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At least 613 records · Page 34Linked to original sources
PubMed1993

[Reconstruction of the lower extremity using partially destroyed or amputated parts].

We are often confronted with heavy destructions of the lower extremities, where there is no possibility to conserve the limb, because of the general or/and local conditions. In this situation it's wise to preserve vital rest structures that can be used for primary or secondary reconstructions of the injured limb. There are different possibilities, some of them are presented in the cases described in this article.

Adult↗
PubMed1993

A new classification of vascularized flaps in plastic and reconstructive surgery.

Advances during the last 15 years in microsurgical technique and in our understanding of vascular anatomy have led to the development of two new branches of plastic and reconstructive surgery. The first is the transfer of free composite flaps with microvascular anastomoses. The second is transposition of island flaps solely on a proximal or distal vascular bundle. Both types of operations require an adequate vascular pedicle to provide sufficient blood circulation for flap viability and survival in the recipient site.

Adolescent↗
PubMed1995

[Successful surgical treatment in a case of type IIIb acute aortic dissection complicated with acute myocardial infarction].

The patient was a 48-year-old man who was brought to our hospital complaining of chest pain, paresthesia of the lower extremities, and pain in the lumbar region. At first, acute myocardial infarction was diagnosed, but transthoracic echocardiogram revealed an intimal flap in the ascending aorta. The presence of an intimal tear below the left subclavian artery was confirmed by intraoperative transesophageal echocardiogram, and a diagnosis of myocardial infarction accompanying type IIIb aortic dissection with retrograde extension to the ascending aorta was made. Coronary artery bypass grafting to segment #2 using a section of saphenous vein and total aortic arch replacement with "elephant trunk" technique, which concurrently served as a means of amputated stump plasty, was performed. The cerebral circulation was preserved by retrograde cerebral circulation. The post operative progress was good, and thrombo-occlusion of the false lumens of the proximal descending aorta was verified. Type IIIb aortic dissection complicated with myocardial infarction is rare, but examination with both transthoracic and transesophageal echocardiograms were useful for the morphological diagnosis and for determining the surgical technique for the dissection.

Acute Disease↗
PubMed1995

[Timing of management of severe injuries of the upper extremity by free flap-plasty].

From October 1986 until December 1993, fifty-five patients with severe injuries to the upper extremity were treated with 59 free flaps. The mean follow-up period was 34 months (8 TO 87 months). The average hospital stay was 19 days (8 to 40 days). Depending on the timing of reconstruction, the patients were divided into three groups: emergency reconstruction (within 24 hours after injury), delayed reconstruction (up to seven days) and late reconstruction (after seven days). In this paper we present our regime of treatment of severe upper extremity injuries using a free flap and discuss the principles of free flap choice.

Adolescent↗
PubMed1996

[Fasciocutaneous flap of the posterior surface of the thigh with distal pedicle. Anatomical study and surgical value. A propos of 3 cases].

In the light of previous studies, the authors conducted an anatomical study on 21 cadaveric dissections with injection in order to define the characteristics of the distally based fasciocutaneous flap of the posterior surface of the thigh, described for the first time in 1988 by Maruyama. This leaf-shaped flap extends from the popliteal region to the gluteal sulcus. It possesses an axial arterial network derived from the popliteal artery, reinforced by the perforating arteries derived from the vessel or the profunda femoris artery. The venous return is ensured by venae comitantes and the communicating saphenous vein. The flap raising technique is described. From 1991 to 1994, 3 patients were operated in order to cover a defect of the knee (1 case) and amputation stumps (2 cases). The postoperative course was uneventful and the results were considered to be stable and of excellent quality with a follow-up of 2 to 4 years.

Adult↗
PubMed1996

[Results of sub-inguinal revascularization in the treatment of diabetic ischemic foot].

From January 1993 to August 1995, we performed 60 revascularizations of the lower limb using 65 bypasses in 55 patients (32 men, 23 women, mean age 66.6 yars) with diabetes. Trophic lesions of the foot existed in 57 of the revascularizations, and in 3 cases pain was provoked by the supine position. Supra-articular femoropopliteal bypass was performed in 8 cases, subarticular femoropopliteal bypasses in 25, femorotibial bypasses in 14 and paramalleolar bypasses in 18. There were 6 post-operative deaths. Six major amputations were required including 2 despite patent bypasses. Twenty-nine minor amputations were required for trophic disorders. There were 5 deaths after the postoperative period in which 4 major amputations were required despite patent bypasses in 2 cases. Retarded cicatrization was seen in 13 of the amputation stumps of areas of atrophism. Actuarial survival at 2 years was 77 +/- 6% with primary patency of 53 +/- 9.5% and secondary patency of 74 +/- 7%. The rate of success in saving the lower limb was 80.5 +/- 5.6%. Bypass revascularization has been effective in the treatment of the diabetic ischemic foot. Operative mortality was high, resulting from associated cerebral vascular events and coronary heart disease.

Aged↗
PubMed1975

[Penetrating hyperkeratosis of an amputated limb].

On the stump of amputated limbs, a peculiar hyperkeratotic chronic lesion may be observed. The histological picture of this lesion shows a hyperkeratotic plug perforating the epidermis. In the dermis disorganised keratine lamelles are found. This lesion could be differenciated from Kyrle's disease by the fact that it consists of a single lesion of traumatic origin and by the presence of hypertrophic bundles underlying the hyperkeratosis.

Amputation Stumps↗
PubMed1986

Changing pattern of lower limb amputation for vascular disease.

In 1980 a review of lower limb amputation over a 3.5 year period between 1974 and 1978 was reported from our centre. More recently 193 amputations were performed for peripheral vascular disease over a similar 3.5 year period, representing an increase of 33 per cent in the amputation rate during the last 6 years. This cannot be explained by the increasing age of the population alone. Fewer below-knee amputations (BKA) (33.0 per cent) and more Gritti-Strokes amputations (GSA) (32.0 per cent) were performed and the overall incidence of re-amputation for stump breakdown was 13.5 per cent. Twenty-eight per cent of below-knee amputation stumps required re-amputation at higher levels, but when successful were associated with a 75 per cent incidence of rehabilitation with an artificial limb. Eight per cent of GSA stumps required re-amputation and were associated with a twenty-eight per cent incidence of successful rehabilitation. Thirty-seven per cent of patients had undergone reconstructive vascular surgery before amputation. Of the 26 patients requiring re-amputation 58 per cent had undergone arterial reconstruction in an attempt to salvage the limb (chi 2 = 5.65, P less than 0.02) and in 26.9 per cent of cases this was performed within the week before amputation. We feel that injudicious attempts at arterial reconstruction, when amputation appears inevitable, may adversely affect the subsequent level of amputation and jeopardize rehabilitation.

Age Factors↗
PubMed1985

The side-to-side flap technique in below-the-knee amputation with long stump.

Wound healing, as well as surgical and prosthetic aspects of the residual limb, was investigated in the below-the-knee amputation using the side-to-side flap technique. Of 23 patients, 74% achieved primary wound healing. The stump length ranged from 27% to 70% of the normal limb, and the mean percentage was 56%. The group with long stumps did not show increased risk of wound complication. All the patients had a nonbulbous dome-shaped stump that posed no prosthetic difficulty. This technique allows the longest possible limb to be preserved, and expenditure of the least amount of energy in ambulation.

Adult↗