INTRODUCTION: Percutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore. METHODS: Patients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months. RESULTS: A total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status. CONCLUSION PTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.
Amputation ; Chronic Disease ; Chronic Limb-Threatening Ischemia ; Humans ; Ischemia/surgery* ; Limb Salvage/methods* ; Lower Extremity/surgery* ; Peripheral Arterial Disease/surgery* ; Retrospective Studies ; Risk Factors ; Singapore ; Treatment Outcome

Ameloblastoma in the tibia is rare. Limb reconstruction after tumor resection is challenging in terms of selection of the operative method. Here, we report a case of radical resection of an ameloblastoma in the mid-distal tibia combined with limb salvage using a three-dimensional (3D)-printed prosthesis replacement, with 1-year follow-up results. After receiving local institutional review board approval, a titanium alloy prosthesis was designed using a computer and manufactured with 3D-printing technology. During the operation, the stem of the prosthesis was inserted closely into the proximal tibial medullary cavity. Then, the metal ankle mortise and the talus were compacted closely. Radiographic results at 1-year follow up showed that the prosthesis was well placed, and no loosening was observed. The Musculoskeletal Tumor Society (MSTS) 93 functional score was 26 points, and the functional recovery percentage was 86.7%. Computer-assisted 3D-printing technology allowed for more volume and structural compatibility of the prosthesis, thereby ensuring a smooth operation and initial prosthetic stabilization. During the follow up, the presence of bone ingrowths on the porous surface of some segments of the prosthesis suggested good outcomes for long-term biological integration between the prosthesis and host bone.
Alloys ; Ameloblastoma ; Ankle ; Ethics Committees, Research ; Extremities ; Follow-Up Studies ; Limb Salvage ; Methods ; Prostheses and Implants ; Talus ; Tibia ; Titanium

Peripheral arterial occlusive disease caused by atherosclerosis can present with intermittent claudication or critical limb ischemia. Proper diagnosis and management is warranted to improve symptoms and salvage limbs. With the introduction of new techniques and dedicated materials, endovascular recanalization is widely performed for the treatment of peripheral arterial occlusive disease because it is less invasive than surgery. However, there are various opinions regarding the appropriate indications and procedure methods for interventional recanalization according to operator and institution in Korea. Therefore, we intend to provide evidence based guidelines for interventional recanalization by multidisciplinary consensus. These guidelines are the result of a close collaboration between physicians from many different areas of expertise including interventional radiology, interventional cardiology, and vascular surgery. The goal of these guidelines is to ensure better treatment, to serve as a guide to the clinician, and consequently, to contribute to public health care.
Arterial Occlusive Diseases/radiography/*therapy ; Arteries/pathology ; Endovascular Procedures/*standards ; Humans ; Intermittent Claudication/radiography/therapy ; Limb Salvage/methods ; Lower Extremity/*blood supply ; Peripheral Arterial Disease/radiography/*therapy ; *Practice Guidelines as Topic ; Republic of Korea

INTRODUCTIONLimb salvage in children with primary malignant bone tumours around the knee is challenging, with considerations such as shortening, bone and joint remodeling and high functional demands of active children. The ultimate aim for reconstruction is restoring a stable, painless and mobile joint. With improved survival rates from chemotherapy, reconstructive techniques should ideally last the child's lifespan. We adopted a biological approach by preserving the patients' native joint, with bony defects bridged by fibula grafts supplemented by autoclaved bone grafts infused with bone marrow. We conducted this retrospective review to determine if we were able to meet our objectives of reconstruction.

MATERIALS AND METHODSA retrospective review of children with osteogenic sarcoma involving the distal femur or proximal tibia treated at our institution was done. Patients aged 13 years and below at the time of surgery who had undergone a limb salvage procedure that preserved the knee joint were included.

RESULTSNine patients were identified, 3 males and 6 females. The average age was 10.0 years (range, 7 to 13 years) at the time of surgery. Seven had tumours involving the distal femur while 2 had tumours involving the proximal tibia. There were no cases of local recurrence. Four of the 9 patients died from metastatic disease, the 5 surviving patients have no evidence of disease, and the average follow-up for survivors was 13.2 years. The average active range of motion for the knee joint was 96° (range, 50° to 130°). The average Musculoskeletal Tumour Society (MSTS) score was 26.3 (range, 23 to 30).

CONCLUSIONWe have observed this technique of limb salvage offers satisfactory limb function with long-term follow-up.

Adolescent ; Bone Neoplasms ; surgery ; Child ; Female ; Femoral Neoplasms ; surgery ; Humans ; Knee Joint ; surgery ; Limb Salvage ; methods ; Male ; Osteosarcoma ; surgery ; Recovery of Function ; Retrospective Studies ; Tibia ; Time Factors ; Treatment Outcome

OBJECTIVETo compare mid-term clinical outcomes between amputation and limb salvage in treating severe open tibial fractures with type Gustilo III B, III C.

METHODSFrom July 2007 to June 2010,68 patients with severe open tibial fractures with type Gustilo III B, III C treated by amputation and limb salvage were retrospectively analyzed. In amputation group, there were 26 males and 12 females with an average age of (44.9±16.3) years old; and 21 cases were type Gustilo (III B, 17 cases were Gustilo III C; amputation were performed in accordance with soft tissue injury degree of shank, fracture types and surgical exploration. In limb salvageg group, there were 21 males and 9 females with an average age of (43.5±14.7) years old; and 23 cases were type Gustilo III B, 7 cases were Gustilo III C; the method of internal fixation and and wound healing were performed in accordance with patients's specific condition. Operative time, blood loss, hospital stay and postoperative infection was compared between two groups; time of loading and rate of return to work was compared; VAS scoring was used to evaluate condition of pain; SF-36 health queationaire was used to assess postoperative life quality.

RESULTSTotally 60 patients were followed up (33 cases in amputation group and 27 cases in limb salvage group) with an average time of 49.1 months. Operative time, blood loss, hospital stay and postoperative infection in amputation and limb salvage group respectively was (109.0±25.7) min, (245.0±58.6) min; (168.0±49.0) ml, (311.0±137.0) ml; (13.8±2.7) d, (28.8±13.1) d; 7.9%, 36.7%. At the final following-up, there was no significance meaning between two groups in VAS scoring and rate of return to work, but time of loading in amputation group was shorter than that of in limb salvage group. Physiological function in amputation group was better than limb salvage group, while body pain was worse; and there was no signicance meaning in psychological health between two groups.

CONCLUSIONAmputation and limb salvage both can treat severe open tibial fractures, and mid-term clinical outcomes between two groups has equivalent efficacy.

Adolescent ; Adult ; Aged ; Amputation ; methods ; Case-Control Studies ; Female ; Humans ; Limb Salvage ; methods ; Male ; Middle Aged ; Tibial Fractures ; surgery

OBJECTIVE: To evaluate the impact on wound healing and long-term clinical outcomes of endovascular revascularization in patients with critical limb ischemia (CLI). MATERIALS AND METHODS: This is a retrospective study on 189 limbs with CLI treated with endovascular revascularization between 2008 and 2010 and followed for a mean 21 months. Angiographic outcome was graded to technical success (TS), partial failure (PF) and complete technical failure. The impact on wound healing of revascularization was assessed with univariate analysis and multivariate logistic regression models. Analysis of long-term event-free limb survival, and limb salvage rate (LSR) was performed by Kaplan-Meier method. RESULTS: TS was achieved in 89% of treated limbs, whereas PF and CF were achieved in 9% and 2% of the limbs, respectively. Major complications occurred in 6% of treated limbs. The 30-day mortality was 2%. Wound healing was successful in 85% and failed in 15%. Impact of angiographic outcome on wound healing was statistically significant. The event-free limb survival was 79.3% and 69.5% at 1- and 3-years, respectively. The LSR was 94.8% and 92.0% at 1- and 3-years, respectively. CONCLUSION: Endovascular revascularization improve wound healing rate and provide good long-term LSRs in CLI.
Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Endovascular Procedures/adverse effects/*methods ; Female ; Foot/*blood supply ; Humans ; Ischemia/physiopathology/*surgery ; Limb Salvage ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Survival Rate ; Treatment Outcome ; Wound Healing/*physiology

OBJECTIVE: To evaluate the efficacy of transposition of the medial gastrocnemius muscle flap in the limb-salvage operation for proximal tibial osteosarcoma. METHODS: From January 2000 to January 2010, 65 patients [37 males, 28 females; (17.0±6.5) years] suffering from the proximal tibial osteosarcoma had a limb-salvage operation. According to the Enneking staging system, 35 patients were in stage IIa, 30 in stage IIb. All of the patients underwent resection of the osteosarcomas and reconstruction of the bone defect by prothesis. Among them, there were 35 patients underwent the medial head of the gastrocnemius muscle flap transposition to reconstruct the soft tissues and the other 30 didn't. RESULTS: All the patients were followed-up. In the group with the transposition of medial gastrocnemius muscle flap, the length of tumor bone resection was (13.5±4.2) cm, operation time was (150±45) min, intraoperative blood loss was (700±135) mL, and drainage volume was (500±200) mL. In the group without the transposition of medial gastrocnemius muscle flap, the length of tumor bone resection was (12.3±5.8) cm, operation time was (135±37) min, intraoperative blood loss was (600±105) mL, and drainage volume was (450±250) mL. There was significant difference in the operation time (P<0.05) but no significant difference in the intraoperative blood loss and drainage volume (P>0.05). In the group with the transposition of medial gastrocnemius muscle flap, local skin necrosis occurred in 2 patients (5.7%), and prosthesis deep infection occurred in 1 (2.9%). In the group without the transposition of medial gastrocnemius muscle flap, subctaneous hematocele, and effusion occurred in 3 (10.0%), wound infection occurred in 4 (13.3%), 1 cured and the other 3 developed prosthesis deep infection.There was significant difference in the rate of local complications (P<0.05). According to the function assessment by the Enneking system, in the group with the transposition of medial gastrocnemius muscle flap, 13 patients had excellent results, 17 had good results, 3 had fair results and 2 had poor results, with a satisfaction rate of 85.7%. In the group without the transposition of medial gastrocnemius muscle flap, 10 patients had excellent results, 12 had good results, 5 had fair results and 3 had poor results, with a satisfaction rate of 73.3%. There was significant difference in function assessment between the 2 groups (P<0.05). CONCLUSION The flap transposition of the medial head of the gastrocnemiusmuscle can reconstruct the soft tissue defect, decrease the local complication rate and improve the clinical outcomes of the limb-salvage for the proximal tibia osteosarcoma.
Adolescent ; Arthroplasty, Replacement ; Bone Neoplasms ; surgery ; Child ; Female ; Humans ; Limb Salvage ; methods ; Male ; Muscle, Skeletal ; Osteosarcoma ; surgery ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Tibia ; Young Adult

BACKGROUND: We report on our experience with using a distally based island flap for soft tissue reconstruction of the foot in limb salvage surgery for malignant melanoma patients. METHODS: A distally based sural flap was used for 10 cases for the hindfoot reconstruction, and a lateral supramalleolar flap was used for 3 cases for the lateral arch reconstruction of the mid- and forefoot after wide excision of malignant melanomas. RESULTS: The length of the flap varied from 7.5 cm to 12 cm (mean, 9.6 cm) and the width varied from 6.5 cm to 12 cm (mean, 8.8 cm). Superficial necrosis developed in four flaps, but this was successfully treated by debridement and suture or a skin graft. All thirteen flaps survived completely and they provided good contour, stable and durable coverage for normal weight bearing. CONCLUSIONS: The distally based sural flap is considered to be useful for reconstructing the hindfoot, and the lateral supramalleolar flap is good for reconstructing the lateral archs of the mid- and forefoot after resection of malignant melanoma of the foot.
Adult ; Aged ; Female ; Foot/*surgery ; Foot Diseases/*surgery ; *Free Tissue Flaps ; Humans ; Limb Salvage ; Male ; Melanoma/*surgery ; Middle Aged ; Reconstructive Surgical Procedures/methods ; Skin Neoplasms/*surgery

Adolescent ; Female ; Gigantism ; diagnosis ; surgery ; Humans ; Limb Salvage ; methods ; Lipomatosis ; diagnosis ; surgery ; Upper Extremity ; pathology ; surgery

Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Femoral Artery ; surgery ; Humans ; Limb Salvage ; Peripheral Vascular Diseases ; surgery ; Stents