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At least 1,117 records · Page 62Linked to original sources
PubMed1996

Is hyperbaric oxygen a useful adjunct in the management of problem lower extremity wounds?

Hyperbaric oxygen (HBO) is currently being used in the treatment of nonhealing or "problem" wounds of the lower extremities. In an attempt to evaluate the efficacy of HBO in problem wounds, a retrospective study of the HBO experience at Orlando Regional Medical Center was conducted. From 1989 to 1994, fifty-four patients with nonhealing lower extremity wounds resulting from underlying peripheral vascular disease and/or diabetes mellitus were treated with HBO. Wounds were grouped into the following five categories: (1) diabetic ulcers (n = 17 [31%]); (2) arterial insufficiency (n = 8 [15%]); (3) gangrenous lesions (n = 6 [11%]); (4) nonhealing amputation stumps (n = 13 [24%]); and (5) nonhealing operative wounds (n = 10 [19%]). Each patient received an average of 30 treatments. Outcomes for all 54 patients treated with HBO in this study were dismal. None of the patients experienced complete healing, six (11%) showed some improvement, 43 (80%) showed no improvement, and in five cases (9%) results were inconclusive because these patients underwent concomitant revascularization or amputation. Thirty-eight of the 43 patients who showed no improvement (88%) ultimately required at least one surgical procedure to treat their wounds. Thirty-four patients (63%) developed complications, most commonly barotrauma to the ears, which occurred in 23 patients (43%). The average cost of 30 HBO treatments was $14,000 excluding daily inpatient charges. Based on the experience with HBO therapy at Orlando Regional Medical Center and the paucity of good supporting literature, it is difficult to justify such an expensive, ineffective complication-prone treatment modality for problem extremity wounds.

Amputation Stumps↗
PubMed2004

[Substitute valve at popliteal vein in treating deep venous valve insufficiency of lower extremities].

OBJECTIVE: To study the effectiveness of substitute valve at the popliteal vein in treatment of deep venous valve insufficiency of lower extremities. METHODS: From January 1996 to August 2002, 27 patients were diagnosed having deep venous valve insufficiency of lower extremities by color Doppler and radiography with an average disease course of 17.4 years. All 27 patients had varicose vein, 25 pain, 22 swelling, 25 pigmentation in ankle area and 19 chronic ulcerations. Two cases had been treated with great saphenous vein ligation and striping. Average vein pressure in resting position was (11.00 +/- 0.73) kPa, and the ambulatory venous pressure was (9.14 +/- 0.68) kPa. All patients were treated with substitute valve at the popliteal vein, and great saphenous vein ligation and stripping, some were treated with subfascial endoscopic perforating veins ablation. RESULTS: The average ambulatory venous pressure after operation was (5.94 +/- 0.82) kPa, were significantly different from that before operation(P < 0.01). The curative results were satisfactory, and all symptom and physical sign disappeared. After a mean follow-up period of 2-6 years, 21 cases had satisfactory results. CONCLUSION: Substitute valve at the popliteal vein have the value of widespread application.

Adult↗
PubMed1992

A preliminary experience with use of magnetic resonance angiography in assessment of failing lower extremity bypass grafts.

BACKGROUND: This study evaluates the ability of magnetic resonance angiography (MRA) to detect hemodynamic failure of lower extremity bypass grafts and questions whether conventional angiography is necessary for this purpose. METHODS: A prospective surveillance protocol with segmental plethysmography and color flow Doppler scanning has been used to detect hemodynamic graft failure in 110 patients with 120 lower extremity bypass grafts (90 vein, 30 polytetrafluoroethylene). Twenty (17%) bypass grafts fit the criteria for impending failure (drop in ankle/brachial index determination greater than or equal to 0.15; velocity less than 45 cm/sec; focal velocity two to three times mean graft flow). Intraarterial digital subtraction angiography and MRA studies were performed on all 20 grafts. RESULTS: Intraarterial digital subtraction angiograms showed graft occlusion in two grafts, severe native artery progression in three grafts, graft wall defects in six grafts, and anastomotic strictures in nine grafts. MRA results showed an exact correlation in 15 (75%) of 20 cases. False-positive tests occurred in four cases (20%), and false-negative tests occurred in one case (5%). Common reasons for interpretation error were metallic clips and field-of-view limitations. These problems are preventable. When MRA results were compared with color flow scan data, overall accuracy improved to 95%. CONCLUSIONS: Our studies suggest that MRA can be useful in graft surveillance and that the need for conventional angiography may be reduced in the future.

Anastomosis, Surgical↗
PubMed2005

Subintimal angioplasty in the management of critical lower-extremity ischemia: value in limb salvage.

The interest in and overall usage of endovascular procedures for the treatment of lower extremity ischemia continues to grow at a rapid pace. An increasing number of centers throughout the world are gaining experience with subintimal angioplasty. Promising results have been reported and the application of the technique has been expanded to include the iliac and crural arteries. The technique of subintimal angioplasty and several variations are discussed. Although primary patency rates compared with bypass are relatively low for patients undergoing subintimal angioplasty, limb salvage rates remain high. When a subintimal angioplasty fails, it frequently does so without the recurrence of symptoms, especially when a gangrenous lesion or ulcer has healed. Given the many advantages of this technique, which include reduced anesthesia requirements, a minimally invasive approach, and potential reductions in length of stay and cost, subintimal angioplasty will continue to have a role in the treatment of lower extremity ischemia. When applied judiciously, bypass options may be preserved. This does not, however, mean that the availability of this technique should be used as justification to lower the threshold for the treatment.

Angioplasty, Balloon↗
PubMed1999

Kinematic and qualitative analysis of lower-extremity movements in preterm infants with brain lesions.

BACKGROUND AND PURPOSE: The purposes of this study were to evaluate the effects of preterm birth, severe brain lesions, and postterm age on kicking movements of young infants and to compare the prognostic value of kinematic analysis of kicking with a qualitative assessment of infants' spontaneous movements. SUBJECTS: The subjects were 12 full-term infants without brain injury, 12 low-risk preterm infants without brain injury, and 11 preterm infants with severe brain lesions (periventricular leukomalacia). METHODS: Videotape recordings of each infant's motor behavior in a supine position were made at 1 and 3 months postterm age. Kicking frequency, temporal organization of the kick cycle, coordination among different joints, and interlimb coordination were measured. A qualitative assessment for lower-extremity movements and a Gestalt judgment of general movement quality according to Prechtl's method were made from the same videotape recordings. RESULTS: Kinematic analysis showed only mild differences among the 3 groups of infants. Qualitative assessment of the lower-extremity movements, however, showed that preterm infants with brain lesions, and particularly those who later were found to have cerebral palsy, consistently had fewer segmental movements of the foot and abnormal general movements at both ages. CONCLUSION AND DISCUSSION: The data suggest that the mechanisms responsible for kicking movements in newborns and young infants do not appear to be influenced by the extrauterine environment or by brain lesions, at least at the ages studied. Qualitative assessment of lower-extremity and general movements seems to be more appropriate for clinical purposes.

Biomechanical Phenomena↗
PubMed2005

Asymmetric lower extremity muscle activity on a gallium scan.

A 17-year-old girl with a history of Hodgkin disease showed increased gallium accumulation in the region of the right hip and reduced uptake in the muscles of the right lower extremity. Increased gallium accumulation in the right hip was attributed to avascular necrosis and the reduced gallium activity was attributed to disuse atrophy of the right lower extremity secondary to avascular necrosis (confirmed on the CT scan).

Adolescent↗
PubMed2006

Haemodynamic and clinical assessment of lateral marginal vein excision in patients with a predominantly venous malformation of the lower extremity.

OBJECTIVE: The purpose of the present study was to determine the effects of the surgical excision of lateral marginal veins (LMVs) in patients with a venous malformation (VM) affecting the lower extremity. METHODS: Preoperative and postoperative air plethysmography (APG), CEAP classification C scores, and venous clinical severity scores (VCSS) of the 25 VM patients who underwent LMV excision were compared. RESULTS: After LMV excision, venous haemodynamic parameters revealed significantly increased ejection fraction (EF, 33.2 S.D.18.5% vs. 39.7 S.D.21.2%, P=.020), and reduced venous volume (VV, 235.0 S.D.141.8 ml vs. 198.0 S.D.114.1 ml, P=.016) and residual venous fraction (RVF, 62.4 S.D. 26.6% vs. 56.9 S.D. 25.3%, P=.046). Clinical assessments of affected limbs revealed significantly improved mean CEAP C scores and VCSS (preoperative score, 4.4 S.D.1.7 vs. postoperative score 2.4 S.D.1.7, P=.026) after LMV excision versus preoperative data. CONCLUSION: Haemodynamic and clinical improvements were observed in patients with lower extremity VM after LMV excision.

Adolescent↗
PubMedDate not supplied

Software for determining lower extremity muscle-tendon kinematics and moment arm lengths during flexion/extension movements.

A computer program was developed to calculate lower extremity muscle-tendon (MT) kinematics and flexion/extension moment arm (MA) lengths for any subject performing movements constrained to occur in the sagittal plane. The program requires as input subject anthropometric and time series ankle, knee, and hip angle data. Using these data a lower extremity link-segment model is constructed for each time element. Muscle-tendon attachment data and a straight line muscle model are used to calculate MT and flexion/extension moment arm lengths. A finite difference technique is used to determine MT shortening velocity. The utility of this program is demonstrated by calculating MT kinematics and MA lengths for six muscles of a single subject both as a function of joint angles and during gait.

Adult↗
PubMedDate not supplied

Lipid and lipoprotein abnormalities in lower-extremity arteriosclerosis obliterans.

The prevalence of abnormal lipid and lipoprotein values was determined in 125 consecutive patients with lower-extremity arteriosclerosis obliterans, and the lipid and lipoprotein abnormalities in these patients were characterized. Only 13% of the patients had normal lipid/lipoprotein profiles. Forty-eight percent of patients had low levels of high-density lipoprotein cholesterol. High-density lipoprotein cholesterol values were lower in patients with concomitant coronary heart disease compared with those without heart disease. High-density lipoprotein cholesterol values were inversely related to weight, to triglyceride values, and to diabetes mellitus. Twenty-eight percent of patients had "desirable" total cholesterol levels (< 200 mg/dL), and 32% had low-density lipoprotein cholesterol values less than 130 mg/dL. Following National Cholesterol Education Program guidelines may be misleading in patients with documented lower-extremity atherosclerosis; therefore, complete lipid/lipoprotein profiles should be performed in these patients.

Aged↗
PubMedDate not supplied

Laser assisted balloon angioplasty in lower extremity occlusive disease.

Percutaneous transluminal laser angioplasty was used as an adjunct to balloon angioplasty in 36 occluded lower extremity artery segments in 32 patients. Indications for intervention were severe claudication in 25 (78.1%) and rest pain or gangrene in 7 (21.9%) patients. Neodymium-yttrium-aluminium-garnet laser heated probe was used to recanalize the iliac artery in 19, femoral artery in 9, both iliac and femoral arteries in 2, and popliteal and tibial arteries in 2 patients. Patients with successful laser recanalization underwent balloon angioplasty to further widen the lumen. Initial angiographic success was achieved in 28 (87.5%) patients with recanalization of 32 (88.9%) of 36 occlusions. Three patients had extra-axial catheter/guide wire passage and 1 patient had acute thrombosis of the recanalized artery which was successfully reperfused by thrombolytic therapy. At discharge the Doppler ankle-arm pressure index had increased from 0.46 +/- 0.15 to 0.84 +/- 0.12 (p < 0.001) in 29 patients with recanalized arteries. There was marked clinical improvement in these patients. On 6-47 (mean = 23.4 +/- 7.5) months follow up of 28 successfully treated patients 26 (92.9%) showed sustained clinical improvement. Thus laser assisted balloon angioplasty appears to be a safe and useful adjunct in recanalization of lower extremity occlusive disease.

Adult↗
PubMed1985

On physiological edema in man's lower extremity.

To examine whether the so-called musculovenous pump counteracts the development of interstitial edema in the lower extremities of man in the upright position, the volume changes in the calf which occurred during twenty minutes of rhythmic muscular exercise were measured in twenty-three subjects by impedance-plethysmography. The results were compared with the volume increase found during quiet relaxed standing for the same length of time. Contrary to the hypothesis, and edema-protective effect of the musculovenous pump could only be shown in about half the number of the subjects. In the others, muscular exercise led to increases in calf volume which were higher than those measured in the normal upright position. These results show that the calf muscle pump does not generally have a edema-protective effect but rather that muscle contractions also activate mechanisms which stimulate the extravasation of fluid. In a second test-series with twenty subjects, changes in calf volume were measured during the course of the day. In nearly all cases, the calf volume was greater in the evening than in the morning. It could be shown that the volume increases in the evening are caused by an increase in extravascular fluid. Compared to the increase in extravascular volume occurring during twenty minutes, in a normal upright position, the accumulation of extravascular fluid during the day is, however, remarkably low. Although it is still unknown how interstitial edema in man's lower extremities is prevented during the day, these findings lead to the hypothesis that the edema-preventing mechanisms, for instance the muscle-lymphpump, do not become maximally effective until a certain volume has accumulated in the interstitial space.

Adult↗
PubMed2004

Multidetector row CT angiography of the abdominal aorta and lower extremities in patients with peripheral arterial occlusive disease: diagnostic accuracy and interobserver agreement.

PURPOSE: To evaluate the accuracy of four channel multidetector row CT angiography (MDCTA) of the abdominal aorta and lower extremities arteries compared with digital subtraction angiography (DSA). MATERIALS AND METHODS: In our prospective study 42 patients with peripheral vascular occlusive disease (27 M, 15 F, age range 40-79 years) underwent MDCTA and DSA within 5 days. Images were blindly interpreted by two radiologists. Maximum intensity projections (MIP), multiplanar (MPR) reformations, three-dimensional (3D) reconstructions as well as axial images were available for analysis of MDCTA. DSA were analyzed on hard copies. RESULTS: Overall sensitivity and specificity of MDCTA were 93 and 95%, respectively, with positive and negative predictive values of 90 and 97%. Overall diagnostic accuracy was 94%. Normal arterial segments and 100% occlusions were correctly identified in all cases by MDCTA. Moderately stenotic segments interpretation in the calves appeared to be more controversial, but no statistical difference in accuracy of MDCTA in the infrapopliteal district arteries was noted with respect to accuracy in the more proximal arterial bed. Good to excellent interobserver and intraobserver agreement were observed, with k values greater than 0.80. CONCLUSIONS: MDCTA of the abdominal aorta and lower extremities is an accurate imaging modality in clinical practice when compared with DSA.

Adult↗
PubMed2006

Indications and outcomes of free tissue transfer to the lower extremity in children: review.

Thirty-four free tissue transfers for reconstruction of various tissue defects to the lower extremities were performed in 32 children over a 20-year period (1980 to 1999). Patient ages ranged from 3 to 19 years (mean: 10.8 years). Four donor sites were used: gracilis muscle, latissimus dorsi muscle, iliac crest osteocutaneous, and vascularized fibula. Fourteen patients had tissue defects related to trauma: nine received a gracilis flap; five received a latissimus dorsi flap. Five patients had tissue defects related to malignant tumor resection: three patients with Ewing's sarcoma received free fibulae; one patient with an osteogenic sarcoma received a gracilis flap, and another received an iliac crest osteocutaneous flap. Fifteen patients had congenital anomaly-related tissue defects: five with talipes equinovarus received gracilis flaps; ten with congenital tibial pseudoarthrosis received free fibulae. Vascular outcome was assessed based on the achievement of flap perfusion and post-surgical vascular revisions. Complete flap survival was achieved in 32 cases (85.3 percent); partial flap loss in three cases (8.82 percent); and complete flap loss in two cases (5.9 percent). Early revision surgery for the five partial or failed flaps consisted of debridement and split-thickness skin graft or flap removal. No patients required vascular take-backs or experienced vascular spasm. There were no systemic problems associated with the long and complex surgeries. Functional outcome was assessed based on ambulation, post-surgical complications, and whether the flap served its intended purpose. Ambulation was achieved in all cases. Functional surgical revisions were required in 32.4 percent of cases, and included scar revisions, flap debulking, bone grafts, and pin insertion. The most prevalent morbidity was persistent leg-length discrepancy (35.3 percent of cases). Only one successful flap was unable to meet its intended purpose, as a tibial pseudoarthrosis persisted, despite initial excision and a well-perfused reconstruction. Results show that free tissue transfer is safe and dependable for tissue defects of the lower extremity in children. From the authors' experience, free flaps used for the repair of defects from congenital tibial pseudoarthrosis have a high vascular success, but also require an extensive rehabilitation course, with only moderate functional success. There was no significant difference between flap surgeries performed immediately, intermediately, or late after trauma. These procedures have a wide range of indications and, despite the need for surgical revision and an extensive rehabilitation course, functional and vascular success can be achieved.

Adolescent↗
PubMed1991

Use of lower extremity deep veins as arterial substitutes: functional status of the donor leg.

Large veins (superior and inferior vena cava, portal vein) have been replaced successfully with lower extremity deep veins (superficial femoral-popliteal). Femoropopliteal bypass with superficial femoral-popliteal veins has been reported to give excellent long-term results. Nevertheless, this source of autogenous veins has not gained acceptance, in part because of the fear that deep vein removal will result in severe venous outflow restriction in the donor limb. To assess the clinical and functional effect of excising a deep vein, we compared a group of limbs in which the superficial femoral-popliteal vein was resected for use as a femoropopliteal bypass graft (25 legs) with a control group of 22 legs in which a saphenous vein or polytetrafluoroethylene graft was used for femoropopliteal bypass. No significant differences were found in age or sex distribution, time from surgery to the venous test, side of bypass, or the incidence of postoperative extremity swelling, either early or late. A mild but significant calf enlargement was observed in the deep vein group (p less than 0.05), and a pattern consistent with venous outflow obstruction was shown by plethysmography in 21 of 25 extremities (84%) in which a deep vein was used for femoropopliteal bypass but in only 11 of 22 (50%) control extremities (p less than 0.02). It is concluded that a lower extremity deep veins should be considered as a suitable replacement for a large vein or, when superficial vein is not available, as an infrainguinal arterial substitute.

Aged↗
PubMedDate not supplied

Lower extremity compartment syndrome from prolonged lithotomy position not masked by epidural bupivacaine and fentanyl.

BACKGROUND. Compartment syndrome involving the lower extremity is a rare complication of surgical procedures that incorporate the lithotomy position. In patients who are at risk for this complication, the safety of using postoperative epidural anesthesia with local anesthetics has been questioned because of the difficulty in recognizing compartment syndrome with ongoing epidural blockade. RESULTS. The authors describe a case of lower extremity compartment syndrome that developed after a radical cystectomy with the patient in the lithotomy position. Prompt recognition occurred despite the use of epidural anesthesia with bupivacaine and fentanyl.

Aged↗
PubMed1996

Long-term outcomes after lower extremity trauma.

Previous studies have shown that over one-quarter of patients who were working before a severe lower extremity fracture had not returned to work by 12 months after injury. Disabilities also persisted in household management, recreation, and social interaction. The objective of this study was to determine whether recovery extended beyond 12 months. Three hundred nineteen patients who were previously working and were treated at three level I trauma centers for a severe lower extremity fracture were prospectively followed at 3, 6, and 12 months after injury. Patients were queried at each follow-up about their work status and completed the Sickness Impact Profile (SIP) at 6 and 12 months. The SIP is a widely used and well validated measure of general health status; it was used in this study to measure functional recovery across several domains of daily living. Patients who had not recovered by 12 months (i.e., 204 who were not working, working with limitations, or had limitations in performing other daily activities as measured by elevated scores on the SIP) were contacted again at 30 months and asked to complete an interview and the SIP. At 30 months, an estimated 82% of the study patients had returned to work (compared to 72% at 12 months). SIP scores improved only slightly from 6.4 at 12 months to 5.7 at 30 months. At 30 months, 64% of the patients had no disability (SIP scores less than 4), 17% had mild disability (SIP scores of 4 to 9), 12% had moderate disability (SIP scores of 10 to 19), and 7% had severe disability (SIP scores of 20 or higher). Although the majority of patients with persistent disabilities at 30 months had residual physical impairments at 12 months, the extent of impairment did not fully explain why some people had and had not recovered at 30 months after injury. The results confirm those of other studies that conclude that overall, outcomes after serious trauma are good when appropriate trauma and rehabilitation care are rendered. However, a minority of patients still report limitations at 30 months after injury, with one-fifth not returning to work.

Adolescent↗
PubMed1989

[Surgical tactics in acute thrombophlebitis of the superficial veins of the lower extremities].

A 20-years experience of the clinic with substantiation of the surgeon's tactics for acute thrombophlebitis of superficial veins of lower extremities is presented. A conclusion is made that radical operations for acute thrombophlebitis of superficial veins of lower extremities without special preoperative preparation prevent further spread of the thrombotic process, development of thromboembolism of the pulmonary artery, make the duration of treatment at the hospital 2 times shorter and contributes to quicker recovery of working ability.

Acute Disease↗