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Braet DJ, Pourak K, Delbono L, Powell C, Smith ME, Schechtman D, Obi AT, Coleman DM, Corriere MA. Comparative evaluation of transcutaneous oxygen tension and ankle-brachial index as predictors of reoperation following below-knee amputation. J Vasc Surg 2024; 80:223-231.e2. [PMID: 38431062 DOI: 10.1016/j.jvs.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Decision-making regarding level of lower extremity amputation is sometimes challenging. Selecting an appropriate anatomic level for major amputation requires consideration of tradeoffs between postoperative function and risk of wound complications that may require additional operations, including debridement and/or conversion to above-knee amputation (AKA). We evaluated the utility of common, non-invasive diagnostic tests used in clinical practice to predict the need for reoperations among patients undergoing primary, elective, below knee-amputations (BKAs) by vascular surgeons. METHODS Patients undergoing elective BKA over a 5-year period were identified using Current Procedural Terminology codes. Medical records were reviewed to characterize demographics, pre-amputation testing transcutaneous oxygen tension (TcPO2), and ankle-brachial index (ABI). The need for ipsilateral post-BKA reoperation (including BKA revision and/or conversion to AKA) regardless of indication was the primary outcome. Associations were evaluated using univariable and multivariable logistic regression models. Cutpoints for TcPO2 values associated with amputation reoperation were evaluated using receiver operating characteristic curves. RESULTS We identified 175 BKAs, of which 46 (26.3%) required ipsilateral reoperation (18.9% BKA revisions and 14.3% conversions to AKA). The mean age was 63.3 ± 14.8 years. Most patients were male (65.1%) and White (72.0%). Mean pre-amputation calf TcPO2 was 40.0 ± 20.5 mmHg, and mean ABI was 0.64 ± 0.45. In univariable models, post-BKA reoperation was associated with calf TcPO2 (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.94-0.99; P = .013) but not ABI (OR, 0.53; 95% CI, 0.19-1.46; P = .217). Univariable associations with reoperation were also identified for age (OR, 0.97; 95% CI, 0.94-0.990; P = .003) and diabetes (OR, 0.43; 95% CI, 0.21-0.87; P = .019). No associations with amputation revision were identified for gender, race, end-stage renal disease, or preoperative antibiotics. Calf TcPO2 remained associated with post-BKA reoperation in a multivariable model (OR, 0.97; 95% CI, 0.94-0.99; P = .022) adjusted for age (OR, 0.98; 95% CI, 0.94-1.01; P = .222) and diabetes (OR, 0.98; 95% CI, 0.94-1.01; P = .559). Receiver operating characteristic analysis suggested a TcPO2 ≥38 mmHg as an appropriate cut-point for assessing risk for BKA revision (area under the curve = 0.682; negative predictive value, 0.91). CONCLUSIONS Reoperation after BKA is common, and reoperation risk was associated with pre-amputation TcPO2. For patients undergoing elective BKA, higher risk of reoperation should be discussed with patients with an ipsilateral TcPO2 <38 mmHg.
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Affiliation(s)
- Drew J Braet
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI.
| | - Kian Pourak
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI
| | - Luciano Delbono
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI
| | - Chloe Powell
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI
| | - Margaret E Smith
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI
| | - David Schechtman
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI
| | - Andrea T Obi
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI
| | - Dawn M Coleman
- Department of Surgery, Division of Vascular Surgery, Duke University School of Medicine, Durham, NC
| | - Matthew A Corriere
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI
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Chou T, Nabavinia M, Tram NK, Rimmerman ET, Patel S, Musini KN, Eisert SN, Wolfe T, Wynveen MK, Matsuzaki Y, Kitsuka T, Iwaki R, Janse SA, Bobbey AJ, Breuer CK, Goodchild L, Malbrue R, Shinoka T, Atway SA, Go MR, Stacy MR. Quantification of Skeletal Muscle Perfusion in Peripheral Artery Disease Using 18F-Sodium Fluoride Positron Emission Tomography Imaging. J Am Heart Assoc 2024; 13:e031823. [PMID: 38353265 PMCID: PMC11010069 DOI: 10.1161/jaha.123.031823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/07/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Perfusion deficits contribute to symptom severity, morbidity, and death in peripheral artery disease (PAD); however, no standard method for quantifying absolute measures of skeletal muscle perfusion exists. This study sought to preclinically test and clinically translate a positron emission tomography (PET) imaging approach using an atherosclerosis-targeted radionuclide, fluorine-18-sodium fluoride (18F-NaF), to quantify absolute perfusion in PAD. METHODS AND RESULTS Eight Yorkshire pigs underwent unilateral femoral artery ligation and dynamic 18F-NaF PET/computed tomography imaging on the day of and 2 weeks after occlusion. Following 2-week imaging, calf muscles were harvested to quantify microvascular density. PET methodology was validated with microspheres in 4 additional pig studies and translated to patients with PAD (n=39) to quantify differences in calf perfusion across clinical symptoms/stages and perfusion responses in a case of revascularization. Associations between PET perfusion, ankle-brachial index, toe-brachial index, and toe pressure were assessed in relation to symptoms. 18F-NaF PET/computed tomography quantified significant deficits in calf perfusion in pigs following arterial occlusion and perfusion recovery 2 weeks after occlusion that coincided with increased muscle microvascular density. Additional studies confirmed that PET-derived perfusion measures agreed with microsphere-derived perfusion measures. Translation of imaging methods demonstrated significant decreases in calf perfusion with increasing severity of PAD and quantified perfusion responses to revascularization. Perfusion measures were also significantly associated with symptom severity, whereas traditional hemodynamic measures were not. CONCLUSIONS 18F-NaF PET imaging quantifies perfusion deficits that correspond to clinical stages of PAD and represents a novel perfusion imaging strategy that could be partnered with atherosclerosis-targeted 18F-NaF PET imaging using a single radioisotope injection. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03622359.
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Affiliation(s)
- Ting‐Heng Chou
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Mahboubeh Nabavinia
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Nguyen K. Tram
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Eleanor T. Rimmerman
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
- Biophysics Graduate ProgramOhio State UniversityColumbusOH
| | - Surina Patel
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Kumudha Narayana Musini
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Susan Natalie Eisert
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Tatiana Wolfe
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Molly K. Wynveen
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Yuichi Matsuzaki
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Takahiro Kitsuka
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Ryuma Iwaki
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | | | - Adam J. Bobbey
- Department of RadiologyNationwide Children’s HospitalColumbusOH
| | - Christopher K. Breuer
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Laurie Goodchild
- Animal Resources CoreResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Raphael Malbrue
- Animal Resources CoreResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Toshiharu Shinoka
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Said A. Atway
- Department of OrthopaedicsOhio State University College of MedicineColumbusOH
| | - Michael R. Go
- Division of Vascular Diseases & Surgery, Department of SurgeryOhio State University College of MedicineColumbusOH
| | - Mitchel R. Stacy
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
- Biophysics Graduate ProgramOhio State UniversityColumbusOH
- Division of Vascular Diseases & Surgery, Department of SurgeryOhio State University College of MedicineColumbusOH
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Schulz RN, Jannace KC, Cooper DB, Sparling TL, Luken ML, Pasquina PF. Health Care Utilization After Major Limb Loss in Adults (18-64) Receiving Care in the Military Health System From 2001 to 2017. Arch Phys Med Rehabil 2024; 105:335-342. [PMID: 37722649 DOI: 10.1016/j.apmr.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To characterize and quantify health care utilization of Military Health System beneficiaries with major limb loss. DESIGN Retrospective cohort study. SETTING Military treatment facilities and civilian health care facilities that accept TRICARE insurance across the United States. PARTICIPANTS A total 5950 adult Military Health System beneficiaries with major limb amputation(s) acquired between January 1st, 2001, and September 30th, 2017 (N=5950). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES This study was an exploratory analysis designed to identify common care specialties, services, and devices utilized by Military Health System beneficiaries with major limb loss. RESULTS Most beneficiaries were retirees/dependents (63.3%), men (73.1%), and had a single amputation (88.7%), with a mean age of 42 years. Differences between beneficiary categories were found. Active-duty service members used a larger proportion of inpatient, emergency, primary care, physical and occupational therapy, prosthetics and orthotics, physical medicine and rehabilitation, and psychiatry services than retirees/dependents. Most common procedures included "revision of amputation stump" (57.2%) for the active-duty population and "other amputation below knee" (24.3%) for the retirees/dependents. CONCLUSIONS These findings highlight the rehabilitation trajectories of beneficiaries receiving treatment for major limb loss in military and civilian care settings. The results could inform staffing decisions and training programs for military treatment facilities, American trauma centers, rehabilitation hospitals, and outpatient health care providers treating individuals with amputation.
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Affiliation(s)
- Rebecca N Schulz
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
| | - Kalyn C Jannace
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Daniel B Cooper
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Tawnee L Sparling
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD
| | - Michelle L Luken
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Paul F Pasquina
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD
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Lee DW, Hwang YS, Byeon JY, Kim JH, Choi HJ. Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction? World J Clin Cases 2023; 11:7570-7582. [DOI: 10.12998/wjcc.v11.i31.7570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/25/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Transcutaneous oxygen pressure (TcpO2) is a precise method for determining oxygen perfusion in wounded tissues. The device uses either electrochemical or optical sensors.
AIM To evaluate the usefulness of TcpO2 measurements on free flaps (FFs) in diabetic foot ulcers (DFUs).
METHODS TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh (ALT)-FF surgery and compared with 30 patients with DFU without FF surgery.
RESULTS Significant differences were observed in the ankle-brachial index; duration of diabetes; and haemoglobin, creatinine, and C-reactive protein levels between the two groups. TcpO2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained < 30 mmHg and did not increase > 50 mmHg.
CONCLUSION Even if the flap is clinically stable, sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues, which is supported by the slow recovery of the sympathetic tone following FF. Therefore, TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.
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Affiliation(s)
- Da Woon Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Yong Seon Hwang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Je Yeon Byeon
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Jun Hyuk Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
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Determinants of healing and readiness for prosthetic fitting after transtibial amputation: Integrative literature review. Prosthet Orthot Int 2023; 47:43-53. [PMID: 36791380 DOI: 10.1097/pxr.0000000000000163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 03/23/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Healing after an amputation is a critical step in the recovery process. Delayed wound healing can lead to deconditioning and flexion contractures which reduce a patient's ability to use a prosthesis, ambulate independently, and return to community participation. The purpose of this integrative literature review was to determine the evidence-based physiological factors, comorbidities, postoperative management, and outcome measures associated with healing after transtibial amputation and address how these factors clinically guide readiness for prosthetic intervention. METHODS Authors completed Google Scholar searches to identify the most effective search terms to locate salient publications. Authors also completed literature searches of Ovid MEDLINE and Epub Ahead of Print, In-Process, and Other Nonindexed Citations and Daily <1946 to August 6, 2020>; Embase Classic + Embase <1947 to August 6, 2020>; and CINAHL Complete <1946 to August 6, 2020> databases using the following search terms: "transtibial," "trans-tibial," "below knee," "BKA," "amputation," amputation stump," "amputee," "wound healing," and "heal/s/ed/ing." The authors decided to include all levels of evidence to capture the maximum number of articles related to the determinants of healing and readiness for prosthetic fitting after transtibial amputation. RESULTS The searches identified 2067 potential articles for review, and after removing articles not relevant to the topic, authors completed full-text assessment on 20 articles. These included review and synthesis on three randomized controlled trials and 12 cohort studies. CONCLUSION Preamputation assessment is most critical in patients who present with a longer list of comorbidities and suboptimal physiologic factors known to predict wound complications. Clinical judgment is most subjective when determining the degree of healing over time. Readiness for prosthetic treatment need not wait for complete healing of the residuum. Future research is needed to assess transcutaneous oxygen profusion along with other noninvasive measures of blood flow and perfusion as a more objective way to track progression of healing over time. This objective methodology would quantify healing, reduce subjectivity, and promote research to compare different enhanced recovery after surgery protocols for their impact on healing after amputation.
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Berli MC. Mid- and Hindfoot Amputations in Diabetic Patients. Foot Ankle Clin 2022; 27:687-700. [PMID: 36096559 DOI: 10.1016/j.fcl.2022.05.004] [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: 02/02/2023]
Abstract
Several surgical options exist to avoid or at least to delay a below-the-knee amputation (BKA). These are the so-called mid- or hindfoot amputations. They are a valuable treatment option in order to maintain the ability to ambulate without major auxiliary means (eg, a prosthesis). Hence, these amputations allow the patients to maintain certain autonomy. The acceptance of these amputations is significantly higher than a BKA, as the body image is less disturbed. The complication rate in hindfoot amputations in diabetic patients is high due to the comorbidities, in particular peripheral arterial disease and polyneuropathy.
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Affiliation(s)
- Martin C Berli
- Division of Technical Orthopaedics, Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland; Universitätsklinik Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland.
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Does re-amputation following lower extremity amputation in diabetic or dysvascular patients negatively affect survival? MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1059068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Essien SK, Linassi AG, Farnan C, Collins K, Zucker-Levin A. The influence of primary and subsequent limb amputation on the overall rate of limb amputation in Saskatchewan, Canada, 2006-2019: a population-based study. BMC Surg 2021; 21:385. [PMID: 34717614 PMCID: PMC8557533 DOI: 10.1186/s12893-021-01381-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Understanding trends in limb amputation (LA) can provide insight into the prevention and optimization of health care delivery. We examine the influence of primary (first report) and subsequent (multiple reports) limb amputation on the overall (all reports) rate of limb amputation in Saskatchewan considering amputation level. Methods Hospital discharged data associated with LA from 2006 to 2019 and population estimates in Saskatchewan were used. LA cases were grouped based on overall, primary, and subsequent LA and further divided by level into major (through/above the ankle/wrist) and minor (below the ankle/wrist). Incidence rates were calculated using LA cases as the numerator and resident population as the denominator. Joinpoint and negative binomial were used to analyze the trends. In addition, the top three amputation predisposing factors (APF) were described by LA groups. Results The rate of overall LA and primary LA remained stable (AAPC − 0.9 [95% CI − 3.9 to 2.3]) and (AAPC −1.9 [95% CI −4.2 to 0.4]) respectively, while the rate of subsequent LA increased 3.2% (AAPC 3.2 [95% CI 3.1 to 9.9]) over the 14-year study period. The rate of overall major LA declined 4.6% (AAPC − 4.6 [95% CI −7.3 to −1.7]) and was largely driven by the 5.9% decline in the rate of primary major LA (AAPC − 5.9 [95% CI − 11.3 to –0.2]). Subsequent major LA remained stable over the study period (AAPC −0.4 [95% CI − 6.8 to 6.5]). In contrast, the overall rate of minor LA increased 2.0% (AAPC 2.0 [95% CI 1.0 to 2.9]) over the study period which was largely driven by a 9.6% increase in the rate of subsequent minor LA (AAPC 9.6 [95% CI 4.9 to 14.4]). Primary minor LA rates remained stable over the study period (AAPC 0.6 [95% CI − 0.2 to 1.5]). The study cohorts were 1.3-fold greater risk of minor LA than major LA. Diabetes mellitus (DM) was the leading APF representing 72.8% of the cohort followed by peripheral vascular disease (PVD) and trauma with 17.1 and 10.1% respectively. Most (86.7%) of subsequent LA were performed on people with DM. Conclusions Overall LA rates remained stable over the study period with declining rates of major LA countered by rising rates of minor LA. Minor LA exceeded major LA with the largest rate increase identified in subsequent minor LA. Diabetes was the greatest APF for all LA groups. This rising rate of more frequent and repeated minor LA may reflect changing intervention strategies implemented to maintain limb function. The importance of long-term surveillance to understand rates of major and minor LA considering primary and subsequent intervention is an important step to evaluate and initiate prevention and limb loss management programs.
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Affiliation(s)
- Samuel Kwaku Essien
- School of Rehabilitation Science, University of Saskatchewan, Health Science Building, E-Wing, Suite 3400, 3rd Floor, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.
| | - A Gary Linassi
- Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, SK, S7K 0M7, Canada
| | - Colin Farnan
- Patient-Oriented Team (PORT), 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Kassondra Collins
- School of Rehabilitation Science, University of Saskatchewan, Health Science Building, E-Wing, Suite 3400, 3rd Floor, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, University of Saskatchewan, Health Science Building, E-Wing, Suite 3400, 3rd Floor, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
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Transtibial Amputation with Removal of the Tibial Intramedullary Nail: Hardware Removal in a Retrograde Manner. Case Rep Orthop 2021; 2021:6654969. [PMID: 34336331 PMCID: PMC8313345 DOI: 10.1155/2021/6654969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Transtibial amputation is the preferred strategy for treating a diabetic foot with an infection and necrosis. However, if a tibial intramedullary nail was previously inserted into the ipsilateral lower extremity, the nail must be removed to perform the transtibial amputation. In this special situation, the removal of the tibial intramedullary nail can cause various complications after transtibial amputation. We present a case and surgical technique report of a 46-year-old male with an uncontrolled diabetic foot with tibial intramedullary nail insertion. With the nail and ankle fixed by distal interlocking screws, a below-knee amputation was performed by removing the nail and the amputated limb together. This surgical method is expected to reduce postoperative complications such as infections and patella instability after the amputation of a diabetic foot.
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Catella J, Long A, Mazzolai L. What Is Currently the Role of TcPO2 in the Choice of the Amputation Level of Lower Limbs? A Comprehensive Review. J Clin Med 2021; 10:jcm10071413. [PMID: 33915838 PMCID: PMC8037184 DOI: 10.3390/jcm10071413] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 11/18/2022] Open
Abstract
Some patients still require major amputation for lower extremity peripheral arterial disease treatment. The purpose of pre-operative amputation level selection is to determine the most distal amputation site with the highest healing probability without re-amputation. Transcutaneous oximetry (TcPO2) can detect viable tissue with the highest probability of healing. Several factors affect the accuracy of TcPO2; nevertheless, surgeons rely on TcPO2 values to determine the optimal amputation level. Background about the development of TcPO2, methods of measurement, consequences of lower limb amputation level, and the place of TcPO2 in the choice of the amputation level are reviewed herein. Most of the retrospective studies indicated that calf TcPO2 values greater than 40 mmHg were associated with a high percentage of successful wound healing after below-knee-amputation, whereas values lower than 20 mmHg indicated an increased risk of unsuccessful healing. However, a consensus on the precise cut-off value of TcPO2 necessary to assure healing is missing. Ways of improvement for TcPO2 performance applied to the optimization of the amputation-level are reported herein. Further prospective data are needed to better approach a TcPO2 value that will promise an acceptable risk of re-amputation. Standardized TcPO2 measurement is crucial to ensure quality of data.
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Affiliation(s)
- Judith Catella
- Service de Médecine Interne et Vasculaire, Hopital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France;
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), Sorbonne, 75015 Paris, France
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France
- UMR 5305: Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, CNRS/Université Claude Bernard Lyon 1, Institut de Biologie et Chimie des Protéines, 7 Passage du Vercors, 69367 Lyon, France
- Correspondence: ; Tel.: +33-472117791; Fax: +33-472116949
| | - Anne Long
- Service de Médecine Interne et Vasculaire, Hopital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France;
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France
| | - Lucia Mazzolai
- Service d’Angiologie, Département Coeur et Vaisseaux, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland;
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Jesani L, Gwilym B, Germain S, Jesani H, Stimpson A, Lennon A, Massey I, Twine CP, Bosanquet DC. Early and Long Term Outcomes Following Long Posterior Flap vs. Skew Flap for Below Knee Amputations. Eur J Vasc Endovasc Surg 2020; 60:301-308. [DOI: 10.1016/j.ejvs.2020.03.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/04/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
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Keszler MS, Wright KS, Miranda A, Hopkins MS. Multidisciplinary Amputation Team Management of Individuals with Limb Loss. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00282-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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