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Vascular management in rotationplasty.

ABSTRACT: The Van Nes rotationplasty is a useful limb-preserving procedure for skeletally immature patients with distal femoral or proximal tibial malignancy. The vascular supply to the lower limb either must be maintained and rotated or transected and reanastomosed. We asked whether there would be any difference in the ankle brachial index or complication rate for the two methods of vascular management. Vessels were resected with the tumor in seven patients and preserved and rotated in nine patients. One amputation occurred in the group in which the vessels were preserved. Four patients died secondary to metastatic disease diagnosed preoperatively. The most recent ankle brachial indices were 0.96 and 0.82 for the posterior tibial and dorsalis pedis arteries, respectively, in the reconstructed group. The ankle brachial indices were 0.98 and 0.96 for the posterior tibial and dorsalis pedis arteries, respectively, in the rotated group. Outcomes appear similar using both methods of vascular management and one should not hesitate to perform an en bloc resection when there is a question of vascular involvement.

SUBMITTER: Mahoney CR

PROVIDER: S-EPMC2311480 | biostudies-literature | 2008 May

REPOSITORIES: biostudies-literature

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Vascular management in rotationplasty.

Mahoney Craig R CR Hartman Curtis W CW Simon Pamela J PJ Baxter B Timothy BT Neff James R JR

Clinical orthopaedics and related research 20080318 5

The Van Nes rotationplasty is a useful limb-preserving procedure for skeletally immature patients with distal femoral or proximal tibial malignancy. The vascular supply to the lower limb either must be maintained and rotated or transected and reanastomosed. We asked whether there would be any difference in the ankle brachial index or complication rate for the two methods of vascular management. Vessels were resected with the tumor in seven patients and preserved and rotated in nine patients. One ...[more]

PMID: 18347891

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Project description:BackgroundVascular malformations (VMs) are a collection of rare diseases that result from abnormal overgrowth of vascular tissue and can lead to pain, infection, disfigurement, and decreased mobility. Vascular malformations can invade or impinge on nearby structures, including nerves, causing pain, numbness, and/or functional impairment. If nonsurgical therapy fails, surgical resection is considered. However, VMs' thin walls and tendency to infiltrate and/or recur makes resection difficult or impossible. Rather than resecting, we have found that patients can still benefit from surgery in the form of nerve decompression. Here, we present a series of patients with VMs causing symptomatic nerve compression that were successfully treated with nerve decompression, with or without VM resection. It is the purpose of this study to demonstrate that VM patients with nerve pain and/or sensorimotor dysfunction should be referred for evaluation by a peripheral nerve surgeon, regardless of whether the VM is considered "resectable."MethodsRetrospective chart review of patient undergoing nerve decompression surgery for symptoms of peripheral nerve compression (pain and/or motor/sensory dysfunction) attributable to a nearby VM (confirmed on preoperative magnetic resonance imaging), with or without VM resection.ResultsSix patients with peripheral nerve compression attributable to VM were treated with nerve decompression. One also underwent VM resection. Five of the 6 patients had undergone previous surgical intervention (resection or sclerotherapy) without clinical improvement in radiculopathy. Following intervention, all patients demonstrated improvement of their pain and motor/sensory dysfunction.ConclusionsPatients with VM nerve pain and/or sensorimotor dysfunction should be referred for evaluation by a peripheral nerve surgeon, regardless of whether the VM is deemed resectable. Even when unresectable, patients may still benefit from surgery in the form of nerve decompression.

Project description:ObjectiveIn orthopedic trauma, identification of extremity trauma combined with vascular injury is challenging. Missed diagnosis may result in amputation or even death. The purpose of this study was to investigate whether physical examination combined with handheld vascular ultrasound Doppler examination could be an effective method of screening for peripheral vascular injury and to explore the characteristics of vascular injuries in orthopedic trauma patients.MethodsRetrospective analysis of patients in the emergency department of orthopedic trauma in our hospital from January 2022 to October 2023. Physical examination combined with handheld vascular ultrasound Doppler examination was used as a screening method for suspected vascular injuries. Patients with suspected vascular injury would undergo further angiography and receive multidisciplinary treatment. Angiography was used as the gold standard for diagnosing vascular injuries. Patient demographics, mechanism of injury, location and type of injury, angiographic results, surgical notes, and early treatment outcome data were recorded.ResultsA total of 55 cases (58 limb injuries) with suspected vascular injury were ultimately included. Angiography revealed that 53 cases (55 limbs, positive rate 94.8%) were considered to have confirmed vascular injuries. Forty-three were male (81.1%) and 10 were female (18.9%), with mean age 44.1 ± 16.6 years. The main mechanism of injury was traffic accident (30, 56.7%). Most common site of vascular injuries was knee joint (30/55, 54.5%), and popliteal artery (23, 47.9%) was the most commonly injured blood vessel. After multidisciplinary collaborative treatment, overall patient mortality was 3.8% (2/53), and limb survival rate among surviving patients was 81.1% (43/53) in our study.ConclusionIn orthopedic trauma, "Hard signs" and "soft signs" combined with handheld vascular ultrasound Doppler examination were effective ways to screen for suspected vascular injuries. Most limbs had associated fractures or dislocations at the site of vascular injury. Collaboration of vascular surgery, microsurgery and orthopedic trauma may help improve patients' prognosis.

Project description:ObjectiveTo investigate whether an internet based, nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinically manifest vascular disease.DesignProspective randomised controlled trial.SettingMulticentre trial in secondary and tertiary healthcare setting.Participants330 patients with a recent clinical manifestation of atherosclerosis in the coronary, cerebral, or peripheral arteries and with at least two treatable risk factors not at goal.InterventionPersonalised website with an overview and actual status of patients' risk factors and mail communication via the website with a nurse practitioner for 12 months; the intervention combined self management support, monitoring of disease control, and drug treatment.Main outcome measuresThe primary endpoint was the relative change in Framingham heart risk score after 1 year. Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor.ResultsParticipants' mean age was 59.9 (SD 8.4) years, and most patients (n=246; 75%) were male. After 1 year, the relative change in Framingham heart risk score of the intervention group compared with the usual care group was -14% (95% confidence interval -25% to -2%). At baseline, the Framingham heart risk score was higher in the intervention group than in the usual care group (16.1 (SD 10.6) v 14.0 (10.5)), so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score. This produced a relative change of -12% (-22% to -3%) in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and -8% (-18% to 2%) adjusted for the baseline score. Of the individual risk factors, a difference between groups was observed in low density lipoprotein cholesterol (-0.3, -0.5 to -0.1, mmol/L) and smoking (-7.7%, -14.9% to -0.4%). Some other risk factors tended to improve (body mass index, triglycerides, systolic blood pressure, renal function) or tended to worsen (glucose concentration, albuminuria).ConclusionAn internet based, nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease.Trial registrationClinical trials NCT00785031.

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Vascular management in rotationplasty.

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Vascular management in rotationplasty.

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