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J L Kaufman

Publications and source records attributed to J L Kaufman.

At least 37 records · Page 2Linked to original sources
PubMed1995

Alternative methods for below-knee amputation: reappraisal of the Kendrick procedure.

BACKGROUND: In 1956, Kendrick described a technique for below-knee amputation (BKA) using anterior and posterior flaps in a length ratio of 1:2. There has been no review of the utility and safety of this technique over the past four decades. STUDY DESIGN: The Kendrick method was studied in 96 consecutive patients who underwent 100 BKAs from 1982 to 1995. Follow-up examination was continued through the period of rehabilitation and included all revisional surgery. RESULTS: Eighty-one patients had diabetes mellitus, 15 patients were nondiabetic, and the mean age was 67 years (range, 12 to 94 years). Fifty-seven patients underwent BKA for diabetic foot sepsis with healing failure after debridement or nonreconstructable vascular disease, 19 patients underwent BKAs for progressive necrosis despite a patent arterial reconstruction, and 24 patients underwent BKAs for other causes, including microembolism, calciphylaxis-related gangrene, bypass failure, trauma, frostbite, and calf-wound healing failure after coronary revascularization. Preliminary guillotine amputations were performed on three limbs. There was an incision in the calf from previous vascular surgery in 25 limbs. The 30-day mortality rate was 6 percent. Healing of the stump and knee salvage occurred in 93 limbs (93 percent). Four patients had local wound complications develop in the stump, yet they eventually healed. During the follow-up period, conversion to an above-knee amputation was necessary in seven patients, five within 30 days. Only one of these was in a limb with a previous arterial reconstruction in the calf. CONCLUSIONS: The Kendrick procedure for BKA with anterior and posterior flaps is efficacious and safe. This procedure is advantageous for its anatomic basis, the ease with which the flaps can be designed despite leg edema or overall size, and the ability of the surgeon to distance the posterior flap margin from sepsis in the lower one-third of the calf.

Adolescent↗
PubMed1995

Deep dorsal vein arterialization in arteriogenic impotence: use of the dorsal artery as a neoarterial source.

Deep dorsal vein (DDV) arterialization has developed as a treatment option for patients with arteriogenic impotence, especially in situations where artery-to-artery bypass is not feasible. The inferior epigastric artery (IEA), harvested through a lower abdominal incision, has usually served as the neoarterial source. Using dynamic infusion cavernosometry and cavernosography (DICC) to evaluate arterial and venous erection factors and pudendal arteriography to define arterial anatomy, we have identified 16 patients with cavernosal artery (CA) obstruction and a normal dorsal artery (DA) to serve as the neoarterial source. All patients were less than 50 years old (mean 34.8 +/- 8.6 years). During DICC, the gradient between systemic and CA systolic occlusion pressures averaged 38.7 mmHg. Two patients showed moderate and two minimal corporal veno-occlusive dysfunction (CVOD). From 1991-94, all 16 underwent microscopic DA-DDV arterialization. Four of these patients also underwent venous ligation procedures and three had IEA bypass to the other DA. With adequate follow-up in 15 men, the results for six are considered excellent or normal (40%); eight improved (53.3%) and one was unchanged. In the improved group are three men who did not respond adequately to maximum penile injection therapy before surgery but used small doses afterward with success. Of the three smokers in the series, two were improved and one unchanged. Excellent results were found in four of five men (80%) under age 30 but only one of five (20%) over age 40. Complications included two instances of penile shortening and one of glans hyperemia requiring reoperation. By avoiding an abdominal approach, operative times, morbidity and recovery were substantially shortened. This operative approach can provide an excellent treatment for nonsmokers with CA obstruction and a normal DA.

Adult↗
PubMed1992

Adventitial cystic disease of the femoral vein: a case report and review of the literature.

Painless edema of the left leg developed in a 65-year-old man without a history of venous disease, and he was found to have a mass compressing the lumen of the left common femoral vein. The intramural cyst was drained through transvenous exposure and found to contain mucoid material. This is the seventh case of adventitial cystic disease of a vein in the world literature. Analogous to adventitial cystic disease of arteries, it is defined by venography, CT scanning, and duplex ultrasonography. Surgical drainage is the treatment of choice.

Aged↗
PubMed1992

Is long vein bypass from groin to ankle a durable procedure? An analysis of a ten-year experience.

Long vein bypass from the femoral artery to the level of the ankle may be performed with good initial success despite extreme bypass length and limited outflow tracts. However, the long-term performance of these bypasses remains to be defined. During the last 10 years we have performed single greater saphenous vein in situ bypass to the ankle level in 270 patients. There were 187 male and 83 female patients, and 61% of the patients were diabetic. The operative mortality rate was 3.7%. Cumulative bypass patency was 79% at 3 years and 73% at 5 years. In a similar manner, limb salvage was 93% at 3 years and 89% at 5 years. The patency rate was similar for various inflow arteries (common femoral, 88 cases; proximal superficial femoral, 135 cases; and deep femoral, 41 cases) and outflow tracts (dorsal pedal, 72 cases; anterior tibial, 59 cases; posterior tibial, 72 cases, and peroneal, 67 cases). Short bypasses, composite bypasses, free-vein grafts, and bypasses proximal to 10 cm above the ankle were excluded from this analysis. These data show that a long bypass to the ankle level for limb salvage is a durable procedure. The basic concept of bypassing all occlusive disease to the distal open artery in patients undergoing limb salvage should be an acceptable dictum. Excellent long-term patency and limb salvage rates are achievable by following this principle.

Adult↗
PubMed1991

Local anesthesia for surgery on the foot: efficacy in the ischemic or diabetic extremity.

The efficacy, risks, and benefits of the use of local anesthesia for surgery on the foot were assessed in 75 patients who underwent 127 procedures with lower calf, ankle, metatarsal-ray, and digital blocks. There were 23 procedures on digits alone, 97 forefoot operations (transmetatarsal amputations, wound debridements, closures, osteotomies, joint resections), six ankle or hind-foot amputations, and one open ankle disarticulation. There were no complications directly related to the use of local anesthesia; specifically, no extension of preexisting infection or ischemia due to injection in the foot. There were three deaths (30-day mortality 4%). The procedures were uniformly well tolerated, even in patients with ongoing myocardial ischemia or severe metabolic disorders. Local anesthesia is a safe and effective method to perform local debridement or amputation of the foot in an ischemic or diabetic extremity.

Aged↗
PubMed1991

Acute arterial insufficiency of the male genitalia.

Three patients developed severe ischemia of the penis or scrotum from acute arterial occlusion. In one case, nonhealing ulceration of the glans developed after atheroembolism to the dorsal penile artery. One patient had penile ischemia after ligation of pelvic and femoral collateral circulation during repair of an aorto-bilateral-iliac artery aneurysm. A third patient had ischemia of the penis and scrotum from thromboembolism to the iliac arteries during repair of an aortoenteric fistula. Only seven patients have been described with acute arterial occlusion and severe ischemia of the male genitalia. A rare phenomenon because of rich collateral circulation, acute ischemia of the genitalia nevertheless must be recognized as a sign of severe vascular disease and a consequence of major arterial ligation or occlusion in the pelvis and groins.

Acute Disease↗