SEARCH · PubMed Health

Results for “Lower Extremity”

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

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

At least 973 records · Page 54Linked to original sources

PubMed1991

[The peripheral hemodynamics in the inter-relapse period in erysipelatous inflammation of the lower extremities].

A study is presented of 89 patients with primary and recurrent erysipelas of the lower extremities. Ultrasound sonography, dopplerography and tetrapolar rheography were used in the examination. It was found that disorders of the peripheral circulation remain stable in the inter-recurrence period, are manifested by lymphovenous insufficiency, continuous state of pre-edema, trophic disorders of the lower extremities.

Adult↗

PubMed1998

Lower extremity sensory nerve conduction studies.

The need for routine recording of sensory potentials in the lower extremity was developed in efforts to better investigate peripheral neuropathy. Sensory nerve conduction studies (NCS) are more sensitive to many abnormalities in the peripheral nervous system than the motor NCS responses. This article provides a thorough review of sensory nerve conduction studies of the lower extremity, with special emphasis on electrodiagnostic issues.

Action Potentials↗

PubMed2000

Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retrospective comparison of helical CT venography and sonography. 2000 ARRS Executive Council Award I. American Roentgen Ray Society.

OBJECTIVE: In patients undergoing a combined CT angiographic and CT venographic protocol, the accuracy of helical CT venography for the detection of deep venous thrombosis was compared with that of lower extremity sonography. MATERIALS AND METHODS: Patients who had undergone a combined CT angiographic and CT venographic protocol and sonography of the lower extremities within 1 week were identified. The final reports were evaluated for the presence or absence of deep venous thrombosis. Statistical measures for the identification of deep venous thrombosis with helical CT venography were calculated. In each true-positive case, the location of the thrombus identified with both techniques was compared. All false-positive and false-negative cases were reviewed to identify the reasons for the discrepancies. RESULTS: Seventy-four patients were included. There were eight patients (11%) with true-positive findings, 61 patients (82%) with true-negative findings, four patients (5%) with false-positive findings, and one patient (1%) with a false-negative finding. When comparing helical CT venography with sonography for the detection of lower extremity deep venous thrombosis, the sensitivity measured 89%; specificity, 94%; positive predictive value, 67%; negative predictive value, 98%; and accuracy, 93%. Of the eight true-positive cases, five had sites of thrombus that were in agreement on both CT venography and sonography. Of the five discordant cases, four were false-positives and one was a false-negative. Possible explanations for all discrepancies were identified. CONCLUSION: Compared with sonography, CT venography had a 93% accuracy in identifying deep venous thrombosis. However, the positive predictive value of only 67% for CT venography suggests that sonography should be used to confirm the presence of isolated deep venous thrombosis before anticoagulation is initiated. In addition, interpretation of CT venography should be performed with knowledge of certain pitfalls.

Aged↗

PubMed2005

Microvascular free flap reconstruction in pediatric lower extremity trauma: a 10-year review.

BACKGROUND: Limb-threatening wounds of the adult distal lower extremity pose a challenge to the microvascular surgeon and are the subject of a sizable body of literature. The microsurgical management of these injuries in the pediatric population has some unique features but has not previously been the subject of a separate study. METHODS: A review was performed of all pediatric patients (<18 years of age) who received lower extremity free flaps for trauma at the University of Kentucky Medical Center between 1992 and 2002. Charts were reviewed and patients were contacted via telephone and given a standardized questionnaire. Logistic regression was used to identify factors predictive of worse outcome or complications. RESULTS: Twenty-six patients (28 flaps) met the selection criteria. The most common mechanism of injury was all-terrain vehicle accidents (n = 6), followed by motorcycle accidents, lawnmower injuries, and gunshot wounds. The latissimus dorsi muscle flap was chosen in 15 cases, with four other muscle flaps chosen for the remaining 13 cases. There were 12 Gustillo 3B or 3C fractures of the tibia. External fixation was used in 10 cases and internal fixation was used in two. Four patients had a bone gap greater than 4 cm. Three were successfully treated with distraction osteogenesis. The postoperative complication rate was 62 percent, with infection and partial skin graft loss being the most common complications. Three flaps were lost. Growth disturbances were seen in two patients. Patients receiving free flaps within 7 days after injury were seen to have a statistically significant lower rate of complications than those undergoing the procedure beyond the first week. Follow-up ranged from 2 to 11 years, with a mean follow-up of 4.5 years. All limbs were successfully salvaged, and all patients were ambulatory at the time of the survey. CONCLUSIONS: There is a significant role for the microvascular surgeon in the management of limb-threatening injuries in children. If the unique features of this population are taken into consideration, a high rate of limb salvage and good function can be expected.

Accidents, Traffic↗

PubMed2005

Age and gender effects on lower extremity kinematics of youth soccer players in a stop-jump task.

BACKGROUND: Gender differences in lower extremity motion patterns were previously identified as a possible risk factor for non-contact anterior cruciate ligament injuries in sports. HYPOTHESIS: Gender differences in lower extremity kinematics in the stop-jump task are functions of age for youth soccer players between 11 and 16 years of age. STUDY DESIGN: Descriptive laboratory study. METHODS: Three-dimensional videographic data were collected for 30 male and 30 female adolescent soccer players between 11 and 16 years of age performing a stop-jump task. The age effects on hip and knee joint angular motions were compared between genders using multiple regression analyses with dummy variables. RESULTS: Gender and age have significant interaction effects on standing height (P = .00), body mass (P = .00), knee flexion angle at initial foot contact with the ground (P = .00), maximum knee flexion angle (P = .00), knee valgus-varus angle (P = .00), knee valgus-varus motion (P = .00), and hip flexion angle at initial foot contact with the ground (P = .00). CONCLUSION: Youth female recreational soccer players have decreased knee and hip flexion angles at initial ground contact and decreased knee and hip flexion motions during the landing of the stop-jump task compared to those of their male counterparts. These gender differences in knee and hip flexion motion patterns of youth recreational soccer players occur after 12 years of age and increase with age before 16 years. CLINICAL RELEVANCE: The results of this study provide significant information for research on the prevention of noncontact anterior cruciate ligament injuries.

Adolescent↗

PubMed2004

Reduced functional performance in the lower extremity predicted radiographic knee osteoarthritis five years later.

BACKGROUND: Reduced quadriceps strength is an early finding in subjects with knee osteoarthritis, but it is not clear whether it is a cause or a consequence of knee osteoarthritis. OBJECTIVE: To determine whether reduced functional performance in the lower extremity predicts the incidence or progression of radiographic knee osteoarthritis. DESIGN: Prospective, epidemiological, population based cohort study. PATIENTS: 148 subjects (62 women), aged 35-54 (mean 44.8), with chronic knee pain from a population based cohort. MEASUREMENTS: Predictors analysed were age, sex, body mass index, baseline knee pain, and three tests of lower extremity functional performance: maximum number of one-leg rises from sitting, time spent walking 300 m, and timed standing on one leg. Weightbearing tibiofemoral knee radiographs were obtained at baseline and after 5 years (median 5.1, range 4.2-6.1), and classified according to Kellgren and Lawrence as no osteoarthritis (Kellgren and Lawrence = 0, n = 94) or prevalent osteoarthritis (Kellgren and Lawrence >/=1, n = 54). RESULTS: Fewer one-leg rises (median 17 v 25) predicted incident radiographic osteoarthritis five years later (OR 2.6, 95% CI 1.1 to 6.0). The association remained significant after controlling for age, sex, body mass index, and pain. No significant predictor of radiographic progression in the group with prevalent osteoarthritis was found. CONCLUSION: Reduced functional performance in the lower extremity predicted development of radiographic knee osteoarthritis 5 years later among people aged 35-55 with chronic knee pain and normal radiographs at baseline. These findings suggest that a test of one-leg rises may be useful, and interventions aimed at improving functional performance may be protective against development of knee osteoarthritis.

Adult↗

PubMed1988

Lower extremity vascular trauma: a comprehensive, aggressive approach.

During this study, 25 patients (26 limbs) incurred 37 vascular injuries to the lower extremity. The majority were young males injured by penetrating trauma (84%). There were 25 arterial and 12 venous injuries (two isolated). Sixteen patients had soft-tissue injuries, 12 had fractures, and six had peroneal nerve damage. Twenty-two arterial injuries were repaired, the majority (17) by saphenous vein bypass. Three tibial vessels were ligated. All major venous injuries were repaired. No synthetic material was used. Vascular repair took precedence in all but two cases. After repair, the vascular surgeon assisted with stabilization. Thirteen limbs required fasciotomy; nine required subsequent debridements and later plastic reconstruction. Limb salvage was 96%. More important, 21 patients can ambulate independently on the injured extremity (84%). These results support an aggressive approach to lower extremity vascular trauma with repair of all major arterial and venous injuries in conjunction with aggressive debridement and soft-tissue repair.

Adolescent↗

PubMed1989

[Plasmapheresis in the treatment of critical stages of ischemia in diabetic angiopathy of the lower extremities].

The authors have used gravitation plasmapheresis in the treatment of 26 patients with diabetic angiopathies of lower extremities. It was established that continuous gravitation plasmapheresis facilitated the immediate correction of most of the altered biochemical and coagulation parameters of blood, in patients with diabetes mellitus. The use of rheopolyglucinum is followed by stable central hemodynamics and stabilization of the general state of the patients during continuous plasmapheresis which allows to recommend rheopolyglucinum as the main plasma-substituting solution for fractionation of blood in patients with diabetic angiopathies. The gravitation plasmapheresis used in the treatment of critical degrees of ischemia in patients with diabetic angiopathies of lower extremities is thought by the authors to allow to preserve the extremity or to make the level of its amputation lower in most patients.

Aged↗

PubMed2007

Holmes-like tremor of the lower extremity following brainstem hemorrhage.

Holmes tremor is an arrhythmic, 2- to 5-Hz resting, postural, and kinetic upper extremity movement disorder that occurs weeks to months after acute mesencephalic pathology. We present a patient who developed tremor in three body parts postbrainstem hemorrhage with subsequent hypertrophic olivary degeneration and discuss the relevant clinical evolution. Our case is unique because in addition to expected upper extremity and cervical dystonic head tremors, the patient also developed a severe lower extremity movement disorder, which we believe to be a form of Holmes tremor. Tremor involving the lower extremity in this setting has not been previously reported.

Acute Disease↗

PubMed1993

Techniques of split-thickness skin grafting for lower extremity ulcerations.

OBJECTIVE: To discuss the role of skin grafts in the functional repair of lower extremity ulcerations. METHODS: The indications, types of skin grafts, and the methods of harvesting grafts are described. RESULTS: Detailed description of our method of bedside split-thickness skin grafting with both pinch and mesh grafts in hospitalized patients is given. We also discuss post-operative care and complications seen with skin grafting. CONCLUSION: Split-thickness skin grafting offers an important therapeutic option in the treatment of lower extremity ulcerations.

Humans↗

PubMed2005

[Latest cognition of treatment on deep vein thrombosis of lower extremity].

OBJECTIVE: To explore the effects of surgical procedure combined with the intravascular minimal invasive technique for the treatment of deep vein thrombosis (DVT) of lower extremity. METHODS: At the curse of disease from six hours to ninety days, one hundred and two patients with DVT including one hundred and three lower extremities had received surgical procedure and intravascular minimal invasive treatment. RESULTS: There were not procedure-related morbidities in 102 cases, and symptoms disappeared, all procedures were successful based on angiography. The detecting head for the intravascular ultrasound ablation was entered to inferior vena cava (IVC) in 74 cases (78%), Forgarty catheter was entered to IVC in 21 cases (21%), the stenosis in the confluence of the common iliac vein and IVC was dilated by sacculus rotundus catheter in 89 cases (88%), including 9 patients underwent percutaneous transluminal stenting. One hundred and two patients followed up for twenty months, follow-up by angiography showed no restenosis in 91 cases, restenosis in ilio-femoral vein in 1 cases, and thrombus recontouring in 4 cases, as well as 6 cases died caused by primary disease. CONCLUSION: Surgical procedure combined with the intravascular minimal invasive technique is a safe and effective therapeutic method for DVT.

Adult↗

PubMed1980

[Bilateral anterior tibial compartment syndrome following burn of lower extremities (author's transl)].

Authors report on a case of anterior tibial compartment syndrome following burn of lower extremities. They emphasise the difficulties in discovering the syndrome after burns. In cases of thermal injuries to lower extremities the possibility of the syndrome should be born in mind, and the necessary clinical investigations should be repeatedly performed. In case of positive diagnosis the only efficacious intervention for avoiding muscle necrosis, a wide fasciotomy of the crural fascia should be carried out.

Accidents, Occupational↗

PubMed1997

Lower extremity salvage after radical resection of malignant tumors in the groin and lower abdominal wall.

BACKGROUND: Resection of a large malignant tumor in the groin often leaves a substantial soft-tissue defect that makes wound closure difficult. Nevertheless, palliation and lower extremity salvage is frequently possible if the tumor is widely excised and the wound closed with well-vascularized tissue; however, few data are available on patients undergoing such procedures. STUDY DESIGN: We retrospectively examined our experience with limb salvage in 25 patients undergoing radical groin resection for metastatic or recurrent malignant tumors between April 1, 1991 and April 8, 1996. RESULTS: Defect size ranged from 15 to 735 cm2 (mean, 238.5 cm2). Tumor resection included part of the abdominal wall in 14 patients and the femoral vessels in 5 patients. Defects were most commonly repaired with a vertical rectus abdominis myocutaneous flap (56%). Mean hospital stay was 10.4 days, and mean followup was 15.5 months. Although the complication rate was 68%, the limb salvage rate was 100%, and normal ambulation was achieved in 88% of patients. The most frequent complications were chronic lymphedema (42%) and seroma (29%). There was one perioperative death (4%). CONCLUSIONS: Functional limb salvage after radical resection of the groin and lower abdominal wall is very successful, has an acceptable morbidity rate, does not prolong hospital stay, and contributes significantly to the patient's quality of life. Chronic lymphedema is a frequent complication after this treatment but can be managed successfully with conservative techniques.

Abdominal Muscles↗

PubMed2006

Complications of combined modality treatment of primary lower extremity soft-tissue sarcomas.

BACKGROUND: Correlations between various patient, tumor, and treatment characteristics and complications in patients undergoing combined modality treatment for primary lower extremity soft-tissue sarcomas were investigated. METHODS: Using the M. D. Anderson Radiation Oncology database, the records of the subset of patients treated with combined radiation and limb-sparing surgery for primary lower extremity soft-tissue sarcomas were retrospectively reviewed from the years 1960 to 2003. RESULTS: In all, 412 patients were identified. With a median follow-up of 9.3 years, there were a total of 113 (27%) acute wound complications and 41 (13% at 20 years) chronic radiation-related limb complications. Preoperative radiation and tumor sizes >5 cm were associated with an increased risk of acute wound complications (34% preoperative vs. 16% postoperative, P < .001; and 31% >5 cm vs. 17% < or =5 cm, P = .005). At 20 years the radiation-related complication rate was higher in patients with a groin or thigh tumor location (16% vs. 4% other; P = .008), prior acute wound complications (20% vs. 10% no surgical complication), and a radiation dose > or =60 grays (Gy) (18% vs. 9% for dose < 60 Gy; P = .04). Five fractures occurred, resulting in a crude overall fracture rate of 1.2%. CONCLUSIONS: Patients treated with preoperative radiation for larger tumors are more likely to have acute surgical wound complications. Acute wound complications followed by postoperative radiation are associated with chronic radiation-related limb problems, as are higher radiation dose and proximal tumor location. The fracture rate is so low that prophylactic fixation is not warranted.

Adolescent↗

PubMed2004

[Changes of regional hemodynamics and microcirculation in patients with obliterating atherosclerosis in stage of chronic critical ischemia of the lower extremities before and after of restorational operation performance].

The state of regional hemodynamics and microcirculation in 47 patients with obliterating atherosclerosis of the lower extremities vessels in stage of chronic critical ischemia before and after performance of restorational operation was studied up. Ileo-femoral shunting using synthetic prosthesis was done in 9 patients and femoro-popliteal shunting--in 38. In 46 patients, in whom before the operation, basing on the Doppler flowmetry data, the preservation of the microcirculation bed functional reserves was noted, after the operation the increase of the regional blood flow and microcirculation indexes was observed beginning from the first up to the fifth day. In one patient the insufficient functional reserve of the microcirculation bed was revealed, the realization of restorational operation turned out to be ineffective, the lower extremity amputation was performed. The dynamics of the microcirculation changes on the first, third, fifth and seventh postoperative days was shown.

Adult↗

PubMed2003

Methicillin-resistant Staphylococcus aureus infection does not adversely affect clinical outcome of lower extremity amputations.

Methicillin-resistant Staphylococcus aureus was first identified in isolation in Europe during the 1960's. Now widespread throughout the world, infection with this organism has emerged as a major problem in surgical practice. However, it remains debatable whether MRSA is more virulent than methicillin-susceptible strains. We have reviewed our most recent 4-year experience of lower extremity amputations to examine the influence of MRSA and non-MRSA infection on clinical outcome. During the past 4 years, 165 patients underwent lower extremity amputation for SVS/ISCVS category III acute limb ischemia and grades II and III chronic limb ischemia. Forty-five had documented MRSA infection, while 57 patients had documented infection with other flora. All patients were treated with appropriate sensitivity-specific antibiotics and aggressive wound care. No significant differences were noted in the level of primary amputation required by the two groups. Similarly, no significant differences were noted in either number of revisions or revision to higher-level amputation, time to heal, hospital length of stay, or 30-day morbidity and mortality rates. Our results demonstrate that MRSA infection does not adversely affect clinical outcome in patients undergoing lower extremity amputations. Appropriate treatment of infections with sensitivity-specific antibiotics, thorough wound debridement, and aggressive wound monitoring should be routine in all patients, regardless of bacterial flora.

Aged↗

PubMed2006

Should pre-operative troponin be a standard requirement in patients undergoing major lower extremity amputation?

OBJECTIVES: The objective of this study was to ascertain the benefit of routine pre-operative cardiac troponin I (cTnI) measurement in patients undergoing major lower extremity amputation for critical limb ischaemia. DESIGN: This was a prospective, blinded observational study. METHODS: All patients scheduled for lower extremity amputation, without evidence of unstable coronary artery disease were recruited prospectively over a period of 1 year. In addition to routine pre-operative evaluation, a blood sample was taken for measurement of serum cTnI. Post-operative screening was conducted for cardiac events with patients followed up to 6 weeks. RESULTS: Ten of the 44 patients included suffered a non-fatal myocardial infarction or died from a cardiac cause post-operatively. A rise in pre-operative cTnI was associated with a very poor outcome (two cardiac deaths and one post-operative myocardial infarction) and was the only significant predictor of post-operative cardiac events. CONCLUSION: Routine pre-operative cTnI measurement may be of use to identify patients at high risk of cardiac complication who would benefit from optimization of cardiac status or in whom surgery could be deferred.

Adult↗

PubMed1996

The use of arm vein as an alternative conduit for lower-extremity bypass.

A 4-year retrospective review of all cases utilizing arm vein for lower-extremity bypass was undertaken. Thirty-six cases were reviewed. The patients had portions of the basilic or cephalic arm veins, or both, harvested and used as a bypass for limb salvage. Composite grafts using a portion of arm vein were excluded. Information on demographics, risk factors, vascular surgical history, presenting signs and symptoms, surgical complications, patient comfort (arm vs. leg pain), and patency rates was studied. We found that all patients were initially seen with claudication or rest pain, that 22% had gangrenous changes, that there was a male dominance (75%), and that all had previous coronary artery bypass grafts or lower-extremity bypass. Limb salvage rate was 85% at 4 years. Primary patency rate was 71% at 4 years. We conclude that arm vein is a useful and durable conduit for bypass. Patient acceptance and comfort is high.

Aged↗