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Li Cai - One of the best experts on this subject based on the ideXlab platform.

  • The Chemoembolization Therapy for Limb Salvage Operations of Malignent Tumours in Bone and Soft Tissues
    Journal of Qilu Oncology, 2002
    Co-Authors: Li Cai
    Abstract:

    Objective To study the clinical siginificance of chemoembolization for bone and soft tissues malignant tumours before Limb Salvage operations.Methods 38 cases with malignant tumours in bone and soft tissues was treated by chemoembolization with Seldinger techniques before the Limb Salvage operations.Results The clinical symptoms was improved and the soft tissues mass reduces in all cases after chemoembolization therapy,the pain disappears by 83%.29 cases was performed Limb Salvage operations.Conclusions Preopration chemoembolization of malignant tumours in bone and soft tissues can result in degeneration and necrosis in tumours,it can reduce the recurrence after operations and increase the success rate of Limb Salvage.

Huang Xiao-yang - One of the best experts on this subject based on the ideXlab platform.

Ellen J Mackenzie - One of the best experts on this subject based on the ideXlab platform.

  • The Military Extremity Trauma Amputation/Limb Salvage (METALS) Study: Outcomes of Amputation Compared with Limb Salvage Following Major Upper-Extremity Trauma.
    The Journal of bone and joint surgery. American volume, 2019
    Co-Authors: Stuart L Mitchell, Roman Hayda, Andrew T Chen, Anthony R Carlini, James R Ficke, Ellen J Mackenzie
    Abstract:

    Severe upper-extremity injuries account for almost one-half of all extremity trauma in recent conflicts in the Global War on Terror. Few long-term outcomes studies address severe combat-related upper-extremity injuries. This study's objective was to describe long-term functional outcomes of amputation compared with those of Limb Salvage in Global War on Terror veterans who sustained severe upper-extremity injuries. Limb Salvage was hypothesized to result in better arm and hand function scores, overall functional status, and quality of life, with similar pain interference. This retrospective cohort study utilized data from the Military Extremity Trauma Amputation/Limb Salvage (METALS) study for a subset of 155 individuals who sustained major upper-extremity injuries treated with amputation or Limb Salvage. Participants were interviewed by telephone 40 months after injury, assessing social support, personal habits, and patient-reported outcome instruments for function, activity, depression, pain, and posttraumatic stress. Outcomes were evaluated for participants with severe upper-extremity injuries and were compared with participants with concomitant severe, lower-extremity injury. The analysis of outcomes comparing Limb Salvage with amputation was restricted to the 137 participants with a unilateral upper-extremity injury because of the small number of patients with bilateral upper-extremity injuries (n = 18). Overall, participants with upper-extremity injuries reported moderate to high levels of physical and psychosocial disability. Short Musculoskeletal Function Assessment (SMFA) scores were high across domains; 19.4% screened positive for posttraumatic stress disorder (PTSD), and 12.3% were positive for depression. Nonetheless, 63.6% of participants were working, were on active duty, or were attending school, and 38.7% of participants were involved in vigorous recreational activities. No significant differences in outcomes were observed between patients who underwent Limb Salvage and those who underwent amputation. Severe, combat-related upper-extremity injuries result in diminished self-reported function and psychosocial health. Our results suggest that long-term outcomes are equivalent for those treated with amputation or Limb Salvage. Addressing or preventing PTSD, depression, chronic pain, and associated health habits may result in less disability burden in this population. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Dhiraj M. Shah - One of the best experts on this subject based on the ideXlab platform.

  • Composite sequential arterial reconstruction for Limb Salvage.
    Journal of vascular surgery, 2002
    Co-Authors: Sean P. Roddy, R. Clement Darling, Kathleen J. Ozsvath, Paul B. Kreienberg, Benjamin B. Chang, Thomas S. Mathew, Philip S.k. Paty, Manish Mehta, Dhiraj M. Shah
    Abstract:

    Abstract Objective: Autogenous vein is the conduit of choice in patients presenting for infrainguinal arterial reconstruction. Venous conduit may be limited because of inadequacy or prior utilization. Our group and others use prosthetics to maximize Limb Salvage with moderate results. However, in cases where patients present with an isolated popliteal segment that may extend below the knee, we have performed prosthetic bypasses to this above-knee segment and then used a venous reconstruction from the native arterial circulation to a more distal outflow tract. In this report, we will analyze our results using this type of reconstruction in patients who present for Limb Salvage with no all-autogenous option. Method: From 1992 to 2000, 27 patients presented for Limb Salvage with an isolated popliteal artery and inadequate vein for continuous bypass. There were 106 patients in this period without an isolated popliteal segment or adequate vein who underwent prosthetic bypass with distal vein cuff or arteriovenous fistula. The vascular registry and patient charts were reviewed for indication, demographics, and type of composite reconstruction. Outcomes were calculated with use of life table methods and compared by log rank analysis. Results: Demographics revealed 16 (59%) men, 16 (59%) patients with diabetes, and 4 (15%) smokers with a mean age of 71 years (range, 51-87 years). The venous reconstructions had the inflow taken from the distal native popliteal artery in 26 (above knee in 8 and below knee in 18) and the peroneal artery in one. The outflow involved the below-knee popliteal in one (4%), a tibial in 23 (85%), and the dorsalis pedis artery in 3 (11%). Morbidity included bleeding (4%), wound infection (4%), and Limb loss (4%). Mortality occurred in one patient (4%), and no revisions were required in follow-up. Six late failures were identified, one of which resulted in amputation. Primary patency and Limb Salvage were 80% and 88% at 1 year, respectively. For comparison, our results using prosthetic with vein cuff had a 1-year primary patency of 52% and Limb Salvage of 92% ( P = NS), whereas prosthetic with an arteriovenous fistula was 73% and 84%, respectively ( P = NS). Conclusions: Composite sequential reconstruction using an isolated popliteal segment as inflow for the distal reconstruction is an acceptable option in patients presenting for Limb Salvage reconstruction with limited venous conduit. This type of reconstruction, when available, may be a better option than pure prosthetic with or without a vein cuff or arteriovenous fistula. (J Vasc Surg 2002;36:325-9.)

  • Choice of peroneal or dorsalis pedis artery bypass for Limb Salvage.
    Seminars in vascular surgery, 1997
    Co-Authors: Benjamin B. Chang, Dhiraj M. Shah, Robert P. Leather
    Abstract:

    BACKGROUND Arterial reconstructions performed for Limb Salvage have increasingly used peroneal and dorsalis pedis arteries as outflow vessels. However, there have been few published reports comparing the patency and Limb Salvage of these alternative outflow tracts. In this report, we have examined our experience with the peroneal and dorsalis pedis artery bypasses for Limb Salvage. METHODS AND MATERIALS During a 19-year period, more than 3,500 infrageniculate reconstructions were performed for Limb Salvage at our institution. Eight hundred and eighty were performed to the peroneal artery and 291 were performed to the dorsalis pedis. Patients' demographics were similar in both groups. Sixty-three percent of patients were male and 52% were diabetic. All surgeries were performed for patients with critical ischemia. In situ technique was used in 68% of peroneal reconstructions and 66% of dorsalis pedis bypasses, respectively. Translocated veins were used in 28% of bypasses and spliced veins were used in 32%. RESULTS Secondary patency rates to the peroneal reconstructions were 89% and 76% at 1 and 5 years, and 88% and 68% for the dorsalis pedis bypasses, respectively. No statistical difference was found. Sixteen (1.8%) of peroneal artery reconstructions were hemodynamic failures and four (1.4%) were hemodynamic failures in the dorsalis pedis group. Wound complications were observed in 19 (2.2%) of the peroneal group and 7 (2.4%) of the dorsalis pedis group. Limb Salvage rates for the peroneal artery are 96% and 93% at 1 and 5 years, respectively, and 95% and 87% for the dorsalis pedis reconstructions, respectively. CONCLUSION This experience indicates that both peroneal and dorsalis pedis artery reconstructions have acceptable patency and Limb Salvage rates. Selection of one of these two outflow tracts, when a choice exists, may depend on the conduit limitation and the adjacent tissue infection. However, both outflow tracts are durable and hemodynamically effective for Limb Salvage.

  • Choice of peroneal or dorsalis pedis artery bypass for Limb Salvage
    American journal of surgery, 1995
    Co-Authors: R. Clement Darling, Benjamin B. Chang, Philip S.k. Paty, William E. Lloyd, Robert P. Leather, Dhiraj M. Shah
    Abstract:

    Abstract Background : Arterial bypasses performed for Limb Salvage have increasingly used peroneal and pedal arteries as outflow. However, few reports have been published that compare the patency of Limb Salvage of these alternative outflow tracts. In this report, we have examined our experience with peroneal and dorsalis pedis (DP) artery bypasses for Limb Salvage. Methods and materials : Of more than 3,000 infrainguinal reconstructions performed for Limb Salvage, 732 were completed to the peroneal artery. During the same period, 238 bypasses were performed to the DP artery. Patient demographics were similar in both groups. The in situ technique was used in 68% of the peroneal bypasses and in 66% of the DP bypasses, respectively. Translocated veins were used in 28% of bypasses, and spliced veins were used in 32%. Results : Secondary patency rates for the DP bypass at 1 and 5 years were 89% and 67%, respectively, as compared with 89% and 78% for the peroneal artery bypass. Limb Salvage rates for the DP bypass were 94% at 1 year and 86% at 5 years, as compared with 96% and 93% at 1 and 5 years, respectively, for the peroneal artery bypass. No statistical difference was found. Four (1.7%) hemodynamic failures occurred in the DP group and 10 (1.4%) in the peroneal group. Wound complications were seen in 9 (3%) patients in the DP group and in 11 (1.5%) in the peroneal group. Conclusion : This experience indicates that both peroneal and DP bypasses have acceptable patency and Limb Salvage rates. Selection of one of these two outflow tracts, where a choice exists, may depend on the conduit limitation and adjacent tissue infection; however, both outflow tracts are durable and hemodynamically effective for Limb Salvage.

  • Increased Limb Salvage by the use of unconventional foot amputations
    Journal of vascular surgery, 1994
    Co-Authors: Benjamin B. Chang, R. Clement Darling, Robert P. Leather, Devon E.m. Bock, Richard L. Jacobs, Dhiraj M. Shah
    Abstract:

    Abstract Purpose: Limb Salvage in the presence of ischemic foot necrosis requires revascularization followed by debridement or partial foot amputation. Necrosis extending beyond the toes and metatarsal heads may require the use of unconventional types of amputations. Methods: Over a 15-year period 2105 ischemic Limbs were treated with infrainguinal revascularization. In 98 cases, extensive foot necrosis was then managed with amputations, including 59 modified Chopart, 14 Lisfranc, 17 Pirogoff and 8 Syme amputations. Patients were not allowed to bear weight for several days to weeks. Results: Skin flap necrosis in 14 cases was managed successfully by debridement and skin grafting. Ambulation required the use of a "clamshell" prosthesis and foot spacer. The overall Limb Salvage rate in this group was 84% (82 of 98). In general, the modified Chopart amputation most frequently produced ambulatory Limb Salvage and is technically easier to perform than a Syme amputation. Patient satisfaction and long-term ambulatory function was highest with the modified Chopart. Conclusions: Ischemic foot necrosis extending beyond the limits of conventional transmetatarsal amputation need not be treated with major amputation. This requires the surgeon to be well versed in the use of less common types of partial foot amputations. Acceptable Limb Salvage and good functional results may be attained by the motivated patient and surgeon with the use of these procedures in the revascularized Limb. (J VASC SURG 1994;19:341-9.)

Bruce M. Elliott - One of the best experts on this subject based on the ideXlab platform.

  • Do Results Justify an Aggressive Strategy Targeting the Pedal Arteries for Limb Salvage
    The Journal of surgical research, 1995
    Co-Authors: Jacob G. Robinson, Marshall A. Cross, Bruce M. Elliott
    Abstract:

    We initiated a strategy to bypass all of the significant popliteal and tibial disease in the setting of Limb-threatening ischemia beginning in September 1986. Of 194 infrapopliteal bypasses performed for Limb Salvage during the ensuing 6 years, 111 (57%) autogenous vein bypasses were performed to the pedal vessels at or distal to the ankle. By life table analysis, primary graft patency at 60 months for pedal bypasses was 57%, with Salvage of failed grafts resulting in secondary patency of 61%. Limb Salvage was 64% at 60 months. Of 33 graft thromboses, 24 (73%) resulted in eventual Limb loss. Five Limbs were amputated due to wound complications or progressive forefoot sepsis despite patent pedal grafts. More bypasses were performed to the dorsalis pedis than the posterior tibial at the ankle (78 vs 33), but patency and Limb Salvage were similar. Bypasses to the pedal arteries resulted in superior Limb Salvage compared with peroneal bypass when forefoot tissue necrosis was present (63 vs 33% at 36 months, P = 0.048). Pedal grafts had comparable overall patency (57 vs 64%) and Limb Salvage (64 vs 75%) to more proximal tibial bypasses. Pedal bypass provides acceptable long-term outcomes for both patency and Limb Salvage. When forefoot ischemic tissue loss is present, pedal bypass, when feasible, appears preferable to peroneal bypass.

  • Limitations of peroneal artery bypass grafting for Limb Salvage
    Journal of vascular surgery, 1993
    Co-Authors: Bruce M. Elliott, Jacob G. Robison, Marshall A. Cross
    Abstract:

    Abstract Purpose:  The purpose of this study was to compare the results of peroneal bypass grafting for Limb Salvage with the results of other tibial and pedal bypass grafts performed concurrently. Methods:  Thirty-four peroneal bypass grafts with autologous vein were performed for Limb Salvage between September 1986 and June 1992. These constituted 18% of an overall experience of 194 tibial or pedal bypasses performed during that time. Preoperative and intraoperative arteriograms were reviewed to identify anatomic characteristics associated with successful Limb Salvage. Results:  Secondary patency rates for peroneal bypass grafts (70%) compared with the other tibial and pedal bypass grafts (65%) did not differ significantly at 48 months by life-table analysis. Limb Salvage achieved by peroneal artery bypass grafting was significantly worse (55%) than that achieved by the remaining tibial and pedal bypasses (67%) at 48 months. Limb Salvage was 33% at 7 months for those undergoing peroneal artery bypass grafting as opposed to 57% at 48 months for patients undergoing other tibial or pedal revascularizations with tissue necrosis. Four anatomic features were identified that were associated with failure after peroneal artery bypass grafting. These were peroneal length less than 10 cm ( p = 0.012), peroneal artery diameter less than 2 mm ( p = 0.035), absence of arteriographically demonstrated collaterals perfusing the foot ( p = 0.0001), and little or no visualization of the pedal arch ( p = 0.008). Conclusions:  Although successful grafts may avoid amputation in carefully selected cases, alternatives to peroneal artery bypass grafting should be considered when less than favorable anatomic conditions are encountered, particularly in the presence of forefoot tissue necrosis. (J VASC SURG 1993;18:881-8.)