[Acral skin resistance measurement in vascular diseases of the lower extremity].
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We evaluated the usefulness of two-dimensional time-of-flight (2D TOF) MR venography (MRV) of the lower extremity using the respiratory compensation (RC) technique. In addition, six variations in patient positioning of the leg and knee were investigated to determine the best method of visualizing the deep popliteal veins and lower leg. All data sets were reviewed and graded for visualization of the deep veins at the pelvis, thigh, and leg portion (4-point scale) by two radiologists and three radiological technologists. The same veins demonstrated with various positions of the patient were also evaluated in the same manner. In conclusion, 2D TOF MRV with RC resulted in increased uniformity of vein signal in the pelvic area. Furthermore, we should position the patient's leg so as not to compress the vein at the posterior portion of the leg, and not to over-extend the knee joint. This enabled the best results to be obtained in MRV of the lower extremity.
We report the development of isolated lower extremity metastases, in a child, 9 years after her initial diagnosis and treatment of bilateral infantile retinoblastomas. The radiographic, scintigraphic, computed tomographic, and magnetic resonance imaging findings are discussed. The dominant metastatic focus was blastic, involving the medial cuneiform. Additional occult lesions were found in the base of the second metatarsal, middle cuneiform, navicular and tibial diaphysis. An open biopsy confirmed the diagnosis. The occurrence of late distant metastases is rare in the USA.
BACKGROUND: Fibular osteocutaneous free tissue transfer represents the work horse procedure in the reconstruction of large oromandibular defects. Before the fibula is harvested the blood supply of the lower leg and foot should be examined, as the perfusion may be based predominantly on the peroneal artery and venae comitantes. To avoid postoperative ischaemia of the lower leg, adequate perfusion must be guaranteed before sacrificing the peroneal vessels. Anatomical variations and peripheral arterial occlusive disease add to the risk of ischaemia. Various methods of evaluating the blood supply have been described. MATERIAL AND METHODS: Fifty-two consecutive cases of fibular flaps were evaluated to study the arterial blood supply of the lower extremity. For angiography, the right femoral artery was punctured using the Seldinger technique and a total of 20-25 ml contrast medium (Imeron 300) was infused and images required at a rate of 0.5/sec. RESULTS: A patent three-vessel supply to both feet could only be detected in 21 patients. Thirty-one angiograms revealed anatomic and/or arteriosclerotic alterations. Angiography provided accurate information in all patients and allowed successful fibular transfer in those patients who were found preoperatively to have regular conditions. CONCLUSION: Preoperative assessment of the blood supply of the lower extremity is important before fibular osteocutaneous free tissue transfer. We advocate angiography as interpretation is not examiner dependent.
Following a review of current knowledge on the anatomical, histological and biomechanical aspects of fracture healing, the authors present an original method for the measurement of relative interfragmentary deformation in diaphyseal fractures of the lower extremity stabilised by flexible intramedullary nailing. The first data obtained is reported. In the examples reported, the authors have determined the precise amount of relative interfragmentary deformation in diaphyseal fractures of the lower extremity stabilised by flexible intramedullary nailing. The first data obtained is reported. In the examples reported, the authors have determined the precise amount of relative interfragmentary deformation in each case, using accurate digitizer measurement on the radiographs with and without loading. This method makes it possible to measure relative interfragmentary deformation and monitor it over a period of time. The authors conclude that relative interfragmentary deformation is beneficial to the healing of fractures provided it is kept within the limits of the "strain-tolerance" of the various types of callus which succeed one another during fracture healing.
The present study was undertaken in order to develop numerical criteria for the parameters of laser Doppler flowmetry-skin blood flow velocity and pulse wave amplitude in the evaluation of lower extremity ischemia. Fifty limbs of young healthy volunteers were examined in order to obtain baseline normal values. Patient population was divided into moderately ischemic (52 limbs) and severely ischemic (22 limbs), based on patients' complaints, physical examination, ankle-brachial indices, pulse volume recordings and arteriographies. Univariate comparison between the three groups of skin blood flow velocity and pulse wave amplitude at each time point were done by analysis of variance. Power of discrimination between degrees of ischemia was evaluated by computing sensitivity and specificity, based on skin blood flow velocity and pulse wave amplitude values at time points best for predicting the severity of disease by multiple regression analysis. Using cutoff points of < 31 for skin blood flow velocity and < 9 for pulse wave amplitude, a 96% sensitivity and 96% specificity were obtained in separating normal from ischemic limbs. Cutoff points of < 9 for skin blood flow velocity and < 4 for pulse wave amplitude discriminated with a 100% sensitivity and specificity between the moderately and severely ischemic limbs. We propose the use of laser Doppler flowmetry with local heating and reactive hyperemia, and the cutoff points stated above as an additional tool to evaluate lower extremity ischemia through assessment of cutaneous microcirculation.