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 1,045 records · Page 58Linked to original sources

PubMed1995

[Reconstruction of the distal lower extremity defects with distal pedicled fasciocutaneous flaps].

Soft-tissue coverage of defects in the distal lower extremity has its limitations because of minimal blood supply to the skin and the thin muscle layer. Split-thickness skin grafting is impossible in cases of defects of tendons or bones. Local flaps are applicable only for smaller defects. With the cross-leg flaps, it is necessary to immobilize the patient for a long time. Special microsurgical technique and knowledge are needed for the free flaps. Fasciocutaneous flaps of the lower extremity after Donski and Fodgestam are simpler and safer than the other methods. From 1987 to 1992, this method was successfully used on 15 patients in the Department of Plastic Surgery of Sişli Etfal Hospital in Istanbul. In the two-thirds of those patients, accidents were the cause of the defects. The advantages of this methods are: simpler technique, larger flap-surface, earlier mobilisation of patients, better adaptation of the flap to its neighbourhood regarding colour and thickness.

Adolescent↗

PubMed2002

[Prevention of lower extremity injuries in handball: initial results of the handball injuries prevention programme].

INTRODUCTION: Injuries of the lower extremity lead to disability to perform sports and may cause degenerative changes of the joints. Hence, we developed a specific injury prevention programme for European team handball and tested this programme in a prospective study. METHOD: One handball team (2 nd division) performed a proprioceptive and neuromuscular training during the preseason. The programme consists of 3 different components: 1. Information on injury mechanisms, 2. Proprioceptive training, and 3. Jump training. During the season the exercises have been continued with lower intensity. Another handball team which performed no injury prevention training served as control. Injuries were recorded in a prospective manner. In a retrospective arm of the study we compared the frequency of severe injuries of the training season with the frequency of severe injuries during the last season. RESULTS: In comparison to the last year no player from the prevention training team suffered a severe injury of the ankle or the knee. During the last season three athletes ruptured their anterior cruciate ligament. In the untrained control group one athlete suffered from an ACL rupture and one athlete had a rupture of the lateral ankle ligaments. These findings have no statistical significance because of the low number of individuals investigated. However, the incidence of light and medium injuries was significantly lower in the injury prevention group. CONCLUSIONS: This study demonstrates that proprioceptive and neuromuscular training is appropriate for the prevention of lower extremity injuries. Prevention strategies should be included in routine handball training programmes.

Adult↗

PubMed1990

Analysis of 1084 consecutive lower extremities involved with acute venous thrombosis diagnosed by duplex scanning.

A retrospective analysis of 8658 consecutive lower extremity venous duplex scans performed between the years 1982 to 1988 revealed 953 patients with involvement of 1084 extremities with acute deep or superficial thrombi. Records of patients with acute thrombi were then evaluated for the incidence, location, and patterns of distribution. There were 485 women (50.9%) and 468 men (49.1%), with a mean age of 62.9 +/- 16.7 years and 58.8 +/- 15.2 years, respectively. There were 371 right-sided thrombi (180 women and 191 men), 451 left-sided thrombi (235 women and 216 men), and 131 (70 women and 61 men) patients with thrombi in both lower extremities. Women were found to be uniformly older, and the left leg was found to be involved more frequently (p less than 0.05). The overall distribution of the 3169 veins involved with acute thrombi in decreasing order were: popliteal, 16.1%; superficial femoral, 15.0%; posterior tibial, 13.4%; common femoral, 13.2%; greater saphenous, 9.9%; soleal, 9.1%; peroneal, 7.2%; deep femoral, 6.6%; lesser saphenous, 5.7%; anterior tibial, 2.0%; varicosities, 1.6%; and perforating, 0.3%. A different rank order was found in analysis of single thrombus patterns as follows: greater saphenous, 27.5%; soleal, 20.1%; lesser saphenous, 13.4%; varicosities, 8.8%; popliteal, 8.1%; posterior tibial, 9.1%; common femoral, 3.5%; superficial femoral, 4.9%; peroneal, 2.8%; deep femoral, 1.0%; anterior tibial, 0.3%; and perforating, 0.3%. In patients with multiple and bilateral thrombi there was a large number of unique patterns of thrombosis. Locations, patterns, and frequency of acute venous thrombi vary with age, sex, and leg involved. Patterns and statistical analyses of pertinent observations were performed.

Acute Disease↗

PubMed1998

Ganglion cysts of the lower extremity: an analysis of 54 cases and review of the literature.

This article reviews 54 consecutive patients with lower extremity ganglion cysts that were surgically removed and histologically confirmed at the Hospital for Special Surgery from 1981 to 1993. Lower extremity ganglia were more common among women. Patients' ages ranged from 13 to 80 years, with the fifth and sixth decades being the most common. Size of the cysts ranged from 3 cm to 10 cm (average: 2.9 cm). Thirty-six (67%) patients had ganglion cysts of the foot and ankle, and 18 (33%) patients had ganglion cysts of the knee area. Four (7%) patients had intraosseous ganglia located in the proximal tibia, patella, and the first metatarsal head. Follow-up data of 40 (74%) patients at an average of 5.9 years (range: 1 to 12.5 years) were obtained. Satisfaction was reported by 83% of patients. Recurrence was seen in 10% of patients, and a report of no or mild pain was given by 86% of the group. Patients who underwent revision ganglion excision had inferior results. Only 25% reported satisfaction and 50% reported no or mild pain. Patients who underwent curettage of an intraosseous ganglion appeared to have superior results. All patients reported satisfaction and no or mild pain. The performance of a concomitant surgical procedure, the anatomic region of the ganglion, or type of postoperative immobilization did not appear to affect the outcome.

Adolescent↗

PubMed2006

Prosthetic intervention effects on activity of lower-extremity amputees.

OBJECTIVE: To investigate the effect of prosthetic interventions on the functional mobility of lower-extremity amputees. DESIGN: Crossover with repeated measures. SETTING: Household and community environment. PARTICIPANTS: Twelve transtibial and 5 transfemoral amputees. INTERVENTIONS: For transtibial amputees, shock-absorbing versus rigid pylons. For transfemoral amputees, C-Leg versus Mauch SNS knees. MAIN OUTCOME MEASURES: Daily activity level (step count) and duration (minutes of activity). RESULTS: Pylon type had no effect on the daily activity level or duration of transtibial amputees. Knee type had no effect on the daily activity level or duration of transfemoral amputees. Transtibial amputees were more active on weekdays (3079+/-1515 steps/d) than weekends (2386+/-1225 steps/d) (P=.007). In general, lower-extremity amputees perform numerous short-duration bouts of activity (1-2 min) consisting of fewer than 17 steps/min, but activities of more than 15 minutes in duration were relatively rare (<1 per day). CONCLUSIONS: Intervention had no effect on amputee activity level and duration. Higher weekday activity levels of transtibial amputees suggest their vocational activities are more demanding than recreational activities. The fitting, alignment, and design of prosthetic components should be optimized for 1 to 2 minute bouts of activity consisting of only a few dozen steps.

Adult↗

PubMed1977

[Age and features of atherosclerosis and primary calcinosis of the tunica media of the major arteries of the pelvis and lower extremities (morphometric study)].

Morphometrical studies were done on 432 longitudinally dissected arteries of the pelvis and lower extremities from 216 fatalities in the age of over 40 years (151 men, 65 women). The atherosclerotic process was found to develop and progress most intensively in the common iliac and popliteal arteries, the third place in the average area of the intima involvement belonging to the femoral artery, while the external iliac and posterior tibial arteries were less affected. In one third of the arteries examined the primary calcinosis of tunica media was found. An inverse relationship between the area of atherosclerotic changes in the intima and the area of primary calcinosis in the media of the vessels was demonstrated. In the lower extremities arteries the fibrinoplastic type of morphogenesis of atherosclerosis was predominant and "complicated" lesions were relatively rare. These data may be the basis for specification of the morphological diagnosis of atherosclerosis and for selection of rational surgical treatment.

Adult↗

PubMedDate not supplied

The MR appearance of volume overload in the lower extremities.

PURPOSE: Our goal was to describe the MR findings of volume overload (VO) in the lower extremities. METHOD: Fifteen individuals were studied, including eight healthy controls and seven patients with VO (four cardiac, three renal). MR evaluation included various SE techniques. Edema detection, localization, and symmetry were assessed subjectively. Relaxation time estimates were also made of the subcutaneous tissue, marrow, and three muscles. RESULTS: Subcutaneous tissue was markedly edematous in seven of seven patients and asymmetric in four of seven, whereas marrow was normal in all patients. Muscle edema was mild and asymmetric in six and two of seven patients, respectively. Perifascial fluid collections were identified in six of seven patients. CONCLUSION: Subcutaneous tissue edema is the dominant feature of VO in the lower extremities. Perifascial fluid is common but does not necessarily distribute symmetrically. Muscle edema is relatively mild. These findings should aid in identifying VO as the potential cause of swelling in patients with swollen legs.

Adult↗

PubMed1999

The effect of increasing blood pressure with dopamine on systemic, splanchnic, and lower extremity hemodynamics in patients with acute liver failure.

BACKGROUND: Arterial hypotension occurs frequently in patients with acute liver failure (ALF). Treatment with epinephrine and norepinephrine in patients with ALF has been associated with a decrease in whole-body (systemic) oxygen consumption. We aimed to investigate the effect of increasing blood pressure with dopamine on whole-body (systemic), splanchnic, and lower extremity hemodynamics and oxygen consumption in patients with acute liver failure and hepatic encephalopathy grade III or IV. METHODS: In seven patients with ALF cardiac output (CO) was measured with the thermodilution technique, and hepatic blood flow (HBF) was estimated with infusion of sorbitol as test compound, liver vein catheterization, and calculations on the basis of Fick's principle. Lower-extremity blood flow was measured with strain-gauge plethysmography. RESULTS: During infusion of dopamine (5 +/- 2 microg kg(-1) min(-1)) mean arterial pressure (MAP) increased from 68 +/- 5 to 85 +/- 8 mmHg. CO increased from 6.8 +/- 0.8 to 9.0 +/- 2.4 l/min (P < 0.05), systemic oxygen delivery from 45 +/- 7 to 63 +/- 19 mmol/min (P < 0.05), systemic oxygen consumption from 10.2 +/- 2.0 to 11.5 +/- 3.3 mmol/min (NS). HBF increased from 2.2 +/- 0.7 to 2.7 +/- 1.0 l/ min (P < 0.05), splanchnic oxygen delivery from 14.4 +/- 5.3 to 18.5 +/- 7.2 mmol/min (P < 0.01), and splanchnic oxygen consumption decreased from 3.9 +/- 1.1 to 2.9 +/- 0.6 mmol/min (P < 0.05). No significant changes in lower extremity flow and oxygenation variables were found. CONCLUSIONS: The use of dopamine in patients with ALF to increase MAP was associated with increases in systemic and splanchnic oxygen delivery. A concomitant decrease in splanchnic oxygen consumption was observed.

Acute Disease↗

PubMed1987

Deep venous thrombosis of the lower extremity: US evaluation.

The sensitivity of duplex ultrasonography (US) for detecting deep venous thrombosis of the lower extremity was compared with that of venography in a prospective study of 54 patients. Doppler analysis of the common femoral vein and US imaging of the deep venous system from the common femoral vein to the popliteal vein was performed. Common femoral vein response to the Valsalva maneuver was recorded. Sonographically visible thrombi and abnormal vein compressibility were 91% sensitive for the common femoral vein, and 94% sensitive for the superficial femoral or popliteal veins, with no false-positive examinations. Abnormal Doppler flow and abnormal response of the common femoral vein to the Valsalva maneuver enabled thrombi to be detected only in the common femoral and iliac veins. Combined data allowed accurate diagnoses in all patients with deep venous thrombosis proximal to the deep calf veins. US should be the screening examination of choice for evaluating patients with suspected lower extremity deep venous thrombosis.

Adult↗

PubMed1993

Experimental volume replacement through lower extremity veins.

Hypovolemic shock was produced in anesthetized pigs by removal of 40% of blood volume over 10 minutes. Following blood loss, the inferior vena cava (IVC) was occluded below the renal veins to simulate the hemodynamics of emergency surgical treatment. Control animals were not treated. Experimental animals received intravenous lactated Ringer's solution equal to three times the blood loss given through catheters either in the IVC or the superior vena cava (SVC) to determine if lower extremity access would be efficacious in this model. To define the path taken by the resuscitation fluids, an additional group of animals received technetium-99m-labelled crystalloid through lower extremity catheters with continuous recording of isotope counts in the IVC and right atrium. The treated animals in all experimental groups had significant improvements in mean arterial pressure, cardiac output, and pH compared with controls. There was no significant difference in hemodynamic response in animals receiving volume replacement through the IVC compared with the SVC. When fluid was infused below a clamped IVC, the arrival of isotope in the right atrium was delayed only 1.5 seconds. We conclude that in a model simulating emergency control of potentially lethal hemorrhage, the beneficial effects of fluid resuscitation are unrelated to the site of venous access. Lower extremity veins provide a valuable site for volume replacement even with IVC occlusion. These findings should have direct application to resuscitation and surgical care of seriously injured patients.

Animals↗

PubMed1999

[Endovascular and vascular surgical reconstruction in the treatment of ischemia of the lower extremities].

The authors analyze the importance of PTA, EAE and vascular reconstructive surgery of obliterative atherosclerosis on lower extremities. According to their own experiences the advantages and also negatives of particular treatment methods are discussed and studied group of patients is presented. On the basis of the achieved results the authors suppose that ischemic syndrome of lower extremities is attractive not only for vascular surgeon, but also for interventional radiologist. When properly indicated, particular treatment modalities can have substantiation in the treatment of obliterative atherosclerosis. (Tab. 9, Fig. 5, Ref. 29.)

Angioplasty, Balloon↗

PubMed1991

Randomized double-blind trial of midazolam/placebo and midazolam/fentanyl for sedation and analgesia in lower-extremity angiography.

Safety and efficacy of two drug regimens used for sedation and analgesia during lower-extremity angiography were studied. Midazolam (loading dose 14.5 micrograms/kg; maintenance dose, 7.2 micrograms/kg) with or without fentanyl (loading dose, 0.725 micrograms/kg; maintenance dose, 0.362 micrograms/kg) was administered in a blind fashion as an IV bolus to 50 patients. Hemodynamic responses were monitored, and a standardized questionnaire was given to the patient before, immediately after, and 8-24 hr after the procedure. Physicians also were asked questions after the procedure. Heart rate and oxygen saturation were not significantly different before and 2 min after administration or between groups. A small but significant decrease in blood pressure occurred 2 min after the loading dose was given in both groups. Both drug regimens had statistically significant anxiolytic effects; however, anxiolytic effects were superior in the midazolam/fentanyl group (p less than .02). Patients rated the overall effectiveness of anesthesia with midazolam/fentanyl as superior (p less than .02). Analysis of physicians' judgments of the effectiveness of sedation and analgesia showed a statistically significant advantage for the midazolam/fentanyl group (p less than .01). We conclude that midazolam/fentanyl appears to be as safe as and more efficacious than midazolam alone for sedation and analgesia during lower-extremity angiography.

Angiography↗

PubMed1998

[Effect of the continuous epidural buprenorphine injection in patients after lower extremity arthroplasty].

We studied the analgesic effects of continuous epidural injection of buprenorphine in patients after lower extremity arthroplasty. In these patients anesthesia was maintained only with lumbar epidural anesthesia with 2% mepivacaine. We employed a balloon type continuous infuser (DIB Catheter, 40 ml.day-1) for postoperative analgesia for twenty-four hours. The patients were classified into three groups according to the method of buprenorphine injection and the content of DIB Catheter. First group (group A ; N = 37) received buprenorphine (0.2 mg) with 0.25% bupivacaine (40 ml) for twenty-four hours. Next group (group B ; N = 27) received bolus injection of buprenorphine (0.2 mg) for the first additional epidural injection of local anesthetic and received continuous injection of buprenorphine (0.2 mg) with 0.25% bupivacaine (40 ml) for twenty-four hours. The last group (Group C ; N = 40) also received bolus injection of buprenorphine as in group B, but received continuous buprenorphine infusion with normal saline instead of local anesthetics. The analgesic effect was determined by the postoperative usage of other analgesics (NSAID or pentazocine) by request of patients. In twenty-four hours, the numbers of patients who did not request other analgesics were 6 (Group A. 16%), 9 (Group B. 33%) and 19 (Group C. 48%), respectively. In Group A, 18 patients requested analgesics, but only 8 patients requested in Group C. It was effective for the postoperative analgesia to use the continuous epidural injection with DIB Catheter for patients after lower extremity arthroplasty. It was necessary to give a bolus injection of buprenorphine before the end of surgery for sufficient analgesia, but it was not necessary to add local anesthetics in the content of DIB Catheter.

Adult↗

PubMed2005

Early experience in the application of distal protection devices in treatment of peripheral vascular disease of the lower extremities.

The objectives of this study were to reduce the risk of showering distal vessels with thromboemboli created during percutaneous interventions of the arteries in the lower extremities. Distal protection devices have been used in coronary and carotid interventions. Hence, using similar techniques, these filters and occlusion balloons were advanced past the targeted lesions and distally into femoral and popliteal arteries. Once opened, these devices allowed standard angioplasty and stent placement and captured the dislodged thromboemboli. Five cases were performed with the distal protection devices. One case used the distal occlusion balloon and four with the filter system. All five passed the lesion and were deployed. All five devices were retrieved without incident and were retrieved with substantial debris. There were no adverse events. The use of distal protection to treat high-risk or unstable lesions in the lower extremities shows great promise. Further case will be needed to evaluate the device for feasibility and safety.

Aged↗

PubMedDate not supplied

[Etiopathogenesis of varicosities of the lower extremities].

This study was performed to validate the importance of heredity in the development of varicosities of lower extremities and to establish the correlation between the sclerotherapy and the pathological changes on the perforating and deep veins. The aim was also to determine the share of trauma in the development of insufficiency of the perforating veins of the lower leg. The author studied 484 hospitalized patients. By application of modern diagnostic procedures, pathological changes in the system of veins were discovered and located and varicose veins were classified into five groups. A positive family history was found in 64.5% of the treated patients. The relationship between the heredity and the pathological changes in the venous system has been given in tables. Of all the treated patients, 12.2% underwent sclerotherapy earlier. Among these patients, 50.8% showed pathological changes on the perforating veins; in 22% pathological changes, however, were found on the deep veins as well. One hundred and thirty-five patients were operated on due to insufficiency of the communicating veins. Of those patients, 21.4% stated a positive trauma in their past history, while 14.1% showed some degenerative changes in the fatty-connective tissue of the deep fascia of leg. In conclusion these results tissue of the deep fascia of leg. In conclusion these results confirm the hypothesis that trauma of lower extremities may lead to insufficiency of the communicating veins.

Humans↗

PubMed2003

Validation of an angiographic method for estimating resting blood flow to distal tissue beds in the lower extremities.

PURPOSE: The authors propose to validate an angiographic scoring system that estimates the resting blood flow in the lower extremities in patients with peripheral vascular disease (PVD). MATERIALS AND METHODS: Twenty patients with PVD underwent lower-extremity angiography. For each patient, three readers used the proposed scheme to estimate flow within 23 separate vessel segments from the infrarenal aorta to the pedal vessels. Each reviewer scored each angiogram twice. The scheme includes not only an assessment of stenoses and occlusions but also corrections for collaterals. Flow reductions to muscles in the thigh and calf were calculated by multiplying the estimated flows in the series of vessels that lead to these regions. The consistency of the scoring scheme was assessed by calculating Pearson correlation coefficients for intra- and interobserver variability. The scoring scheme was also used to estimate the ankle-brachial index (ABI) and these estimates were compared to the known ABIs. RESULTS: Overall, the scoring scheme demonstrated very good intra- and interobserver agreement. Correlation coefficients were typically greater than 0.9. In general, the correlation coefficients for proximal vessels were higher than those for distal vessels. The scoring scheme also had minimal intra- and interobserver variability for estimated flows to distal tissue beds. Agreement was better for a series of vessels than it was for individual segments. The estimated ABIs correlated well with the measured ABIs in all but two cases. These outliers include one case in which the measured ABI was >1 as a result of noncompressible vessels and the estimated ABI correctly reflected PVD. In the second case, the ABI was near normal because of a patent peroneal artery and our estimated ABI was abnormally low because our estimation method failed to factor in the peroneal artery. CONCLUSIONS: The proposed angiography scoring system reproducibly estimated flow reductions to distal tissue beds. The authors plan to use this system as a research tool for evaluating new methods of assessing and treating PVD.

Adult↗

PubMed2003

Late gestational intrauterine myelomeningocele repair does not improve lower extremity function.

OBJECTIVE: To determine whether intrauterine myelomeningocele repair performed at between 20 and 28 weeks gestation improves lower extremity function (LEF). METHODS: Thirty-seven consecutive patients who had undergone intrauterine repair of their myelomeningocele at Vanderbilt University Medical Center had their lower extremity function and radiographic level (first defective vertebral level) compared to these same parameters in 40 controls who had undergone traditional postgestational repair of their myelomeningocele at the Children's Hospital in Birmingham, Ala., USA. RESULTS: Of all 77 patients (controls and study group), 13 had a LEF that matched their radiographic level, 27 had a LEF that was rostral to their radiographic level, and 37 had a LEF that was caudal to their radiographic level. Further stratification revealed that for the intrauterine repaired myelomeningoceles, 11% had no difference between LEF and radiographic level, 43% had a LEF that was rostral to their radiographic level, and 46% had a LEF that was caudal to their radiographic level. For those closed in a traditional manner, LEF matched their radiographic level, was rostral to their radiographic level, and was caudal to their radiographic level in 22.5%, 27.5%, and 50% respectively. However, the overall mean differences between institutions produced a p-value of 0.2026 (paired t-test). CONCLUSIONS: Although the current timing of intrauterine myelomeningocele repair has been found to lessen the degree of herniation of the rhombencephalon and reduce the incidence of shunt-dependent hydrocephalus, it does not statistically improve LEF. Parents should be advised of these findings prior to surgical intervention so as to focus their expectations.

Female↗

PubMed1997

Pediatric lower extremity splinting and bracing techniques.

Pediatric splinting and bracing techniques may be effectively used in the treatment of lower extremity rotational deformities. Early diagnosis coupled with the timely implementation of these techniques allows the practitioner to enhance normal development of the pediatric patient's lower extremities.

Adolescent↗