American Society for Metabolic and Bariatric Surgery literature review on the effect of Roux-en-Y gastric bypass limb lengths on outcomes

This literature review is issued by the American Society for Metabolic and Bariatric Surgery regarding limb lengths in Roux-en-Y gastric bypass (RYGB) and their effect on metabolic and bariatric outcomes. Limbs in RYGB consist of the alimentary and biliopancreatic limbs and the common channel. Variation of limb lengths in primary RYGB and as a revisional option for weight recurrence after RYGB are described in this review.     

Correction of lower limb lipodystrophy

The authors study various types of thigh lipodystrophy. To each type is applied a special technique. The complications are studied and the limitations given.     

The epidemiology of acute sports-related fractures in adults

Objective

To determine the incidence and epidemiology of acute sports-related fractures in adults.

Design

Retrospective analysis of a prospectively collected database containing all in-patient and out-patient fractures in a defined patient population in 2000.

Setting

Orthopaedic Trauma Unit.

Results

There were 5953 fractures in 2000 of which 761 (12.8%) were caused in sporting accidents. The overall incidence was 142/10⁵ with 261/10⁵ in males and 35/10⁵ in females. The mean age was 25.6 years. 41 sports caused the fractures but 10 sports accounted for 86.8% of fractures. In 40 sports the highest prevalence of fractures were in the upper limb and the commonest fractures seen were in the distal radius, metacarpus and finger phalanges although the highest prevalence was in the clavicle. Sports fractures comprised 16.5% of upper limb fractures and 7.5% of lower limb fractures. Our results suggest that there are 80,000–85,000 sports fractures annually in the United Kingdom of which about 18,000 require operative treatment.

Conclusions

Sporting activities are the third most common cause of fractures. With increasing affluence it is likely that they will increase. Fractures of the wrist and hand are the most common but in some sports there are a number of higher energy fractures. Our results suggest that, even in sport, there are a number of osteoporotic fractures usually occurring in women.     

Acute and chronic limb ischaemia

Acute (ALI) and chronic limb ischaemic (CLI) make up a major part of the workload of vascular surgeons and carry considerable morbidity and mortality. Peripheral artery disease (PAD) is the major cause of these conditions. Diagnosis of these conditions involves proper use of imaging including duplex ultrasound, computed tomography angiography (CTA), magnetic resonance angiography (MRA), as well as invasive techniques like digital subtraction angiography (DSA). Management ranges from conservative techniques, the mainstay of management in intermittent claudication (IC), with medical optimization, through to endovascular and open revascularization techniques in CLI and ALI. Finally where no revascularization options exist, primary amputation or palliation must be considered.     

Limb trauma: the use of an advanced wound care device in the treatment of full-thickness wounds

This is an observational case series of 15 patients with full-thickness traumatic wound defects treated with a dermal substitute. There were 8 male and 7 female patients with a mean age of 36.6 years. Eight patients had trauma to the lower limbs and 7 were of the upper limbs, with the average lesion size 104.4 cm² (range 6–490 cm²). The time to complete healing had a mean average time of 26.8 days (range 16–60 days). All patients went on to successful repair with 6 patients requiring a second application of the substitute and 5 patients needing split thickness skin grafts. Infection was recorded in one patient.     

糖尿病肢体动脉闭塞症红外热像图研究

目的:分析糖尿病肢体动脉闭塞症(DLAO)患者的红外热像图表现、直接与间接冷负荷后的温度恢复率与相差值.方法:用红外热像仪检测22例健康成年人和57例DLAO患者的手背与下肢热图像,手背、足背直接冷负荷后的温度恢复率,手指冷负荷后间接测定足趾温度相差值.结果:健康正常组与DLAO组热图像手背、手指、足背、足趾温差显著(P<0.05).手背、足背直接冷负荷后的温度恢复率正常组明显高于DLAO组,差异非常显著(P<0.01).手指冷负荷后间接测定足趾温度相差值差异也非常显著(P<0.01).结论:红外热像仪检查DLAO患者手背、足背温度反应,是一种准确而无创伤检测肢体循环状态的方法.     

Phantom limb pain

Br J Anaesth 2001; 87: 107–116     

ARTERIAL LESIONS IN SEVERE LOWER LIMB ISCHAEMIA: A PROSPECTIVE STUDY OF 100 CONSECUTIVE ISCHAEMIC LIMBS IN A HONG KONG CHINESE POPULATION

Background : The pattern and distribution of arterial lesions in a local Chinese population were studied to assess the feasibility of reconstruction and the possibility of avoiding major amputation of ischaemic limbs. Method : Between March 1995 and August 1997, 90 consecutive patients with 100 severely ischaemic lower limbs and their arteriograms were analysed. There were 48 female and 42 male patients with a mean age of 72 years. All the patients were in fair general health, did not have foot pulses and were willing to undergo major arterial reconstruction. Ten patients had bilateral limb ischaemia and 94 of the ischaemic limbs were affected by rest pain with or without ulcer and/or gangrene. The remaining six patients had debilitating claudication. These lesions were classified into low-grade (less than 50% stenosis), high-grade (50–90% stenosis) and critical (> 90% stenosis to occlusion). Results : Critically stenotic or occlusive lesions were present in 16% of aorto-iliac segments; 76% of femoropopliteal arteries; and 82% of trifurcation and infrapopliteal segments. In at least 27 patients one of the two main foot arteries was also severely diseased. The present analysis suggested that 79 of these ischaemic limbs had reconstructable lesions. Sixteen were not suitable for intervention and in five patients the reconstructability was uncertain radiologically. Conclusion : Contrary to local belief, the majority of patients in the Chinese community with severe lower limb ischaemia without foot pulses would have technically reconstructable arterial lesions and could benefit from a revascularization procedure.     

下肢静脉高压肿胀诊断及治疗

下肢静脉高压是慢性静脉疾病的基础病理生理改变，而下肢肿胀是下肢静脉高压所致静脉疾病的常见病理改变及临床表现。从发病机制看，能诱发下肢静脉高压而导致下肢肿胀的疾病主要分为“血液倒流性病变”和“回流障碍性病变”两类病变。包括原发性深静脉瓣膜功能不全、下肢深静脉血栓形成、髂静脉压迫综合征、血栓形成后综合征等。引发下肢静脉高压肿胀病因不同，其干预手段也有所不同：（1）改变生活方式，避免久坐久站，平卧时抬高患肢，规律活动踝关节和小腿。（2）加压治疗，包括弹力袜、弹力绷带气压泵加压治疗。（3）药物治疗，如口服黄酮类、七叶皂苷类，马栗树籽提取物等静脉活性药物。（4）应用长效青霉素等抗炎药物进行长期抗炎治疗。     

Lymphangiectasis of lower limb: A rare challenging case

Lymphangiectasis usually occurs in the viscera. Involvement of the lower limb is very rare. It is difficult to establish the diagnosis without detailed investigations. Clinical features are peculiar and may mimic lymphoedema of different origins which needs to be ruled out. Contrary to the expectation, the post-operative result is excellent in the long-term follow-up.     

三截骨术在下肢畸形中的应用

本文报告了我院自1983年10月至1988年10月采用三截骨术治疗儿麻后遗症同一下肢存在的多关节畸形及肢体短缩92例的临床资料。经2～7年随诊观察,疗效满意。92例患者中,优67例(72.83％),良15例(16.30％),可6例(6.52％),差4例(4.35％),总优良率89.13％。证明此种手术是治疗上述畸形,减少患者痛苦及经济负担,缩短疗程较为理想的手术方法。本文还就手术适应证的选择及与手术有关的几个问题进行了较为详尽的讨论。     

An isolated limb infusion technique: a guide for the perfusionist

Isolated limb perfusion with the administration of cytotoxic drugs has been successfully used to treat melanomas of the extremity since it was first introduced in 1958. The use of hyperthermia (40 degrees C) combined with chemotherapy agents, primarily melphalan, has resulted in greater cytotoxicity in laboratory studies, which led to the application of hyperthermia in clinical studies during the 1960s. The effectiveness of this regional technique and the absence of any good systemic therapy made hyperthermic-isolated limb perfusion (HILP) the main treatment for patients with regionally advanced melanoma. HILP involves open surgical dissection and cannulation of the peripheral vessels and is associated with moderate morbidity rates. Blood transfusions, systemic drug leak, infection, and damage to the blood vessels and nerves are all potential hazards associated with this technique. Recently, however, there has been increased interest in an alternative technique termed isolated limb infusion (ILI), which was first reported in 1994 from the Sydney Melanoma Unit in Australia. Based on a few single institution experiences, it was found that there are fewer morbidities associated with HILP than with ILI but no compromise in patient outcomes. ILI is a less invasive procedure involving the use of angiographically placed catheters inserted percutaneously through the femoral vessels that does not require blood donor exposure or use of a heart lung machine. Preliminary data suggest that the resultant local hypoxia and acidosis induced by this procedure potentiates the cytotoxic effects of melphalan. Response rates comparing ILI to HILP seem similar, and both are markedly better than systemic chemotherapy. ILI may be a more desirable option because morbidity is greatly reduced and outcomes appear similar. There is a potential role for the perfusionist in the application of ILI, an evolving area of cancer therapy.     

Above-the-knee replantation in a child: a case report with a 24-year follow-up

Replantation of an amputated limb is generally contraindicated in crushing and traction injuries. Injury to muscle tissue and skin also creates difficulties in coverage, and bony fractures may shorten limb length which can impede lower extremity function. Numerous cases have been reported on the successful replantation of the lower limb in children; however, review of previous English literature has documented only very few replantation at the thigh level, and those with severe crushing injury resulted in subsequent amputation. We report a case of successful thigh-level replantation in a 3-year-old child who sustained a crushing–traction type of injury with a follow-up of 24 years. After the replantation, early and late complications developed but these were successfully managed. On her last visit, the patient had pain-free ambulation without assistance, had intact protective sensation distal to the injury, and was very satisfied with the outcome. Replantation of the lower limb in children with crushing or avulsion type of injuries is still a worthwhile procedure. However, both the patient and the family should be aware that multiple surgeries may be needed to accommodate to long-term complications such as joint stiffness, scar contractures, and limb length discrepancies.     

Limb preference impacts single-leg forward hop limb symmetry index values following ACL reconstruction

Following anterior cruciate ligament (ACL) reconstruction limb dominance for performing tasks is not considered when making rehabilitation progression decisions. The purpose of this study was to determine if strength and functional outcomes differ between individuals who injured their preferred or nonpreferred jumping limb and to determine if these same outcomes differ between individuals who injured their preferred or nonpreferred limb used to kick a ball. A secondary purpose was to determine the association of quadriceps strength and single-leg forward hop performance with patient self-reported function. Forty individuals with ACL reconstruction (age = 20.0 ± 4.6 years, height = 174.2 ± 12.7 cm, mass = 71.2 ± 12.7 kg, time since surgery = 5.3 ± 0.8 months) were included in the study. Primary outcome measures included, International Knee Documentation Committee Subjective Knee Form (IKDC) scores, quadriceps limb symmetry index (LSI) values, and single-leg forward hop LSI values. Limb preference was defined two ways, kicking a ball and performing a unilateral jump. There were no significant differences between groups based on injury to the preferred limb to kick a ball for any of the outcome variables. Individuals who injured their nonpreferred jumping limb demonstrated significantly (p = 0.05, d = 0.77) lower single-leg forward hop LSI values (81.1% ± 19.5%) compared to individuals who injured their preferred jumping limb (94.1% ± 12.6%), but demonstrated no differences in IKDC scores or quadriceps LSI values. Quadriceps LSI and single-leg forward hop LSI explained 73% of the variance in IKDC scores, but quadriceps LSI had the strongest association (r = 0.790). These findings suggests that limb preference influences single forward hop LSI values and should be considered following ACL reconstruction.     

负压抽吸治疗肢体淋巴水肿

目的:研究负压抽吸治疗肢体淋巴水肿的治疗效果、预后及防止复发的措施。方法:利用脂肪负压吸引器,负压控制在0.08～0.1MPa,抽吸治疗28例患者共42例侧肢体淋巴水肿。抽吸方向尽量和肢体的纵轴平行,避免较多地损伤肢体浅部的皮神经和血管。结果:42例侧肢体淋巴水肿术后疗效较佳,上臂中段周径平均减少7cm,上举功能改善;小腿中段周径平均减少9～12cm,大腿中段周径平均减少10～14cm。随访2年效果基本稳定,在此期间,未见复发征象。结论:负压抽吸治疗肢体淋巴水肿有较好的疗效,为淋巴水肿的临床治疗提供了一种新的方法。     

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1987年Taylor初次提出血管区域(angiosome)概念,即特定血管支配特定皮肤区域及皮下组织,并用于整形科的皮瓣移植。近年来血管区域概念已扩展运用于评估下肢重症缺血(critical limb ischemia,CLI)的术前情况、诊疗方法、远期预后。本文就血管区域概念及其在CLI临床应用方面的进展进行综述。