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At least 811 records · Page 45Linked to original sources

PubMed2003

The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective.

Although patellofemoral pain (PFP) is recognized as being one of the most common disorders of the lower extremity, treatment guidelines and underlying rationales remain vague and controversial. The premise behind most treatment approaches is that PFP is the result of abnormal patellar tracking and/or patellar malalignment. Given as such, interventions typically focus on the joint itself and have traditionally included strengthening the vastus medialis oblique, taping, bracing, soft tissue mobilization, and patellar mobilization. More recently, it has been recognized that the patellofemoral joint and, therefore, PFP may be influenced by the interaction of the segments and joints of the lower extremity. In particular, abnormal motion of the tibia and femur in the transverse and frontal planes may have an effect on patellofemoral joint mechanics. With this in mind, interventions aimed at controlling hip and pelvic motion (proximal stability) and ankle/foot motion (distal stability) may be warranted and should be considered when treating persons with patellofemoral joint dysfunction. The purpose of this paper is to provide a biomechanical overview of how altered lower-extremity mechanics may influence the patellofemoral joint. By addressing these factors, better long-term treatment success and prevention may be achieved.

Biomechanical Phenomena↗

PubMed2006

Patient follow-up after negative lower extremity bedside ultrasound for deep venous thrombosis in the ED.

OBJECTIVES: To evaluate the rate of patient compliance with follow-up ultrasound (US) examinations 5 to 7 days after emergency physician EP performed US exams to rule out lower extremity deep venous thrombosis (DVT) in the ED. METHODS: This was a prospective observational study at a level I ED with a residency program, US training program, and an annual census of 75000. Hospital-based emergency US credentialing is available and derived from American College of Emergency Physicians guidelines. Five US-credentialed emergency physicians participated in the study. All patients who received negative lower extremity DVT US exams were eligible. All higher risk patients were given verbal and written instructions and provided with prescriptions to have a follow-up US examination 5 to 7 days after their examination in the ED. Those classified as "low risk" based on Wells criteria were excluded. After 3 months, patients were contacted via telephone and asked questions regarding their follow-up US examinations, reasons for not following up, continued symptoms, and thromboembolic events. Statistical methods included descriptive statistics. RESULTS: One hundred fifty-nine patients were eligible for enrollment during the 10-month study period. Eighty-five patients (54%) fell into the higher risk category of these; 54 (64%) were contacted successfully. Fifteen (28%) of the patients contacted had obtained a follow-up US exam. Of the 39 who did not follow-up, 29% were told by their physician that a follow-up US was unnecessary, 21% forgot to follow-up, 8% did not follow-up for financial reasons, 16% felt better, 5% could not arrange a study, 21% were unsure. One patient died from sepsis before a follow-up scan. Two patients were diagnosed with DVT, one at 7 days follow-up and the other 9 months later (this particular patient had their 7-day scan cancelled by their primary care physician). CONCLUSION: Patients who were instructed to obtain follow-up lower extremity US examinations to rule out propagation of unseen, distal DVTs did so at a very low rate in our study. One of the largest impediments in our study population was a patients' primary care physician who may not understand the need for a follow-up US examination.

Emergency Service, Hospital↗

PubMed2004

Chronic lower extremity ischemia: a human model of ischemic tolerance.

BACKGROUND: Ischemic preconditioning (IPC) has been found in animals to have a protective effect against future ischemic injury to muscle tissue. Such injury is unavoidable during some surgical procedures. To determine whether chronic ischemia in the lower extremities would imitate IPC and reduce ischemic injury during vascular surgery, we designed a controlled clinical study. PATIENTS AND METHODS: Two groups of patients at a university-affiliated medical centre with chronic lower-extremity ischemia served as models of IPC: 6 patients awaiting femoral distal bypass (FDB) and 4 scheduled for aortobifemoral (ABF) bypass grafting for aortoiliac occlusive disease. Seven patients undergoing elective open repair of an infrarenal abdominal aortic aneurysm (AAA) were chosen as non-IPC controls. Three hematologic indicators of skeletal-muscle injury, lactate dehydrogenase (LDH), creatine kinase (CK) and myoglobin, were measured before placement of the proximal clamp, during surgical ischemia, immediately upon reperfusion, 15 minutes after and 1 hour after reperfusion, and during the first, second and third postoperative days. RESULTS: Baseline markers of skeletal-muscle injury were similar in all groups. In postreperfusion samples, concentrations of muscle-injury markers were significantly lower in the 2 PC groups than in the control group. For example, at day 2, LDH levels were increased by about 30% over baseline measures in the elective AAA (control) group, whereas levels in the FDB and ABF groups remained statistically unchanged from baseline. Myoglobin in controls had increased by 977%, but only by 160% in the FDB and 528% in the ABF groups. CK levels, in a similar trend, were 1432% higher in the control group and only 111% (FDB) and 1029% (ABF) in the study groups. Taken together, these data represent a significant level of protection. CONCLUSIONS: Patients with chronic lower-extremity ischemia suffered less severe ischemic injury after a period of acute ischemia than those with acute ischemia alone. Ischemic preconditioning is one proposed mechanism to help explain this protective effect.

Aged↗

PubMed2003

Superficial femoral lymph node dissection after positive sentinel lymphadenectomy for early-stage melanoma of the lower extremity.

The purpose of this study was to evaluate retrospectively the value of a subsequent superficial femoral lymph node dissection for patients with early melanoma of the lower extremity after a positive sentinel lymphadenectomy. During a 6-year period at the H. Lee Moffitt Cancer Center & Research Institute, 16 consecutive patients with clinical stage I or stage II melanoma of the lower extremity underwent subsequent superficial femoral lymph node dissections after positive sentinel lymphadenectomies and wide local excisions of the primary lesions. Fifteen patients (94%) were found to have no additional positive lymph nodes from their superficial femoral lymph node dissection specimens. In contrast, only 1 patient (6%) with a thick primary lesion (7.5 mm) was found to have one additional positive lymph node on a subsequent superficial femoral lymph node dissection. No patients developed any regional nodal recurrences during a mean follow-up of 31.1 months (range, 3-80 months). This preliminary report suggests that the majority of the time the sentinel lymph node may be the only site of regional microscopic nodal disease and that a subsequent superficial femoral lymph node dissection may not be necessary in patients with early melanoma of the lower extremity after a positive sentinel lymphadenectomy. However, whether the sentinel lymphadenectomy can be used solely as a regional surgical treatment for this subgroup of patients still warrants further evaluation.

Adolescent↗

PubMed2004

Early intramedullary nailing of lower extremity fracture and respiratory function in polytraumatized patients with a chest injury: a retrospective study of 61 patients.

BACKGROUND: The optimal treatment of diaphyseal fractures of the lower extremities in patients who also have serious chest injuries is not known. PATIENTS AND METHODS: We retrospectively evaluated the effect of an early intramedullary nailing (IMN) of femur or tibia fractures on respiratory function in 61 consecutive polytraumatized patients with unilateral or bilateral pulmonary contusion (thoracic AIS=3) admitted to our trauma intensive care unit between January 2000 and June 2001. 27 patients had a diaphyseal fracture of at least one long bone of the lower extremity, which was treated with IMN within 24 hours of admission. RESULTS: We found no difference between patients with or without a lower extremity fracture regarding the length of ventilator treatment, oxygenation ratio (PaO2/FiO2) or in the incidence of acute respiratory distress syndrome (ARDS), pneumonia, multi-organ failure or mortality. INTERPRETATION: In this retrospective study, IMN of a long bone fracture in a patient with multiple injuries and with a coexisting pulmonary contusion did not impair pulmonary function or outcome.

Adolescent↗

PubMed1983

Lower extremity manifestations of phenylketonuria.

Phenylketonuria is an inborn error of metabolism with its most notable characteristic being that of mental retardation. The literature describing this disorder has been reviewed to identify the abnormal lower extremity findings in affected individuals. The dermatologic, osteologic, and neuromuscular systems were all found to be involved. Lower extremity physical examinations were then performed on nine phenylketonuric adults. It was determined that several of the reported manifestations of phenylketonuria were similarly evident in these individuals as well as the presence of additional lower extremity pathology not previously documented. However, the conclusion was made that all findings, past and present, were variable and that no consistent manifestation was apparent.

Adult↗

PubMed2006

Chiropractic treatment of lower extremity conditions: a literature review.

OBJECTIVE: The purpose of this study was to document the quantity and type of research conducted on the chiropractic management of lower extremity conditions. METHODS: A review of the literature was conducted using the CINAHL, MEDLINE, MANTIS, and Science Direct databases (each from inception to December 15, 2005). Search terms included chiropractic, hip, knee, ankle, foot, with Medical Subject Heading terms for each region. Inclusion criteria included studies with a lower extremity diagnosis, and the treatment was performed by doctors of chiropractic. Articles were excluded if pain was referred from spinal sites and if there was a duplicate publication; articles published in non-peer-reviewed literature and abstracts in conference proceedings were also excluded. Of the articles identified, an analysis was conducted assessing those including peripheral and/or spinal treatment. Clinical trials were assessed for quality using the Physiotherapy Evidence Database scale. RESULTS: There was a total of 1652 citations. Of these, 76 were deemed relevant; 24 were related to the foot, 10 to the ankle, 25 to the knee, and 17 to the hip. Twenty-nine citations included spinal treatment, 47 solely peripheral, and 2 solely spinal. Ten citations were clinical trials and scored on the Physiotherapy Evidence Database scale. CONCLUSIONS: Literature on the chiropractic management of lower extremity conditions has a large number of case studies (level 4 evidence) and a smaller number of higher-level publications (level 1-3 evidence). The management available in the peer-reviewed literature is predominantly multimodal and contains combined spinal and peripheral components. Future chiropractic research should use higher-level research designs, such as randomized controlled trials.

Ankle↗

PubMed1988

Management of chronic osteomyelitis of the lower extremity.

Chronic osteomyelitis is a frequent complication after compound fractures of the lower extremity. Essential in the treatment is the radical debridement of all scar tissue, muscle and infected bone. This often creates large tissue defects, which especially in the distal third of the tibia, can only be closed with a free tissue transfer and revascularized by a microvascular anastomosis. Ten patients were operated on for chronic osteomyelitis of the lower extremity. The latissimus dorsi or rectus abdominis muscle was used as a free flap. During the follow-up period (3-18 months) 9 patients have remained free of symptoms of recurrence.

Adult↗

PubMed2003

[Some features of orthostatic venous hemodynamics of the lower extremities in healthy, subjects and patients with varicose disease according to duplex scanning data].

Duplex scanning of the subcutaneous, deep and perforating veins was performed to examine venous return and to establish the diagnosis of valvular venous insufficiency of the lower extremities in 32 clinically healthy subjects (64 extremities) and 38 patients suffering from varicose disease (VD), when the patient was in the horizontal and vertical position. It has been established that in VD patients, the diameter of the deep and subcutaneous veins is greater than that in healthy subjects. When the patient is in the vertical position, the venous lumen expands 1.5-fold on the average (1.6-fold in healthy subjects and 1.4-fold in VD patients) under the influence of orthoshtatic venous pressure (,the sum of hydrodynamic and hydrostatic pressure). The growth of the total venous pressure up to the design values in the distal segments of the lower extremities is removed not only by musculovenous pump (MVP) motion but also by the MVP of free standing (maintenance of body balance) as well as by the action of the arteriovenous pump (AVP). The frequency of recording the retrograde blood runoff at functional exerelse in healthy subjects when they are in the orthostatic position is dramatically reduced. This phenomenon may be related to the orthostatic dilatation of the great veins and tension of the cusps of the unchanged valves, which should be regarded as a functional component of the closing mechanism of the MVP, In YD patients when they are in the orthostatic position, the frequency of revealing the design valvular insufficiency (according to the duration of retrograde runoff) decreases in the deep and rises in the subcutaneous veins. Valvular insufficiency of the perforating veins of the leg was primarily recorded in the veins of Cockett. The data obtained indicate that examination of venous function of the lower extremities is desirable when the patients are in both horizontal and vertical position.

Female↗

PubMedDate not supplied

Fourth-degree burns to the lower extremity with exposed tendon and bone: a ten-year experience.

Fourth-degree extremity burns involve muscle, tendon, and bone, often leading to amputation or significant functional impairment. We report our 10-year experience (1995-2004) at an urban burn center with fourth-degree burns to the lower extremity to characterize treatments and outcomes. Twenty-one patients (40 limbs), mean age of 45 years, were treated for fourth-degree lower-extremity burns with the average extremity burn size of 24% TBSA (range, 2-36%) and a mean fourth-degree burn size of 9% TBSA (range, 2-18%). A mean of eight operations were required for limb salvage. Six free-tissue transfers, 2 fillet flaps, 14 local flaps, and multiple skin grafts were performed. Five patients underwent tibial burring for granulation tissue stimulation, and the subatmospheric pressure device was used in eight patients. Seven limb amputations (18%) were required in four patients, and 76% of patients were ambulatory on follow-up. The mean hospital stay was 76 days with high rates of cellulitis, deep vein thrombosis, and bacteremia. Patients treated with flap closure had a significant decrease in the number of operations required for limb salvage. Fourth-degree lower-extremity burns require multistage reconstructive procedures using multiple levels of the reconstructive ladder but limb salvage is possible in a majority of cases.

Adolescent↗

PubMed1998

Increased soft-tissue blood flow in patients with reflex sympathetic dystrophy of the lower extremity revealed by power Doppler sonography.

OBJECTIVE: We evaluated the ability of power Doppler sonography to show increased soft-tissue blood flow in patients with reflex sympathetic dystrophy of the lower extremity. SUBJECTS AND METHODS: Power Doppler sonography was performed in 30 patients with reflex sympathetic dystrophy of the lower extremity and in 26 asymptomatic control subjects. The bilateral power Doppler sonograms that were obtained of the soft tissues of the dorsum of the foot of each subject were grouped in pairs, and three sonologists who were unaware of clinical information independently reviewed the images. Images were evaluated for the amount of power Doppler signal shown on the following scale: 1 = no flow or minimal flow; 2 = mild flow; 3 = moderate flow; and 4 = marked flow. RESULTS: More power Doppler flow was seen in the patients with reflex sympathetic dystrophy than in the control subjects (p < .005). In addition, side-to-side asymmetry of flow was seen in patients, but this trend was not statistically significant (p < .20). Receiver operating characteristic (ROC) analysis showed that combined flow and asymmetry were more related to reflex sympathetic dystrophy than either parameter alone (area under the ROC curve: for flow, 0.748; for asymmetry, 0.566; for both, 0.799). We found that when the sum of power Doppler flow in both feet was greater than or equal to five, and asymmetry of flow was greater than or equal to one, the sensitivity of power Doppler sonography for reflex sympathetic dystrophy was 73% and the specificity was 92%. CONCLUSION: Patients with reflex sympathetic dystrophy of the lower extremity have increased power Doppler flow compared with asymptomatic control subjects. Patients may also exhibit more side-to-side asymmetry of flow than control subjects.

Adolescent↗

PubMed2003

Lower-extremity biomechanics during forward and lateral stepping activities in older adults.

OBJECTIVE: To characterize the lower-extremity biomechanics associated with stepping activities in older adults. DESIGN: Repeated-measures comparison of kinematics and kinetics associated with forward step-up and lateral step-up activities. BACKGROUND: Biomechanical analysis may be used to assess the effectiveness of various 'in-home activities' in targeting appropriate muscle groups and preserving functional strength and power in elders. METHODS: Data were analyzed from 21 participants (mean 74.7 yr (standard deviation, 4.4 yr)) who performed the forward and lateral step-up activities while instrumented for biomechanical analysis. Motion analysis equipment, inverse dynamics equations, and repeated measures ANOVAs were used to contrast the maximum joint angles, peak net joint moments, angular impulse, work, and power associated with the activities. RESULTS: The lateral step-up resulted in greater maximum knee flexion (P<0.001) and ankle dorsiflexion angles (P<0.01). Peak joint moments were similar between exercises. The forward step-up generated greater peak hip power (P<0.05) and total work (P<0.001); whereas, the lateral step-up generated greater impulse (P<0.05), work (P<0.01), and power (P<0.05) at the knee and ankle. CONCLUSIONS: In older adults, the forward step-up places greater demand on the hip extensors, while lateral step-up places greater demand on the knee extensors and ankle plantar flexors. RELEVANCE: Clinicians may use data from biomechanical analyses of in-home exercises to more effectively target specific lower-extremity muscle groups when prescribing exercise activities for older adults. The forward step-up is recommended for maintaining or improving hip extensor performance; whereas, the lateral step-up is recommended when targeting the knee extensors and ankle plantar flexors.

Activities of Daily Living↗

PubMed2004

Are we underestimating diabetes-related lower-extremity amputation rates? Results and benefits of the first prospective study.

OBJECTIVE: The objective of this study was to accurately determine the incidence of lower-extremity amputation using prospective data collection and to compare the results with those obtained by retrospective methods. RESEARCH DESIGN AND METHODS: The study was carried out over a 3-year period in a large district general hospital covering a clearly defined and relatively static population. All diabetic inpatients with foot problems were identified and followed-up until discharge or death. The demographic and admission details, medical history, investigations, procedures, and history and etiology of the foot lesion were collected twice weekly by a specialist nurse and podiatrist from all relevant wards. Thus, all subjects who underwent amputation could be identified. For comparison, retrospective data were collected from the hospital coding activities database, operating theater log books, anesthetic database, and limb-fitting records. RESULTS: The total population of the region in 2000 was 337,859, of which 9,183 were known to have diabetes. The total number of amputations during the 3-year survey period was 79, of which 45 were major and 34 minor. In our local population, the mean incidence during the survey period (1997-2000) equates to 7.8/100,000 general population and 2.85/1,000 diabetic population for all amputations, 4.5/100,000 general population and 1.62/1,000 diabetic population for major amputations, and 3.3/100,000 general population and 1.23/1,000 diabetic population for minor amputations. The prospective survey detected all lower-extremity amputations identified by the various retrospective methods; however, for the reverse, this was not the case. All of the retrospective methods, including the most commonly used (ICD-9 and OPCS-4 coding), failed to detect all of the cases revealed by the prospective survey (error rate ranging from 4.2 to 90.6%), and between 4.5 and 17.4% of amputations were misclassified. CONCLUSIONS: This study demonstrates the advantages of prospective data collection as a means of determining the incidence of lower-extremity amputations and highlights the limitations of retrospective data collection methods, which underestimate the incidence. In particular, the operating theater records, which have been the gold standard for many surveys, were found to be unreliable. Moreover, we have shown a 47% reduction in the major amputations during the survey period. Thus, we recommend that a prospective audit be incorporated into the activities of the specialist foot care team as a means of assessing and improving clinical care.

Amputation, Surgical↗

PubMed2003

Lower extremity abnormalities in children.

Rotational and angular problems are two types of lower extremity abnormalities common in children. Rotational problems include intoeing and out-toeing. Intoeing is caused by one of three types of deformity: metatarsus adductus, internal tibial torsion, and increased femoral anteversion. Out-toeing is less common than intoeing, and its causes are similar but opposite to those of intoeing. These include femoral retroversion and external tibial torsion. Angular problems include bowlegs and knock-knees. An accurate diagnosis can be made with careful history and physical examination, which includes torsional profile (a four-component composite of measurements of the lower extremities). Charts of normal values and values with two standard deviations for each component of the torsional profile are available. In most cases, the abnormality improves with time. A careful physical examination, explanation of the natural history, and serial measurements are usually reassuring to the parents. Treatment is usually conservative. Special shoes, cast, or braces are rarely beneficial and have no proven efficacy. Surgery is reserved for older children with deformity from three to four standard deviations from the normal.

Child↗

PubMed1992

The prevalence and incidence of lower extremity amputation in a diabetic population.

OBJECTIVE: To describe the incidence of lower extremity amputations and sores or ulcers and investigate risk factors for these complications. DESIGN: Cohort. SETTING: Primary care. PARTICIPANTS: Population-based sample (N = 1210) of younger-onset diabetic persons (diagnosed before age 30 years and taking insulin) and a stratified random sample (N = 1780) of older-onset diabetic persons (diagnosed after age 30 years). Baseline and 4-year follow-up examinations were completed by 996 and 891 younger-onset persons, respectively, and by 1370 and 987 older-onset persons, respectively. MAIN OUTCOME MEASURES: Amputations and sores or ulcers of the lower extremities. RESULTS: Four-year incidence of amputations was 2.2% in both groups. Incidence of sores or ulcers was 9.5% in younger-onset and 10.5% in older-onset persons. In younger-onset persons, significant risk factors for amputation with odds ratios (and 95% confidence intervals) include age, 2.0 for 10 years (1.2 to 3.1), history of sores or ulcers, 10.5 (3.7 to 29.8), diastolic blood pressure, 2.1 for 10 mm Hg (1.3 to 3.5), and pack-years smoked, 1.3 for 10 years (1.0 to 1.6). Risk factors for sores or ulcers include glycosylated hemoglobin, 1.6 for 2% (1.3 to 2.0), retinopathy, 1.3 for two steps (1.1 to 1.6), and current smoking, 2.3 (1.0 to 5.6). In older-onset persons, risk factors for amputation are history of sores or ulcers, 4.6 (1.7 to 12.2), proteinuria, 4.3 (1.6 to 11.5), glycosylated hemoglobin, 1.5 for 2% (1.0 to 2.2), sex, 2.8 for males (1.0 to 7.5), and duration of diabetes, 1.8 for 10 years (1.0 to 3.2). For sores or ulcers, risk factors are glycosylated hemoglobin, 1.6 for 2% (1.3 to 2.0), duration, 1.5 for 10 years (1.0 to 2.1), proteinuria, 2.2 (1.1 to 4.3), and diastolic blood pressure, 0.8 for 10 mm Hg (0.6 to 1.0). CONCLUSIONS: Several factors offer potential for modification for the prevention of amputations but require further study. These include blood pressure, glycosylated hemoglobin, and smoking.

Adolescent↗

PubMed1997

Biopsy specimen findings in patients with previous lower extremity cellulitis after saphenous venectomy for coronary artery bypass graft surgery.

BACKGROUND: No previous study has examined the immune and inflammatory mechanisms involved in the pathogenesis of lower extremity cellulitis after saphenous venectomy for coronary artery bypass graft surgery. OBJECTIVE: Our purpose was to determine the histopathologic, immunologic, and inflammatory findings in skin biopsy specimens from saphenous venectomy limbs of patients with previous bouts of cellulitis. METHODS: Biopsy specimens were obtained from five patients with previous episodes of cellulitis. Specimens of the contralateral lower extremity of each patient were obtained for controlled comparisons. RESULTS: Histopathologic findings did not provide evidence that could account for the tendency for cellulitis to develop. Moreover, the distribution of CD1a, HLA-DR, intercellular adhesion molecule-1, and lymphocyte function-associated antigen type 1 were similar in specimens from the postvenectomy and contralateral legs. No tumor necrosis factor-alpha expression was found in specimens from the lower extremities. CONCLUSION: The mechanisms responsible for the production of this disorder do not involve the mediators studied.

Cellulitis↗

PubMed1986

Stroke hemiplegia and subsequent lower extremity amputation: which side is at risk?

The purpose of this study was to see 1) if there is a relationship between side of hemiparesis and subsequent lower extremity amputation and 2) if time from onset of cerebrovascular accident (CVA) to onset of amputation is less in patients with diabetes mellitus than in those without that disease. Twenty-two subjects with a mean age of 63.9 +/- 11.4 years met the criterion of having a CVA followed by a lower extremity amputation. Date and side of hemiparesis and amputation were noted and a relationship was determined using the two-tailed chi-square test. Twenty-one of 22 subjects had the amputation on the same side as their hemiparesis which represents a significant relationship (chi 2 = 18.16, p less than 0.001). Mean time from CVA to amputation was 32.5 +/- 26.12 mo for diabetics and 55.0 +/- 33.1 mo for nondiabetics which also represents a significant difference (t = 1.74, p less than 0.05). It is concluded there is a strong relationship between side of hemiparesis and subsequent lower extremity amputation with the amputation occurring most often on the hemiparetic side and earlier in patients with diabetes mellitus. The causal relationship between side of CVA and subsequent same sided amputation may be due to altered autonomic nervous system control, altered sensation with increased incidence of local unobserved trauma or decreased/altered muscle fiber use on the affected side. Implications for clinical rehabilitation include education for skin protection and attempting to increase muscle fiber activity.

Aged↗

PubMedDate not supplied

Subcutaneous emphysema of the lower extremity of gastrointestinal origin.

Two cases of subcutaneous emphysema of the left lower extremity secondary to perforations of the rectum ,nd sigmoid colon are presented. Although this is an extremely rare syndrome, the true incidence is probably higher, as some cases will be misdiagnosed as gas gangrene unless careful clinical and postmortem examinations are performed. Only rapid recognition of the probable origin of the gas, coupled with aggressive, definitive therapy, can prevent the usually fatal course of this condition. In the absence of trauma to the chest or infection in a previously normal leg, subcutaneous emphysema of a limb should alert the physician to the possibility of a gastrointestinal perforation as a source of the gas. Perforations of the gastrointestinal tract into the subcutaneous tissue can occur anywhere from the neck to the lower extremities.

Aged↗