initiated with more horizontal shank and thigh positions required significantly greater knee and hip extensor net joint moments than those with more vertical shank and thigh positions. Sit-to-stand tasks initiated with vertical shank positions also required significantly greater hip extensor net joint moments as compared to those with more horizontal shank orientations. INTERPRETATION: When changes in initial center of mass position are made, alteration in center of mass horizontal momentum and the orientation of the lower extremity segments relative to the reaction force are observed. Consequently, mechanical demand imposed on the ankle, knee, and hip joint is redistributed. The magnitude of the net joint moments is dependent on the segment orientation, the reaction force, and the adjacent net joint moment.

Adaptation, Physiological↗

PubMed1985

A new method for measuring motor block in the lower extremities.

A method for determining muscle strength in the lower extremities was developed and its clinical application evaluated in ten elderly, healthy subjects, and also subsequently in one of them during spinal anaesthesia. With the subject lying in the lithotomy position on a modified operating table, muscle strength measurements were made during flexion of the hip, extension of the knee and plantar flexion of the big toe. The electromechanical performance of the apparatus was stable, and the maximum measurement errors observed at loads of 245 and 49 N were 4 and 11% of the deflections, respectively. The subjects underwent repeated muscle strength measurements during a 4-h period without any difficulty. No signs of muscular fatigue were observed. The variation of the measured isometric muscle strength was small and the average coefficient of variation roughly 10%. In the patient receiving spinal anaesthesia, the degree of motor block was determined, and the results are presented graphically. This new method for evaluation of motor block in the lower extremities is a reliable quantitative method for bilateral, three-joint muscle strength measurements, which is also applicable during regional anaesthesia.

Aged↗

PubMed2004

[Report on the investigation of lower extremity osteonecrosis with magnetic resonance imaging in recovered severe acute respiratory syndrome in Guangzhou].

OBJECTIVE: To report the occurrence of lower extremity avascular abnormalities in 124 cases of recovered severe acute respiratory syndrome (SARS) health care workers of four hospitals in Guangzhou and preliminary investigate the correlation with the treatment of steroid. METHODS: 124 health care workers with recovered SARS from four hospitals in Guangzhou were examined with MR imaging of the lower extremity including bilateral hips and knees. In 124 health care workers, 38 cases have not treated with steroid, while 86 cases have treated with varied dosage. The imaging protocol was consisted of screening and full examination. Coronal T1-weighted imaging and short tau inversion recovery sequence were defined as the screening examination. The full examination was defined as images from the screening examination plus three additional imaging sequences: transverse and coronal T2-weighted imaging and short tau inversion recovery sequence. RESULTS: In 86 health care workers, 5 cases were found positive in the lower extremity. Osteonecrosis was found in 3 cases. One was involved in bilateral femoral head, and another was unilateral femoral head, and the remaining one was bilateral femoral heads and unilateral femoral condyle and tibial condyle. Bilateral femoral and tibial marrow edema were found in one case. Femoral infarction with significant calcification occurred in one health care worker. Logistic regression analysis indicated that the presence of avascular abnormalities was related with maximum daily dosage. CONCLUSION: Osteonecrosis definitely exists in the minority of health care workers with recovered SARS in Guangzhou, who had treated with steroid. The maximum daily dosage of steroid may significantly influence on the occurrence of avascular abnormalities.

Adolescent↗

PubMed1998

Primary malignant tumors of the venous system in the lower extremities.

Malignant tumors arising from venous walls in the lower extremity are uncommon. Histologically they are divided into two groups: hemangioendotheliomas of intermediate malignancy and leiomyosarcomas. This report describes a retrospective series of seven primary venous tumors observed in four men and three women with a mean age of 49.8 years (range: 18 to 64 years) who underwent surgical treatment between 1985 and 1995. The tumor was located in the superficial femoral vein in four patients, common femoral vein in two patients, and greater saphenous vein in one patient. A palpable tumor was present in five patients, localized pain in two patients, and metastasis in two patients. The histological diagnosis was leiomyosarcoma in six patients and hemangioendothelioma in one patient. Surgical treatment consisted of complete resection in six patients and partial excision in one patient. Venous reconstruction was performed in two patients and adjuvant radiation therapy in four patients. There was no operative morbidity/mortality. Median survival was 31 months. Four patients with leiomyosarcoma died from metastasis. Two patients with leiomyosarcoma and one with hemangioendothelioma are alive at 9 years, 16 months, and 9 months, respectively. Local recurrence was never observed after complete resection. The prognosis of venous leiomyosarcoma of the lower extremities is poor due to early occurrence of metastasis. Doppler ultrasound and MRI are useful to establish early diagnosis at the nontumoral stage. Improvement in the prognosis of leiomyosarcoma may justify perioperative chemotherapy before and after radical surgical excision.

Combined Modality Therapy↗

PubMed2001

Has arteriography gotten a bad name? Current accuracy and morbidity of diagnostic contrast arteriography for aortoiliac and lower extremity arterial disease.

Recently, contrast arteriography has been challenged as the diagnostic test of choice for lower extremity arterial disease because of its associated morbidity and questionable accuracy in identifying suitable distal outflow arteries. The purpose of this report was to analyze our experience to determine if these concerns were justified. We reviewed 500 consecutive contrast arteriograms performed at our hospital for aortoiliac and lower extremity arterial disease between November 1994 and November 1998. Arteriograms performed in conjunction with therapeutic procedures such as balloon angioplasty, stent placement, and thrombolysis were excluded, leaving 244 diagnostic cases for analysis. Forty-six percent (112) of patients had diabetes mellitus, 14% (34) had an elevated baseline serum creatinine (> or =1.5 mg/dL), and an additional 7% (17) were dialysis dependent. Radiologists limited contrast volume by imaging only the symptomatic extremity when appropriate and using digital subtraction techniques as indicated. Our results showed that diagnostic contrast arteriography is associated with an acceptably low morbidity, has an accuracy that is unlikely to be surpassed by other modalities, and remains the diagnostic test of choice for lower extremity arterial disease.

Adult↗