Vascularised and Modified Lower-Leg Rotationplasty for the Treatment of Severe Infection and Bone Loss of the Proximal Femur: A Case Report

2017 ◽  
Vol 27 (5) ◽  
pp. e11-e13
Author(s):  
Sebastian Fischer ◽  
Christoph Hirche ◽  
Volkmar G. Heppert ◽  
Paul A. Grützner ◽  
Ulrich Kneser ◽  
...  
Keyword(s):  
Wound Healing ◽  
Proximal Femur ◽  
Severe Infection ◽  
Lower Leg ◽  
Case Description ◽  
Infection Site ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Paraplegic Patient

Case description We report a reconstructive case in a paraplegic patient, who suffers from a severe proximal femur infection. Aiming at the preservation of the capacity to remain in a seated position to operate a wheelchair, lower leg rotationplasty was considered suitable for reconstruction. Due to severe infection and subclinical femoral artery stenosis, rotationplasty was supercharged by the inferior epigastric artery. Furthermore, extensor tendons of the foot were attached to the acetabulum to facilitate stability of the neo-hip joint. Results Follow-up examination 1 year after surgery revealed no complications and a satisfied patient. Conclusions Especially in paraplegic patients, lower leg rotationplasty is a possible treatment option for severe femoral infection. Supercharging provides well-vascularised tissue to the former infection site and improves wound healing.

Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: A Multicenter Study

2020 ◽  
Vol 36 (09) ◽  
pp. 694-702 ◽  
Author(s):  
Lukas Prantl ◽  
Nicholas Moellhoff ◽  
Uwe V. Fritschen ◽  
Guenter Germann ◽  
Riccardo E. Giunta ◽  
...  
Keyword(s):  
Wound Healing ◽  
Revision Surgery ◽  
Diep Flap ◽  
Inferior Epigastric Artery ◽  
Cancer Centers ◽  
Flap Loss ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
The Impact ◽  
Artery Perforator

Abstract Background Several patient-related factors have been identified with regard to the safety and efficacy of breast reconstructions. Using the largest database available in Europe, the presented study investigated the impact of cigarette smoking on deep inferior epigastric artery perforator (DIEP) free-flap breast reconstructions. Methods In total, 3,926 female patients underwent 4,577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases were divided into two groups: nonsmokers (NS) and smokers (S). Impact of smoking on surgical complications, controlled for covariates, and cluster effects within the cancer centers were analyzed by using generalized linear mixed models. Results Overall, there was no significant difference between the groups of patients regarding the rate of total flap loss. However, the rate of partial flap loss (0.9 vs. 3.2%, p < 0.001) and wound-healing disturbances requiring revision surgery (donor site: 1.5 vs. 4.0; recipient site: 1.3 vs. 3.6%, both p < 0.001) was significantly higher in smokers. Multivariable analysis identified smoking to be an independent risk factor for revision surgery (p = 0.001) and partial flap loss (p < 0.0001). Conclusion Our findings suggest that successful free tissue transfer can be achieved in smokers despite higher rates of partial flap losses and wound-healing disturbances. However, patients with a history of smoking requiring DIEP flap reconstruction should be critically evaluated preoperatively, informed in detail about the higher risk of complications and encouraged to quit smoking prior to surgery.

Bone and Bone Marrow Blood Flow in Blastic Crisis of Chronic Granulocytic Leukaemia

1979 ◽  
Vol 18 (06) ◽  
pp. 290-292 ◽  
Author(s):  
R. Lahtinen ◽  
T. Lahtinen
Keyword(s):  
Bone Marrow ◽  
Cell Proliferation ◽  
Blood Flow ◽  
Proximal Femur ◽  
Blastic Crisis ◽  
Normal Bone ◽  
Chronic Granulocytic Leukaemia ◽  
Washout Curves ◽  
Bone Marrow Blood

SummaryA l33Xe washout method has been used for measuring changes of blood flow in the proximal femur of a patient with the blastic crisis of chronic granulocytic leukaemia. In the hyperplastic phase the blood flow was highly increased and over three times greater than in the hypoplastic phase of the disease and over thirteen times greater than the value in normal bone. The bone circulation and especially the first component of the two-exponential bone washout curves appeared to reflect cell proliferation and neoplastic activity of the whole bone marrow. The method may provide clinically important information in the follow-up of selected haematological diseases.

Pilonidal sinus disease: Karydakis flap procedure in our patients

2020 ◽  
Vol 99 (8) ◽  
Keyword(s):  
Wound Healing ◽  
Pilonidal Sinus ◽  
Healing Process ◽  
Pilonidal Sinus Disease ◽  
Wound Complications ◽  
Limberg Flap ◽  
New Disease ◽  
Sinus Disease ◽  
Flap Procedure

Introduction: Despite the available guidelines, opinions of many surgeons are quite ambiguous when it comes to the therapy of pilonidal sinus disease. The treatment can be a frustrating problem both for the surgeon and the patient because it is associated with wound complications and high recurrence rate. The objective of this study was to analyze the results of patients with pilonidal sinus disease undergoing the Karydakis flap procedure. Methods: A total of 27 patients treated for primary and recurrent pilonidal disease using the Karydakis flap procedure at our department between October 23, 2018 and November 22, 2019 were analyzed prospectively. We evaluated postoperative wound healing, complications and recurrence of the disease in a short-term follow-up period. Disease recurrence was defined as prolonged healing or as a new disease requiring repeated surgery. Results: In December 2019 all 27 patients came for a follow-up visit. The result was a fully lateralized wound without any signs of a new disease in all patients. In May 2020 a follow-up visit by phone was performed. The median follow-up was 12 months. The healing process was free of any serious complications in 25 patients. Seroma formation cases were managed by puncture in the outpatient setting. Conclusion: According to the available evidence and guidelines, off-midline procedures – the Karydakis flap, Bascom cleft lift, and Limberg flap procedures – are associated with lower recurrence rates and better wound healing. An important goal is to achieve complete wound lateralization and to change the configuration of the gluteal cleft by reshaping it, which results in a nicely flattened gluteal crease.

Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series

2021 ◽  
pp. 153473462110310
Author(s):  
Marta García-Madrid ◽  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Raúl J. Molines-Barroso ◽  
Mateo López-Moral ◽  
...  
Keyword(s):  
Wound Healing ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Donor Site ◽  
Case Series ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Debridement ◽  
Prospective Case Series

Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.

scholarly journals Desmoplastic fibroma in the proximal femur: A case report with long-term follow-up

2015 ◽  
Vol 10 (4) ◽  
pp. 2465-2467 ◽  
Author(s):  
YU-BAO GONG ◽  
LI-MEI QU ◽  
XIN QI ◽  
JIAN-GUO LIU
Keyword(s):  
Case Report ◽  
Proximal Femur ◽  
Desmoplastic Fibroma ◽  
Long Term Follow Up
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