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PubMed2000

[The pathogenesis and surgical treatment of trophic ulcers of the lower extremities against a background of varicose veins].

The state of the musculo-venous pump of lower extremities was studied in 72 patients with trophic ulcers caused by varicose disease. The methods used were: phlebotonometry, phleboplethysmography, US dopplerography, distal ascending and retrograde-femoral, popliteal and talocrural phlebography. It was established that ectasia and/or valve incompetence of deep and muscle veins of the lower extremities with the formation of blood refluxes along the profound, communicating and superficial veins underlie the disturbances of venous hemodynamics. The authors propose a scheme of pathogenesis of the varicose disease trophic ulcers and recommend to perform pathogenetically justified operations.

Adult↗
PubMed1992

[Angioscopic prediction of late vascular patency after transluminal balloon angioplasty for arteriosclerotic obstructions of the artery of the lower extremities].

Arterial occlusion or stenosis of the lower extremity due to arteriosclerosis obliterans (ASO) was treated by transluminal balloon angioplasty (TBA). Angioscopic observation of the vascular lumen, performed immediately after TBA, provided five major findings: (1) abrasion of the intima, (2) irregularity of the lumen due to poor expansion, (3) laceration of the wall, (4) mural thrombus and (5) calcification. The degree of each of these abnormalities was scored with a 3-grade scale (0, 1 and 2), and scores for the 5 abnormalities were totaled in each patient. Analysis of the relationship between scores and postoperative vascular patency demonstrated that patients without vascular patency in the early (within 6 months) or late period (6 months or more) after the operation had higher total scores as compared to those in whom the vessel remained patient in the corresponding postoperative periods (p less than 0.01, p less than 0.05). Among others, patients with a total score over 5 showed markedly lower patency rates in the early period (10%) as well as late period (0%) after the operation (p less than 0.01). These results indicate the usefulness of post-TBA angioscopic observation of vascular lumen in predicting the long-term patency of the vessels operated on.

Aged↗
PubMed2004

Performance of epimysial stimulating electrodes in the lower extremities of individuals with spinal cord injury.

This study describes the performance of surgically-implanted epimysial stimulating electrodes in the muscles of the lower extremities for use in functional neuromuscular stimulation (FNS) systems for standing after spinal cord injury. A total of 86 epimysial electrodes were implanted in 13 volunteers with low tetraplegia or paraplegia receiving the Case Western Reserve University/Veteran Affairs (CWRU/VA)-implanted standing/transfer neuroprosthesis. The neuroprosthesis consisted of bilateral epimysial electrodes in the knee and hip extensors (vastus lateralis, gluteus maximus, and adductor magnus or semimembranosus) and intramuscular electrodes at the T12/L1 or L1/L2 spinal roots for trunk extension. Recruitment properties, stimulated knee and hip extension moments, standing performance, and mechanical integrity over time were measured for a period up to four years post-implantation. Stimulated thresholds were stable and recruitment was sufficient to generate joint moments adequate for standing, with up to 97% body weight supported by the legs. Four mechanical failures were observed, all in the posterior muscles of the thigh, leaving 95% of all electrodes operational at all followup intervals. Probability of 24-month survival is estimated to be 93% plateauing to a steady state of 90% at four years. These results indicate that epimysial designs are appropriate for long-term clinical use in the large muscles of the lower extremities with implanted motor system neuroprostheses.

Adult↗
PubMed2003

[Surgical treatment policy during motor rehabilitation of patients with a single ischemic lower extremity].

Altogether 218 patients suffering from obliterating arterial diseases with unilateral postamputation defects (PAD) of the lower extremities and 13 patients with bilateral PAD were examined. A study was made of the data pertaining to the age, motivation for rehabilitation, occupational and social status, degree of social independence, and severity of circulatory disorders. The surgical treatment and rehabilitation policy for patients with unilateral PAD of the lower extremities was defined taking into account the social factory.

Adult↗
PubMed1987

Anthropometric and computerized tomographic measurements of lower extremity lean body mass.

The loss of lean muscle mass is one of the hallmarks of protein-calorie malnutrition. Anthropometry is a standardized technique used to assess the response of muscle mass to nutrition therapy by quantifying the muscle and fat compartments. That technique does not accurately reflect actual limb composition, whereas computerized tomography does. Twenty lower extremities on randomly chosen men and women patients were evaluated by anthropometry and computerized tomography. Total area, muscle plus bone area, total volume, and muscle plus bone volume were correlated, using Heymsfield's equation and computerized tomography-generated areas. Anthropometrics overestimated total and muscle plus bone cross-sectional areas at almost every level. Anthropometry overestimated total area and total volume by 5% to 10% but overestimated muscle plus bone area and muscle plus bone volume by as much as 40%. Anthropometry, while easily performed and useful in large population groups for epidemiological studies, offers a poor assessment of lower extremity composition. On the other hand, computerized tomography is also easily performed and, while impractical for large population groups, does offer an accurate assessment of the lower extremity tissue compartments and is an instrument that might be used in research on lean muscle mass.

Adipose Tissue↗
PubMed1982

New trends in the management of lower extremity metastases.

Metastases involving the pelvis and lower extremities are common among the large population of cancer patients presently treated by hormonal or chemotherapy. The use of methylmethacrylate as an adjunct to conventional fracture fixation has improved markedly the results of pathological fracture management. Intertrochanteric femoral fractures should be internally fixed by a combination of a compression hip screw and methylmethacrylate. Subtrochanteric pathological fractures should be internally fixed using a Zickel nail and methylmethacrylate. Pathologic fractures of the femoral neck should be treated by replacement with a long-stem proximal femoral prosthesis. Fractures of the acetabulum must be analyzed as to the extent of medial wall or superior wall osteolysis. Prosthetic hip replacement is appropriate for these fractures but must be augmented by specialized fixation devices, depending on the extent of tumor osteolysis. The indications for prophylactic fixation of lytic lesions of the femur include: (1) a lesion 2.5 cm or larger in size; (2) a lesion destroying 50% or more of the femoral cortex; and (3) a lesion causing local pain with weight-bearing despite adequate radiotherapy. Local radiotherapy can be administered in an abbreviated interval and with much lower dosage than has been accepted conventionally, and the results with regard to tumor control, fracture healing, and cost to the patient will be much improved.

Acetabulum↗
PubMedDate not supplied

Lower extremity alignment in children with spina bifida.

Our purpose was to describe the natural history of lower extremity alignment in spina bifida patients. We prospectively evaluated all spina bifida patients seen at the Children's Hospital in Seattle since 1971 and at the Royal Children's Hospital in Melbourne since 1979. Serial examinations were performed on 434 patients, ranging from birth to 23 years of age. The lower limbs of children with spina bifida had neutral alignment at birth that gradually increased to 6 degrees of valgus--a pattern different from normal children. Valgus greater than 10 degrees was observed in only 6% of patients, and the degree of angular deformity was not affected by walking, the use of an above-knee orthosis, or neurosegmental level. An above-knee orthosis to prevent malalignment does not appear to be warranted and continued ambulation does not significantly contribute to lower extremity deformity.

Adolescent↗
PubMed2002

Randomised controlled trial of transcutaneous electrical muscle stimulation of the lower extremities in patients with chronic obstructive pulmonary disease.

BACKGROUND: Although exercise training improves exercise tolerance in most patients with chronic obstructive pulmonary disease (COPD), some patients with severe disease may not be able to tolerate exercise training due to incapacitating breathlessness. Transcutaneous electrical muscle stimulation (TCEMS) has been shown to improve muscle strength, muscle mass, and performance in paraplegics, patients with knee ligament injury, and patients with peripheral vascular disease. We hypothesised that TCEMS of the lower extremities can improve muscle strength and exercise tolerance in patients with moderate to severe COPD. METHODS: A randomised controlled trial of TCEMS of the lower extremities was performed in 18 medically stable patients of mean (SD) age 60.0 (1.5) years with a mean forced expiratory volume in 1 second (FEV(1)) of 1.03 (0.10) l (38% predicted) and residual volume/total lung capacity (RV/TLC) of 59 (2)%. Stimulation of the lower extremities was performed three times a week, 20 minutes each session, for six continuous weeks. Quadriceps and hamstring muscle strength, exercise capacity, and peak oxygen uptake were measured at baseline and after 6 weeks of stimulation. RESULTS: TCEMS improved both the quadriceps strength (by 39.0 (20.4)% v 9.0 (8.1)%, p=0.046) and hamstring muscle strength (by 33.9 (13.0)% v 2.9 (4.7)%, p=0.038) in the treated (n=9) and sham treated (n=9) groups, respectively. The improvement in muscle strength carried over to better performance in the shuttle walk test in the treated group (36.1% v 1.6% in the treated and sham groups respectively, p=0.007, Mann-Whitney U test). There was no significant change in lung function, peak workload, or peak oxygen consumption in either group. Muscle stimulation was well tolerated by the patients with no dropouts and better than 95% compliance with the protocol. CONCLUSIONS: TCEMS of peripheral muscles can be a useful adjunct to the comprehensive pulmonary rehabilitation of patients with COPD.

Double-Blind Method↗
PubMed2005

Lower extremity compartmental anatomy: clinical relevance to radiologists.

A thorough understanding of compartmental anatomy is necessary for the radiologist participating in the care of a patient with a lower extremity musculoskeletal malignancy. Localization of tumor to compartment of origin and identification of extracompartmental spread preoperatively are needed to correctly stage a tumor and determine the appropriate surgical management. An understanding of the locations of fascial boundaries, extracompartmental tissues, and neurovascular structures of the thigh and lower leg facilitates this diagnostic process. For the radiologist planning to biopsy a suspicious musculoskeletal lesion, consultation with the referring orthopaedic surgeon is recommended in order to jointly select an appropriate percutaneous biopsy approach. Adequate preprocedural planning ensures selection of an approach which prevents iatrogenic tumor spread beyond the compartment of origin, protects neurovascular structures, and allows complete resection of the biopsy tract and scar at the time of surgical resection without jeopardizing a potential limb-sparing procedure. Cross-sectional anatomic review and case examples demonstrate the importance of a detailed understanding of compartmental anatomy when approaching the patient with a lower extremity musculoskeletal tumor.

Adult↗
PubMed1989

Diagnosis of thrombosis of the deep veins of the lower extremities and pelvis and pulmonary thromboembolism using 99Tcm human serum albumin macroaggregates.

Radionuclide phlebography of the lower extremities, pelvis and pulmonary scintigraphy was performed using 99Tcm human serum albumin macroaggregates (MAA) in 90 patients aged 20 to 80 years, 13 (14%) in post-operative period and 77 (85%) with suspected deep venous thrombosis or pulmonary thromboembolism. The aim of the study was to evaluate the diagnosis of thrombosis of the deep veins of the lower extremities and pelvis and pulmonary thromboembolism using a refined technique. Deep venous thrombosis (DVT) was detected in all surgical patients and in 59 patients with systemic diseases. Perfusion scintigraphic defects characteristic of pulmonary thromboembolism (PE) were discovered in 12 of the surgical patients and in 38 of the medical patients. The results of the examinations have again shown that patients after surgery are exposed to high risks of DVT and pulmonary thromboembolism, while a relatively high percentage of normal findings in patients with suspected DVT have indicated unreliability of clinical symptoms and signs in diagnosing this disease.

Adolescent↗
PubMed2002

[Change in lymphatic circulation of lower extremities and prospects for lymphotrophic therapy in trophic ulcers of venous etiology].

Investigations of the lymphatic bed of lower extremities by the method of rentgen-contrast lymphography were performed in 64 patients with trophic ulcers of lower extremities and postthrombotic disease. The data obtained by lymphography allowed formation of a group of patients perspective for treatment by lymphotropic antibacterial therapy. The lymphotropic therapy using Gentamycin and Cefazolin resulted in a more rapid arresting of local inflammatory alterations and development of reparative processes in the trophic ulcer area and in normalization of the main clinico-laboratory parameters.

Adult↗
PubMed1992

Clinical and hemodynamic sequelae of lower-extremity, deep-vein thrombosis after total joint arthroplasty.

To determine the long-term sequelae of lower-extremity deep-vein thrombosis (DVT) after total hip or knee arthroplasty, 25 patients with venographically proven lower-extremity DVT were studied. A study group of 16 patients was available 14 months postoperatively. The results of clinical and hemodynamic evaluation were compared with those of a randomly selected group of patients who had negative venographic findings after total joint arthroplasty. There were no statistically significant differences in calf pain or swelling between the two groups. The presence of venous varicosities and pigmentation were unreliable indicators of the post-thrombotic syndrome. There were no statistically significant differences in vein patency, valve competency, and venous recovery times. There was a high incidence of hemodynamic abnormalities in the historically uninvolved extremities of patients with postoperative DVT.

Aged↗
PubMed2005

Functional outcome after treatment of lower-extremity nonunions.

BACKGROUND: The results for nonunion surgery usually have been judged in terms of bony union, time to union, infection rate, range of motion for the adjacent joints, and muscle strength. The goal of this study was to assess the improvement of patient-oriented physical and mental functional outcomes. METHODS: The functional status of 23 patients with nonunion of the lower extremity was assessed using the Short-Form Health Survey (SF-36) questionnaire. The SF-36 subscores were compared with preoperative values and with the average values for the U.S. population. RESULTS: Of the 23 patients, 21 healed. The functional status for nonunions of the lower extremity was greatly improved 1 year after operative intervention in this study. Nevertheless, the results show that it did not reach the level of the average U.S. population. CONCLUSION: The results of this study can be used to guide patients' expectations regarding the functional outcome of treatment for a nonunion of the lower extremity.

Femoral Fractures↗
PubMed1988

Assessment of captopril and nicardipine effects on chronic occlusive arterial disease of the lower extremity using Doppler ultrasound.

The effects of two potent vasodilating drugs, captopril (C) (25 mg tid), nicardipine (N) (20 mg tid), and placebo (P) were evaluated and compared, in 10 men (mean age of sixty-five years) with intermittent claudication from moderate to severe multilevel chronic occlusive arterial disease (COAD) of the lower extremity, by use of the Doppler ultrasonic method, at rest and after Carter's exercise test. All the examined subjects were normotensive, without diabetes or cardiopathy; all have been smokers. The eight-week total protocol consisted of an initial two-week placebo run-in period followed by two active drug phases and a two-week placebo phase, according to a double-blind, randomized, crossover design. At the end of each two-week period, ankle-arm index (AAI) and, following exercise, onset of lower extremity discomfort time (ODT), duration of exercise (ET), decrease of ankle systolic pressure after test (APD), and recovery time (RT) were determined. Moreover, at rest, just after exercise, and after recovery, simultaneous common femoral artery velocity waves were recorded and analyzed by a quantitative approach to detect the peripheral vasomotor adjustments. None of the patients required the withdrawal of the active treatments. Compared with P, C significantly reduced APD and RT, and N reduced RT and AAI; furthermore N caused a significant decrease in ODT, whereas C showed a trend, although not statistically significant, to increase ODT. Neither active therapy modified ET. These results suggest that C and N have different short-term effects on peripheral circulation in COAD. During exercise, C induces hemodynamic improvement in the ischemic lower extremity probably by inhibition of the sympathetic system and consequent reduction in collateral vessel vasoconstriction.

Arterial Occlusive Diseases↗
PubMed1994

Bilateral lower extremity evaluation of deep venous thrombosis with color flow and compression sonography.

Recognition of the accuracy of CUS for diagnosis of DVT has led to increased requests for bilateral lower extremity CUS studies. Compared to unilateral lower limb CUS studies, these examinations are often requested when the clinical suspicion of DVT is less strong. We undertook a 15 month prospective study of bilateral lower extremity CUS examinations to determine the diagnostic yield of positive studies and any correlation with clinical parameters. Eighty-six patients were studied; six patients (7%) had studies positive for acute DVT, and 78 patients (91%) had negative studies. Positive studies did not correlate with clinical parameters except erythema. Concurrently, 23% of unilateral lower limb sonographic studies were positive. Bilateral lower limb CUS is a low yield investigation, which may be indicated in view of the morbidity and mortality associated with DVT and pulmonary embolism.

Constriction↗
PubMed1992

Surveillance of lower extremity vein grafts.

Development of stenosis in lower extremity vein grafts or its anastomotic segments is responsible for most graft failures. While these lesions can be treated by minor procedures, timely identification may improve long-term graft patency. In this review, diagnostic methods that are currently applied for vein graft surveillance, criteria for stenosis and recommendations for intervention are discussed.

Ankle↗
PubMed1984

The gastrocnemius myocutaneous flap in lower-extremity injuries.

Coverage of full-thickness lower extremity wounds has been the bane of surgeons who care for patients with skin and soft-tissue losses. A prolonged period of convalescence may be avoided by immediate coverage with a gastrocnemius myocutaneous flap. Case reports demonstrating the successful use of medial and lateral gastrocnemius myocutaneous flaps are presented. Advantages are that large amounts of tissue can be moved in one step, shortening hospitalization, and most are reliable because of their excellent blood supply. Care must be taken to preserve deep fascia and to dissect the fascia from the Achilles tendon. Fluorescein examination is recommended.

Adult↗