scholarly journals Role of disarticulation and guillotine amputation of the shin in the lower limb ischemic gangrene surgical treatment strategy

2020 ◽  
Vol 7 (1) ◽  
pp. 26-35
Author(s):  
V. A. Mitish ◽  
Yu. S. Paskhalova ◽  
A. A. Ushakov ◽  
S. Yu. Slepnev ◽  
E. A. Mishurinskaya
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
General Condition ◽  
Lower Limb ◽  
Treatment Strategy ◽  
Limb Amputation ◽  
Individual Treatment ◽  
City Hospital ◽  
Amputation Level ◽  
Complications And Mortality

Ischemic foot gangrene is one of the most common reasons of nontraumatic low limb amputations all over the world. Objective: to analyze the clinical effectiveness of an individual treatment strategy application for patients with absolute indications for high limb amputation, aimed to reduce amputation level, the number of postoperative complications and mortality. Materials and methods. This article presents the results of comparative clinical trial executing a lower-extremity amputation in 992 patients with ischemic gangrene. Applied in this study strategy of surgical treatment included usual below-knee, above-knee amputations and guillotine amputations in the lower third of the shin also the shin exarticulation without wound plastic. Guillotine amputations was used as an intermediate stage of treatment in cases where due to the severe general condition of patients to perform a classic myoplastic amputation with stump formation was impossible, since it is accompanied by a very high risk of postoperative complications and mortality. Results. Using guillotine amputations and shin exarticulation as the first stage of complex surgical strategy aimed to rapid elimination of the purulent focus with minimal risks and the speedy stabilization of the patients general condition, emaciated and weakened by developing gangrene, led to reduce general lethality by 17.1 % and increased the quantity of below-knee amputations by 23.0 % compared with the comparison group. Conclusion. Patients with ischemic gangrene require the development of an individual strategy for surgical treatment (taking into account the severity of the patients general condition, the prevalence of the purulent-necrotic process in the lower limb, the nature and degree of peripheral macroangiopathy), which can reliably and significantly reduce the number of amputations at the hip level (by 46.2%), as well as reduce mortality after high amputations of the lower extremities (by 17.1%) in an emergency city hospital. We consider it extremely important to reduce the number of primary amputations at the hip level!

Clinical Features and Outcomes Following Bilateral Lower Limb Amputation in Korea

2006 ◽  
Vol 30 (2) ◽  
pp. 155-164 ◽  
Author(s):  
Ji Cheol Shin ◽  
Eun Joo Kim ◽  
Chang Il Park ◽  
Eun Sook Park ◽  
Kyoo-Ho Shin
Keyword(s):  
Clinical Features ◽  
Lower Limb ◽  
Daily Living ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Medical Problems ◽  
Amputation Level ◽  
Significant Difference ◽  
Bilateral Lower Limb ◽  
Lower Limb Amputees

The objectives of this study were to evaluate the clinical features and outcomes of 43 bilateral lower limb amputees. The clinical features obtained included the causes of amputation, level of amputation, concurrent medical problems, and stump condition. Outcome measures were obtained using the activities of daily living (ADL) index, the Frenchay Activities Index (FAI), and mobility grading with prostheses or wheelchair. Of 33 amputees who were prosthetic ambulators, 22 (67%), mainly bilateral trans-tibial (TT) amputees, were community ambulators, and participated in activities which included stair-walking, and six of 11 household ambulators were combination trans-femoral (TF) and TT amputees. Of 10 amputees who were wheelchair ambulators, only one was able to perform wheelchair transfers independently and five were independent wheelchair ambulators. Using the ADL index and FAI, there was no significant difference in scores according to the level of amputation ( p > 0.05), but the scores of community prosthetic ambulators were significantly higher than those of wheelchair ambulators ( p < 0.05). Age was found to be negatively correlated with ADL index and FAI scores ( r = −0.518 vs. r = −0.550) ( p < 0.01). This study concludes that overall independence in ADL after bilateral lower limb amputation improved with young age and prosthetic mobility.

Surgical Treatment of Chronic Phantom Limb Sensation and Limb Pain after Lower Limb Amputation

2006 ◽  
Vol 118 (7) ◽  
pp. 1562-1572 ◽  
Author(s):  
Lukas Prantl ◽  
Stephan Schreml ◽  
Norbert Heine ◽  
Marita Eisenmann-Klein ◽  
Peter Angele
Keyword(s):  
Surgical Treatment ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Limb Pain

scholarly journals Selection of lower limb amputation level not aided by transcutaneous pO2measurements

1989 ◽  
Vol 60 (4) ◽  
pp. 483-485 ◽  
Author(s):  
Niels Falstie-jensen ◽  
Knud S. Christensen ◽  
Jens Brøchner-Mortensen
Keyword(s):  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Amputation Level ◽  
Selection Of

scholarly journals Surgical Treatment for Chronic Pancreatitis: Past, Present, and Future

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Stephanie Plagemann ◽  
Maria Welte ◽  
Jakob R. Izbicki ◽  
Kai Bachmann
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Surgical Procedures ◽  
Human Body ◽  
General Condition ◽  
Surgical Approach ◽  
Pancreatic Surgery ◽  
Blood Donation ◽  
Perioperative Morbidity

The pancreas was one of the last explored organs in the human body. The first surgical experiences were made before fully understanding the function of the gland. Surgical procedures remained less successful until the discovery of insulin, blood groups, and finally the possibility of blood donation. Throughout the centuries, the surgical approach went from radical resections to minimal resections or only drainage of the gland in comparison to an adequate resection combined with drainage procedures. Today, the well-known and standardized procedures are considered as safe due to the high experience of operating surgeons, the centering of pancreatic surgery in specialized centers, and optimized perioperative treatment. Although surgical procedures have become safer and more efficient than ever, the overall perioperative morbidity after pancreatic surgery remains high and management of postoperative complications stagnates. Current research focuses on the prevention of complications, optimizing the patient’s general condition preoperatively and finding the appropriate timing for surgical treatment.

scholarly journals VIDEO-ASSISTED GASTROENTEROSTOMY PILORODUDODENAL STENOSISIN PATIENTS WITH SENIOR AND SENIOR AGE

2017 ◽  
Vol 9 (4) ◽  
pp. 23-28
Author(s):  
N I Glushkov ◽  
T L Gorshenin ◽  
S K Dulaeva
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Nutritional Support ◽  
Age Groups ◽  
Electrolyte Balance ◽  
Preoperative Preparation ◽  
Acid Base ◽  
Optimal Variant ◽  
Surgical Tactics ◽  
Complications And Mortality

Introduction. The immediate results of surgical treatment of 80 patients with pyloroduodenal stenosis of older age groups, operated in the traditional way and with the use of endovideosurgical techniques, were analyzed. An optimal variant of preoperative preparation with inclusion of early enteral therapy and nutritional support was offered, which allowed to reduce the degree of hypovolemia and tissue dehydration, to correct the water-electrolyte balance and acid-base state. The incidence of postoperative complications and mortality in both groups were studied. Individualized surgical tactics that allowed to reduce the number of postoperative complications and lethality were proposed.

scholarly journals Predictors for reoperation after lower limb amputation in patients with peripheral arterial disease

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 419-424 ◽  
Author(s):  
Martin C. Berli ◽  
Florian Wanivenhaus ◽  
Method Kabelitz ◽  
Tobias Götschi ◽  
Thomas Böni ◽  
...  
Keyword(s):  
Wound Healing ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Balloon Angioplasty ◽  
Revision Surgery ◽  
Lower Limb ◽  
Arterial Disease ◽  
Limb Amputation ◽  
Amputation Level ◽  
Peripheral Arterial

Summary. Background: Major amputations in patients with peripheral arterial disease (PAD) carry a high risk for complications, including revision of the amputation, sometimes to a higher level. Determining a safe level for amputation with good wound healing potential depends largely on vascular measurements. This study evaluated potential predictive factors for revision of major lower extremity amputations in patients with PAD. Patients and methods: A retrospective chart review of all major lower extremity amputations at our institution was conducted. Amputations due to trauma or tumor and below-ankle amputations were excluded. Patient demographics, level/type of amputation, level/time of revision, comorbidities and risk factors were extracted. Results: 180 patients with PAD, mean age 66.48 (range: 31–93) years, 125 (69.4%) male were included. Most (154/180, 86.6%) underwent below-knee amputation. 71 (39.4%) patients had coronary arterial disease, 104 (57.8%) had diabetes. More than half of patients, (93/138; 51.7%) had undergone previous balloon angioplasty. 44 (30%) patients required revision surgery: 42/180 (23.3%) were revised at the same level, and in 12/180 (6.7%) a more proximal amputation was necessary. PAD stage was not associated with the level of reamputation (p = 0.4369). Significantly more patients who had previous balloon angioplasty required revision surgery (66.7% versus 45.2%, p = 0.009). 67 (37.2%) patients underwent preoperative TcPO2 measurement: 40/67 (59.7%) had TcPO2 ≥ 40 mmHg; 4/67 (6%) had TcPO2 < 10 mmHG. Three patients with TcPO2 ≥ 40 mmHg, one with 30 mmHg ≤ TcPO2 ≤ 40 mmHg and one with 10 mmHg ≤ TcPO2 ≤ 20 mmHg required re-amputation to a more proximal level. Conclusions: TcPO2 measurements are useful for determining level of lower limb amputation and predicting wound healing problems when an amputation level with TcPO2 < 40 mmHg is chosen. In transtibial amputations, TcPO2 ≥ 40 mmHg does not safely predict wound healing.

Aggressive Soft Tissue Infections and Amputation in Military Trauma Patients

2012 ◽  
Vol 98 (2) ◽  
pp. 14-20
Author(s):  
JG Penn-Barwell ◽  
CA Fries ◽  
ID Sargeant ◽  
PM Bennett ◽  
K Porter
Keyword(s):  
Lower Limb ◽  
Surgical Techniques ◽  
Current Treatment ◽  
Limb Amputation ◽  
Trauma Patients ◽  
Residual Limb ◽  
Amputation Level ◽  
Military Trauma ◽  
Limb Injuries ◽  
The Impact

AbstractDue to the nature of IED injuries, during the conflicts in Iraq and Afghanistan The traditional, two-stage amputation for unsalvageable combat lower limb injuries has evolved into a strategy of serial debridement and greater use of plastic surgical techniques in order to preserve residual limb length. This study aimed to characterise the current treatment of lower limb loss with particular focus on the impact of specific wound infections. The UK military trauma registry and clinical notes were reviewed for details of all lower limb amputation identifying: 51 patients with 70 lower limb amputations. The mean number of debridements per stump prior to closure was 4.1 (95% CI 3.5-4.7). A final more proximal amputation level was required in 21 stumps (30%). Recovery of A. hydrophillia from wounds was significantly associated with a requirement for a more proximal amputation level (p=0.0038) and greater number of debridements (p=0.0474) when compared to residual limb wounds without A. hydrophillia.

scholarly journals Prognostic factors of intracerebral hematomas surgical removal and role for treatment strategy

2020 ◽  
Vol 29 (3) ◽  
pp. 14-20 ◽  
Author(s):  
A.M. Netliukh ◽  
O.I. Hryshchuk ◽  
B.O. Mandzyuk ◽  
O.Ya. Kobyletskyi ◽  
O.V. Mandzyuk ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Intracerebral Hemorrhage ◽  
Treatment Strategy ◽  
Neurological Status ◽  
Surgical Removal ◽  
City Hospital ◽  
Midline Shift ◽  
Group I ◽  
Group 2 ◽  
Ich Score

Objective – to elaborate prognostic criteria of surgical treatment of patients with intracerebral hematomas.Materials and methods. Sixty nine patients with intracerebral hematomas were operated by craniotomy or craniectomy with encephalotomy in Lviv Emergency Hospital, 8th Lviv City Hospital and Chervonohrad Central City Hospital in 2013–2018. The results of radiological (computed tomography, cerebral angiography) and clinical examination (neurological status before and after surgery) of patients who were operated, with the use of Glasgo coma scale (GCS), Functional Outcome in Patients with Primary Intracerebral Hemorrhage (FUNC), Intracerebral Hemorrhage Score (ICH Score) scales were analyzed. Such parameters as the duration and type of surgery, size and location of ICH, the level of consciousness, and neurological deficit at admission and the time of surgery were determined. Patients were divided into two groups depending on the degree of brain midline shift on computed tomograms obtained at the time of hospitalization: group I (≤5 mm) – 18 patients, group II (>5 mm) – 51 patients. There were 22 women (31.9 %), 47 men (68.1 %). Twenty nine (42.0 %) patients died. The age of patients was as follows: 25–44 years – 9 (13.1 %), 45–60 years – 36 (52.2 %), 60–75 years – 21 (30.4 %), 75–90 years – 3 (4.3 %). Localization of intracerebral hematomas was as follows: subcortical – 15 (21.7 %), putaminal (lateral) – 36 (52.2 %), thalamic (medial) – 12 (17.4 %), cerebellar – 6 (8.7 %). Results. For the most part, surgical treatment of ICH required craniectomy with encephalotomy. When choosing method and timing of surgery, the data of brain CT scans (midline shift, size and location of ICH) were taken into account, based on which patients were divided into 2 groups. Expected recovery of operated patients was analyzed with the FUNC and ICH Score scales. It was determined that, taking into account the neurological status and CT scan data, patients from group 2 were operated 12.2 hours earlier than patients from group 1. Delay of surgery, when the condition of patients in group 2 worsened, led to the worsening in the 90-day functional independence level, but did not affect the 30-day mortality rate.Conclusions. Surgery by craniotomy or craniectomy with encephalotomy remains the method of choice to treat the intracerebral hematomas. Early computed diagnostics and appropriate treatment strategy provide improvement, better functional recovery of patients in postoperative period.

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