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Background: Microsurgical free tissue transfer may be the only reconstructive option for lower extremity limb salvage. However, the functional and aesthetic results following free tissue transfer after initial salvage may be suboptimal, thus requiring secondary operations to facilitate definitive wound healing and/or refinement.
Methods: A multi-institutional retrospective cohort study was performed including patients who underwent lower extremity free tissue transfer from January of 2002 to December of 2020. The authors' primary outcome variable was the presence of secondary surgery after free tissue transfer for lower extremity reconstruction. Independent variables (eg, wound cause, flap, donor type, recipient, comorbidities) were collected. Secondary surgery was categorized as (1) procedures for definitive wound closure and (2) refinement procedures. Multivariable logistic regression was performed to determine which variables were independently associated with the outcome.
Results: A total of 420 free tissue transfers for lower extremity reconstruction were identified. Secondary surgery was performed in over half (57%) of the patients. Presence of diabetes (OR, 2.0; P = 0.01; 95% CI, 1.2 to 3.5) and use of a latissimus dorsi donor (OR, 2.4; P = 0.037; 95% CI, 1.1 to 5.4) were predictors of wound closure procedures. Fasciocutaneous (OR, 3.6; P < 0.001; 95% CI, 1.8 to 7.2) and myocutaneous (OR, 3.0; P = 0.005; 95% CI, 1.5 to 9.9) flaps were predictors of refinement procedures when compared with muscle-only flaps with skin grafts.
Conclusions: The majority of lower extremity free tissue reconstructions required secondary procedures to provide definitive wound closure and/or refinement. Overall, this study provides predictors of secondary surgery that will help formulate patients' expectations of lower extremity limb salvage.
Clinical Question/level Of Evidence: Risk, III.
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http://dx.doi.org/10.1097/PRS.0000000000010403 | DOI Listing |
Knee Surg Sports Traumatol Arthrosc
December 2024
Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden.
Purpose: To investigate the association between common measures of trunk and lower extremity range of motion (ROM), strength, the results of one-leg jump tests at baseline and the incidence of subsequent substantial knee injuries in adolescent female football players.
Methods: Players were assessed at baseline regarding (1) ROM of trunk, hip, and ankle; (2) trunk, hip, and knee strength; and (3) one-leg jump tests. Players were prospectively monitored weekly for 1 year regarding knee injuries and the volume of matches and training.
Ochsner J
January 2024
The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA.
Spinal cord sarcoidosis, an uncommon manifestation of neurosarcoidosis, presents diagnostic and therapeutic challenges because the condition is rare and has diverse clinical manifestations that can mimic other conditions such as multiple sclerosis and neuromyelitis optica spectrum disorder. A middle-aged African American female with a history of idiopathic intracranial hypertension and hydrocephalus with ventriculoperitoneal shunt presented with progressive, predominantly left-sided gait instability, weakness, and paresthesia. Cerebrospinal fluid showed lymphocytosis, red blood cells, elevated oligoclonal bands, and elevated kappa free light chains, concerning for multiple sclerosis.
View Article and Find Full Text PDFCureus
November 2024
Emergency Medicine, West Midlands Deanery, Birmingham, GBR.
Complex limb injuries are combination injuries that involve all components of a limb's tissue, such as skin, bone with its surrounding soft tissue cover, and neurovascular elements. Complex limb trauma often has a background of a significant mechanism of injuries such as high-velocity road traffic accidents, ballistic injuries, industrial accidents, and other major mechanisms of injuries which involve high amounts of energy transfer through these tissue layers. These injuries pose a major challenge to trauma and orthopaedic surgeons.
View Article and Find Full Text PDFRadiol Case Rep
February 2025
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha, Maharashtra, India, 442001.
A rare type of localized gigantism known as macrodystrophia lipomatosa is characterized by a disproportionate increase in fibroadipose tissues and a gradual overgrowth of all mesenchymal elements. The distribution in the lower extremities' plantar nerves and the upper extremity's median nerve is most commonly observed. This abnormality is congenital and typically manifests at birth or during the neonatal stage.
View Article and Find Full Text PDFJ Biomed Opt
December 2024
New York University, Tandon School of Engineering, Department of Biomedical Engineering, New York, United States.
Significance: Tracking changes in the vasculature of patients with peripheral arterial disease (PAD) may identify the need for follow-up treatment within only weeks after an initial intervention, enabling timely support and improving patient outcomes.
Aim: We aim to evaluate dynamic vascular optical spectroscopy's (DVOS's) ability to accurately monitor the hemodynamics of affected arteries in patients with PAD after a surgical intervention and predict long-term clinical outcomes.
Approach: A DVOS system non-invasively monitored the blood flow through 256 lower extremity arteries in 80 PAD patients immediately before, immediately after, and 3 to 4 weeks after they underwent a surgical intervention.
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