13,943 results match your criteria Amputations of the Lower Extremity


A Bibliometric Analysis of Global Research Production Pertaining to Diabetic Foot Ulcers in the Past Ten Years.

J Foot Ankle Surg 2019 Jan 15. Epub 2019 Jan 15.

Professor, School of Nursing, Nantong University, Nantong, Jiangsu, People's Republic of China. Electronic address:

The aim of this study was to demonstrate the state of diabetic foot ulcer (DFU) research in the past 10 years by bibliometric analysis, especially by performing document co-citation and co-word visualization analysis to reveal the research hotspots, frontiers, and core literature. The literature in connection with DFUs from 2007 to 2018 was retrieved from the Web of Science Core Collection database (WoSCC). We used the WoSCC and CiteSpace to analyze publication outcomes, journals, research direction, research hotspots, and frontiers. Read More

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http://dx.doi.org/10.1053/j.jfas.2018.08.052DOI Listing
January 2019

Asymmetric limb lengthening in the treatment of tibial hemimelia caused by osteomyelitis: A case report.

Medicine (Baltimore) 2019 Jan;98(3):e14031

Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.

Rationale: Tibial hemimelia is known as a rare congenital lower limb deficiency. It has been classified into different types based on Jones classification, and the traditional treatment of tibial hemimelia is amputation. Here we present a variant and unclassified case of tibial hemimelia, which was caused by osteomyelitis. Read More

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http://dx.doi.org/10.1097/MD.0000000000014031DOI Listing
January 2019

Polyvascular Disease and Risk of Major Adverse Cardiovascular Events in Peripheral Artery Disease: A Secondary Analysis of the EUCLID Trial.

JAMA Netw Open 2018 Nov 2;1(7):e185239. Epub 2018 Nov 2.

Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.

Importance: The effect of polyvascular disease on cardiovascular outcomes in the background of peripheral artery disease (PAD) is unclear.

Objective: To determine the risk of ischemic events (both cardiac and limb) among patients with PAD and polyvascular disease.

Design, Setting, And Participants: In this post hoc secondary analysis of the international Examining Use of Ticagrelor in Peripheral Artery Disease (EUCLID) trial, outcomes were compared among 13 885 enrolled patients with PAD alone, PAD + coronary artery disease (CAD), PAD + cerebrovascular disease (CVD), and PAD + CAD + CVD. Read More

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http://dx.doi.org/10.1001/jamanetworkopen.2018.5239DOI Listing
November 2018
1 Read

Extremity Arterial Thromboses in Hospitalized Children: A National Database Analysis of Prevalence and Therapeutic Interventions.

Pediatr Crit Care Med 2019 Jan 11. Epub 2019 Jan 11.

Department of Pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL.

Objectives: The purpose of this study was to evaluate the prevalence, demographics, predisposing conditions, therapeutic interventions, and outcomes of extremity arterial thrombosis in hospitalized children.

Design: Retrospective cohort study.

Patients: National discharge database analysis. Read More

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http://dx.doi.org/10.1097/PCC.0000000000001860DOI Listing
January 2019

The relationship between gait and functional outcomes in patients treated with circular external fixation for malunited tibial fractures.

Gait Posture 2019 Jan 8;68:569-574. Epub 2019 Jan 8.

Walk-a-Mile Centre for Advanced Orthopaedics, Pretoria, South Africa; School of Medicine, University of Pretoria, South Africa; Valiant Clinic/Houston Methodist Group, United Arab Emirates. Electronic address:

Background: Lower extremity fractures have a profound negative effect on a patient's gait and outcomes. Correction of deformity, and with it normalization of objective gait parameters, may result in better subjective and objective functional outcomes in patients treated with circular external fixation for malunited tibial fractures.

Aim: The purpose of this study was to investigate the relationships between gait parameters, patient reported outcome measures (PROMs), and health related quality of life measures in patients treated with circular external fixation for the correction of deformity related to tibial malunions. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S09666362183163
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http://dx.doi.org/10.1016/j.gaitpost.2019.01.008DOI Listing
January 2019
1 Read

Predictors and Timing of Amputations in Military Lower Extremity Trauma With Arterial Injury.

J Trauma Acute Care Surg 2019 Jan 10. Epub 2019 Jan 10.

Vascular Surgery Service, San Antonio Military Medical Center.

Introduction: Military lower extremity arterial injuries present threats to life and limb. These injuries are common and limb salvage is a trauma system priority. Understanding the timing and predictors of amputation through the phases of casualty evacuation can help inform future limb salvage efforts. Read More

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http://dx.doi.org/10.1097/TA.0000000000002185DOI Listing
January 2019

Microvascular Thrombosis and Ischaemic Limb Losses in Critically Ill Patients.

Hamostaseologie 2019 Jan 9. Epub 2019 Jan 9.

Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.

Relatively little scientific attention has been given to the small subset of critically ill patients with circulatory shock who develop ischaemic limb losses (symmetrical peripheral gangrene [SPG]). The clinical picture consists of acral (distal extremity) tissue necrosis involving lower limbs in a largely symmetrical fashion and with detectable arterial pulses; in one-third of patients the upper extremities are also affected (potential for four-limb amputations). The laboratory picture includes thrombocytopenia, coagulopathy, and normoblastemia (circulating nucleated red blood cells). Read More

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http://dx.doi.org/10.1055/s-0038-1676823DOI Listing
January 2019
3 Reads

The Vertical Contour Calcanectomy: An Alternative Surgical Technique to the Conventional Partial Calcanectomy.

J Foot Ankle Surg 2019 Jan 3. Epub 2019 Jan 3.

Senior Surgeon, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC. Electronic address:

Heel ulcers have a significant impact on lower extremity morbidity and confer a high risk for major amputations. Although there are many conservative treatment options, once calcaneal osteomyelitis occurs or a heel ulcer becomes chronic or recalcitrant, more invasive management is required. The partial calcanectomy is a surgical solution that can address both pathologies-the ulceration and the infected bone. Read More

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http://dx.doi.org/10.1053/j.jfas.2018.08.040DOI Listing
January 2019
1 Read

Effect of Amputation Level on Quality of Life and Subjective Function in Children.

J Pediatr Orthop 2019 Jan 2. Epub 2019 Jan 2.

Lexington Shriners Hospitals for Children and University of Kentucky, Lexington, KY.

Background: Our aim was to discern whether children with amputations have differences in subjective function based on amputation level. We hypothesized that children with more proximal amputations would report poorer function and quality of life.

Methods: An IRB-approved, retrospective chart review of patients aged 0 to 21 years old with lower extremity amputations was performed. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001321DOI Listing
January 2019
1 Read

A Prospective Longitudinal Study of Trajectories of Depressive Symptoms after Dysvascular Amputation.

Arch Phys Med Rehabil 2018 Dec 31. Epub 2018 Dec 31.

VA Puget Sound Health Care System, Rehabilitation Care Service, Seattle, Washington; University of Washington, Department of Rehabilitation Medicine, Seattle, Washington.

Objective: Characterize the course of depressive symptoms during the first year after dysvascular amputation and identify factors that predict symptom trajectories.

Design: Prospective cohort study of individuals undergoing lower extremity amputation (LEA), surveyed at 4 timepoints (peri-operative period, 6 weeks, 4 months, and 12 months post-amputation). Multilevel modeling was used to describe and predict trajectories. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00039993183159
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http://dx.doi.org/10.1016/j.apmr.2018.11.024DOI Listing
December 2018
1 Read

Lower Extremity Amputation: Analysis by Postcode.

Authors:
Brian J Manning

Eur J Vasc Endovasc Surg 2018 Dec 28. Epub 2018 Dec 28.

Cork University Hospital, Cork, Ireland. Electronic address:

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http://dx.doi.org/10.1016/j.ejvs.2018.11.014DOI Listing
December 2018

Myiasis-induced sepsis: a rare case report of Wohlfahrtiimonas chitiniclastica and Ignatzschineria indica bacteremia in the continental United States.

Medicine (Baltimore) 2018 Dec;97(52):e13627

Trauma and Acute Care Surgery, Indiana University Health Methodist Hospital, Indianapolis, Indiana.

Rationale: The presentation of sepsis and bacteremia in cutaneous and cavitary myiasis is uncommon. We present a patient, residing in a temperate region of the United States, with myiasis and sepsis from the emerging human pathogens Wohlfahrtiimonas chitiniclastica and Ignatzschineria indica.

Patient Concerns: A 37-year-old male patient with an 8-month history of chronic lymphedema and ulcers of the lower left extremity presented with myiasis of the left foot and leg. Read More

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http://dx.doi.org/10.1097/MD.0000000000013627DOI Listing
December 2018
1 Read

Alpha-glucosidase inhibitors for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus.

Cochrane Database Syst Rev 2018 12 28;12:CD005061. Epub 2018 Dec 28.

Department of Primary and Community Care, Radboud University Nijmegen Medical Center, PO Box 9101, Nijmegen, Netherlands, 6500 HB.

Background: Alpha-glucosidase inhibitors (AGI) reduce blood glucose levels and may thus prevent or delay type 2 diabetes mellitus (T2DM) and its associated complications in people at risk of developing of T2DM.

Objectives: To assess the effects of AGI in people with impaired glucose tolerance (IGT), impaired fasting blood glucose (IFG), moderately elevated glycosylated haemoglobin A1c (HbA1c) or any combination of these.

Search Methods: We searched CENTRAL, MEDLINE, Embase, ClinicalTrials. Read More

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http://dx.doi.org/10.1002/14651858.CD005061.pub3DOI Listing
December 2018

Phantom limb pain: A literature review.

Chin J Traumatol 2018 Dec 4. Epub 2018 Dec 4.

California School of Podiatric Medicine, Samuel Merritt University, Oakland, CA 94601, USA. Electronic address:

Since the phantom limb sensation was first described by the French military surgeon Ambroise Pare in the 16th century, the number of studies surrounding phantom limb pain has increased every year. Especially in recent decades, scientists have achieved a better understanding of the mechanism and treatment of phantom limb pain. Although many hypotheses have been agreed and many treatments have been proven effective, scientists still do not have a very systematic understanding of the phantom limbs. Read More

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http://dx.doi.org/10.1016/j.cjtee.2018.04.006DOI Listing
December 2018

Outcomes for peripheral vascular intervention and lower extremity bypass in kidney transplant recipients are superior to outcomes of patients remaining on dialysis.

J Vasc Surg 2018 Dec 21. Epub 2018 Dec 21.

Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC.

Background: Improved survival is reported for patients with end-stage renal disease who are kidney transplant recipients (KTRs) compared with dialysis-dependent patients (DDPs). Whether amputation-free survival (AFS) and freedom from major adverse limb events (MALEs) after peripheral vascular intervention (PVI) or lower extremity bypass (LEB) are superior after renal transplantation remains incompletely defined.

Methods: A retrospective cohort study was undertaken of KTRs and DDPs undergoing infrainguinal PVI or LEB for symptoms of limb-threatening ischemia recorded in the Vascular Quality Initiative from 2003 to 2017. Read More

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http://dx.doi.org/10.1016/j.jvs.2018.10.060DOI Listing
December 2018
1 Read

Hypercoagulability predicts worse outcomes in young patients undergoing lower extremity revascularization.

J Vasc Surg 2018 Dec 21. Epub 2018 Dec 21.

Vascular and Endovascular Department, Novant Health Heart and Vascular Institute, Charlotte, NC.

Objective: Although we know that young patients with peripheral artery disease (PAD) have worse outcomes than older patients, there is a scarcity of information about the incidence of hypercoagulability in this population. Our aim was to analyze outcomes of young patients diagnosed with a hypercoagulable state (unusual tendency toward thrombosis) after lower extremity revascularization compared with similar patients without hypercoagulability.

Methods: All patients 50 years of age or younger undergoing an initial procedure for lower extremity PAD from 2000 to 2015 at the Cleveland Clinic were retrospectively analyzed. Read More

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http://dx.doi.org/10.1016/j.jvs.2018.09.062DOI Listing
December 2018

Peroneal bypass versus endovascular peroneal intervention for critical limb ischemia.

J Vasc Surg 2019 Jan 28;69(1):148-155. Epub 2018 Jun 28.

Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.

Objective: The peroneal artery is a well-established target for bypass in patients with critical limb ischemia (CLI). The objective of this study was to evaluate the outcomes of peroneal artery revascularization in terms of wound healing and limb salvage in patients with CLI.

Methods: Patients presenting between 2006 and 2013 with CLI (Rutherford 4-6) and isolated peroneal runoff were included in the study. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S07415214183105
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http://dx.doi.org/10.1016/j.jvs.2018.04.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310052PMC
January 2019
5 Reads

Clinical outcomes of bypass-first versus endovascular-first strategy in patients with chronic limb-threatening ischemia due to infrageniculate arterial disease.

J Vasc Surg 2019 Jan;69(1):156-163.e1

Division of Vascular and Endovascular Surgery, UC Davis Medical Center, Sacramento, Calif.

Background: Chronic limb-threatening ischemia (CLTI), defined as ischemic rest pain or tissue loss secondary to arterial insufficiency, is caused by multilevel arterial disease with frequent, severe infrageniculate disease. The rise in CLTI is in part the result of increasing worldwide prevalence of diabetes, renal insufficiency, and advanced aging of the population. The aim of this study was to compare a bypass-first with an endovascular-first revascularization strategy in patients with CLTI due to infrageniculate arterial disease. Read More

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http://dx.doi.org/10.1016/j.jvs.2018.05.244DOI Listing
January 2019

Treatment of Acute Compartment Syndrome Sequela of the Leg: A Case Report Demonstrating Negative Pressure Wound Therapy with Instillation and Dwell Utilizing a Novel Dressing and Serial Automated Suction Blister Epidermal Harvesting and Grafting.

Cureus 2018 Oct 12;10(10):e3443. Epub 2018 Oct 12.

Podiatry and Wound Care, OrthoNeuro, Columbus, USA.

Compartment syndrome is a pathologic condition in which a closed anatomical compartment's pressure, most often in the arms and legs, increases to such an extent that the microcirculation of the tissues in that compartment is diminished either acutely or subacutely over time. Such vascular compromise, if untreated, may result in tissue necrosis and muscle and nerve damage. If limb tissue damage is severe enough, amputation of the involved extremity may be necessary. Read More

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http://dx.doi.org/10.7759/cureus.3443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294276PMC
October 2018
1 Read

Estimating State-Level Health Burden of Diabetes: Diabetes-Attributable Fractions for Diabetes Complications.

Am J Prev Med 2019 Feb 13;56(2):232-240. Epub 2018 Dec 13.

Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: Limited information is available on the health burden of diabetes at the state level. This study estimated state-specific attributable fractions and the number of cases attributable to diabetes for diabetes-related complications.

Methods: For each state, diabetes-attributable fractions for nine diabetes complications were estimated: three self-reported complications from the 2013 Behavioral Risk Factor Surveillance System, hospitalizations with three complications from 2011 to 2014 State Inpatient Databases, and three complications from 2013 Medicare data. Read More

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http://dx.doi.org/10.1016/j.amepre.2018.09.023DOI Listing
February 2019
1 Read

Histopathologic Characterization of Peripheral Arteries in Subjects With Abundant Risk Factors: Correlating Imaging With Pathology.

JACC Cardiovasc Imaging 2018 Dec 6. Epub 2018 Dec 6.

CVPath Institute, Gaithersburg, Maryland.

Objectives: The aim of this study was to comprehensively evaluate the pathology of the lower extremity arteries across their entire length in subjects dying with abundant risk factors and to evaluate the clinical and imaging implications of the pathological characteristics.

Background: Lower extremity peripheral arterial disease is a major cause of cardiovascular morbidity, but a systematic characterization of the pathology has never been undertaken.

Methods: Twelve legs were obtained from 8 cadavers with histories of coronary risk factors (median age 82 years, 6 men); 8 of 12 legs were evaluated using computed tomography before the major peripheral arteries were dissected along their entire length. Read More

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http://dx.doi.org/10.1016/j.jcmg.2018.08.039DOI Listing
December 2018
1 Read

Review of Socioeconomic Disparities in Lower Extremity Amputations: A Continuing Healthcare Problem in the United States.

Cureus 2018 Oct 5;10(10):e3418. Epub 2018 Oct 5.

Surgery, University of Houston College of Medicine, Houston, USA.

Lower extremity amputation is one of the most unfortunate, yet preventable, consequences of uncontrolled lower limb ischemia occurring secondary to diabetes mellitus or peripheral arterial disease. In the United States, racial and socioeconomic disparities are associated with significant differences seen in the incidence and type or level of lower extremity amputation among patients. Due to shifting demographics and the uncertain state of healthcare coverage, lower extremity amputation rates are only projected to increase in the future. Read More

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http://dx.doi.org/10.7759/cureus.3418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284870PMC
October 2018

Renal Function as a Predictor of Early Transmetatarsal Amputation Failure.

Foot Ankle Spec 2018 Dec 12:1938640018816371. Epub 2018 Dec 12.

Department of Orthopaedic Surgery (JA, KMR, GTL, DKW), University of Texas Southwestern Medical Center, Dallas, Texas.

Chronic kidney disease (CKD) is a major concern in patients with foot disease because it is associated with high rates of neuropathy, peripheral vascular disease, and poor wound healing. The purpose of this study was to evaluate renal dysfunction as a risk factor for reamputation after initial transmetatarsal amputation (TMA). Patients who underwent a TMA were retrospectively identified in the American College of Surgeons National Surgical Quality Improvement Program database. Read More

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http://dx.doi.org/10.1177/1938640018816371DOI Listing
December 2018
4 Reads

Functional performance and safety of bone-anchored prostheses in persons with a transfemoral or transtibial amputation: a prospective one-year follow-up cohort study.

Clin Rehabil 2018 Dec 12:269215518815215. Epub 2018 Dec 12.

4 Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.

Objectives:: (1) To compare level of function, activity, health-related quality of life (HRQoL) and satisfaction in persons with a lower extremity amputation before surgery and 6- and 12-months after implantation of an osseointegration implant and (2) to report adverse events.

Design:: Prospective cohort study.

Setting:: University medical centre. Read More

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http://dx.doi.org/10.1177/0269215518815215DOI Listing
December 2018

En Route Resuscitation - Utilization of CCATT to Transport and Stabilize Critically Injured and Unstable Casualties.

Mil Med 2018 Dec 7. Epub 2018 Dec 7.

University of Colorado School of Medicine, Aurora, CO.

Introduction: The U.S. Air Force utilizes specialized Critical Care Air Transport Teams (CCATT) for transporting "stabilized" patients. Read More

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http://dx.doi.org/10.1093/milmed/usy371DOI Listing
December 2018
2 Reads

The Utility of Preoperative Arteriography for Free Flap Planning in Patients with Chronic Lower Extremity Wounds.

Plast Reconstr Surg 2018 Nov 26. Epub 2018 Nov 26.

Center for Wound Healing and Hyperbaric Medicine, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC, United States of America.

Background: In patients with lower extremity wounds, free tissue transfer is often the last option before amputation, making it crucial to optimize preoperative planning in order to prevent flap breakdown. No consensus exists regarding preoperative vascular work ups before lower extremity free tissue transfer. Here we analyzed the utility of using arteriography for lower extremity free flap planning. Read More

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http://dx.doi.org/10.1097/PRS.0000000000005265DOI Listing
November 2018

Pain Support for Adults with a Diabetes-Related Lower Limb Amputation: an Empirical Phenomenology Study.

Pain Manag Nurs 2018 Dec 5. Epub 2018 Dec 5.

College of Nursing, East Carolina University, Greenville, North Carolina.

Background: Chronic pain after lower extremity amputation surgery has been reported in up to 80% of patients. Amputations are among the most debilitating chronic complication of diabetes with a variety of consequences including depression, inability to perform daily activities, and change in quality of life.

Aims: This study sought to understand the lived experience of chronic pain support among those who have undergone a diabetes-related lower limb amputation. Read More

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http://dx.doi.org/10.1016/j.pmn.2018.09.007DOI Listing
December 2018

Effects of Sodium-glucose Cotransporter 2 Inhibitors on Amputation, Bone Fracture, and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus Using an Alternative Measure to the Hazard Ratio.

Clin Drug Investig 2018 Nov 30. Epub 2018 Nov 30.

Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan.

Background And Objective: Empagliflozin and canagliflozin decreased the risk of major adverse cardiovascular events (MACE) compared with placebo in randomized clinical trials which were conducted to evaluate their cardiovascular risks. However, canagliflozin increased the risks of amputation and bone fracture, and the reasons for these observed differences remain unclear. The objective of this study was to evaluate the safety risks, specifically the risks of amputation and bone fracture, associated with sodium-glucose cotransporter 2 (SGLT2) inhibitors by using the difference in restricted mean survival time (RMST), an alternative measure to the hazard ratio. Read More

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http://dx.doi.org/10.1007/s40261-018-0731-4DOI Listing
November 2018

Amputation-Site Soft-Tissue Restoration Using Adipose Stem Cell Therapy.

Plast Reconstr Surg 2018 Nov;142(5):1349-1352

Pittsburgh, Pa.; Bethesda, Md.; and New York, N.Y. From the Departments of Plastic Surgery, Psychiatry, Radiology, Rehabilitation Science and Technology, and Bioengineering, University of Pittsburgh; the VA Pittsburgh Healthcare System; the University of Pittsburgh McGowan Institute of Regenerative Medicine; the Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center; and New York University Langone Medical Center.

Soft-tissue deficits in amputation stumps can lead to significant pain and disability. An emerging treatment option is stem cell-enriched fat grafting. This is the first study assessing the potential for this treatment modality in lower extremity amputation sites. Read More

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http://dx.doi.org/10.1097/PRS.0000000000004889DOI Listing
November 2018
6 Reads

Re-amputations and mortality after below-knee, through-knee and above-knee amputations.

Dan Med J 2018 Dec;65(12)

Introduction: From January 2013, we changed the surgical strategy in our department and ceased to perform the through-knee amputation (TKA). The primary aim of this study was to investigate re-amputation rates ≤ 90 days after non-traumatic major lower-extremity amputations performed before and after this change of practice. Furthermore, we reported mortality before and after the change of practice. Read More

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December 2018

Clinical Characteristics and Surgical Outcomes of Limb-Sparing Surgery with Vascular Reconstruction for Soft Tissue Sarcomas.

Ann Vasc Surg 2018 Nov 27. Epub 2018 Nov 27.

Department of Orthopedics and Traumatology, Ankara University School of Medicine, Ankara, Turkey.

Background: The standard treatment for lower extremity soft tissue sarcoma (STS) is limb-sparing surgery. For a small subset of patients, concomitant vascular reconstruction may be required to preserve limb viability and function while completely excising the tumor with an adequate resection margin. The aim of this study was to evaluate the surgical outcomes and clinical characteristics of patients with STS of the extremities requiring vascular reconstructions. Read More

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http://dx.doi.org/10.1016/j.avsg.2018.09.018DOI Listing
November 2018
1 Read

[A patient with a red and swollen leg].

Ned Tijdschr Geneeskd 2018 11 19;162. Epub 2018 Nov 19.

Medisch Centrum Leeuwarden, afd. Spoedeisende Hulp.

A 66-year-old patient was seen at the emergency department with a skin infection of the left leg, probably erysipelas, which worsened despite the use of antibiotics. The symptoms had started 5 days earlier. The patient was respiratory and haemodynamically stable, he was not clinically ill and had relatively little pain. Read More

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November 2018

Impact of time to repair on outcomes in patients with lower extremity arterial injuries.

J Vasc Surg 2018 Nov 26. Epub 2018 Nov 26.

Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md.

Background: Six hours has long been considered the threshold of ischemia after peripheral artery injury. However, there is a paucity of evidence regarding the impact of operative delays on morbidity and mortality in patients with lower extremity arterial injuries.

Methods: We analyzed the records of 3,441,259 injured patients entered into the National Trauma Data Bank Research Dataset from 2012 to 2015. Read More

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http://dx.doi.org/10.1016/j.jvs.2018.07.075DOI Listing
November 2018
7 Reads

Postoperative Low-Dose Heparin Infusion Does Not Change Complication Rates after Limb Revascularization.

Ann Vasc Surg 2018 Nov 26. Epub 2018 Nov 26.

Washington University School of Medicine, Department of Surgery, Section of Vascular Surgery, Saint Louis, MO.

Background: Postoperative subtherapeutic low-dose heparin infusion (LDHI) is sometimes administered in patients undergoing extremity arterial revascularization to maintain graft patency and decrease the risk of thrombosis. However, the safety of this management strategy is unknown.

Methods: From 2013 to 2015, we retrospectively reviewed all patients undergoing upper and lower extremity arterial revascularization at a single university-affiliated medical center. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S08905096183085
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http://dx.doi.org/10.1016/j.avsg.2018.08.090DOI Listing
November 2018
3 Reads

The Effect of Body Weight Support on Energy Expenditure in an Individual With High-Level Lower Extremity Amputation.

Phys Ther 2018 Nov 28. Epub 2018 Nov 28.

Philadelphia College of Osteopathic Medicine, 625 Old Peachtree Rd NW, Suwanee, GA 30024 (USA).

Background: High-level lower extremity amputation (HLLEA) has significant impact on an individual's ability to ambulate and maintain cardiovascular fitness for extended periods of time.

Objective: The purpose of this study was to evaluate whether body weight support (BWS) would improve energy efficiency in an individual with HLLEA in order to achieve appropriate target cardiovascular intensity for aerobic training.

Design: This is an exploratory single-subject study. Read More

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http://dx.doi.org/10.1093/ptj/pzy147DOI Listing
November 2018
1 Read

Three-Dimensional Take-off Step Kinetics of Long Jumpers with and without a Transtibial Amputation.

Med Sci Sports Exerc 2018 Nov 26. Epub 2018 Nov 26.

Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Germany.

Purpose: The loads applied on the musculo-skeletal system during the long jump take-off step are not well established for non-amputee athletes or athletes with a lower extremity amputation. Information on joint loading and potential injury mechanisms is important for improving training or rehabilitation protocols, prosthetic design and the general understanding of the long jump.

Methods: Three-dimensional take-off step kinematics and kinetics were used for inverse dynamic model calculations on three male athletes with and seven male athletes without a below the knee amputation (BKA). Read More

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http://dx.doi.org/10.1249/MSS.0000000000001853DOI Listing
November 2018
3 Reads

Testing the sympathetic nervous system of the foot has a high predictive value for early amputation in patients with diabetes with a neuroischemic ulcer.

BMJ Open Diabetes Res Care 2018 21;6(1):e000592. Epub 2018 Nov 21.

Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, The Netherlands.

Objective: There is evidence from the literature that dysfunctionality of the sympathetic nervous system of the foot with subsequent loss of local autoregulation could be a predictor of early amputation in patients with diabetes with a neuroischemic ulcer. To confirm this we tested the functionality of the sympathetic nervous system in the foot in a consecutive group of 31 patients with diabetes with critical limb ischemia and non-healing neuroischemic ulcer.

Research Design And Methods: Prospective cohort with retrospective analysis after 12 months of routinely acquired clinical data. Read More

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http://dx.doi.org/10.1136/bmjdrc-2018-000592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254746PMC
November 2018
1 Read

Evaluation of Risk Factors for Limb-Specific Peripheral Vascular Events in Patients With Peripheral Artery Disease: A Post Hoc Analysis of the SEASON Prospective Observational Study.

Angiology 2018 Nov 26:3319718814351. Epub 2018 Nov 26.

7 Mitsubishi Tanabe Pharma Corporation, Osaka, Japan.

Surveillance of cardiovascular Events in Antiplatelet-treated arterioSclerosis Obliterans patients in JapaN (SEASON) is a 2-year, prospective, real-world, registry study conducted in Japan from 2009 to 2013. This post hoc analysis evaluated risk factors for limb ischemia in patients with peripheral arterial disease (PAD) and ankle-brachial index (ABI) <0.90. Read More

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http://journals.sagepub.com/doi/10.1177/0003319718814351
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http://dx.doi.org/10.1177/0003319718814351DOI Listing
November 2018
17 Reads

Incisional Application of Negative Pressure for Nontraumatic Lower Extremity Amputations: A Review.

Surg Technol Int 2018 Nov 23;34. Epub 2018 Nov 23.

eorgetown University School of Medicine, Vice Chair of Research for MedStar Plastic and Reconstructive Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC.

In the environment of diabetes and peripheral vascular disease (PVD), there is a high risk of incisional complications following amputation, including seroma, hematoma, infection, and dehiscence. Incisional negative-pressure wound therapy (iNPWT) is a novel application of negative-pressure wound therapy (NPWT) that may be able to mitigate these complications and reduce the need for revisional surgery (including higher-level major lower-extremity amputations). It may also facilitate an increased rate of healing and earlier return to function. Read More

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November 2018
2 Reads

Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations.

Authors:
Joseph B Webster

Phys Med Rehabil Clin N Am 2019 02 31;30(1):89-109. Epub 2018 Oct 31.

Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Hunter Holmes McGuire VA Medical Center, Building 514, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA. Electronic address:

Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and require specialized management with an interdisciplinary team approach and care coordination across the continuum of care to facilitate optimal outcomes. Management considerations include issues with the amputation itself, issues related to injury of other body parts, and the management of longer-term secondary conditions. Read More

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http://dx.doi.org/10.1016/j.pmr.2018.08.008DOI Listing
February 2019

Major adverse limb events and major adverse cardiac events after contemporary lower extremity bypass and infrainguinal endovascular intervention in patients with claudication.

J Vasc Surg 2018 Dec;68(6):1817-1823

Department of Surgery, University of Virginia, Charlottesville, Va. Electronic address:

Objective: Major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) at 30 days provide standardized metrics for comparison and have been adopted by the Society for Vascular Surgery's objective performance goals for critical limb ischemia. However, MALEs and MACEs have not been widely adopted within the claudication population, and the comparative outcomes after lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) remain unclear. The purpose of this study was to compare MALEs and MACEs after LEB and IEI in a contemporary national cohort and to determine predictors of MALEs and MACEs after revascularization for claudication. Read More

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http://dx.doi.org/10.1016/j.jvs.2018.06.193DOI Listing
December 2018
7 Reads

Effects of arm swing on spatiotemporal characteristics of gait in unilateral transhumeral amputees.

Gait Posture 2018 Nov 12;68:95-100. Epub 2018 Nov 12.

Hacettepe University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, 06100, Ankara, Turkey.

Background: Gait is an autonomic process consisting of coordinated movements of the upper extremities, lower extremities, trunk and pelvis. However, researches regarding effects of upper extremity problems on gait parameters are limited.

Research Question: The aim of this study was to investigate the effects of arm swing on spatiotemporal characteristics of gait in individuals with unilateral transhumeral amputations. Read More

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http://dx.doi.org/10.1016/j.gaitpost.2018.11.010DOI Listing
November 2018
1 Read

Diabetes pharmacotherapy and effects on the musculoskeletal system.

Diabetes Metab Res Rev 2018 Nov 22:e3100. Epub 2018 Nov 22.

University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA.

Persons with type 1 or type 2 diabetes have a significantly higher fracture risk than age-matched persons without diabetes, attributed to disease-specific deficits in the microarchitecture and material properties of bone tissue. Therefore, independent effects of diabetes drugs on skeletal integrity are vitally important. Studies of incretin-based therapies have shown divergent effects of different agents on fracture risk, including detrimental, beneficial, and neutral effects. Read More

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http://dx.doi.org/10.1002/dmrr.3100DOI Listing
November 2018
11 Reads

Experimental comparisons of passive and powered ankle-foot orthoses in individuals with limb reconstruction.

J Neuroeng Rehabil 2018 Nov 21;15(1):111. Epub 2018 Nov 21.

Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft, Sam Houston, TX, USA.

Background: Ankle-foot orthoses (AFO) are commonly prescribed to provide functional assistance for patients with lower limb injuries or weakness. Their passive mechanical elements can provide some energy return to improve walking ability, but cannot restore plantar flexor push-off. Powered AFOs provide an assistive torque about the ankle to address the limitations of passive devices, but current designs have yet to be implemented on a large scale clinically. Read More

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http://dx.doi.org/10.1186/s12984-018-0455-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249722PMC
November 2018
3 Reads

Biomechanical and neurocognitive performance outcomes of walking with transtibial limb loss while challenged by a concurrent task.

Exp Brain Res 2018 Nov 20. Epub 2018 Nov 20.

Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD, USA.

Individuals who have sustained loss of a lower limb may require adaptations in sensorimotor and control systems to effectively utilize a prosthesis, and the interaction of these systems during walking is not clearly understood for this patient population. The aim of this study was to concurrently evaluate temporospatial gait mechanics and cortical dynamics in a population with and without unilateral transtibial limb loss (TT). Utilizing motion capture and electroencephalography, these outcomes were simultaneously collected while participants with and without TT completed a concurrent task of varying difficulty (low- and high-demand) while seated and walking. Read More

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http://dx.doi.org/10.1007/s00221-018-5419-8DOI Listing
November 2018
4 Reads

Factors Contributing to Increases in Diabetes-Related Preventable Hospitalization Costs Among U.S. Adults During 2001-2014.

Diabetes Care 2018 Nov 19. Epub 2018 Nov 19.

Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.

Objective: To examine changes in diabetes-related preventable hospitalization costs and to determine the contribution of each underlying factor to these changes.

Research Design And Methods: We used data from the 2001-2014 U.S. Read More

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http://dx.doi.org/10.2337/dc18-1078DOI Listing
November 2018

Association between Foot Care Knowledge and Practices among African Americans with Type 2 Diabetes: An Exploratory Pilot Study.

J Natl Med Assoc 2018 Nov 16. Epub 2018 Nov 16.

Texas A&M University, Department of Health and Kinesiology; College Station, TX, USA.

Objectives: African Americans bear a disproportionate burden of lower extremity complications associated with a type 2 diabetes diagnosis. We examined the relationship that self-reported foot care knowledge, foot self-care behaviors, and foot self-care management barriers had on a participants' intention to maintain long term foot self-care.

Methods: African Americans were recruited using a convenience and snowball sampling plan, as well as telephone, email and flyers detailing the study. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00279684173008
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http://dx.doi.org/10.1016/j.jnma.2018.10.004DOI Listing
November 2018
6 Reads

Minimally Invasive Aortobiilliofemoral Endarterectomy for Aortoiliac Occlusive Disease Is a Compelling Alternative to Bypass.

Vasc Endovascular Surg 2018 Nov 14:1538574418807104. Epub 2018 Nov 14.

2 Division of Vascular Surgery, Department of Surgery, The Mount Sinai Medical Center, New York, NY, USA.

Introduction:: Aortobifemoral bypass is a time-honored, durable surgery allowing restoration of lower extremity blood. However, the potential for significant complications exists, impacting mortality, morbidity, and quality of life. Minimally invasive aortobiiliofemoral endarterectomy offers an alternative to prosthetic bypass and its associated complications. Read More

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http://dx.doi.org/10.1177/1538574418807104DOI Listing
November 2018
1 Read

Surgical Application of Viable Cryopreserved Placental Membrane for the Treatment of Chronic Wounds in 12 High-risk Patients.

Wounds 2018 Nov;30(11):324-328

Osiris Therapeutics, Inc, Columbia, MD.

Treatment of lower extremity ulcers remains a challenge to physicians and surgeons. These wounds lead to an increased risk of amputation and increased mortality rate and must be treated aggressively, in many cases requiring surgical debridement, to prevent these complications. The objective of this retrospective case series is to evaluate the safety and efficacy of a viable cryopreserved placental membrane (vCPM) in 12 patients with 16 wounds of mixed etiologies when surgically debrided and augmented with vCPM 1 time, followed by standard of care (nonadherent dressing, gauze, and compression) until healed. Read More

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November 2018
7 Reads