No abstract available.
Extremities* ; Limb Salvage* ; Tendons*

No abstract available.
Extremities* ; Limb Salvage* ; Tibia*

No abstract available.
Extremities ; Limb Salvage ; Polytetrafluoroethylene ; Transplants

The small saphenous vein (SSV) is an important graft in limb salvage surgery. It is frequently translocated for bypass surgery. Sometimes, the use of the SSV as an in-situ graft for posterior tibial artery or peroneal artery reconstruction offers the advantages of reduced vein graft injury and improved patency. Recently, saphenous vein mapping through computed tomography (CT) volume rendering technique offers a great quality view to the surgeon. We experienced a patient in whom a CT image with volume rendering technique revealed an aberrant SSV connected with the great saphenous vein at the medial malleolus level. This case indicates that an aberrant SSV may be successfully used as an in-situ conduit for bypass to the dorsalis pedis artery. Here, we present the case of a popliteal-to-dorsalis pedis in-situ vein bypass using a LeMaitre valvulotome (LeMaitre Vascular Inc., USA) under mapping of the aberrant SSV by CT volume rendering technique.
Arteries ; Humans ; Limb Salvage ; Saphenous Vein* ; Tibial Arteries ; Transplants ; Veins

Amputation ; Chronic Limb-Threatening Ischemia ; Fibrinolytic Agents/therapeutic use* ; Humans ; Limb Salvage ; Peripheral Arterial Disease ; Risk Factors ; Singapore ; Treatment Outcome

PURPOSE: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) below the knee as a treatment in diabetic foot gangrene. MATERIALS AND METHODS: Between May 2003 and May 2006, angiography was performed in 35 diabetic foot gangrene classified as either Wagner grade IV or V. Infrapopliteal PTA was performed in 10 patients among them. Clinical success was defined as prevention of major amputation. RESULTS: Among 25 patients who did not receive infrapopliteal PTA, the major amputation rate is 22% (in one arterial occlusion cases), 50% (in two arterial occlusion cases), 63% (in three arterial occlusion cases), respectively. Infrapopliteal PTA was successfully performed in 8 among 10 patients. Two patients were failed and undergone below-knee amputation. Toe amputation were performed in 2 patients with one arterial occlusion. Out of 6 patients with three arterial occlusions, toe amputations were performed in 4 patients and the other 2 patients were healed through debridement. CONCLUSION: As a first choice revascularization procedure for limb salvage in diabetic foot gangrene, infrapopliteal PTA can be one of treatment options.
Amputation ; Angiography ; Angioplasty* ; Debridement ; Diabetic Foot ; Gangrene* ; Humans ; Knee ; Limb Salvage ; Toes

PURPOSE: Lumbar sympathectomy has been performed in critical lower limb ischemia patients who have no reconstructable arteries. However, much controversy still persists over the its physiologic & clinical effects. This study was performed to determine the value of lumbar sympathectomy as a treatment modality. METHOD: A consecutive series of 35 patients who underwent lumbar sympathectomy during October 1995 and February 1999 were included in this study, and clinical, angiographic and postoperative results were evaluated. RESULT: The limb salvage rate was obtained in 85.7% (30/35) of the cases. Morbidity was 8.6% (3/35) and there were no mortality. Prevention of major amputation was achieved in a significant percentage of patients who received lumbar sympathectomy. Sympathectomy was carried out in long segment and was confirmed by frozen biopsy intraoperatively. CONCLUSION: Lumbar sympathectomy is a valuable procedure for prevention of major amputation in critical limb ischemia patients who have no reconstructable arteries.
Amputation ; Arteries ; Biopsy ; Extremities* ; Humans ; Ischemia* ; Limb Salvage ; Lower Extremity ; Mortality ; Sympathectomy*

PURPOSE: Percutaneous transluminal angioplasty (PTA) is being increasingly used as a primary treatment for critical limb ischemia (CLI). The aim of this study was to evaluate the results of performing PTA for the superficial femoral arteries (SFA) for treating CLI or claudication. METHOD: From April 2003 to February 2007, PTA of the SFA was performed on 44 limbs in 39 patients. The mean follow-up was 10.1 months. RESULT: The demographic features included a mean age of 67.6 years; the patients were 89.7% males, and CLI was present in 56.8% of the subjects. The lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC) as A (6.8%), B (40.9%), C (31.8%) and D (20.5%). PTA was confined to the SFA in 29 limbs (65.9%), and 15 patients (34.1%) underwent concurrent interventions in other anatomic locations. The SFA interventions included angioplasty only in 9 limbs (20.5%) and at least one stent in 35 limbs (79.5%). Clinical success was obtained in 33 limbs (75.0%) and limb salvage for CLI was achieved in 80% limbs (20/25 limbs). The complications included two access site hematomas and six intimal dissections. Interval conversion to bypass surgery was done in 5 limbs and major amputation was performed in 4 limbs. One patient died perioperatively after bypass surgery. The primary patency rates were 83.0% at 3 months, 78.9% at 6months and 72.3% at 12 months. The variables associated with the inferior primary patency rate by univariate analysis included CLI, the type of lesions (TASC A/B vs C/D), and the length of the treated lesions (P=0.01, P=0.008 and P=0.007, respectively). The modified runoff scoring system was predictive of PTA failure (P=0.003). CONCLUSION: PTA of the SFA for treating CLI or claudication is feasible and safe, and it provides acceptable clinical results. It would be appropriate to use PTA as the initial treatment option for chronic superficial femoral occlusive disease.
Amputation ; Angioplasty* ; Consensus ; Extremities ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Humans ; Ischemia ; Limb Salvage ; Male ; Stents

PURPOSE: Percutaneous transluminal angioplasty (PTA) is being increasingly used as a primary treatment for critical limb ischemia (CLI). The aim of this study was to evaluate the results of performing PTA for the superficial femoral arteries (SFA) for treating CLI or claudication. METHOD: From April 2003 to February 2007, PTA of the SFA was performed on 44 limbs in 39 patients. The mean follow-up was 10.1 months. RESULT: The demographic features included a mean age of 67.6 years; the patients were 89.7% males, and CLI was present in 56.8% of the subjects. The lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC) as A (6.8%), B (40.9%), C (31.8%) and D (20.5%). PTA was confined to the SFA in 29 limbs (65.9%), and 15 patients (34.1%) underwent concurrent interventions in other anatomic locations. The SFA interventions included angioplasty only in 9 limbs (20.5%) and at least one stent in 35 limbs (79.5%). Clinical success was obtained in 33 limbs (75.0%) and limb salvage for CLI was achieved in 80% limbs (20/25 limbs). The complications included two access site hematomas and six intimal dissections. Interval conversion to bypass surgery was done in 5 limbs and major amputation was performed in 4 limbs. One patient died perioperatively after bypass surgery. The primary patency rates were 83.0% at 3 months, 78.9% at 6months and 72.3% at 12 months. The variables associated with the inferior primary patency rate by univariate analysis included CLI, the type of lesions (TASC A/B vs C/D), and the length of the treated lesions (P=0.01, P=0.008 and P=0.007, respectively). The modified runoff scoring system was predictive of PTA failure (P=0.003). CONCLUSION: PTA of the SFA for treating CLI or claudication is feasible and safe, and it provides acceptable clinical results. It would be appropriate to use PTA as the initial treatment option for chronic superficial femoral occlusive disease.
Amputation ; Angioplasty* ; Consensus ; Extremities ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Humans ; Ischemia ; Limb Salvage ; Male ; Stents

Nowadays, more aggressive local control of primary cancer site is believed to be the most effective among the oncologists. However, this aggressive local control of cancer leaves a large defect of tissue which needs the reconstruction by a plastic surgeon.Post-oncologic reconstruction usually needs to use free flap coverage rather than local flap because of extensive tissue defect and post-radiation fibrosis. End-to-side microvascular anastomosis rather than end-to-end microvascular anastomosis is necessary especially for limb salvage in case of malignant cancer of the limb or for saving the important recipient vessel. The effect of radiation of end-to-end microvascular anastomosis was revealed to be minimal in the previous studies, but the effect of radiation on end-to-side microvascular anastomosis has not been researched up to present. The authors designed this experimental study model to clarify the effect of radiation on the patency of end-to-side microvascular anastomosis. For control group, total 20 rats were used. In one control group which consists of 10 rats, end-to-side microvascular anastomoses were carried out on their carotid arteries. In the other control group of 10 rats, end-to-end microvascular anastomoses were done. In radiation groups, 2000 rad X-radiation(peak 250 kV, 30 mA) was given on the neck areas of 40 rats. In two radiation groups, each of which consists of 10 rats, end-to-end and end-to-side microvascular anastomoses were carried out respectively on their carotid arteries 3 weeks after radiation. In another two radiation groups, each of 10 rats, the same procedures were done respectively 6 weeks after radiation. On the fourth week after anastomsis, the vascular patency and histological examinations were done. This study revealed that no effect of radiation on the vascular patency was found depending on both types of microanastomoses although some histologic changes were evident.
Animals ; Carotid Arteries ; Extremities ; Fibrosis ; Free Tissue Flaps ; Limb Salvage ; Neck ; Rats ; Vascular Patency