Below knee amputation

Savaş Çamur, Sefa G Batlbay, Serkan Bayram
Lower extremity amputation as a treatment of diabetic foot ulcer is probably a major burden for the patient's family and friends, who typically act as caregivers and support the patient in coping with the physical disabilities and emotional distress. In the present prospective study, we investigated the effects of different lower extremity amputation levels for diabetic foot ulcer treatment on caregivers of patients with diabetes using the Zarit Burden Interview (ZBI-12) scale. Patients with diabetic foot ulcers who underwent unilateral major amputation (above-below knee) and minor amputation of foot (heel sparing) and their caregivers were requested to volunteer to participate in this study from June 2016 to December 2018...
March 26, 2020: International Wound Journal
E R I Janssen, L van Silfhout
INTRODUCTION: Despite improved revascularization options, many patients with chronic limb-threatening ischaemia (CLI) require lower limb amputation. Duplex ultrasound (DUS) is recommended as first choice imaging technique in CLI. However, the prognostic utility of DUS for planning lower limb amputations has never been described before. This study aims to evaluate if DUS and findings from physical examination could be used to help predict the best level of lower limb amputation in patients with CLI...
March 20, 2020: Annals of Vascular Surgery
Iftikhar Haider Naqvi, Abu Talib, Sajjad Haider Naqvi, Lubabah Yasin, Nayema Zehra Rizvi
BACKGROUND: The rising prevalence of type 2 diabetes mellitus (T2DM) with the huge burden of diabetic foot amputation is a challenge to the health economy of Pakistan and other countries. Identification of various risk factors for amputation along with its financial burden is needed to address this problem. OBJECTIVES: This study aimed to determine financial burden and risk factors associated with T2DM-related foot amputation. METHODS: Retrospective hospital-based study from January 2017 to December 2018...
March 20, 2020: Current Vascular Pharmacology
Stephan H Wirth, Arnd F Viehöfer, Timo Tondelli, Rebecca Hartmann, Martin C Berli, Thomas Böni, Felix W A Waibel
BACKGROUND: Failed conservative treatment and complications are indications for foot reconstruction in Charcot arthropathy. External fixation using the Ilizarov principles offers a one-stage procedure for deformity correction and resection of osteomyelitic bone. The aim of this study was to determine whether external fixation with an Ilizarov ring fixator leads reliably to walking ability. MATERIALS AND METHODS: 29 patients treated with an Ilizarov ring fixator for Charcot arthropathy were retrospectively analyzed...
March 13, 2020: Archives of Orthopaedic and Trauma Surgery
Alexander Meyer, Colin Griesbach, Nils Maudanz, Werner Lang, Veronika Almasi-Sperling, Ulrich Rother
<b/> Background : To analyze long-term outcomes and possible influencing factors in patients with endstage renal disease (ESRD) and critical limb ischemia (CLI) after major amputation compared to patients with normal renal function and non-dialysis-dependent chronic kidney disease. Patients and methods : Abstraction of single-center medical records of patients undergoing above knee (AKA) and below knee (BKA) amputation over a 10 years period (n = 436; 2009-2018). Excluded were amputations due to trauma or tumor...
March 12, 2020: VASA. Zeitschrift Für Gefässkrankheiten
A O Wamalwa, S O Khainga
Although routinely utilized in reconstruction of groin, perineal and thigh defects, the pedicled vertical rectus abdominis myocutaneous (VRAM) flap has only once been previously reported for coverage of above knee amputation (AKA) stumps. A 36 year old man sustained a traumatic above knee amputation after stepping on an improvised explosive device (IED). Following several sessions of debridement, an ipsilateral pedicled VRAM flap was utilized to provide padded soft tissue coverage and maintain bone length (6 cm below the greater trochanter), avoiding both a debilitating hip disarticulation and a need for a free flap...
March 2020: JPRAS Open
Joseph Kahan, Jordan Brand, Christopher Schneble, Don Li, Maarouf Saad, Justin Kuether, Brad Yoo
INTRODUCTION: Pronation abduction (PA) ankle fractures are often associated with a medial tension failure wound. Though this injury pattern was defined based on the mechanism of injury, there is a paucity of literature evaluating risk factors for understanding which patients will sustain an open PA fracture. Furthermore, how patients with these types of fractures perform relative to other open ankle fractures has not been established. We hypothesized that open PA fractures are associated with obesity and increased number of reoperations...
February 17, 2020: Injury
Mohammed Asif, Kevin M Klifto, Tomer Lagziel, Julie Caffrey
Heterotopic ossification has been reported in patients who have undergone traumatic amputations, burn injuries, and total hip arthroplasty; however, the incidence of heterotopic ossification following purpura fulminans has only been reported in one case with unilateral involvement. Here we present a bilateral lower extremity case of heterotopic ossification as sequelae of purpura fulminans.  A 34-year-old male smoker with a past medical history of stab wounds to the chest and abdomen requiring emergent exploratory laparotomy, diaphragmatic repair, and splenectomy 15 years ago presented to the emergency department with a rapid onset of high fevers, chills and myalgia...
January 21, 2020: Curēus
Joanna Grudziak, Cornelius Mukuzunga, Caroline Melhado, Sven Young, Leonard Banza, Bruce Cairns, Anthony Charles
Introduction: Amputations in low- and middle-income countries (LMICs) represent an important cause of disability and economic hardship. LMIC patients are young and suffer from preventable causes, such as trauma and trauma-related infections. We herein studied the etiology in amputations in a Malawian tertiary care hospital over a 9-year period. Methods: Operative and anaesthesia logs at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, were reviewed for 2008-2016...
December 2019: Malawi Medical Journal: the Journal of Medical Association of Malawi
E Dinoto, F Pecoraro, D Mirabella, F Ferlito, A Farina, N Lo Biundo, P Orlando-Conti, G Bajardi
Diabetic ulceration of the foot is a major global medical, social and economic problem and is the most frequent end-point of diabetic complications. A retrospective analysis from February 2017 to May 2019 of diabetic patients presenting below-the-knee artery disease (PAD) was carried out. Only patients treated with endovascular techniques as first choice treatment were evaluated. Outcome measured was perioperative mortality and morbidity. Freedom from occlusion, secondary patency and amputation rate were all registered...
January 2020: Translational Medicine @ UniSa
Marko Bumbaširević, Aleksandar Lešić, Tomislav Palibrk, Alexandru Valentin Georgescu, Ileana Rodica Matei, Dejan Tabaković, Slađana Matić, Ivana Glišović Jovanović, Aleksandra Petrović, Radovan Manojlović
Replantation of lower extremity is a very complex and difficult procedure. There are still a lot of controversies about indications, even numerous scoring systems are now available that can facilitate the surgeon's decision. We present the functional results of a replanted below-knee amputation in an elderly patient, 27 years after the injury and discuss the indication for replantation.
February 22, 2020: Injury
Charles Pitts, Bradley Alexander, Joshua Washington, Hannah Barranco, Romil Patel, Gerald McGwin, Ashish B Shah
AIMS: Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion...
March 2020: Bone & Joint Journal
Bahare Fazeli, Ali Mirhosseini, Zahra Hashemi, Hossein Taheri
Until recently, the aetiology of Buerger's disease (BD) has been unknown. Although there is a close relationship between BD and smoking, it cannot explain the low prevalence of BD among smokers or the disease's geographical distribution. Infectious pathogens, such as Rickettsial infection, have also been suggested as the trigger of BD development, but this theory has neither been proven nor ruled out. The aim of this study was to evaluate the footprint of Rickettsial infection in tissue specimens obtained from amputees with Buerger's disease...
2020: International Medical Case Reports Journal
Tracy J Cheun, Lalithapriya Jayakumar, Matthew J Sideman, Lori C Pounds, Mark G Davies
BACKGROUND: Inframalleolar disease is present in many diabetic patients presenting with tissue loss. The aim of this study was to examine the patient-centered outcomes after isolated inframalleolar interventions. METHODS: A database of patients undergoing lower extremity endovascular interventions for tissue loss (critical limb-threatening ischemia, Wound, Ischemia, and foot Infection [WIfI] stage 1-3) and a de novo intervention on the index limb between 2007 and 2017 was retrospectively queried...
February 17, 2020: Journal of Vascular Surgery
Thomas Zeller, Antonio Micari, Dierk Scheinert, Iris Baumgartner, Marc Bosiers, Frank E G Vermassen, Martin Banyai, Mehdi H Shishehbor, Hong Wang, Marianne Brodmann
OBJECTIVES: The goal of this study was to evaluate the 5-year follow-up data of the IN.PACT DEEP (Randomized IN.PACT Amphirion Drug-Coated Balloon [DCB] vs. Standard Percutaneous Transluminal Angioplasty [PTA] for the Treatment of Below-the-Knee Critical Limb Ischemia [CLI]) trial. BACKGROUND: Initial studies from randomized controlled trials have shown comparable short-term outcomes of DCB angioplasty versus PTA in patients with CLI with infrapopliteal disease...
February 24, 2020: JACC. Cardiovascular Interventions
John M Schuberth, Christy M King, Shen-Fang Jiang, Justin S Ross, Jeffrey C Christensen, Jerome K Steck
Treatment of painful or malaligned ankle arthrodesis can present as a challenging issue. Several published studies have demonstrated that takedown of a painful ankle arthrodesis to total ankle arthroplasty can assist in restoring some sagittal plane motion and improving functional scores. The goal of this study was to contribute to the limited body of literature with the largest cohort and longest follow-up to date. A retrospective analysis was performed on patient and surgical characteristics of those who underwent a conversion of a painful ankle arthrodesis to a total ankle arthroplasty by 1 of 3 experienced total ankle arthroplasty surgeons from February 2003 to December 2016 with ≥2 years of follow up...
February 13, 2020: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Kathryn L Bohnert, Mary K Hastings, David R Sinacore, Jeffrey E Johnson, Sandra E Klein, Jeremy J McCormick, Paul Gontarz, Gretchen A Meyer
BACKGROUND: Decreased lean muscle mass in the lower extremity in diabetic peripheral neuropathy (DPN) is thought to contribute to altered joint loading, immobility, and disability. However, the mechanism behind this loss is unknown and could derive from a reduction in size of myofibers (atrophy), destruction of myofibers (degeneration), or both. Degenerative changes require participation of muscle stem (satellite) cells to regenerate lost myofibers and restore lean mass. Determining the degenerative state and residual regenerative capacity of DPN muscle will inform the utility of regeneration-targeted therapeutic strategies...
February 14, 2020: Foot & Ankle International
Qusai Aljarrah, Sohail Bakkar, Abdelwahab Aleshawi, Omar Al-Gharaibeh, Mooath Al-Jarrah, Radi Ebwayne, Mohammed Allouh, Ahmad K Abou-Foul
Purpose: Non-traumatic major lower extremity amputation (NMLEA) is a commonly performed procedure that presents a substantial cost burden. Patients who undergo NMLEA are usually considered as a high-risk group with significant comorbidities, which translates into a protracted peri-operative course and increased health-care costs. The primary aim of this study was therefore to perform a contemporary peri-operative cost analysis of NMLEA performed in our center. We are a major tertiary referral hospital that provides vascular surgery services to the entire northern counties in Jordan...
2020: ClinicoEconomics and Outcomes Research: CEOR
Frank Bunch, Pradeep Nair, Gaurav Aggarwala, Eric Dippel, Elias Kassab, Muhammad A Khan, Christopher LeCroy, John M McClure, Thaddeus Tolleson, Craig Walker
OBJECTIVE: The objective of this study was to investigate the safety and feasibility of treating infrapopliteal lesions using a novel drug delivery catheter locally delivering liquid paclitaxel. BACKGROUND: Balloon angioplasty is currently the Gold Standard to treat below-the-knee disease; however, restenosis continues to be a great challenge following these percutaneous revascularization procedures. METHODS: The Occlusion Perfusion Catheter for Optimal Delivery of Paclitaxel for the Prevention of Endovascular Restenosis (COPPER-A) study-Below-the-Knee Cohort was a prospective, nonrandomized, multicenter, feasibility, and safety study that enrolled 35 patients at 11 participating sites...
February 4, 2020: Catheterization and Cardiovascular Interventions
Lidia Marcos García, Eduardo Mateos Torres, Alina Velescu, Carles Díaz Duran, Mónica Lacambra Peñart, Albert Clará Velasco
INTRODUCTION: This study sought to evaluate the natural history of patients undergoing below-knee amputation (BKA) and compare their evolution over 2 decades, as well as survival predictors, prosthetic fitting, and contralateral amputation. METHODS: Retrospective study of 209 consecutive patients (mean age 72.9 years; 68% males) who underwent BKA in 2 periods: 1996-2005 and 2006-2015. The fitting of prostheses, risk of contralateral amputation and survival, as well as their predictive factors, were assessed by survival analysis...
January 29, 2020: Cirugía Española
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