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At least 397 records · Page 22Linked to original sources
PubMed2005

Elevated pregnancy losses at high and low extremes of maternal glucose in early normal and diabetic pregnancy: evidence for a protective adaptation in diabetes.

OBJECTIVE: Early pregnancy losses increase with marked hyperglycemia in diabetic pregnancy. However, mean loss rates do not differ from those of nondiabetic pregnancy. This observation might be explained by increased fetal losses at the extremes of glycemia in diabetic and nondiabetic pregnancy. To test this hypothesis, we examined relationships of proximate measures of prior glycemia, glycated protein and fructosamine, to pregnancy loss. RESEARCH DESIGN AND METHODS: A total of 389 diabetic and 429 nondiabetic pregnant subjects participated in the Diabetes In Early Pregnancy study. Glycated protein and fructosamine measurements were standardized as multiples of control values for each center (Z score). The logarithm of odds of pregnancy loss were plotted against Z scores and tested by logistic models. RESULTS: Mean pregnancy loss rates were 12% in diabetic and 13% in normal pregnancies. However, over six intervals of glycated protein in diabetic pregnancy, fetal loss rates at the upper and lower extremes (24 and 33%, respectively) were approximately threefold higher than the four intervening rates (8-14%). The odds ratio of pregnancy loss for these extreme intervals to the intervening intervals is 3.0 (P = 0.01). Nondiabetic losses showed a similar pattern. In confirmation, logit pregnancy losses were increased in a J-shaped curve at the glycemic extremes in normal (P < 0.019) and diabetic (P < 0.015) pregnancy. The upper glycemic extreme in diabetic pregnancy was two- to fivefold higher than in control pregnancy. CONCLUSIONS: Pregnancy losses are increased at the extremes of glycemia in both normal and diabetic pregnancy but at higher levels in diabetic pregnancy. The data suggest defensive adaptations against hyperglycemia in diabetic pregnancy.

Abortion, Spontaneous↗
PubMed1998

Upper-extremity self-amputation and replantation: 2 case reports and a review of the literature.

BACKGROUND: Patients who deliberately amputate 1 or more of their own extremities present a unique set of challenges for the entire treatment team. Decisions regarding replantation of the amputated extremity must be made quickly, and the psychiatrist is involved early in the care of these difficult patients. Surgical staff may feel that replantation surgery is inappropriate for such patients, although there is limited literature addressing this issue. Therefore, the psychiatrist must also address the strong feelings that such patients generate in nonpsychiatric caregivers. METHOD: Two cases of deliberate upper-extremity self-amputation are discussed, and the world literature on self-amputation and replantation from 1966 to the present, identified via a MEDLINE search, using the key words self-amputation, self-inflicted, upper extremity, and amputation, is reviewed. RESULTS: There have been 11 reported cases (plus 2 in the current report) of deliberate upper-extremity amputation in the last 30 years. All patients have been psychotic, and many of the case reports note that patients with this presentation are rarely suicidal. Instead, the amputation usually stems from psychotically driven feelings of guilt and concrete religious preoccupations. Patients who undergo replantation often are pleased with the reattachment, and both psychiatric and surgical outcomes appear to benefit from prompt and aggressive psychiatric treatment. CONCLUSION: Patients who deliberately amputate one or more of their extremities can be unsettling as well as challenging. The psychiatrist must coordinate diagnosis and treatment among multiple services to ensure the best possible outcome. As replantation surgery becomes more common, the psychiatric implications of surgical reattachment are of increasing importance. More cases need to be described to better understand the best treatment options for this particular patient population.

Adult↗
PubMed2002

Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities.

BACKGROUND: The optimal strategy for diagnosis of deep venous thrombosis (DVT) is less well established for the upper extremities than for the lower extremities. Duplex color ultrasonography can be difficult to perform in the upper extremities because of their anatomy, and contrast venography is often indicated. Moreover, limited data exist on the use of duplex color ultrasonography in this setting. OBJECTIVE: To determine the accuracy of duplex ultrasonography for diagnosis of DVT of the upper extremities. DESIGN: Prospective study of duplex ultrasonography compared with venography. SETTING: A teaching hospital in Amsterdam, the Netherlands. PATIENTS: 126 consecutive inpatients and outpatients with suspected DVT of the upper extremities. MEASUREMENTS: Contrast venography was obtained after duplex ultrasonography and was judged independently. A three-step protocol, involving compression ultrasonography, color ultrasonography, and color Doppler ultrasonography, was used. Sensitivity, specificity, and likelihood ratios for ultrasonography as a whole were calculated. The independent value of each step was assessed. RESULTS: Venography and ultrasonography were not feasible in 23 of 126 patients (18%) and 1 of 126 patients (0.8%), respectively. Results of ultrasonography were inconclusive in 3 patients. Venography demonstrated thrombosis in 44 of 99 patients (44%); in 36 patients (36%), thrombosis was related to intravenous catheters or malignant disease. Sensitivity and specificity of duplex ultrasonography were 82% (95% CI, 70% to 93%) and 82% (CI, 72% to 92%), respectively. Venous incompressibility correlated well with thrombosis, whereas only 50% of isolated flow abnormalities proved to be thrombosis-related. CONCLUSIONS: Duplex ultrasonography may be the method of choice for initial diagnosis of patients with suspected thrombosis of the upper extremities. However, in patients with isolated flow abnormalities, contrast venography should be performed.

Adolescent↗
PubMed1986

Utility of a screening examination of the fetal extremities during obstetrical sonography.

The hands, feet, and long bones of the extremities were visualized and an image of the femur was obtained as part of a brief fetal anatomy survey during approximately 6,700 low-risk and high-risk obstetric sonograms. This examination identified four fetuses with five instances of isolated extremity abnormalities and nine fetuses with ten instances of generalized extremity abnormalities. Isolated abnormalities included malformation or complete or partial absence of an extremity. Generalized abnormalities included fused hands and feet, polydactyly, phocomelia, hyperechoic muscle with contractures, and several varieties of dwarfism. Most fetuses had other structural abnormalities as well and two had an abnormal family history. The sensitivity of the fetal anatomy survey for the detection of extremity malformations would not have been changed if the routine femur measurement had been retained but the systematic visualization of the fetal extremities had been done only in selected fetuses with a malformation of any kind or an abnormal family history.

Bone and Bones↗
PubMed2003

Sonographic evaluation of lower extremity interosseous membrane injuries: retrospective review in 3 patients.

OBJECTIVE: To describe the sonographic findings of lower extremity interosseous membrane disruption with computed tomographic and surgical correlation. METHODS: Three patients with sonographic evaluation of the lower extremity interosseous membrane were identified through the clinical experience of 1 author over a 5-year period. Sonographic images of the symptomatic and unaffected lower extremities were retrospectively characterized and correlated with computed tomographic and surgical findings by 2 fellowship-trained musculoskeletal radiologists. RESULTS: The normal interosseous membrane was identified in the asymptomatic lower extremities in all 3 patients, which appeared as a thin, hyperechoic (nearly equal to bone cortex) line, continuous from the tibia to the fibula. The abnormal interosseous membrane in all 3 cases appeared abnormally hypoechoic, poorly defined, and discontinuous at the tibia. A proximal fibular fracture was shown on sonography in 1 of 3 symptomatic lower extremities with radiographic evidence of a fracture. The sonographic findings correlated with the computed tomographic images. Distal tibiofibular syndesmosis injuries were confirmed and treated at surgery in 2 patients. CONCLUSIONS: Sonography can show both normal and injured interosseous membranes of the lower extremity, as well as associated proximal fibular fractures.

Adult↗
PubMed1999

Lower extremity bypass using only duplex ultrasonography: is the time now?

Imaging for lower extremity arterial bypasses continues to evolve as distal target vessels are more frequently small infragenicular arteries. For these procedures to be properly planned and executed, accurate anatomic knowledge of the lower extremity arterial system and potential venous conduits is essential. The utility of current imaging methods for planning lower extremity revascularization is examined, including the relatively recent use of duplex arterial mapping. Arteriography is a poor "gold standard" in many cases of iliac and infrainguinal arterial occlusive disease. Duplex arterial scanning can be performed successfully in patients being considered for lower extremity revascularization. Patients with isolated stenoses or short occlusions, particularly those above the inguinal ligament, may be identified in whom percutaneous endovascular therapy is appropriate, depending on their clinical presentation. Patients with more severe disease may be taken to the operating room, where the quality of the inflow is evaluated with arterial pressure measurement. If the inflow pressure is not equal to systemic pressure, arteriography with pullback pressure measurements can be performed, and the responsible lesion can be identified and appropriately treated. Once inflow obstruction has been corrected, intraoperative outflow arteriography is performed. If duplex arterial mapping does not demonstrate a distal site for bypass, arteriography should be performed, as a preoperative or intraoperative study, before considering amputation. This approach should decrease the cost and complications of lower extremity revascularization while allowing treatment planning for lower extremity vascular occlusive disease to be based on accurate anatomic and physiological data.

Angiography↗
PubMed2000

[Mechanisms of extreme states in human].

Pathogenesis of extreme states during hypoxic hypoxia, exogenic and combined hyperthermia, aerial and immersion hypothermia is mainly associated with deterioration of reactivity and decline of functional reserves of the neuroendocrinal system, energetic dysbalance against more pronounced signs of anaerobic catabolism and recruitment of plastic resources of the body, activation of peroxide oxidation of lipids (POL), depletion of AOS potential with labilization of cellular membranes, and progressing changes in structural and functional relations within the antigenous/structural homeostasis. The determinacy of extreme state is influenced by initial status of the body functioning. The bodily extreme state has been found to depend on severity of asthenisation, peculiarities of the autonomous regulation, metabolic and immune status. Partial or full reversibility of decompensation disorders distinguishes extreme state from the critical (predeterminal) one. The relative adequacy of compensation and the principal possibility of a beneficial result are the necessary conditions for extreme state verification. Otherwise, in the lack of time for effective compensation typical syndromes of critical states may develop already during acute adaptation. There can develop partial insufficiency of a dominating functional system which will be compensated at the sacrifice of other organs and tissues. Sometimes extreme state may result in development of marginal or pathological states with human living activities preserved.

Adaptation, Physiological↗
PubMed2000

Utility of lower extremity venous ultrasound scanning in the diagnosis and exclusion of pulmonary embolism in outpatients.

STUDY OBJECTIVE: Emergency physicians frequently rely on normal findings from a lower extremity venous ultrasound examination as a method to decrease the probability of pulmonary embolism (PE) in outpatients with a nondiagnostic ventilation-perfusion lung scan (V/Q scan). The objective of this study was to evaluate the diagnostic utility of bilateral lower extremity venous ultrasound scanning in the diagnosis of PE in emergency department patients with a low-, moderate-, or indeterminate-probability (nondiagnostic) V/Q scan. METHODS: This prospective, 2-center, descriptive study was conducted at the EDs of 2 large teaching hospitals. From an initial cohort of 570 nonreferred outpatients, a convenience sample of 156 patients who had both a nondiagnostic V/Q scan and a lower extremity venous ultrasound scan performed was selected as the study population. The sensitivity and specificity for a single lower extremity venous ultrasound scan and the posttest probability of PE were determined for the study population. RESULTS: In the study population, the best-case sensitivity of the lower extremity venous ultrasound scan for PE was 54% (95% confidence interval [CI] 37% to 71%) and the specificity was 98% (95% CI 94% to 100%). The likelihood ratio of a positive test result was 27. The likelihood ratio of a negative test result was 0.49, yielding a lowest possible posttest probability of PE of 12% (95% CI 6% to 17%). CONCLUSION: This study demonstrates that the combination of a nondiagnostic (low, moderate, or indeterminate) V/Q scan plus a single negative result from lower extremity venous ultrasound examination, even in a best-case scenario, does not exclude the diagnosis of PE.

Adult↗
PubMed2000

Complications of lower extremity arteriovenous grafts in patients with end-stage renal disease.

BACKGROUND: More data are needed to assess lower extremity angioaccess sites for hemodialysis. METHODS: We did a retrospective review of 843 consecutive hospital records of upper and lower extremity arteriovenous (AV) fistulas from 1992 to 1996. RESULTS: Lower extremity grafts accounted for 16% (134/843) of patients in this series. Complications occurred in 58 of 134 patients (43%) and were more prevalent in women, blacks, diabetic, and hypertensive patients, but not of statistical significance. Dialysis was done for a mean duration of 13.3 years, with a mean graft patency rate of 13.8 months. The 12-month survival rate of lower extremity AV grafts was 62% (83/134). Complications in the lower extremity AV graft group (58 patients) included infections in 27 patients (46%), thrombosis within 30 days in 16 (28%), pseudoaneurysm in 9 (16%), and graft hemorrhage in 6 (10%). CONCLUSIONS: There is a decreased patency rate in lower extremity AV grafts.

Adult↗
PubMed2000

[Post-traumatic lymphatic and venous drainage changes in persistent edema of lower extremities].

Mechanical injury of soft tissues and bones of the lower extremity is followed by chronic edema at the site of trauma and distally to it. This complication affects almost every patient with a fracture of the lower limb. The question is whether posttraumatic edema is due to lymphatic obstruction, venous thrombosis or both, or a local cytokine and growth factor hyperactivity at the fracture site. The aim of study was to assess the venous and lymph outflow in patient with chronic postraumatic edema of the lower limbs. A group of 19 patients with chronic edema lasting for more than 3 months was evaluated. Limb circumference, tissue tone measurements, skin temperature and Doppler enhanced ultrasonography were all taken down for the 19 patients in the evaluated group. Limb circumference was measured at the following level: foot, ankle, calf and thigh. Results showed an increase of circumference in comparison with the healthy extremity at each evaluated level of: 1.20 +/- 1.65 cm, 1.63 +/- 1.41 cm, 1.40 +/- 1.72 cm and 0.30 +/- 1.90 cm. Local temperature increase compared to the healthy extremity was also noted (0.93 +/- 0.81 degree C and 0.37 +/- 0.21 degree C measured at ankle and calf level). Tissue tone measurements and tone index (a quotient of tone measurement values in the extremity with edema and in the healthy extremity) were also increased by 0.86 +/- 0.57, 0.85 +/- 0.34 and 0.86 +/- 0.28, when measured with 40 g, 110 g and 180 g weights respectively. In 17 cases (89.5%) lymphoscintigraphy demonstrated an increased lymphatic outflow compared to the contralateral extremity. A marked increase in the inguinal lymph nodes was also noted. In the remaining 2 cases (10.5%) extravasation of the contrast medium into the skin indicated lymph outflow disorders. Only in 5 cases (26.3%) ultrasonography indicated deep vein thrombosis. The obtained results indicate that the pathophysiology of chronic postraumatic edema is linked with an inflammatory and restorative reaction at the fracture site. Only in a limited number of cases deep vein thrombosis and damaged lymphatic vessels are responsible for postraumatic edema.

Chronic Disease↗
PubMed2001

[Therapeutic approach in vascular injuries of the lower extremity: Amputation or limb salvage].

The management of lower extremity trauma with vasculary involvement should be directed toward to the salvage of the extremity or to the primary amputation according to the additional pathologies, parameters of the patient and the extremity. We investigated the efficiency of Mangled Extremity Severity Score (MESS) system which is proposed as an grading system to evaluate the change to extremity salvage or the risk for onset of systemic complications. 81 patients with lower extremity trauma were analyzed according to MESS criteria. 79 of the patients were men and mean age was 23 +/- 4. Fourteen patients had higher MESS score. (MESS > 7). Seven of them were older than 50 years. Primary amputation was performed in four of these 7 patients. Vascular repair was performed in three of patients. Multiorgan failure was developed in two of them and both patients died. Secondary amputation was performed to another patients underwent vasculary repair who had MESS > 7 score. Primary amputation was not performed directly in young patients who had MESS > 7. Secondary amputation was required in two of these patients. MESS scoring system can easily predict amputation in older patients but may cause unnecessary amputation in young patients.

Adolescent↗
PubMed2001

[The course of pregnancy, delivery and puerperium in women with varices and thrombophlebitis of lower extremities, after application of low molecular weight heparins].

OBJECTIVES: Estimation of the long term prophylactic or therapeutic application of low molecular weight heparin (LMWH) on the platelets count, and incidence bleedings during pregnancy, delivery and puerperium in the women with varices of lower extremities and past thrombophlebitis of lower extremities. MATERIAL AND METHODS: 5212 pregnant, women in labour and in puerperium divided into 4 groups.; 142 women with varices and thrombophlebitis of lower extremities (group I); 10 with past thrombophlebitis of lower extremities (group II); 15 with thrombophlebitis in current pregnancy; 5045 without vascular complications (group IV--control). In group I during pregnancy compression therapy was applied (stockings) and low molecular weight heparins (LMWH) in course of puerperium. In group II during the 1st trimester of pregnancy and in labour the same heparin doses were administered, while the doses were increased in the 2nd and 3rd trimester. In group III, when thrombophlebitis was stated non-steroid anti-inflammatory drugs and LMWH were administered. In all cases treated with heparin both number of platelets and incidents of bleedings from genitourinary tract were observed. Presence of embolic complications was also noted. RESULTS: No cases of decrease platelets number or bleedings from genitourinary tract were observed in group I-III during administering of LMWH. In women in group II where prophylactic with LMWH was applied no incidences of recurrent thrombophlebitis during pregnancy and puerperium were observed. In group I-III all newborns were born in good condition and no complications were observed. Average blood loss during both labour and cesarean section, among women in group I-III was not significantly different comparing with control group. No incidences of pulmonary artery embolism or decrease number of platelets were observed. CONCLUSIONS: 1. The long term prophylactic or therapeutical administration of LMWH in the women with varices of lower extremities or thrombophlebitis has no influence on the platelets count and incidence of bleedings from genitourinary tract during pregnancy or increase of blood loss during labour and puerperium. 2. In the women with past thrombophlebitis of the lower extremities after application of LMWH during pregnancy there were no recurrence observed.

Adult↗
PubMed2002

[Somatometric and impedance measurements of the lower extremities in orthopedics].

PURPOSE OF THE STUDY: The objective was to demonstrate the contribution of somatometry and vascular impedance measurement to the evaluation of somatic status and nutrition, particularly the state and function of the vascular system of lower extremities, in patients with arthropathy of the weight-bearing joints. MATERIAL: Impedance plethysmography and impedance phlebography appeared to be the best methods for assessment of vascular hemodynamics; pulse oxymetry, carried out on toes, was most convenient for measurement of haemoglobin saturation with oxygen (HbO2). The state of vessels was determined according to the CEAP classification. Somatometric methods included measurement of the circumference and volume of calves, and assessment of body height, at the anthropometric wall, and weight to calculate the body mass index (BMI). RESULTS: The lower extremities affected by arthropathy were compared with the unaffected ones by means of CEAP classes and related to the body mass values of patients. It was found that only 15 men and 26 women had normal body mass. The rest of the patients were overweight or obese (grade I and II). Only 14 men and 17 women were free of signs of vascular insufficiency, the others were classified in the range of C1 to C4 of the CEAP system. Impedance measurements showed lower mean values for affected extremities and for overweight or obese patients. A comparison of the parameters of arterial and venous hemodynamics between the affected and unaffected extremity by means of the paried t-test gave statistically significant results in patients with higher BMI grades and higher classes of vascular insufficiency, regardless of their gender. The results of HbO2 saturation measurement showed normal values in both men and women. DISCUSSION: To meet the requirements of orthopaedists, the Biophysical Laboratory carried out non-invasive measurements of somatometric parameters and vascular impedance values in patients with arthropathy of the weight-bearing joints of lower extremities. The results were similar to those of a large Framingham cohort study on knee arthropathy and obesity. The data derived from measurement of basic impedance, specific impedance and pulse-related impedance changes show that it is important to record and evaluate skin lesions and oedema because they are related to vascular disease. The finding that an increasing volume the calf was indirectly related to a decreasing basic impedance of calf vessels was confirmed by our results. This information is important for the evaluation of impedance measurement results in order to make diagnosis in individual patients. CONCLUSIONS: Our results showed that, in the group investigated, (i) there was a high proportion of overweight and obese patients; (ii) assessment by CEAP classification revealed higher grades of vascular insufficiency; (iii) affected extremities showed a significant decrease in arterial and venous haemodynamics, particularly in women with higher-grade vascular insufficiency; (iv) there was no difference in HbO2 saturation measured on toes.

Adolescent↗
PubMed2002

Evaluation of an upper extremity student-role functioning scale using item response theory.

Millions of workers suffer from upper extremity (musculoskeletal) disorders. Many of these workers are predisposed to upper extremity musculoskeletal disorders because of early exposure to ergonomic risks as students. Computer usage for four or more hours remains the greatest risk for upper extremity musculoskeletal disorders for workers and students alike. Developing preventative methods to reduce student exposure, and thus protect future workers from upper extremity musculoskeletal disorders later in life, requires an appropriate measure for upper extremity musculoskeletal disorder prevalence and related limitations for student functioning. Item response theory analysis was used to evaluate and further develop a upper extremity functioning scale for the student role.

Adult↗
PubMed2003

Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia.

BACKGROUND AND PURPOSE: Constraint-induced movement therapy (CIMT) has been documented to improve motor function in the upper extremity of people with mild hemiparesis. The use of CIMT has not been documented for people with severe hemiparesis. This case report describes a CIMT program for an individual with severe upper-extremity deficits as a result of stroke. CASE DESCRIPTION: The client was a 53-year-old woman who had a stroke 15 years previously and had no isolated movement in her right upper extremity. METHODS: The client completed a 3-week CIMT program during which she restrained her left upper extremity and participated in intensive training of her right upper extremity. Task practice and shaping were the primary techniques used for training. OUTCOMES: Increased scores were noted from pretreatment to posttreatment on the Motor Activity Log, Graded Wolf Motor Function Test (GWMFT), and Fugl-Meyer Evaluation of Physical Performance. Further progress on the GWMFT was noted at the 6-month follow-up. Fugl-Meyer test scores remained higher than at pretreatment, but Motor Activity Log scores returned to near baseline by the 6-month follow-up. The speed of performance on the GWFMT did not change. Although some scores increased, the client reported and demonstrated no progress in functional use of the involved upper extremity at the end of the program. DISCUSSION: This case report describes the use of CIMT with an individual who had severe chronic motor deficits as a result of stroke. Further investigation of CIMT, as well as investigation of CIMT in combination with other motor recovery interventions, is warranted.

Activities of Daily Living↗
PubMed2003

Vascular injuries to the extremities in a suburban trauma center.

The purpose of this study was to examine the experience with extremity vascular injuries of a level II suburban trauma center. A retrospective chart review was undertaken to include all patients admitted in a 6-year period with vascular injuries to the extremities. The vessels injured were identified along with the mechanism of injury. The method of repair was recorded. All associated neurologic injuries were investigated. Follow-up records, when available, were reviewed. Between January 1, 1996, and November 30, 2002, 48 patients were admitted with 56 vascular injuries to the extremities. Blunt trauma was the mechanism in 24 patients while penetrating trauma was the mechanism in the other 24 patients. The limb salvage rate was 95 per cent. Of the 28 injuries to upper extremity vessels, 24 were associated with neurologic injuries. In contrast, only 3 neurologic injuries were found in patients with lower extremity vascular injuries. In contrast to most urban centers, the distribution of vascular injuries to the extremities in a suburban setting was equally divided between blunt and penetrating injuries. The majority of functional impairment was related to neurologic injury rather than tissue ischemia from vascular injury.

Adult↗
PubMed1992

[A case of monoballism in unilateral lower extremity--somatotopic relation in subthalamic nucleus].

A 62-year-old man with monoballism in the right lower extremity was reported. The cranial MRI showed a small lesion affecting the posterior portion of the contralateral subthalamic nucleus. Superficial EMG recording revealed 1-2 Hz rhythmic grouping discharges in right quadriceps femoris, hamstrings, tibialis anterior and gastrocnemius-soleus. In the vast majority of cases, ballistic movements involved both upper and lower extremities of one side (hemiballism), but the present case showed monoballism in the lower extremity only. Previous reports suggested the somatotopy mapping subthalamic nucleus; the posterior portion being associated with the lower extremity, middle part with the upper extremity and the oral pole with the face. In the present case, the affected part of subthalamic nucleus was towards its posterior portion and it seemed legitimate to associate such topographic location of the lesion with the absence of involuntary movements in the upper extremity and the face. Coronal and axial sections of high-field MR scans were useful for the detection of the responsible lesion.

Electromyography↗
PubMed2005

Rescue and treatment of severely injured lower extremities.

OBJECTIVE: To explore a treatment approach for severely injured lower extremities. METHODS: The data of 42 patients with severely traumatic lower extremities from 1989 to 1999 were retrospectively reviewed. According to MESS (mangled extremity severity score) the mean score of all the limbs was 6.24+/-1.45, 34 cases had MESS score < 7 and 8 cases had MESS score > or = 7. Treatment approaches included microvascular anastomosis technique, compound tissue flap transplantation technique and compound bone tissue flap transplantation. RESULTS: Two patients died after operation and one patient had delayed amputation of a lower limb. The rest 39 patients were followed up for 4-13 years. All the lower extremities of the 39 patients survived and had equal length. The 39 cases were evaluated by Chen's criterion, showing that 37 had good result (29, Chen I and 8, Chen II), 1 sufficient (Chen III) and 1 poor (Chen IV). CONCLUSIONS: Successful emergency treatment of severely injured lower extremities could be achieved by using microsurgery techniques and strict controlling of lower extremity salvagel indications.

Adolescent↗