1
|
Huang YJ, Assi PE, Drolet BC, Al Kassis S, Bastas G, Chaker S, Manzanera Esteve IV, Perdikis G, Thayer WP. A Systematic Review and Meta-analysis on the Incidence of Patients With Lower-Limb Amputations Who Developed Symptomatic Neuromata in the Residual Limb. Ann Plast Surg 2022; 88:574-580. [PMID: 34270470 DOI: 10.1097/sap.0000000000002946] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuromata developed after major extremity amputation can cause pain, limit the use of prosthetics, and negatively affect the quality of life. The frequency of postamputation neuroma varies widely. The objective of this study was to determine the incidence of patients who developed symptomatic neuromata after lower-limb amputation through a systematic review and meta-analysis. METHODS A systematic review of the literature was performed on 4 major databases. Studies that reported the incidence of symptomatic neuroma in lower-limb amputees were included. A meta-analysis was performed to calculate the pooled incidence of neuromata. RESULTS Thirteen studies consisting of 1329 patients were included in this meta-analysis. The reported incidence of patients who developed symptomatic neuromata ranged between 4% and 49%. The median duration of follow-up was 8.6 years (interquartile range, 2.0-17.4 years). The pooled percentage (95% confidence interval [CI]) of lower-limb amputees who developed symptomatic neuromata was 19% (12%-29%). In studies with a duration of follow-up at least 3 years, the pooled percentage (95% CI) of lower-limb amputees who developed symptomatic neuromata was 30% (22%-40%). In studies with a follow-up period of fewer than 3 years, the pooled percentage (95% CI) of neuroma incidence was 3% (2%-6%). CONCLUSIONS In summary, the overall incidence of patients who developed symptomatic neuromata was 19% or approximately 1 in 5 lower-limb amputees. Symptomatic neuromata are more commonly diagnosed when the follow-up period is longer than 3 years. These findings suggest that neuroma after amputation might be underestimated in studies with a short duration of follow-up.
Collapse
Affiliation(s)
| | | | | | | | - Gerasimos Bastas
- Department of Physical Medicine and Rehabilitation, Vanderbilt University
| | | | | | | | | |
Collapse
|
2
|
Macauley M, Adams G, Mackenny P, Kubelka I, Scott E, Buckworth R, Biddiscombe C, Aitkins C, Lake H, Matthews V, Ashraff S, Ashwell S. Microbiological evaluation of resection margins of the infected diabetic foot ulcer. Diabet Med 2021; 38:e14440. [PMID: 33113230 DOI: 10.1111/dme.14440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023]
Abstract
AIM To evaluate the impact of surgical debridement on the microbiology of resection margins of an infected diabetic foot ulcer and to compare the use of marginal sampling as a guide for antimicrobial therapy. METHODS Forty consecutive participants were studied. Tissue samples from infected diabetic foot ulcers were obtained at first contact by podiatrists. After surgical debridement to macroscopically healthy tissue, multiple samples were obtained from the margins of the residuum and also from excised non-viable tissue. Debridement was done by a single surgeon. Bacterial species were classified according to pathogenic potential a priori into Red Group-Definite pathogen causing infection, Yellow Group-Likely to be causing infection if present in more than one specimen and Green Group -Commensals, not causing infection. RESULTS There was a relative reduction of 49% (p = 0.002) in bacteria in the most pathogenic (red) group, and 59% (p = 0.002) in the yellow group in podiatry samples compared with resection specimen. Positive cultures from margins of the residuum were observed in 75% of cases. There was a relative reduction of 67% (p = 0.0001) in bacteria in the red and 48% (p = 0.06) in the yellow group in marginal samples from the residuum compared with podiatry samples. CONCLUSIONS After surgical debridement to healthy tissue, positive cultures from marginal tissue samples provided vital information on the presence of pathogenic bacteria. This allowed antibiotics to be individualised post-surgical debridement.
Collapse
Affiliation(s)
- Mavin Macauley
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - George Adams
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Paul Mackenny
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
- Orthopaedic Department Hartlepool, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Igor Kubelka
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Emma Scott
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Rebecca Buckworth
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Claire Biddiscombe
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Christopher Aitkins
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Hannah Lake
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Vicky Matthews
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Suhel Ashraff
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Simon Ashwell
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| |
Collapse
|
3
|
Piaggesi A, Iacopi E, Pieruzzi L, Coppelli A, Goretti C. Diabetic foot surgery "Made in Italy". Results of 15 years of activity of a third-level centre managed by diabetologists. Diabetes Res Clin Pract 2020; 167:108355. [PMID: 32739379 DOI: 10.1016/j.diabres.2020.108355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/11/2020] [Accepted: 07/25/2020] [Indexed: 11/21/2022]
Abstract
AIM To evaluate clinical outcomes in patients who underwent diabetic foot surgery (DFS) managed directly by diabetologists in a third-level Centre over 15-year. METHODS We retrospectively evaluated 1.857 patients affected by diabetic foot (Age 67.1 ± 12.3 yrs, diabetes duration 19.2 ± 9.8 yrs, HbA1c 8.1 ± 2.0%) treated in our Department between 2001 and 2015 and divided them into 3 groups: Group 1, treated between 2001 and 2005 (448 pts), group 2, between 2006 and 2010 (540 pts) and Group 3, between 2011 and 2015 (869 pts). Main clinical outcomes [peripheral revascularization rate (PR), healing rate (HR), healing time (HT), recurrences after healing (R), major amputation (MA) and death (D) rates] were compared between groups. RESULTS The overall outcomes of our cohort were: HR 81.6% (HT 143 ± 54 days), PR 84.8%, MA 4.9% and D 27.9%. There were no differences in clinical characteristics, except for age, higher (p < 0.05) in Group 3 (70.6 ± 14.7 yrs) than in Groups 1 (64.4 ± 11.6 yrs) and 2 (65.1 ± 11.2 yrs). No differences emerged when comparing HR and MA; HT was shorter (p < 0.05) in group 3 (104 ± 44 days) than in Group 2 (169 ± 72 days) and 1 (235 ± 67 days). D was higher (p < 0.05) in Group 3 (43.8%) than in Group 1 (23.1%) and 2 (28.1%). PR was 19.4% in Group 1, 28.1% in Group 2 and 53.8% in Group 3 (p < 0.05). CONCLUSIONS Despite the increasing age and complexity of patients our data show improvement of outcomes throughout 15 years, probably due to better surgical techniques, more aggressive medical therapy and more effective treatment of critical limb ischemia.
Collapse
Affiliation(s)
| | | | | | | | - Chiara Goretti
- Diabetic Foot Section, Pisa University Hospital, Pisa, Italy
| |
Collapse
|
4
|
Hsu AR. Transfemoral Amputation Adductor Myodesis Using FiberTape and Knotless Anchors. Foot Ankle Int 2018; 39:874-879. [PMID: 29761748 DOI: 10.1177/1071100718776041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED Transfemoral amputation is considered the last treatment option for severe infection, vascular disease, trauma, and malignant tumors of the lower extremity that have failed limb salvage. Unopposed pull of the hip abductors causes a flexion-abduction thigh deformity that results in abnormal biomechanics and increased oxygen consumption during ambulation. Myodesis of the adductor tendons is a critical component of transfemoral amputation that creates dynamic muscle balance, enhances prosthetic fitting and function, and improves clinical outcomes. Traditional adductor myodesis uses locking sutures passed through cortical drill holes along the anterolateral aspect of the distal femur that are tensioned and tied by hand. In this report we describe a novel technique for adductor myodesis using FiberTape suture and knotless anchors that we have found to be quick, easy, and reproducible with strong tendon-bone fixation. LEVEL OF EVIDENCE Level V, expert opinion.
Collapse
Affiliation(s)
- Andrew R Hsu
- 1 Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA, USA
| |
Collapse
|
5
|
Sansosti LE, Crowell A, Choi ET, Meyr AJ. Rate of and Factors Associated with Ambulation After Unilateral Major Lower-Limb Amputation at an Urban US Tertiary-Care Hospital with a Multidisciplinary Limb Salvage Team. J Am Podiatr Med Assoc 2017; 107:355-364. [PMID: 29077505 DOI: 10.7547/16-073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND One relatively universal functional goal after major lower-limb amputation is ambulation in a prosthesis. This retrospective, observational investigation sought to 1) determine what percentage of patients successfully walked in a prosthesis within 1 year after major limb amputation and 2) assess which patient factors might be associated with ambulation at an urban US tertiary-care hospital. METHODS A retrospective medical record review was performed to identify consecutive patients undergoing major lower-limb amputation. RESULTS The overall rate of ambulation in a prosthesis was 29.94% (50.0% of those with unilateral below-the-knee amputation [BKA] and 20.0% of those with unilateral above-the-knee amputation [AKA]). In 24.81% of patients with unilateral BKA or AKA, a secondary surgical procedure of the amputation site was required. In those with unilateral BKA or AKA, statistically significant factors associated with ambulation included male sex (odds ratio [OR] = 2.50) and at least 6 months of outpatient follow-up (OR = 8.10), survival for at least 1 postoperative year (OR = 8.98), ambulatory preamputation (OR = 14.40), returned home after the amputation (OR = 6.12), and healing of the amputation primarily without a secondary surgical procedure (OR = 3.62). Those who had a history of dementia (OR = 0.00), a history of peripheral arterial disease (OR = 0.35), and a preamputation history of ipsilateral limb revascularization (OR = 0.14) were less likely to walk. We also observed that patients with a history of outpatient evaluation by a podiatric physician before major amputation were 2.63 times as likely to undergo BKA as opposed to AKA and were 2.90 times as likely to walk after these procedures. CONCLUSIONS These results add to the body of knowledge regarding outcomes after major amputation and could be useful in the education and consent of patients faced with major amputation.
Collapse
Affiliation(s)
- Laura E. Sansosti
- Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, PA
| | - Amanda Crowell
- Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, PA
| | - Eric T. Choi
- Department of Vascular Surgery, Temple University Hospital, Philadelphia, PA
| | - Andrew J. Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| |
Collapse
|
6
|
Sun X, Zhai W, Fossey JS, James TD. Boronic acids for fluorescence imaging of carbohydrates. Chem Commun (Camb) 2016; 52:3456-69. [DOI: 10.1039/c5cc08633g] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Carbohydrate biomarkers are particularly important targets for fluorescence imaging given their pivotal role in numerous important biological events. This review highlights the development of fluorescence imaging agents based on boronic acids.
Collapse
Affiliation(s)
| | - Wenlei Zhai
- School of Chemistry
- University of Birmingham
- Birmingham
- UK
| | | | | |
Collapse
|
7
|
Affiliation(s)
- Xiaolong Sun
- Department
of Chemistry, University of Bath, Bath, BA2 7AY, United Kingdom
| | - Tony D. James
- Department
of Chemistry, University of Bath, Bath, BA2 7AY, United Kingdom
| |
Collapse
|
8
|
Berber R, Pappas Y, Khoo M, Miles J, Carrington R, Skinner J, Hart A. A new approach to managing patients with problematic metal hip implants: the use of an Internet-enhanced multidisciplinary team meeting: AAOS exhibit selection. J Bone Joint Surg Am 2015; 97:e20. [PMID: 25695991 DOI: 10.2106/jbjs.n.00973] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Over one million patients worldwide are estimated to have a metal-on-metal hip arthroplasty. To improve the management of these patients and reduce surgeon uncertainty regarding decision-making, we designed an Internet-enhanced multidisciplinary team (iMDT) working approach. METHODS From August 2012 to April 2014, the iMDT discussed 215 patients with 266 metal-on-metal hip arthroplasties. Of these, 236 primary arthroplasties (132 hip resurfacing and 104 total hip) were analyzed. The remaining thirty cases involved problematic revised hips and were therefore excluded. The possible recommendations of the iMDT were monitoring, further investigation, or surgery. The concordance between the recommendation and the actual management was used to assess the usefulness of this approach in reducing uncertainty in surgeon-level decision-making. RESULTS The median Oxford Hip Score was 35 (range, 4 to 48), and median cobalt and chromium levels in whole blood were 3.54 ppb (range, 0.18 to 161.46 ppb) and 3.17 ppb (range, 0.20 to 100.67 ppb), respectively. Magnetic resonance imaging revealed abductor muscle atrophy in ninety-two (39%) of the hips and a pseudotumor in eighty (34%). The iMDT recommended monitoring of 146 (61.9%) of the hips, further investigation of thirty (12.7%), and surgery in sixty (25.4%). The actual outcome was concordant with the recommendation in 211 (91.7%) of the hips. CONCLUSIONS Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance, and up-to-date evidence to improve decision-making among surgeons. The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes.
Collapse
Affiliation(s)
- Reshid Berber
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Putteridge Bury Campus, Hitchin Road, Luton, Bedfordshire, LU2 8LE, United Kingdom
| | - Michael Khoo
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Jonathan Miles
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Richard Carrington
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - John Skinner
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Alister Hart
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| |
Collapse
|