14,825 results match your criteria Amputations of the Lower Extremity


Mid-term outcomes of thrombolysis for acute lower extremity ischemia at a tertiary care center.

Ann Vasc Surg 2020 Jun 2. Epub 2020 Jun 2.

Stony Brook University Medical Center Department of Surgery, Division of Vascular and Endovascular Surgery, Health Sciences Center T19-090 Stony Brook Medicine Stony Brook, NY 11794-8191. Electronic address:

Objectives: Acute limb ischemia (ALI) is challenging to treat due to high morbidity and mortality. Endovascular-first options beginning with thrombolysis are technically feasible with similar results to open surgery. We examined our experience with thrombolysis to identify patients and target conduits that are predictive of improved outcomes. Read More

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http://dx.doi.org/10.1016/j.avsg.2020.05.050DOI Listing

Association between sodium-glucose cotransporter 2 (SGLT2) inhibitors and lower extremity amputation: A systematic review and meta-analysis.

PLoS One 2020 5;15(6):e0234065. Epub 2020 Jun 5.

Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

Background: The association between sodium-glucose cotransporter 2 inhibitors (SGLT2i's) and lower extremity amputation is unclear.

Purpose: To systematically review randomized control trials (RCTs) and observational studies quantifying risk of lower extremity amputations associated with SGLT2i use.

Data Sources And Study Selection: We searched PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials from January 2011 to February 2020 for RCTs and observational studies including lower extremity amputation outcomes for individuals with type 2 diabetes mellitus treated with SGLT2i's vs. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234065PLOS

Giant primitive neuroectodermal pelvic tumour: a case report and literature review.

J Int Med Res 2020 Jun;48(6):300060520906747

Department of Orthopaedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, China.

Primitive neuroectodermal tumours (PNETs) are rare malignant small round cell tumours. Notably, despite widespread reports of PNET in multiple parts of the body, it is extremely rare in the pelvis. Here, a rare case of giant PNET of the pelvis, that was treated with surgical intervention comprising hemipelvectomy and amputation, is reported. Read More

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http://dx.doi.org/10.1177/0300060520906747DOI Listing

Treatment of lower extremity fractures in chronic spinal cord injury: a systematic review of the literature.

PM R 2020 Jun 5. Epub 2020 Jun 5.

Charlie Norwood VA Medical Center, Augusta, Georgia, USA.

Objective: Review the literature regarding outcomes of surgical and nonsurgical management of lower extremity (LE) fractures in chronic SCI.

Literature Survey: Medline (PubMed), Embase, Cochrane Database of Systemic Reviews, Cochrane Central, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trials were searched from January 1, 1966 to March 1, 2019. Read More

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http://dx.doi.org/10.1002/pmrj.12428DOI Listing

The Impact of Multidrug-Resistant Organisms on Outcomes in Patients With Diabetic Foot Infections.

Open Forum Infect Dis 2020 May 6;7(5):ofaa161. Epub 2020 May 6.

Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.

Background: Multidrug-resistant organisms (MDROs) are important diabetic foot infection (DFI) pathogens. This study evaluated the impact of DFIs associated with MDRO pathogens (DFI-MDRO) on clinical outcomes.

Methods: Adults admitted to Detroit Medical Center from January 2012 to December 2015 with culture-positive DFI were included. Read More

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http://dx.doi.org/10.1093/ofid/ofaa161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255643PMC

Single Tertiary Care Center Outcomes After Lower Extremity Cadaveric Vein Bypass for Limb Salvage.

Vasc Endovascular Surg 2020 Jul;54(5):430-435

Staten Island University Hospital, Staten Island, NY, USA.

Objective: Cadaveric saphenous vein (CV) conduits are used in rare instances for limb salvage in patients without autogenous veins although long-term outcome data are scarce. This study was designed to evaluate the outcomes of CV bypass in patients with threatened limbs.

Methods: We retrospectively reviewed the charts from 2010 to 2017 of 25 patients who underwent 30 CV allografts for critical limb ischemia and acute limb ischemia. Read More

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http://dx.doi.org/10.1177/1538574420925586DOI Listing

Estimated forces and moments experienced by osseointegrated endoprostheses for lower extremity amputees.

Gait Posture 2020 May 20;80:49-55. Epub 2020 May 20.

Department of Veterans Affairs, 500 Foothill Dr (151), Salt Lake City, UT, United States; Department of Orthopaedics, University of Utah, 590 Wakara Way, Rm A100, Salt Lake City, UT, United States; Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, Rm 3100, Salt Lake City, UT, United States. Electronic address:

Background: Percutaneous osseointegrated (OI) docking of prosthetic limbs returns loading directly to the residual bone of individuals with amputations. Lower limb diaphyseal biomechanics have not been studied during the wide range of daily activities performed by individuals with lower extremity amputations; therefore, little is known about the loads experienced at the bone-endoprosthetic interface of a percutaneous OI device.

Research Question: Does residual limb length and/or gender influence loading magnitudes in the diaphysis of the femur or tibia during daily activities?

Methods: This observational study used motion capture data from 40 non-amputee volunteers performing nine activities ranging from low to high demand, to virtually simulate residual limbs of amputees. Read More

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http://dx.doi.org/10.1016/j.gaitpost.2020.05.018DOI Listing

Embolization Techniques for Arteriovenous Malformations in Parkes-Weber Syndrome.

Ann Vasc Surg 2020 May 29. Epub 2020 May 29.

The AVM Center of New York at Lenox Hill, Northwell Health System.

Objectives: Multiple high-flow arteriovenous malformations (AVMs) are the hallmark of Parkes-Weber syndrome (PWS). Surgical resection has historically shown poor outcomes with PWS. The aim of this study was to assess the management of PWS in the current era. Read More

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http://dx.doi.org/10.1016/j.avsg.2020.05.039DOI Listing

The Reintervention Index: A new outcome measure for comparative effectiveness of lower extremity revascularization.

Ann Vasc Surg 2020 May 28. Epub 2020 May 28.

Division of Vascular Surgery, Department of Surgery, Yale School of Medicine.

Introduction: Reinterventions after lower extremity revascularization (LER) are common. Current outcome measures assessing durability of revascularization rely on freedom from reintervention but do not account for the frequency of repeated LER. The aim of this study is to compare the reintervention index, defined as the mean number of repeat LER, after open and endovascular revascularization. Read More

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http://dx.doi.org/10.1016/j.avsg.2020.05.040DOI Listing

Muscle Contributions to Balance Control During Amputee and Non-Amputee Stair Ascent.

J Biomech Eng 2020 May 29. Epub 2020 May 29.

Walker Department of Mechanical Engineering, The University of Texas at Austin, 204 E. Dean Keeton Street, Stop C2200, Austin, TX 78712.

Dynamic balance is controlled by lower-limb muscles and more difficult to maintain during stair ascent compared to level walking. As a result, individuals with lower-limb amputations often have difficulty ascending stairs and are more susceptible to falls. The purpose of this study was to identify the biomechanical mechanisms used by individuals with and without amputation to maintain dynamic balance during stair ascent. Read More

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http://dx.doi.org/10.1115/1.4047387DOI Listing

Derivation and validation of a clinical prediction model for assessing the risk of lower extremity amputation in patients with type 2 diabetes.

Diabetes Res Clin Pract 2020 May 21:108231. Epub 2020 May 21.

Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan. Electronic address:

Aim: This study aims to develop and validate a lower extremity amputation (LEA) risk score system in persons with type 2 diabetes.

Methods: A retrospective population-based cohort study was conducted among eligible 21,484 participants in the derivation set and 10,742 participants in the validation set who were enrolled in the Taiwan National Diabetes Care Management Program. The risk score system was developed following the steps proposed by the Framingham Heart Study with a Cox proportional hazards model algorithm. Read More

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http://dx.doi.org/10.1016/j.diabres.2020.108231DOI Listing

The Influence of Tobacco Use, Alcohol Consumption, and Weight Gain on Development of Secondary Musculoskeletal Injury after Lower Limb Amputation.

Arch Phys Med Rehabil 2020 May 20. Epub 2020 May 20.

DoD-VA Extremity Trauma & Amputation Center of Excellence, San Diego, CA; The Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA.

Objective: To evaluate whether tobacco use, alcohol consumption, and weight gain are associated with the diagnosis of overuse musculoskeletal injuries within the first 12 months following lower limb amputation.

Design: Retrospective cohort study.

Setting: Military treatment facilities. Read More

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http://dx.doi.org/10.1016/j.apmr.2020.04.022DOI Listing

Health Care Costs Associated With Macrovascular, Microvascular, and Metabolic Complications of Type 2 Diabetes Across Time: Estimates From a Population-Based Cohort of More Than 0.8 Million Individuals With Up to 15 Years of Follow-up.

Diabetes Care 2020 May 22. Epub 2020 May 22.

Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Objective: Developing country-specific unit-cost catalogs is a key area for advancing economic research to improve medical and policy decisions. However, little is known about how health care costs vary by type 2 diabetes (T2D) complications across time in Asian countries. We sought to quantify the economic burden of various T2D complications in Taiwan. Read More

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http://dx.doi.org/10.2337/dc20-0072DOI Listing

Trends, Factors, And Disparities Associated With Length of Stay After Lower Extremity Bypass For Tissue Loss: Lessons Learned From NSQIP.

J Vasc Surg 2020 May 19. Epub 2020 May 19.

Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029. Electronic address:

Objective: To determine predictors of increased length of stay (LOS) in patients who underwent lower extremity bypass for tissue loss (LEB-TL).

Methods: Using 2011 to 2016 National Surgical Quality Improvement Program (NSQIP) vascular-targeted databases, we compared demographics, co-morbidities, procedural characteristics, and 30-day outcomes between patients who had expected vs extended LOS (> 75th percentile, 9 days) after non-emergent LEB-TL. We also compare factors associated with short (< 25 percentile, 4 days) and extended LOS (> 75 percentile, 9 days) versus the interquartile range of LOS (IQR; 4-9 days). Read More

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http://dx.doi.org/10.1016/j.jvs.2020.04.511DOI Listing

Major limb amputations in patients with congenital vascular malformations.

Ann Vasc Surg 2020 May 18. Epub 2020 May 18.

Department of Surgery, Lenox Hill Hospital, Northwell Health System.

Objective: The need for major amputations in patients with vascular malformations is rare. This study reviews our contemporary experience with major amputations in patients with vascular malformations.

Methods: A retrospective review from April 2014 to November 2018 identified 993 patients undergoing management of a vascular malformation involving the upper or lower extremity at a tertiary center. Read More

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http://dx.doi.org/10.1016/j.avsg.2020.04.058DOI Listing

Removal of Peripheral Arterial Occlusive Material with the Rotarex® S Device: Mechanical Atherothrombectomy.

Authors:
Miroslav Bulvas

Surg Technol Int 2020 May;36:225-232

Charles University Prague, Third School of Medicine, University Hospital Královské Vinohrady, Department of Surgery and Division of Interventional Angiology, Prague, Czech Republic.

Mechanical atherothrombectomy (MATH) with the Rotarex® S (Straub Medical AG, Wangs, Switzerland) catheter is an endovascular therapeutic technique for removing fragmentable occlusive material from the lumen of peripheral vessels. It can be used as a rapid, safe and efficacious initial modality for the treatment of acute or subacute ischemia of the lower limbs, even in patients with an immediately threatened extremity and those with a contraindication for surgical and/or thrombolytic therapy. Patient placement in an intensive care unit and routine embolic prevention with a filter are not necessary. Read More

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Stromal Cell-Derived Factor-1 Plasmid Treatment for Patients With Peripheral Artery Disease (STOP-PAD) Trial: Six-Month Results.

J Endovasc Ther 2020 May 18:1526602820919951. Epub 2020 May 18.

Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA.

To present the 6-month results of the tromal Cell-Derived Factor-1 Plasmid reatment fr atients with eripheral rtery isease (STOP-PAD) trial. The trial was an attempt to alter the course of chronic limb-threatening ischemia (CLTI) with a biological agent vs placebo after successful arterial revascularization at or below the knee. The multicenter, randomized, double-blinded, placebo-controlled, phase 2B STOP-PAD trial ( identifier NCT02544204) randomized 109 patients (mean age 71 years; 68 men) with Rutherford category 5 or 6 CLTI and evidence of persistent impaired forefoot perfusion following recent successful revascularization to 8- (n=34) or 16-mg (n=36) intramuscular injections of a non-viral DNA plasmid-based treatment vs placebo (n=34). Read More

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http://dx.doi.org/10.1177/1526602820919951DOI Listing

The Effects of Endovascular Timing and In-line Flow on the Success of Pedal Amputations.

J Foot Ankle Surg 2020 May 12. Epub 2020 May 12.

Attending Staff and Research Director, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Permanente Oakland Medical Center, Oakland, CA.

There has been a growing trend toward endovascular intervention to improve peripheral flow in patients with peripheral arterial disease. To date, there is no clear consensus regarding timing of lower-extremity amputations after revascularization. The purpose of this study was to evaluate the effects of timing between endovascular intervention and minor lower-extremity amputations and its influence on wound healing and limb loss within 1 year. Read More

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http://dx.doi.org/10.1053/j.jfas.2020.03.018DOI Listing

Thirty-Day Outcomes after Surgery for Primary Sarcomas of the Extremities: An Analysis of the NSQIP Database.

J Oncol 2020 13;2020:7282846. Epub 2020 Jan 13.

Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA.

Background: Primary bone and soft tissue sarcomas are rare tumors requiring wide surgical resection and reconstruction to achieve local control. Postoperative complications can lead to delays in adjuvant therapy, potentially affecting long-term oncologic outcomes. Understanding postoperative complication risks is essential; however, past studies are limited by small sample sizes. Read More

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http://dx.doi.org/10.1155/2020/7282846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201584PMC
January 2020

Disparities in Amputation Rates for Non-metastatic Extremity Soft Tissue Sarcomas and the Impact on Survival.

Ann Surg Oncol 2020 May 14. Epub 2020 May 14.

Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.

Background: There are no definitive recommendations guiding amputation use in extremity soft tissue sarcomas (STSs). This study explores disparities in amputation rates and survival in patients with non-metastatic adult-type extremity STSs.

Methods: Patients with non-metastatic adult-type extremity STSs were identified from the 1998-2012 National Cancer Database. Read More

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http://dx.doi.org/10.1245/s10434-020-08586-4DOI Listing

Limb sparing surgery with vascular reconstruction for nonrhabdomyosarcoma soft tissue sarcoma in infants: A novel solution using allogenic vein graft from the parent.

J Pediatr Surg 2020 Apr 14. Epub 2020 Apr 14.

Homi Bhabha National Institute (HBNI), Mumbai, India; Department of Radiology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India.

Surgery continues to remain an integral component of treatment, especially for nonrhabdomyosarcoma soft tissue sarcoma as compared to rhabdomyosarcoma owing to their general insensitivity to chemotherapy. A key determinant of outcomes, particularly for extremity tumors includes complete tumor resection with negative margins; however, a significant limitation for limb salvage surgery is the adherence of sarcomas to vital vascular structures. Hitherto, vascular involvement constituted an adequate reason for amputation. Read More

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http://dx.doi.org/10.1016/j.jpedsurg.2020.03.029DOI Listing

SGLT2 Inhibitors: the Star in the Treatment of Type 2 Diabetes?

Authors:
Yoshifumi Saisho

Diseases 2020 May 11;8(2). Epub 2020 May 11.

Department of Internal Medicine, Keio University School of Medicine, Tokyo 1608582, Japan.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of oral hypoglycemic agents which increase urinary glucose excretion by suppressing glucose reabsorption at the proximal tubule in the kidney. SGLT2 inhibitors lower glycated hemoglobin (HbA1c) by 0.6-0. Read More

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http://dx.doi.org/10.3390/diseases8020014DOI Listing

Successful Treatment of War Zone Traumatic Lower Extremity Wound With Exposed Tendons Using an Autologous Homologous Skin Construct.

Cureus 2020 May 4;12(5):e7952. Epub 2020 May 4.

Medical Affairs, PolarityTE, Inc., Salt Lake City, USA.

Extremity injuries are common in contemporary combat and have become more prevalent as fatality rates have dropped to historic lows. Traumatic extremity wounds, especially those sustained in theater, often present with exposed structures such as tendon, bone, and joint, preventing the use of split-thickness skin grafts (STSG) for coverage. Traditional reconstructive options for these complex wounds include skin substitute with delayed STSG, local flaps, debridement of tendons, pedicled distant flaps (such as cross-leg flap), free tissue transfer, and amputation. Read More

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http://dx.doi.org/10.7759/cureus.7952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212742PMC

Trends in diabetes-related complications in Hong Kong, 2001-2016: a retrospective cohort study.

Cardiovasc Diabetol 2020 May 12;19(1):60. Epub 2020 May 12.

Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.

Background: Nationwide studies on contemporary trends in incidence of diabetes-related complications in Asia are lacking. We describe trends in incident coronary heart disease (CHD), stroke, heart failure, hyperglycaemic crisis, and lower-extremity amputation (LEA) in people with diabetes in Hong Kong between 2001 and 2016.

Methods: The Hong Kong Diabetes Surveillance Database (HKDSD) is a territory-wide diabetes cohort identified from Hong Kong Hospital Authority electronic medical record system. Read More

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http://dx.doi.org/10.1186/s12933-020-01039-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218631PMC

Protamine sulfate use during tibial bypass does not appear to increase thrombotic events or affect short-term graft patency.

Vascular 2020 May 11:1708538120924149. Epub 2020 May 11.

Division of Vascular Surgery, Montefiore Medical Center, New York, NY, USA.

Objectives: While the use of protamine sulfate as a heparin reversal agent has been extensively reviewed in patients undergoing carotid endarterectomy and coronary artery bypass grafting, there is a lack of literature on protamine's effects on lower extremity bypasses. The purpose of this study was to determine the risk of protamine sulfate dosing after tibial bypass on thrombotic or bleeding events, including early bypass failure.

Methods: We performed a retrospective review of our institutional database for patients undergoing primary distal peripheral bypass from January 2009 through December 2015 (contralateral bypass was considered to be a new primary bypass). Read More

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http://dx.doi.org/10.1177/1708538120924149DOI Listing

Risk Factors for Lower Extremity Amputation Following Attempted Free Flap Limb Salvage.

J Reconstr Microsurg 2020 May 11. Epub 2020 May 11.

Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.

Background:  Traumatic limb salvage with free flap reconstruction versus primary amputation for lower extremity (LE) injuries remains an oft debated topic. Limb salvage has well-studied benefits and advances in microsurgery have helped reduce the complication rates. A subset of patients eventually requires secondary amputation after a failed attempt at limb salvage. Read More

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http://dx.doi.org/10.1055/s-0040-1710358DOI Listing

[Local flaps as a last attempt to avoid lower extremity amputation: an overview].

Unfallchirurg 2020 May 8. Epub 2020 May 8.

Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland.

Background: Soft tissue reconstruction in aged patients is challenging. Free tissue transfer can be carried out in healthy patients with a high success rate despite old age. When free tissue transfer is contraindicated in multimorbid patients, local flaps are often chosen, which are associated with a high complication rate. Read More

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http://dx.doi.org/10.1007/s00113-020-00814-6DOI Listing

Physiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease: protocol for a systematic review.

Syst Rev 2020 May 8;9(1):107. Epub 2020 May 8.

School of Epidemiology and Public Health, Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, K1Y4W7, Ottawa, Canada.

Background: Endovascular therapy is a fundamental treatment for peripheral arterial disease. However, the success rate of endovascular therapy remains poor, as a third of patients with critical limb ischemia ultimately require a major amputation for gangrene despite endovascular treatment. This failure rate has prompted investigation into methods of determining physiologic procedural success before and after treatment, before clinically apparent outcomes occur such as gangrene. Read More

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http://dx.doi.org/10.1186/s13643-020-01357-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210685PMC

Sodium-Glucose Cotransporter-2 Inhibitors and the Risk of Amputation: What Is Currently Known?

Am J Ther 2020 May 6. Epub 2020 May 6.

Clinical and Administrative Pharmacy Department, The University of Georgia College of Pharmacy, Athens, GA.

Background: Diabetes mellitus is a major cause of morbidity and mortality in the United States. Twelve medication classes on the market reduce serum glucose including sodium-glucose cotransporter-2 (SGLT2) inhibitors. Potential benefits of these agents include improved glycemic control, weight loss, reduction in blood pressure, and possible reduction in cardiovascular events in patients with elevated cardiovascular risk. Read More

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http://dx.doi.org/10.1097/MJT.0000000000001164DOI Listing

[Observational gait scale for persons with lower extremity amputation. Design and content validity].

Rehabilitacion (Madr) 2020 Apr - Jun;54(2):79-86. Epub 2020 Feb 6.

Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor (LAMBECOM), Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos, Madrid, España; Servicio de Rehabilitación, Hospital de Fuenlabrada, Fuenlabrada (Madrid), España.

Introduction: Gait pattern is altered in persons with lower extremity amputation. To assess gait pattern, it is important to use observational gait scales with a good content validity.

Objectives: To design an observational gait scale and to analyze its content validity. Read More

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http://dx.doi.org/10.1016/j.rh.2019.12.002DOI Listing
February 2020

Risk factors affecting amputation in diabetic foot.

Yeungnam Univ J Med 2020 May 6. Epub 2020 May 6.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.

Background: A diabetic foot is the most common cause of non-traumatic lower extremity amputations (LEA). The study seeks to assess the risk factors of amputation in patients with diabetic foot ulcers (DFU).

Methods: The study was conducted on 351 patients with DFUs from January 2010 to December 2018. Read More

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http://dx.doi.org/10.12701/yujm.2020.00129DOI Listing

Asymmetry of mass and motion affects the regulation of whole-body angular momentum in individuals with upper limb absence.

Clin Biomech (Bristol, Avon) 2020 Apr 23;76:105015. Epub 2020 Apr 23.

Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611, USA; Jesse Brown VA Medical Center, 820 S Damen Ave, Chicago, IL 60612, USA. Electronic address:

Background: There is a high fall prevalence in individuals with upper limb absence, which may be related to a momentum imbalance resulting from the loss of all or part of one arm. The purpose of this study was to characterise whole-body angular momentum in individuals with upper limb absence during walking, and determine the effect of restoring the mass and inertial properties of the impaired side with a mock prosthesis.

Methods: Ten individuals with unilateral upper limb absence walked at self-selected speeds, with and without a mock prosthesis. Read More

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http://dx.doi.org/10.1016/j.clinbiomech.2020.105015DOI Listing

Transmetatarsal and Minor Amputation Versus Major Leg Amputation: 30-Day Readmissions, Reamputations, and Complications.

J Foot Ankle Surg 2020 May - Jun;59(3):484-490

Professor, Texas A&M University, College of Medicine, Temple, TX; Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; Department of Surgery, Baylor Scott & White Health, Temple, TX.

Aims: The optimal level of lower-extremity amputation, particularly in diabetic patients with ulceration, is debated. Proximal amputations more greatly decrease function versus distal amputations, but healing and complication rates may differ between the 2 types. This study compares early postoperative outcomes after transmetatarsal and other partial foot amputations and major leg amputations. Read More

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http://dx.doi.org/10.1053/j.jfas.2019.09.019DOI Listing

Temporal Trends in Cardiovascular Complications in People With or Without Type 2 Diabetes: The Fremantle Diabetes Study.

J Clin Endocrinol Metab 2020 Jul;105(7)

Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.

Context: There is evidence that diabetes-related complications are declining but most data sources have limitations.

Objective: To characterize temporal changes in incidence rates (IRs) of chronic complications and mortality in well-characterized, community-based Australians.

Design: Longitudinal observational study. Read More

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http://dx.doi.org/10.1210/clinem/dgaa215DOI Listing

Short- and mid-term effects of covered stent implantation on extremity findings and heart failure in Parkes Weber syndrome: a case report.

Eur Heart J Case Rep 2020 Apr 10;4(2):1-4. Epub 2020 Mar 10.

Department of Cardiovascular Surgery, Medicalpark Karadeniz Hospital, Trabzon, Turkey.

Background : Parkes Weber syndrome (PWS) is a congenital disease characterized by vascular malformations, such as arteriovenous fistulas (AVFs). It frequently presents with overgrowth of a lower limb and high-output heart failure. The main treatment is to close vascular malformations. Read More

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http://dx.doi.org/10.1093/ehjcr/ytaa046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180698PMC

Communicating emerging risks of SGLT2 inhibitors-timeliness and transparency of medicine regulators.

BMJ 2020 04 29;369:m1107. Epub 2020 Apr 29.

Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.

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http://dx.doi.org/10.1136/bmj.m1107DOI Listing

Acute Aortic Occlusion and its Sequelae: Metabolic, Pathologic Etiology and Management.

Cardiol Rev 2020 Apr 28. Epub 2020 Apr 28.

Division of Vascular Surgery, New York University/Winthrop Hospital, Mineola, NY 11501.

Acute occlusion of the abdominal aorta is a catastrophic occurrence that results in high risk of limb loss and death. The etiology has historically been either acute embolism obstructing the aortic bifurcation in 8-75% of patients, or thrombosis of existing aorta-iliac occlusive disease in 35-84% of patients. Other etiologies include thrombosis of either a previously-placed endograft or aortic graft or acute dissection. Read More

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http://dx.doi.org/10.1097/CRD.0000000000000313DOI Listing

(Cost-)effectiveness of lower extremity nerve decompression surgery in subjects with diabetes: the DeCompression (DECO) trial-study protocol for a randomised controlled trial.

BMJ Open 2020 Apr 26;10(4):e035644. Epub 2020 Apr 26.

Department of Plastic-, Reconstructive- and Hand Surgery, Utrecht University Medical Center, Utrecht, The Netherlands.

Introduction: The peripheral nerves of patients with diabetes are often pathologically swollen, which results in entrapment at places of anatomical narrowing. This results in nerve dysfunction. Surgical treatment of compression neuropathies in the lower extremities (lower extremity nerve decompression (LEND)) results in relief of symptoms and gain in peripheral nerve function, which may lead to less sensory loss (short term) and less associated detrimental effects including foot ulceration and amputations, and lower costs (long term). Read More

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http://dx.doi.org/10.1136/bmjopen-2019-035644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204866PMC

Association of six-minute walk distance with subsequent lower extremity events in peripheral artery disease.

Vasc Med 2020 Apr 27:1358863X20901599. Epub 2020 Apr 27.

Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

The prognostic significance of the six-minute walk distance for lower extremity events in people with peripheral artery disease (PAD) is unknown. This longitudinal study assessed whether a poorer six-minute walk distance at baseline was associated with higher rates of subsequent lower extremity atherosclerotic disease events in PAD. A total of 369 patients (mean age 69. Read More

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http://dx.doi.org/10.1177/1358863X20901599DOI Listing

The territorial distribution of amputations in healthcare and social context in Hungary in 2016–2017.

Orv Hetil 2020 05 1;161(18):747-755. Epub 2020 May 1.

Epidy Health Research Kft., Debrecen

Introduction and aim: Peripheral artery disease and lower extremity artery disease occur in 4 to 6% of the population. In Hungary, the number of major amputations was 6798 in the observed period. With timely and appropriate treatment, the number of leg amputations (30-day mortality: 20%, 2-year mortality: 40-60%) can be effectively reduced. Read More

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http://dx.doi.org/10.1556/650.2020.31742DOI Listing

Early-stage Management of Complex Lower Extremity Wounds Using Negative Pressure Wound Therapy With Instillation and a Reticulated Open Cell Foam With Through Holes.

Authors:
Windy Cole

Wounds 2020 Mar 31. Epub 2020 Mar 31.

Kent State University College of Podiatric Medicine Wound Care, Independence, OH.

Introduction: Treatment modalities that overcome stalled wound healing in lower extremity wounds are crucial for reducing lower limb amputations, which have a 5-year mortality rate of an astounding 70%. Recent non-comparative studies have shown negative pressure wound therapy with instillation and dwell time (NPWTi-d) using a dressing comprised of reticulated open cell foam with through holes (ROCF-CC) provides favorable clinical outcomes for various wound types, including complex lower extremity wounds.

Objective: The objective of this study is to compare NPWTi-d using ROCF-CC dressings (treatment group) with advanced wound dressings (control group) in patients with chronic lower extremity wounds and known systemic risk factors for delayed healing. Read More

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Vascular Injuries in Intravenous Drug Addicts-A Single-Center Experience.

Ann Vasc Surg 2020 Apr 23. Epub 2020 Apr 23.

Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia.

Background: Infected false aneurysms (IFA) caused by intravenous drug abuse are uncommon but challenging lesions. The best approach for the surgical management of this condition is still unknown. The aim is to present a single-center 14-year experience in the IFA treatment in intravenous drug abusers, thus providing additional data regarding the treatment options and outcome in these patients. Read More

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http://dx.doi.org/10.1016/j.avsg.2020.02.041DOI Listing

Factors influencing quality of life, function, reintegration and participation after musculoskeletal tumour operations.

BMC Cancer 2020 Apr 25;20(1):351. Epub 2020 Apr 25.

Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.

Background: The number of people living with soft-tissue and bone sarcomas is increasing due to improved individual therapy and changes in demographics. At present, there are no recommendations for psychological co-treatment, occupational and social reintegration following the treatment of soft tissue and bone sarcomas.

Methods: Seventy-four patients, 42 males and 32 females, aged between 18 and 80 years (54. Read More

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http://dx.doi.org/10.1186/s12885-020-06837-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183621PMC

Identifying Factors Most Important to Lower Extremity Trauma Patients: Key Concepts from the Development of a Patient-Reported Outcome Instrument for Lower Extremity Trauma, The LIMB-Q.

Plast Reconstr Surg 2020 May;145(5):1292-1301

Durham, N.C.; Hamilton, Ontario, Canada; and Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, Duke University; the Department of Pediatrics, McMaster University; and the Patient Reported Outcomes, Value & Experience Center and the Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital.

Background: Severe lower extremity injuries are challenging to treat. The aspects of limb salvage and amputation most important to patients are not well-defined. This study's aim is to develop a conceptual framework for a patient-reported outcome instrument for lower extremity trauma patients, by defining issues and concepts most important to this patient population. Read More

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http://dx.doi.org/10.1097/PRS.0000000000006760DOI Listing

Comparing the performance of different open injury scores in predicting salvage and amputation in type IIIB open tibia fractures.

Int Orthop 2020 Apr 23. Epub 2020 Apr 23.

Ganga Hospital, Coimbatore, Tamil Nadu, India.

Background: Various open injury scores have been devised to aid the difficult decision of salvage or amputation following open fractures of the lower limb. Our aim of the study was to compare the performance of mangled extremity severity score (MESS), limb salvage index (LSI), orthopaedic trauma association-open fracture classification (OTA-OFC) and Ganga hospital score (GHS) in our population of type IIIB injuries.

Materials And Methods: A total of 219 patients with 225 type IIIB open fractures of the tibia were studied prospectively between July 2016 and June 2017. Read More

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http://dx.doi.org/10.1007/s00264-020-04538-5DOI Listing

Trends and outcomes of non-traumatic major lower extremity amputations in an Irish tertiary referral hospital.

Ir J Med Sci 2020 Apr 23. Epub 2020 Apr 23.

Department of Vascular Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.

Objectives: Data on vascular patients following amputation in Ireland is lacking, limiting capability to plan services. This paper seeks to benchmark survival and rehabilitation outcomes among vascular patients in Ireland following lower extremity amputation (LEA), and compare subgroups of those undergoing transfemoral (TFA) or transtibial amputation (TTA).

Methods: A review was conducted of all patients who underwent non-traumatic TFA or TTA from 2000 to 2009 in a tertiary vascular surgery centre. Read More

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http://dx.doi.org/10.1007/s11845-020-02231-5DOI Listing
April 2020
0.573 Impact Factor

Deleterious Musculoskeletal Conditions Secondary to Lower Limb Loss: Considerations for Prosthesis-Related Factors.

Adv Wound Care (New Rochelle) 2020 May 22. Epub 2020 May 22.

DoD-VA Extremity Trauma & Amputation Center of Excellence, Bethesda, Maryland, USA.

The intent of this work was to summarize the existing evidence of, and highlight knowledge gaps specific to, prosthetic devices/componentry and training regimes, particularly in the context of the human-device interaction and deleterious musculoskeletal conditions secondary to lower limb loss. With the recent and evolving technological advancements in prostheses, there are numerous devices available to individuals with lower limb loss. Current literature demonstrates the importance of expanding the knowledge of all prosthetic device-specific factors and the significance of proper prescription, fit, and alignment, along with adequate device-/activity-specific training, to enhance human-device interaction, reduce gait abnormalities and compensatory motions, and as a result, mitigate risk for secondary musculoskeletal conditions. Read More

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http://dx.doi.org/10.1089/wound.2019.1079DOI Listing

Use of Noncontact Infrared Skin Thermometer for Peripheral Arterial Disease Screening in Patients With and Without Diabetes.

Angiology 2020 Apr 22:3319720920162. Epub 2020 Apr 22.

The Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.

Peripheral arterial disease (PAD) poses a threat of limb amputation and cardiovascular events. However, PAD diagnostic procedure requiring time, cost, and technical skills preclude its application as a screening test in the general population. Although PAD tends to be associated with lower foot skin temperature, none has yet to appreciate its usefulness for diagnosis/screening. Read More

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http://dx.doi.org/10.1177/0003319720920162DOI Listing

Qualitative analysis of resilience characteristics of people with unilateral transtibial amputation.

Disabil Health J 2020 Apr 8:100925. Epub 2020 Apr 8.

Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA.

Background: Resilience characteristics are a significant factor in the highly variable rehabilitation outcomes for people in middle age or later with transtibial amputation.

Objective: The purpose of this study was to describe resilience characteristics meaningful to people with transtibial amputation in middle age or later, who use a prosthesis.

Methods: Semi-structured interviews were conducted, audio recorded, and transcribed with eighteen participants. Read More

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http://dx.doi.org/10.1016/j.dhjo.2020.100925DOI Listing

[Lower limb ischemia cured by stimulation electrode implantation assisted with microendoscopic discectomy system: A case report].

Authors:
Y L Qian S Xu H Y Liu

Beijing Da Xue Xue Bao Yi Xue Ban 2020 Apr;52(2):378-381

Department of Spinal Surgery, Peking University People's Hospital, Beijing 100044, China.

A 58-year-old male patient diagnosed with thromboangiitis obliterans (Fontaine stage IV) was recently treated with microendoscope discectomy system-assisted spinal cord stimulation electrode implantation and cured by department of vascular surgery combined with department of spinal surgery at Peking University People's Hospital. The patient suffered from cold injury to the right foot 14 years ago, which was cold, painful, numb, and then the toe was ulcerated and gangrene. Only the right foot small toe was left. Read More

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