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PubMed1994

Accuracy of correction of complex lower-extremity deformities by the Ilizarov method.

Gradual mechanical distraction with the Ilizarov external fixator was used on 28 limbs in 23 patients to correct complex lower-extremity deformities of diverse causes. To determine the accuracy of realignment and deformity correction, the charts and radiographs were reviewed retrospectively. Preoperative long-standing anteroposterior radiographs of the entire lower extremity were compared with those obtained at the most recent follow-up visit. The parameters used to assess accuracy of correction were joint alignment and joint orientation. Alignment was determined by mechanical axis deviation (MAD) and mechanical tibiofemoral angle (mTFA). The preoperative MAD averaged 48 mm and the postoperative MAD 8.6 mm. The preoperative mTFA averaged 16 degrees and the postoperative mTFA 3 degrees. The result of deformity correction from early cases was compared with the result obtained from recent cases. Residual MAD averaged 13.2 mm in the early group and 6.4 mm in the recent group. Residual mTFA averaged 4.7 degrees in the early group and 2.2 degrees in the recent group. Gradual correction by dynamic external fixation can restore alignment and correct complex deformities with great accuracy. These results suggest the accuracy of correction increases with surgical experience.

Adolescent↗

PubMed1998

Is routine preoperative aortoiliac arteriography necessary in the treatment of lower extremity ischemia?

PURPOSE: To determine whether preoperative aortoiliac arteriography can be replaced with noninvasive evaluation in the management of some patients with chronic lower extremity ischemia. METHODS: Preoperative evaluation was performed on 184 ischemic limbs (119 patients) over 19 months by means of aortoiliac arteriography with runoff and noninvasive studies, which included common femoral artery duplex scanning, waveform and acceleration time (normal <140 msec), and aortoiliac duplex scanning. An algorithm was proposed for combining indirect (common femoral artery evaluation) and direct (aortoiliac evaluation) noninvasive studies to decrease the need for aortoiliac arteriography when possible. RESULTS: Aortoiliac occlusive disease (> or =50% stenosis to occlusion) was present at arteriography in 48 limbs (30%), and there was no inflow disease in 114 (70%). Aortoiliac lesions were identified by means of noninvasive studies. The accuracies of femoral waveform, acceleration time, and aortoiliac duplex studies were 85%, 89% and 87%. The negative predictive values were 92%, 94% and 100%. The acceleration time results were not affected by runoff status but were significantly different for various categories of stenosis (p < 0.05). The algorithm was applied to the data obtained. When acceleration time and waveform were normal, 84 of 86 patients (98%) had no stenosis at arteriography. When aortoiliac duplex findings were normal, the arteriographic findings were normal in all examinations. CONCLUSION: A combination of indirect and direct noninvasive studies can be used reliably to rule out clinically significant inflow occlusive disease and allows selective use of aortoiliac arteriography in patients with lower extremity ischemia.

Algorithms↗

PubMed1992

[Mechanisms of the positive clinical effect of plasmapheresis for arteriosclerosis obliterans in the lower extremities].

Some mechanisms of clinical improvement of peripheral atherosclerosis were studied on the basis of changes occurred in hemorheological parameters and lipid spectrum in 107 patients with atherosclerosis obliterans of the lower extremity vessels who had undergone 166 courses (468 sessions) of therapeutical plasmapheresis. In addition to improved lower extremity blood flow in 94.8% of patients with Stage II ischemia and 78.2% with Stage III, clinically improved cerebral circulation was seen in 87.6% and clinically better coronary circulation in 85.2%. This suggests definite unique hemodynamic effects of plasmapheresis. The paper also indicates that there are at least three mechanisms providing a positive clinical effect of plasmapheresis in peripheral atherosclerosis: (1) peripheral macro- and microhemodynamic improvement due to decreased levels of plasma and perimembrane fibrinogen and increased erythrocyte deformability; (2) a decrease in thrombus risk due to lower fibrinogen levels and fibrinolytic activation; (3) monitoring risk factors of atherosclerosis due to lower levels of atherogenic lipoproteins, triglycerides, and cholesterol.

Arteriosclerosis Obliterans↗

PubMed2002

Effects of long-term training specificity on maximal strength and power of the upper and lower extremities in athletes from different sports.

Maximal concentric one repetition maximum half-squat (1RM(HS)), bench-press (1RM(BP)), power-load curves during concentric actions with loads ranging from 30% to 100% of 1RM(HS) and 1RM(BP)were examined in 70 male subjects divided into five groups: weightlifters (WL, n=11), handball players (HP, n=19), amateur road cyclists (RC, n=18), middle-distance runners (MDR, n=10) and age-matched control subjects (C, n=12). The 1RM(HS)values in WL, HP and RC were 50%, 29% and 28% greater, respectively, ( P<0.001-0.01) than those recorded for MDR and C. The half-squat average power outputs at all loads examined (from 30% to 100%) in WL and HP ( P<0.001 at 45% and 60% with HP) were higher ( P<0.05-0.001) than those in MDR, RC and C. Average power output at the load of 30% of 1RM(HS) in RC was higher ( P<0.05) than that recorded in MDR and C. Maximal power output was produced at the load of 60% for HP, MDR and C, and at the load of 45% for WL and RC. The 1RM(BP) in WL was larger ( P<0.05) than those recorded in HP, RC, MDR and C. In the bench press, average muscle power outputs in WL and HP were higher ( P<0.05-0.001) than those in MDR, RC and C, and were maximized at a load of 30% of 1RM for WL and HP, and at 45% for RC, MDR and C. In addition, the velocities that elicited the maximal power in the lower extremities were lower ( approximately 0.75 m.s(-1)) than those occurring in the upper extremities ( approximately 1 m.s(-1)). The data suggest that the magnitude of the sport-related differences in strength and/or muscle power output may be explained in part by differences in muscle cross-sectional area, fibre type distribution and in the muscle mechanics of the upper and lower limbs as well as by training background.

Adult↗

PubMed1993

Value of lower extremity venous duplex examination in the diagnosis of pulmonary embolism.

PURPOSE: This study tests the hypothesis that the absence of deep venous thrombosis (DVT) on lower extremity color-flow venous duplex examination (LECFD) combined with a non-high-probability ventilation/perfusion (V/Q) scanning results rules out pulmonary embolus (PE). The use of LECFD as a diagnostic aid for PE is based on data that show that 90% of PE originate from lower extremity DVT, and therefore on the assumption that PE cannot be present if DVT is not present as the source. METHODS: Over a 3-year period 51 patients with clinically suspected PE underwent LECFD and pulmonary angiography (PA) within 72 hours of each other. Forty-one patients also underwent V/Q scanning during the same time period. The results of LECFD and V/Q scans were compared with the results of PA, the gold standard for the diagnosis of pulmonary emboli. RESULTS: Results of LECFD were positive for DVT in seven of 16 cases of angiographically documented PE. Thus the "sensitivity" of LECFD as a diagnostic aid in cases of suspected PE is 44%. The results of LECFD and V/Q scans were combined and compared with the results of PA. A high-probability V/Q scanning result was considered positive for PE. Intermediate- and low-probability scanning results were considered negative, because in the literature the decision to begin heparin therapy is not made on the basis of this result. The combination of test results was considered positive if either test result was positive and negative only if results of both were negative. With these criteria the combination of test results was positive in only 62% of cases of angiographically documented PE. CONCLUSIONS: If treatment of suspected PE were based on LECFD alone or on duplex combined with V/Q scanning, 40% to 50% of patients with PE would remain untreated. In cases of suspected PE where these noninvasive tests do not confirm its presence, PA should be performed.

Aged↗

PubMed1990

[Acute circulatory disorders in the lower extremities in polymyositis].

A 32-year-old women with a definite diagnosis of polymyositis is described. The disease began acutely with two episodes of acute ischaemia of one lower extremity without evidence of organic occlusion of the arteries. Further on, signs predominated suggestive of deep thrombophlebitis of the lower extremities. The diagnosis was based on electromyography, histological examination of muscle biopsy material and rapid improvement after treatment with corticosteroids.

Acute Disease↗

PubMed1995

Nonprescription, padded, lightweight support socks in treatment of mild to moderate lower extremity venous insufficiency.

Currently, strength greater than 20 mm Hg of compression is considered necessary for support hose used to treat symptomatic venous insufficiency in lower extremities. This strength is frequently uncomfortable, which reduces compliance and therefore clinical effectiveness. Whether more comfortable, nonprescription, light-compression support hose is effective in the treatment of mild to moderate venous insufficiency was investigated in 36 men with subjective complaints and objective signs (per Doppler ultrasound) of lower extremity venous insufficiency. All participants wore padded, light-compression (6 mm Hg), crew-height socks for 1 month. Then, participants were assigned to one of two groups on the basis of initial Doppler results. The half with the worst results wore stronger-compression (12 mm Hg) over-the-calf support socks, on the assumption that patients with worse venous insufficiency would require more support; those with the better Doppler results continued to wear the light-compression socks. Participants were retested at monthly intervals for 3 months. In each group, data indicated that the venous insufficiency for all patients improved objectively and subjectively. Many of the objective venous values improved with either statistical or highly statistical significance--specifically deep venous valve function, superficial venous valve functions, and venous capacity--without statistically altering arterial function. Improvement occurred in the first month of the trial and continued throughout the study. The use of light-compression support socks is effective and should be considered as a first line of therapy in treatment of mild to moderate venous insufficiency.

Adult↗

PubMed2000

Percutaneous balloon fenestration in a case of traumatic abdominal aortic dissection with lower extremity ischemia.

A 38-year-old man was involved in a traffic accident and experienced a heavy blow to the abdomen. He had traumatic abdominal aortic dissection with right lower extremity ischemia. He underwent percutaneous balloon fenestration, which is safe and minimally invasive, for relief of right lower extremity ischemia. He has been working for 2 years without any signs of vascular compromise. Percutaneous balloon fenestration is one of the few treatments for traumatic abdominal aortic dissection.

Abdominal Injuries↗

PubMed1985

Lower extremity salvage and reconstruction by free-tissue transfer. Analysis of results.

The application of soft tissue or bone free-tissue transfers to lower extremity salvage or reconstruction was assessed in a review of 86 consecutive procedures done during a 36-month period. This group included 65 cases of free skin or muscle flap transfer and 21 cases of free vascularized bone transfer. In terms of tissue viability, the success rate was 80.2% (78.5% for the soft tissue group and 85.7% for the bone group). With due consideration of indications, the incidence of secondary sepsis in patients with chronic osteomyelitis, and other potential complications, free-tissue transfers are valuable for salvage and reconstructive surgery of the lower extremity.

Adolescent↗

PubMed1996

[The principle of the spiral-like structure of skeletal muscles--the basis for motor optimal performance of the active lower extremity].

Searching for the new skeletal muscles characteristics makes a complicated problem of the objective analysis of structural and functional evaluations. Spiral-like structure of lower extremity skeletal muscles demonstrated is a part of spirals of the organism level, reflecting the systematic biomechanical integrity of muscles. New patterns of skeletal muscles orientation directly deal with mechanism of the internal twisting of lower extremity long segments and are pathogenic in mechanism of correction of the acquired and congenital pathologies.

Adult↗

PubMed1996

Thrombocytosis after major lower extremity trauma: mechanism and possible role in free flap failure.

Microvascular thrombosis and free flap failure are complications of free tissue transfer for coverage of lower extremity soft-tissue and bony defects despite appropriate vessel selection and adherence to meticulous technique. Increased rates of flap failure have been associated with reconstruction performed between 3 days and 6 weeks after injury, as well as in patients with thrombocytosis. We have found that serum platelet levels rise significantly after lower extremity injury. It is our theory that a circulating mediator or cytokine is released in response to injury, inducing the thrombocytosis. Twenty-one patients with Gustilo grade IIIb and IIIc injuries were studied prospectively. Serum was collected throughout the postinjury period. Platelet count, leukocyte count, hemoglobin concentration, and hematocrit were determined. Samples were also subjected to a platelet aggregation study as well as enzyme-linked immunosorbent assay for interleukin-3, interleukin-6, interleukin-11, and granulocyte macrophage-colony-stimulating factor. Megakaryocyte growth and development factor enzyme-linked immunosorbent assay and a myleoproliferative leukemia virus-transfected cell line assay for thrombopoietin were performed. Bone marrow was studied with flow cytometric analysis. Mean initial platelet count was 196,000 per cubic millimeter. There was an initial 26% decline to 140,000 per cubic millimeter, followed by an increase to 361% of baseline on day 16. No significant variations in serum leukocyte count or hemoglobin concentration were seen. Spontaneous and induced platelet aggregation responses were normal. Interleukin-6 was detected at elevated levels. However, interleukin-3, interleukin-11, granulocyte macrophage-colony-stimulating factor, and thrombopoietin were not measurable. Marked megakaryocytosis was seen on bone marrow analysis. Interleukin-6 may, therefore, play a role in the mechanism of thrombocytosis. We suggest that because patients with complex bony injuries of the leg experience platelet elevations that peak approximately 2 weeks after injury, microvascular free flap reconstructions should be considered high risk during this time period.

Adult↗

PubMed1999

Muscle flaps in osteomyelitis of the lower extremity: a 20-year account.

Between 1977 and 1993, 64 patients had local muscle flap transposition as an integral portion of treatment for lower-extremity osteomyelitis. All muscle flaps were performed by a single surgeon. There were 54 men and 10 women with an average age of 45 years (range, 16 to 87 years). Median follow-up period was 9.3 years (range, 5 to 21 years). The muscles used included medial gastrocnemius (n = 28), soleus (n = 19), lateral gastrocnemius (n = 13), and peroneus tertius (n = 1). At final follow-up, the recurrence free rates at 5, 10, and 15 years were 94, 92.5, and 86 percent, respectively. These long-term results support the use of local muscle flap transposition as an important management method in the treatment of lower extremity osteomyelitis; however, the risk of treatment failure may arise after extended periods of time.

Female↗

PubMed2006

[Intravascular laser irradiation of blood in complex treatment of obliterating atherosclerosis of the lower extremity vessels in elderly and senile patients].

The authors describe comparative results of treatment of 60 elderly and senile patients with obliterating atherosclerosis of the lower extremity vessels. In 50 patients treatment with traditional medicines was combined with intravascular laser irradiation of blood, 10 patients were treated with traditional medicines only. The data obtained by questionnaires concerning the patients' state, expert judgment of doctors in charge of the profile department, indices of instrumental examinations of regional hemodynamics (rheovasography of the lower extremity vessels), data of laboratory investigations of morphofunctional state of erythrocytes and hemorheology showed that laser irradiation of blood gave better results of treatment. Its therapeutic effect persisted during 3 months in most patients.

Aged↗

PubMed1992

Changing patterns in the predisposition for amputation of the lower extremities.

The purpose of this study was to evaluate and determine the role of diabetes and other common predisposing factors in amputation of the lower extremities. A retrospective review of 110 patients with peripheral vascular disease who underwent amputation between 1987 and 1990 at Hahnemann University Hospital (Philadelphia, PA) was performed. Patients who underwent amputations for trauma or cancer were excluded from this analysis. The patients were divided into four groups according to the site of amputation: Above Knee (n = 43), Below Knee (n = 26), Foot (n = 7) and Transmetatarsal (n = 34). The mean age was 60 years. Fifty-five patients (51%) were white. Sixty-four patients (58%) were men. Twenty-nine patients (26%) were cigarette smokers; sixteen smokers (55%) had above-knee amputation. Thirty-five patients (32%) had previous vascular surgery of the lower extremities. The combination of diabetes and hypertension was present in 40 patients (36%). When either diabetes or hypertension alone was present in a patient, hypertension, not diabetes, was more commonly the dominant underlying medical condition in patients with amputation (32 hypertension-alone patients vs. 10 diabetes-alone patients). The high frequency of hypertension suggests that enhanced control of this disease may affect peripheral vascular disease and related amputations in the future.

Age Factors↗

PubMed1979

The elderly patient with severe arterial insufficiency of the lower extremity: limb salvage by femoro-popliteal reconstruction.

To determine the feasibility of limb salvage in elderly patients in whom severe ischemia of the lower extremity is present, the results of femoro-popliteal reconstruction done primarily for limb salvage were reviewed. Of 310 femoro-popliteal bypasses, 72 were performed on patients 70 years of age or older. In the over-70 group, ischemic necrosis was present in 70.8% rest pain in 22.2%, and claudication in 7.0%. Initial limb salvage patients 70 years of age or older was 71.4%. Cumulative limb salvage at 5 years was 51.1% and at 10 years was 44.8%. Operative mortality, including mortality of subsequent amputation, when required, was 8.3%. Appreciable limb salvage can be achieved by femoro-popliteal arterial reconstruction in lieu of primary amputation in elderly patients in whom severe arterial insufficiency of the lower extremity is present.

Age Factors↗

PubMed1987

Autogenous reversed vein bypass for lower extremity ischemia in patients with absent or inadequate greater saphenous vein.

This report has presented the results of 329 reversed vein bypasses performed for lower extremity ischemia over a 6 3/4 year period. One hundred eighty-nine bypasses were formed from intact ipsilateral greater saphenous veins of adequate size and length. One hundred forty bypasses were formed in patients in whom the ipsilateral greater saphenous vein was absent or of inadequate size or length to complete the bypass. The grafts in these patients were accomplished using a variety of techniques including distal graft origin, use of arm veins and lesser saphenous veins, and use of vein splicing. The patency rates of these grafts were equivalent to those achieved using adequate intact ipsilateral greater saphenous vein. In view of these results, we conclude that the absence of a greater saphenous vein does not preclude successful autogenous lower extremity vein bypass and that prosthetic bypass is rarely justified.

Femoral Artery↗

PubMedDate not supplied

[Comparison of the diagnostic contribution of rheography and ultrasound in diabetic macroangiopathy of the lower extremities].

In a group of 140 patients with diabetes mellitus ultrasonographic Doppler examination revealed a 30% incidence, rheographic examination a 34% incidence (p greater than 0.05) of macroangiopathies of the lower extremities. The asset of rheography was the ability to differentiate between pathological functional (21% incidence) and organic changes (13% incidence). The contribution of sonographic examination was the localization of the portion most severely affected by the macroangiopathy. The most frequent variant was general affection of the distal portion of extremities, followed by predominating affection of the posterior tibial artery and affection of the entire circulation of the lower extremity. In the authors' practice rheography is the basic examination. In the event of revealed pathological changes it is supplemented by sonographic Doppler examination.

Adult↗

PubMed1996

Association of athlete's foot with cellulitis of the lower extremities: diagnostic value of bacterial cultures of ipsilateral interdigital space samples.

We performed a study to determine how often patients with cellulitis of the lower extremities in the absence of trauma, peripheral vascular disease, or chronic open ulcers have ipsilateral interdigital athlete's foot and whether cultures of samples from the involved interdigital spaces would yield potentially pathogenic bacteria. Athlete's foot was present in 20 (83%) of 24 episodes of cellulitis that were studied. Cultures of samples from interdigital spaces yielded Beta-hemolytic streptococci in 17 (85%) of 20 cases, Staphylococcus aureus in 9 (45%) of 20 cases, and gram-negative rods in 7 (35%) of 20 cases. Only Beta-hemolytic streptococci were recovered significantly more often from patients than from a group of controls with athlete's foot who did not have cellulitis (P < .01). Athlete's foot may be a common predisposing condition for cellulitis of the lower extremities. In comparison with attempts at microbiological diagnosis such as aspiration and/or biopsy of the area of cellulitis, cultures of samples from the interdigital spaces combined with serial determinations of antistreptolysin titers may offer a simpler noninvasive method of microbiological diagnosis.

Bacteria↗