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Background: Amputees suffer from symptomatic neuroma and phantom limb pain. Regenerative peripheral nerve interface (RPNI) has recently been regarded as an effective method to prevent neuroma after amputation. However, the verifications of RPNI efficacy are mostly based on subjective evaluation, lacking objective approaches. This study aims to unveil the effect of RPNI on preventing neuroma formation and provide evidence supporting the efficacy of RPNI based on ultrasound. Methods: Amputees of lower limb at Peking University People's Hospital from July 2020 to March 2022 were analyzed retrospectively. The clinical data collected consisted of general information, pathology of primary disease, history of limb-salvage treatment, amputation level of nerve, pain scales such as the Numerical Rating Scale (NRS) and the Manchester Foot Pain and Disability Index (MFPDI). Three months after amputation, the transverse diameter, anteroposterior diameter, and cross-sectional area of neuromas in stump nerves at the end of residual limbs were measured using ultrasound and compared to adjacent normal nerves. Results: Fourteen patients were enrolled in the study, including 7 in the traditional amputation group (TA group) and 7 in the RPNI group. There was no significant difference in basic information and amputation sites between the two groups. The NRS and MFPDI scores of patients in RPNI group were significantly lower than those in TA group, and decreased with the follow-up time increasing, indicating that RPNI could reduce symptomatic neuroma pain. The comparison of preoperative ultrasound and postoperative pathology showed ultrasound could reflect the size of neuroma in vivo. Independent-sample t tests indicated that the ratios of anteroposterior diameter, transverse diameter and area of the cross section of both the neuroma and adjacent normal nerve obtained via ultrasound were significantly reduced in the RPNI group. Conclusion: This study suggested that RPNI can effectively prevent the formation of symptomatic neuroma after amputation using ultrasound. [ABSTRACT FROM AUTHOR]

Background: There is a long latent period for the sciatic nerve block before a satisfactory block is attained. Changes in the temperature of local anesthetics may influence the characters of the peripheral nerve block. This study was designed to evaluate the effect of warming ropivacaine on the ultrasound-guided subgluteal sciatic nerve block. Methods: Fifty-four patients for distal lower limbs surgery were randomly allocated into warming group (group W, n = 27) or room tempeture group (group R, n = 27) with the ultrasound-guided subgluteal sciatic nerve block. The group W received 30 ml of ropivacaine 0.5% at 30℃ and the group R received 30 ml of ropivacaine 0.5% at 23℃. The sensory and motor blockade were assessed every 2 min for 30 min after injection. The primary outcome was the onset time of limb sensory blockade. Results: The onset time of sensory blockade was shorter in group W than in group R (16 (16,18) min vs 22 (20,23) min, p < 0.001), and the onset time of motor blockade was also shorter in group W than in group R (22 (20,24) min vs 26 (24,28) min, p < 0.001). The onset time of sensory blockade for each nerve was shorter in group W than in group R (p < 0.001). No obvious differences for the duration of sensory and motor blockade and the patient satisfaction were discovered between both groups. No complications associated with nerve block were observed 2 days after surgery. Conclusions: Warming ropivacaine 0.5% to 30℃ accelerates the onset time of sensory and motor blockade in the ultrasound-guided subgluteal sciatic nerve block and it has no influence on the duration of sensory and motor blockade. Trial registration: The trial was registered on October 3, 2022 in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/bin/project/edit?pid=181104), registration number ChiCTR2200064350 (03/10/2022). [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to compare the outcomes of the two-stage induced membrane technique (IMT) and one-stage autografting in the treatment of aseptic atrophic nonunion in lower limb long bones. Methods: From January 2014 to January 2022, we reviewed all surgically treated long bone nonunion patients, including patients aged 18 years or older with atrophic nonunion, who were either treated with the two-stage induced membrane technique (IMT) or one-stage autografting. Outcome parameters interns of clinical, quality of life and healthcare burden were recorded and retrospectively analysed between the two treatment populations. The follow-up time was at least 1 year. Results: In total, 103 patients who met the criteria for aseptic atrophic nonunion were enrolled. Among them, 41 (39.8%) patients were treated with two-stage IMT, and 62 (60.2%) patients were treated with one-stage autologous bone grafting. The follow-up time was 12 to 68 months, with an average of 28.4 months. The bone healing rate was comparable in both groups (IMT: 92.7% vs. one-stage grafting: 91.9%, P = 0.089) at 12 months post-operation, and the bone healing Lane–Sandhu score was superior in the IMT group (mean: 8.68 vs. 7.81, P = 0.002). Meanwhile, the SF-12 scores of subjective physical component score (PCS) (mean: 21.36 vs. 49.64, P < 0.01) and mental health component score (MCS) (mean: 24.85 vs. 46.14, P < 0.01) significantly increased in the IMT group, as well as in the one-stage grafting group, and no statistically significant difference was found within groups. However, the total hospital stays (median: 8 days vs. 14 days, P < 0.01) and direct medical healthcare costs (median: ¥30,432 vs. ¥56,327, P < 0.05) were greater in the IMT group, while the complications (nonunion 8, infection 3, material failure 2, and donor site pain 6) were not significantly different between the two groups (17.1% vs. 19.4, P = 0.770). Conclusion: The data indicate that two-stage method of IMT serves as an alternative method in treating atrophic nonunion; however, it may not be a preferred option, in comprehensive considering patient clinical outcomes and healthcare burden. More evidence-based research is needed to further guide clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: To investigate the accuracy and safety of a newly constructed robotic arm which can cover the whole process of THA, we performed a series of robot-assisted total hip replacement on the cadaver. Methods: Fifteen frozen cadaveric specimens (30 hips) were used for this study. In this investigation, united hip system and Longwell robotic-assisted system were used. The entire lower limb was CT scanned prior to surgery. The 3D model was produced based on CT data; the site of the prosthesis, including acetabular anteversion, inclination angle, and the position of femoral prosthesis, was planned. With the assistance of a robotic arm, the surgeon changed the parameters based on the preoperative plan and the actual condition during surgery, and completed the whole procedure. Following surgery, we measured the acetabular anteversion angle, acetabular inclination angle, femur anteversion angle, combined anteversion angle, stem angulation, and canal fill ratio. Results: The parameters proved that the acetabular anteversion angle was 16.85 ± 3.00°, the acetabular inclination angle was 40.38 ± 5.37°, femur anteversion angle was 15.90 ± 9.01°, combined anteversion angle was 32.75 ± 9.03°, stem angulation was 1.84 ± 0.99°, and leg length discrepancy was 2.47 ± 1.43 mm. The canal fill ratio (CFR) of femoral prosthesis of osteotomy line in sagittal section is 99.72 ± 1.54% and in coronal section is 62.94 ± 8.91%; below osteotomy line 2.5 cm in sagittal section is 100.00% and in coronal section is 81.48 ± 12.94%; below osteotomy line 7.5 cm in sagittal section is 59.51 ± 12.94% and in coronal section is 89.79 ± 11.13%; femoral shaft isthmus in sagittal section is 56.41 ± 13.80% and in coronal section is 84.95 ± 15.17%. Conclusion: The accuracy and safety of this novel robotic arm are suitable for preparing both the acetabular and femoral sides, providing evidence for clinical trial. [ABSTRACT FROM AUTHOR]

This case report presents the management of a 69-year-old man with an extensive history of peripheral vascular disease including 2 previous failed right femoral to distal bypasses and a left above-the-knee amputation who presented with right lower extremity rest pain and non-healing shin ulcers. A redo bypass was performed for limb salvage via the obturator foramen to avoid his extensively scarred femoral region. The postoperative course was uneventful and the bypass remained patent in the early period. This case demonstrates the usefulness of the obturator bypass to provide revascularization and avoid amputation in a patient with chronic limb-threatening ischemia and multiple failed bypasses. [ABSTRACT FROM AUTHOR]

Objective: Inguinal lymphadenectomy is essential for staging and disease control. Minimally invasive techniques are recently replacing open techniques to reduce complications. We present our experience and lessons learnt from 21 patients who underwent lateral video endoscopic inguinal lymphadenectomy (L-VEIL) for penile malignancy. Methods: All patients above 18 years of age with histo pathology-confirmed squamous cell carcinoma penis with stages = T1b and T1a with persistent lymphadenopathy who underwent L-VEIL over a period of 2 years (2020-2022) were included. The data were analyzed on the basis of intraoperative and postoperative complications, lymph node yield, hospital stay, and histopathology report. Results: Forty-one lower limbs of 21 patients underwent L-VEIL during the abovementioned period. Median age was 52 years. Mean operative time (on 1 side) was 80 minutes. Median lymph node yield per side was 7.2. Intraoperatively, 1 patient had a vascular injury at the saphenofemoral junction, requiring conversion to open. Postoperative complications were superficial surgical site infection (n = 4), lymphedema (n = 1), and lymphocoele (n = 3), one of which was drained by pigtail catheter. One patient required exploration on the second postoperative day because of vascular injury. Average duration of hospital stay was 3 days. The median time of drain removal was 13 days. Histopathology suggested seminoma in 1 patient and mature teratoma in 1 patient; the rest of the patients' reports were negative for malignancy. Conclusion: The L-VEIL is safe and feasible, and there is a reduction (~30%) in complications; oncological outcomes are also not affected. It has better ergonomics, resulting in ease and comfort for surgeons when compared with classical VEIL. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Venous Insufficiency (CVI) is a set of clinical manifestations resulting from the chronic dysfunction of the peripheral venous system that affects the lower limbs. There is a growing search for complementary therapies, such as Medicinal Biomagnetism (MB), which acts in a non-invasive, painless, low-cost and with rare contraindications, aiming to improve quality of life. MB uses Static Magnetic Fields (SMF) to restore bioenergetic balance and promote health, including CVI. Objective: The aim of this study is to evaluate the effect of SMF application, through the MB Lower Limb Blood Flow Protocol (LLBFP), on pain resulting from vascular alterations of the lower limbs. Methodology: This is a cross-sectional clinical experimental study in three female participants with vascular alterations in the lower limbs who underwent the LLBFP Protocol. Pain, edema and quality of life complaints were assessed using the Venous Insufficiency Epidemiological and Economic Study (VEINES), Visual Analogue Scale (VAS), and perimeter measurements questionnaires, before and after the application of the LLBFP. Results: After treatment with the LLBFP Protocol, there was a trend towards the analgesic effect and reduction of edema, as well as improvement in the aspects related to the symptoms of heavy, restless, tired legs, and tingling, burning and itching, promoting improvement in quality of life. Conclusion: This study demonstrated that the application of the MB LLBFP Protocol has the potential to reduce the subjective perception of pain and edema in lower limbs with vascular alterations. The magnets used in the LLBFP may promote an anti-inflammatory response, contributing to the improvement of quality of life. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the efficacy of the PRECICE 2® nail in the treatment of lower limb length discrepancy in patients with a history of bone tumors. This study reports on outcomes, complications, and the safety of the PRECICE 2 limb lengthening nail in a cohort of pediatric patients with limb length discrepancy after surgery for bone tumors. Seventeen patients were treated with intramedullary magnetic nails. The average patient age at the time of surgery was 19 (range 11–32). The PRECICE 2 nail was used on 14 femurs (6 retrograde and 8 anterograde) and 3 tibias. The average consolidation time was 141 days (range 50–360) with a mean CI of 31 ± 12 days/cm. The ASAMI bone score showed 14 (82%) excellent results, 1 (6%) good result, and 2 (12%) poor results. The ASAMI functional score showed 13 (84.6%) excellent results, 3 (11.5%) good results, and 1 (3.8%) fair result. Patients treated with chemotherapy for bone cancer did not show any increase in distraction time or consolidation time. A total of 3 (17%) problems, 1 obstacle (5.5%), and 1 complication (5.5%) were encountered in our case series. The PRECICE 2 nail allows for effective and accurate lengthening preserving the range of motion in patients treated for bone tumors. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to compare the impact of postoperative closed-incision negative-pressure wound therapy (ciNPWT) and conventional dressings in wound-related complications after bone tumor resection and reconstruction. Patients and methods: A total of 50 patients with bone tumors and clinical indication for wide resection and reconstruction were included and divided into two groups (A and B). Bone defect reconstructions were achieved with modular endoprosthesis or biologic techniques, mainly involving allografts with free vascularized fibula. Group A received ciNPWT, and Group B conventional dressings. Wound-related complications, including wound dehiscence, persistent wound leakage, surgical site infections (SSIs), and causes for surgical revision, were assessed. Results: Nineteen patients were included in Group A and 31 in Group B. No significant differences were found between groups regarding epidemiologic and clinical presentation features, contrarily to reconstructive options, which were significantly different between both (Fisher = 10,100; p = 0.005). Additionally, Group A presented lower wound dehiscence rate (0 vs. 19.4%; χ2(1) = 4.179; p = 0.041), SSI rate (0 vs. 19.4%; χ2(1) = 4.179; p = 0.041), and surgical revision rate (5.3% vs. 32.3%; χ2(1) = 5.003; p = 0.025) compared to Group B. Conclusions: This is the first study reporting the impact of ciNPWT after bone tumor resection and reconstruction, and its results support a potential role for this technique in diminishing postoperative wound complications and SSIs. A multicentric randomized controlled trial may help clarify the role and impact of ciNPWT after bone tumor resection and reconstruction. [ABSTRACT FROM AUTHOR]

Occupational therapy is beneficial among adults with chronic pain; however, occupational therapy interventions addressing earlier phases of pain have not been clearly explicated. This systematic review characterized acute and subacute interventions billable by occupational therapy after hip or knee replacement to improve pain and function. Seven articles met inclusion criteria. Six articles had a low risk of bias. Three intervention types were found: task-oriented exercise, water-based, and modalities. Only task-oriented interventions improved both pain and function one-year after surgery. There are long-term benefits to early task-oriented exercise. Further research is needed to contextualize occupational therapy's role in early pain interventions. [ABSTRACT FROM AUTHOR]

Objective: Acute type A aortic dissection (ATAAD) accompanied with lower limb malperfusion (LLM) is considered to be a catastrophic event, and remains a great challenge for cardiac surgeons. Here we introduce our experience in treating ATAAD patients accompanied with LLM. Methods: 61 patients diagnosed with ATAAD accompanied by LLM enrolled in this study. All patients received aortic repair (Total-arch replacement or Hemi-arch replacement) as soon as possible on admission. Patients who still suffered LLM were performed extra-anatomic bypass using artificial vessels. All the discharged patients underwent the standard follow-up protocol. Results: 38 patients (38/61, 62.3%) got satisfied reperfusion of the lower limbs after aortic repair while the others did not. Five patients had femorofemoral bypass, 16 received aortofemoral bypass, and two underwent aortofemoral bypass plus femorofemoral bypass. The ICU stay time was 5.4 ± 3.6 days. Fifty-five patients were discharged home successfully, while six patients died postoperatively with hospital mortality of 9.8%. Major postoperative complications included acute kidney injury requiring hemodialysis in seven patients, delayed wake-up (>3 days) in 5, prolonged ventilation (>4 days) in 8, and lower limb ischaemia in 1. Follow-up was successfully conducted in 50 patients with a mean follow-up time 4.9 ± 2.6 years. Five patients died during the follow-up. The estimated 5-year survival rate was 87.5 ± 6.1%. CTA images showed 100% patency of the extra-anatomic bypass. Conclusion: Aortic repair plus concomitant extra-anatomic bypass grafting in one operative setting could be a simple, safe and effective treatment on ATAAD patients with LLM. [ABSTRACT FROM AUTHOR]

Objective The long-term performance of the quadriceps femoris muscle and physical function following surgical repair of a lower extremity fracture remains largely undefined. The purpose of this study was to investigate between-limb differences in quadriceps performance 12 months after surgical fixation of a lower extremity fracture. It was hypothesized that the injured limb would be significantly weaker, have a lower rate of torque development (RTD), and that there would be a reduced step-down performance compared to the uninjured limb 12 months after surgery. Additionally, this study sought to identify demographic, surgical, and psychological factors associated with poor quadriceps function 12 months after surgery. Methods Quadriceps performance was measured bilaterally in 95 participants (49 female), aged 42 (SD = 14.5) years, 12 months after surgical fixation of a lower extremity fracture. Isometric quadriceps strength and RTD were quantified using isometric dynamometry, and a timed step-down test was used to evaluate quadriceps performance. Independent predictor variables from the time of surgery were extracted from participants' medical records. Kinesiophobia was screened at the time of testing. Wilcoxon signed-rank tests and linear regression analyses were used to assess between-limb differences in quadriceps performance and to determine factors associated with quadriceps performance 12 months after surgery. Results Significant between-limb differences in each measure of quadriceps performance were identified (peak torque involved: 1.37 [0.71] Nm × kg−1; uninvolved: 1.87 [0.74] Nm × kg−1; RTD involved: 4.16 [2.75] Nm × kg−1 × s−1; uninvolved: 6.10 [3.02] Nm × kg−1 × × −1; and single-leg step-downs involved: 12.6 [5.0]; uninvolved: 21.7 [14.8]). Female biological sex, external fixation, and kinesiophobia at 12 months were associated with reduced after-surgery quadriceps performance outcomes. Conclusion Quadriceps performance is impaired 12 months after surgical repair of a lower extremity fracture, particularly in female participants, in cases requiring external fixation, and in those with higher kinesiophobia 12 months after surgery. Impact Because long-term quadriceps weakness negatively impacts functional mobility, targeted strengthening should be emphasized after surgical repair of lower extremity fracture. [ABSTRACT FROM AUTHOR]

Intoduc.on: Lower extremity wounds have been always a challenge for reconstruc:ve surgeons. Free perforator flaps are considered to be the best op:on for this problem but require the complexity of microsurgery. So, pedicled perforator flaps have emerged as alterna:ve op:ons for lower limb reconstruc:on. Pa.ents and methods: Prospec:ve study was conducted upon 40 pa:ents with trauma:c soD :ssue defects in the leg and foot in the period from (9/2017) to (8/2019). The free flaps used were, Anterolateral Thigh flap (ALT) and Medial Sural artery perforator flap (MSAP). In pedicled perforator flaps group, 10 cases were designed as propeller flaps while the other 10 flaps were designed as perforator plus flaps. Results: Free flaps were mainly used for large sized defects; we had one case of par:al flap loss and one case of complete flap necrosis. There was no difference in the survival of free flaps regarding the number of venous anastomoses or number of perforators which the flaps were based on. MSAP flap was the first op:on for coverage of large sized defects on foot and ankle as it s a thin and pliable flap, while ALT flap was used for coverage of larger defects on the leg. Pedicled perforator flaps were used mainly for small to medium-sized defects especially in the lower third of the leg; we had 3 cases of flap loss in propeller flap design while we had no cases of flap loss in perforator plus flap. Conclusion: Perforator flaps have become a reasonable solu:on for soD :ssue defects of the lower extremity. Careful as-sessment of the dimensions, loca:on, pa:ent comorbidi:es, availability of surrounding soD :ssue and presence of adequate perforators are mandatory for proper perforator flap selec:on. [ABSTRACT FROM AUTHOR]

A meta‐analysis study was conducted to measure the consequence of diabetic foot ulcers (DFUs) and other risk factors (RFs) on the prevalence of lower extremity amputation (LEA). A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. Of the 32 chosen studies enclosed, 9934 subjects were in the chosen studies' starting point, and 2906 of them were with LEA. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of DFUs and other RFs on the prevalence of LEA by the continuous and dichotomous approaches and a fixed or random effect model. Male gender (OR, 1.30; 95% CI, 1.17–1.44, P <.001), smoking (OR, 1.24; 95% CI, 1.01–1.53, P =.04), previous foot ulcer (OR, 2.69; 95% CI, 1.93–3.74, P <.001), osteomyelitis (OR, 3.87; 95% CI, 2.28–6.57, P <.001), gangrene (OR, 14.45; 95% CI, 7.03–29.72, P <.001), hypertension (OR, 1.17; 95% CI, 1.03–1.33, P =.01), and white blood cells count (WBCC) (MD, 2.05; 95% CI, 1.37–2.74, P <.001) were significantly shown to be an RF in LEA in subjects with DFUs. Age (MD, 0.81; 95% CI, −0.75 to 2.37, P =.31), body mass index (MD, −0.55; 95% CI, −1.15 to 0.05, P =.07), diabetes mellitus type (OR, 0.99; 95% CI, 0.63–1.56, P =.96), and glycated haemoglobin (MD, 0.33; 95% CI, −0.15 to 0.81, P =.17) were not shown to be an RF in LEA in subjects with DFUs. Male gender, smoking, previous foot ulcer, osteomyelitis, gangrene, hypertension, and WBCC were significantly shown to be an RF in LEA in subjects with DFUs. However, age and diabetes mellitus type were not shown to be RF in LEA in subjects with DFUs. However, caused of the small sample sizes of several chosen studies for this meta‐analysis, care must be exercised when dealing with its values. [ABSTRACT FROM AUTHOR]

Background: Spinal anaesthesia has its unique place in modern anaesthetic practice. In past, most of the surgeries, irrespective of the site of surgery, were performed in general anaesthesia but now in the modern anaesthetic field, spinal anaesthesia has markedly replaced general anaesthesia, specifically in obstetrics, lower limbs, and abdominal surgeries. Methods: A total of 100 patients fit to undergo lower limb surgery between the ages of 20 to 70 years were included in the study. 50 patients were in 0.5% hyperbaric bupivacaine (Group A) while 50 patients were in the 0.75% hyperbaric bupivacaine group (Group B). Patients with a history of allergies to local anaesthetics, ischemic heart disease and contraindications to spinal anaesthesia were excluded. At the end of the injection, the patient was immediately laid down and tilted to 30 degrees lateral on the operative side for unilateral anaesthesia. Mean arterial pressure at baseline, 15, 30, 45 and 60 minutes was recorded by trainee anaesthesia. A baseline was taken of mean arterial pressure measured 15 minutes before induction of spinal anaesthesia in a lying position. Results: The mean baseline arterial pressure of patients in group A was 88.72±1.71 mmHg and in group B was 88.94±1.95 mmHg. Mean arterial pressure MAP at 15, 30, 45 and 60 minutes in both groups was as follows; 86.22±2.55 vs 81.78±1.52 mmHg, 83.72±3.36 vs 75.84±1.34 mmHg, 80.02±3.40 vs 70.90±0.97 mmHg and 77.14±4.24 vs 66.06±1.62 mmHg respectively (p-value <0.05). Conclusion: This study concluded that the hemodynamic parameters in terms of mean arterial pressure remained more stable by deviating less from the baseline value with the use of a low dose of 0.5% hyperbaric bupivacaine instead of 0.75% hyperbaric bupivacaine in patients undergoing lower limb surgery under unilateral spinal anaesthesia. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Facultad de Medicina Humana is the property of Instituto de Investigaciones en Ciencias Biomedicas de la Universidad Ricardo Palma and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Complex regional pain syndrome (CRPS) is a chronic localized pain condition affecting all age groups with more propensity toward adolescent girls. This disease has a multifactorial pathophysiology involving the sympathetic and central nervous system, along with psychosocial, immune, and genetic factors. We reported a case of CRPS Type I in an adolescent boy who was successfully managed by continuous lower limb nerve blocks through perineural catheters along with the continuation of pharmacological management. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to identify factors that may predict community participation among adults with lower limb amputation. Design: This study is a secondary analysis of a cross-sectional data set, including 126 community-dwelling adults, ≥1 yr after unilateral transfemoral- (n = 44; mean age = 59 ± 14 yrs) or transtibial-level amputation (n = 82; mean age = 59 ± 14 yrs) seen in an outpatient limb loss clinic. Participation was assessed with the Community Integration Questionnaire. Factors, that is, demographics, comorbidities, prosthesis use per the Houghton Scale, Socket Comfort Score, assistive device use, falls history, and activity level per General Practice Physical Activity Questionnaire were evaluated. Moreover, balance confidence per the Activities-Specific Balance Confidence Scale, mobility per the Locomotor Capabilities Index, fast and self-selected gait speed per 10-meter walk tests, and functionalmobility via Timed Up and Go were also included. Results: Community participation was correlated with several factors (P ≤ 0.050). Stepwise regression of correlated factors found absence of peripheral neuropathy and greater self-reported physical activity, balance confidence, and prosthesis use, as the strongest correlates, collectively explaining 50.1% of the variance in community participation post-lower limb amputation. Conclusions: Findings identify key modifiable factors for consideration in future prospective research seeking to enhance community reintegration and participation among adults living with a unilateral transfemoral- or transtibial-level amputation. [ABSTRACT FROM AUTHOR]

Background: Survivors of primary malignant musculoskeletal tumors often face long‐term disability. Clinicians at present are unable to provide evidence‐based advice about returning to sports, which is important for active patients. Purposes: Identify patients returning to sports.Describe the sporting activities in which patients participate.Identify the outcome measures used to assess return to sport.Identify barriers preventing return to sports. Study design: Systematic review. Methods: A comprehensive search strategy was used to identify relevant studies combining the following concepts: (1) Bone/Soft tissue tumor, (2) Lower limb, (3) Surgical interventions, and (4) Sports. Studies were selected according to eligibility criteria with the consensus of three authors (MTB, FS, and CG). Results: Twenty‐two studies were selected, published between 1985 and 2020, including 1005 patients. Fifteen of the 22 studies had valid data on return to sports, with 705 participants, of which 412 (58.4%) returned to some form of sport such as swimming and cycling, at a mean follow‐up period of 7.6 years. Four studies directly compared limb sparing surgery and amputation; none of these were able to identify a difference in sports participation or ability. Conclusion: There is insufficient published research to provide guidance for patients with respect to return to sports following musculoskeletal tumors. Future prospective studies are needed to collect better pre‐ and post‐treatment data at multiple time intervals. Validated clinical and patient sports participation outcomes such as type of sports, level, frequency, and validated sports‐specific outcome scores should be recorded. In particular, more comparison between limb sparing surgery and amputation would be welcome. [ABSTRACT FROM AUTHOR]

Background: Methylene blue (MB) is a conventional lymphatic tracer. We evaluated the application of indocyanine green (ICG) lymphography combined with MB staining in lower limb lymphaticovenular anastomosis (LVA). Methods: A total of 49 patients with lower limb lymphedema were selected as the study subjects and divided into the research (n = 27) and control groups (n = 22). The patients were treated with LVA using ICG lymphography combined with MB staining and simple ICG lymphography as the positioning method, respectively. The number of lymphatic vessels anastomosed and the operating time were compared between the groups. Lower Extremity Lymphedema Index (LEL index) and Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) were used as prognostic indices; 6 months after LVA, both groups were evaluated for the symptomatic relief of lymphedema. Results: The number of anastomotic lymphatic vessels in the study group was higher than that in the control group (p <.05), and their procedural time was shorter than that in the control group. The two groups had no significant difference in lymphatic anastomosis time (p >.05). The LEL index and Lymph-ICF-LL of the research and control groups at 6-month follow-up after LVA were lower than those before the operation (p <.05). Conclusion: The circumference of the affected limb is reduced after LVA in patients with lower extremity lymphedema with a favorable prognosis. ICG lymphography combined with MB staining has the advantages of real-time visualization and accurate localization. [ABSTRACT FROM AUTHOR]

To investigate the influencing factors of lower limb amputation in patients with diabetic foot ulcers. Patients with diabetic foot ulcers who were hospitalised in a tertiary general hospital in Guizhou Province from January 2019 to March 2022 were retrospectively collected. Sociological information of the general population, comorbidities, laboratory‐related indicators, and information on the specialty situation, using univariate analysis and multifactor analysis, compared the influencing factors of amputation and non‐amputee patients. A total of 205 patients with diabetic foot and 69 ampute patients (33.7%) were enrolled. The univariate analysis found that the decrease in HDL cholesterol levels was associated with the occurrence of lower extremity amputation, and logistic stepwise regression analysis showed that HDL‐C was inversely correlated with the amputation rate of patients with diabetic foot ulcers, and the risk of amputation at low levels of HDL‐C was 2.452 times higher than that of high‐level HDL‐C (95% CI: 1.105–5.846). Decreased HDL cholesterol levels are an independent predictor of amputation in patients with diabetic foot ulcers. [ABSTRACT FROM AUTHOR]

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Employment status is considered a determinant of health, yet returning to work is frequently a challenge after lower limb amputation. No studies have documented if working after lower limb amputation is associated with functional recovery. The study's purpose was to examine the influence of full-time employment on functioning after lower limb amputation. Multisite, cross-sectional study of 49 people with dysvascular lower limb amputation. Outcomes of interest included performance-based measures, the Component Timed-Up-and-Go test, the 2-min walk test, and self-reported measures of prosthetic mobility and activity participation. Average participant age was 62.1 ± 9.7 years, 39% were female and 45% were persons of color. Results indicated that 80% of participants were not employed full-time. Accounting for age, people lacking full-time employment exhibited significantly poorer outcomes of mobility and activity participation. Per regression analyses, primary contributors to better prosthetic mobility were working full-time (R2 ranging from 0.06 to 0.24) and greater self-efficacy (R2 ranging from 0.32 to 0.75). This study offers novel evidence of associations between employment and performance-based mobility outcomes after dysvascular lower limb amputation. Further research is required to determine cause-effect directionalities. These results provide the foundation for future patient-centered research into how work affects outcomes after lower limb amputation. Lower limb amputation can pose barriers to employment and activity participation, potentially affecting the quality of life. This study found that the majority of people living with lower limb amputation due to dysvascular causes were not employed full-time and were exhibiting poorer prosthetic outcomes. Healthcare practitioners should consider the modifiable variable of employment when evaluating factors that may affect prosthetic mobility. The modifiable variable of self-efficacy should be assessed by healthcare professionals when evaluating factors that may affect prosthetic mobility. [ABSTRACT FROM AUTHOR]

Introduction: Quality of life (QoL) has been advocated for as an outcome measure for assessing the effect of treatment and quality of care given to prosthetic users. As such, it is necessary to assess the factors that play a role in influencing QoL to achieve better outcomes. Unfortunately, QoL has not been adequately studied in Saudi Arabia, which warranted further research. The objectives of this study were to estimate the QoL of prosthetic users in Riyadh and determine its association with Ambulation (AM), Social Burden (SB), and Appearance (AP). Methods: A cross-sectional study design was used to achieve our objectives. Our participants were asked to fill out our self-administered questionnaire, which was composed of the Arabic versions of the Well-being (WB), AP, AM, and SB scales of the Prosthesis Evaluation Questionnaire (PEQ). Results: A sample of 62 prosthetic users due to unilateral amputations were randomly selected from our sampling frame, 10 of which acted as outliers from the 95% confidence interval of QoL (CI) (56.13–67.94) and were omitted. The WB scale was shown to have a median of 57.5, whereas QoL had a mean of 62.58. In addition, a positive relationship was found between QoL and SB (P < 0.001; R s = 0.657), AP (P < 0.001; R = 0.547), and AM (P < 0.001; R = 0.634). Conclusion: Prosthetic users in Riyadh suffer from low QoL and satisfaction. Moreover, QoL was shown to be a multifactorial concept with many different elements and constituents. This suggests that a more comprehensive and inclusive method of prosthetic rehabilitation is required. Clinical Relevance: There is a scarcity of QoL and well-being studies in Saudi Arabia regarding individuals with amputation and prosthetic users, given the number of prosthetic users, estimated to be around 2092 individuals. By estimating their QoL, we could identify what improvements are to be made to improve their lives. [ABSTRACT FROM AUTHOR]

Introduction: Proper prosthetic prescription directly impacts rehabilitation and the quality of life of an individual with amputation, yet complications during the prescription process remain a challenge for prosthetists as a variety of patient-specific and prosthetic-specific factors need to be considered simultaneously during prescription. This research aims to identify the factors that affect decision making during prosthetic prescription and rehabilitation processes of individuals with lower-limb amputation via evidence-based approaches. Materials and Methods: Abstracts of 140 articles were analyzed using topic modeling—a natural language processing algorithm. Results: Mining abstracts of relevant literature revealed seven factors that influence prosthetic prescription and six factors that affect rehabilitation of individuals with amputation. Conclusion: The findings of this study focus on improving the rehabilitation process of individuals with lower-limb amputation, enhancing the patient-provider relationship, and improving the overall quality of life via evidence-based methods. Clinical Relevance: Understanding the factors that affect prosthetic prescription and patient rehabilitation from the past literature is critical to the establishment of formal and standard prescription strategies that can eventually improve the quality of life of persons with lower-limb amputation. [ABSTRACT FROM AUTHOR]

Background: Reconstruction of defects around the knee and proximal leg are difficult to reconstruct. Out of the multiple flaps described for reconstruction, the pedicled Medial Sural Artery Perforating Flap (MSAP) has recently gained popularity. We conducted this study to assess the clinical outcomes of pedicled MSAP for this purpose at our hospital. Methods: A descriptive case series was conducted from April 2022 to March 2023. All patients above 18 years with defects around the knee and proximal leg were included. Patients with tissue loss in the calf area were excluded. Results: A total of 14 patients were included. Twelve (86%) were males, while only 2 were females (14%). The mean age was 33.5 years (±8.76). The most common cause of the defect was trauma (n=11, 85%). The Mean distance of the distal-most perforator from the popliteal crease was 12.714 (±1.990) cm (range 9-16 cm). It was observed that the most distal perforator is usually present in a 2 cm radius of the medial musculo-tendinous junction of the gastrocnemius. Complications were seen in 2 (14%) patients. The mean duration of hospital stay was 4.2 (±0.96) days. Patients were followed up weekly for the first two weeks and then at 1, 3 and 6 months. Conclusion: MSAP Flap is a reliable thin, long pedicled fasciocutaneous flap with low donor site morbidity and aesthetically good results for reconstruction around the knee and proximal leg. [ABSTRACT FROM AUTHOR]

Microvascular reconstruction in pregnancy is rare. We report a case of complex distal lower-extremity trauma in early pregnancy reconstructed with a microvascular free muscle flap. A 30‑year‑old female with 13 weeks gestation had a crush avulsion of the distal left leg with medial malleolar fracture; she had two sessions of debridement, joint stabilising external fixator frame, and a vaccum assisted closure dressing application. Two weeks later, a right latissimus muscle flap was harvested. Flap was transferred to the debrided leg defect. The thoracodorsal vessels were anastomosed end to end to the anterior tibial artery and the concomitant vein. The flap was immediately revascularised. Continuous post‑operative heparin infusion was administered. The muscle was covered with split‑thickness skin graft 48 hrs later. Healing and post‑operative recovery were uneventful. This report suggests that careful surgical and anesthetic techniques, along with a balanced post-operative anticoagulation protocol, can achieve satisfactory microvascular reconstruction in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Complementary and integrative medicine may be effective for postoperative outcomes. This study aimed to determine the effect of lemon inhalation aromatherapy on pain, nausea, and vomiting and neurovascular assessment in patients for lower extremity fracture surgery. Methods: This is a randomized clinical trial study. Ninety patients who had undergone lower extremity fracture surgery were randomly assigned to the intervention (lemon aromatherapy) and control groups. Lemon aromatherapy was started in the morning of the surgery and extended at two-hour intervals until the end of the surgery, in the recovery room, and 16 h after surgery. Numerical pain and nausea and vomiting scales, the Rhodes Index of Nausea, Vomiting, and Retching, and the WACHS Neurovascular Observation Chart were used to assess the outcomes before and after the intervention (in the recovery room and 4, 8, 12, and 16 h post-surgery). The data were analyzed using the Wilcoxon test, ANCOVA, and Repeated Measure ANCOVA. Results: A significant difference was observed between the groups in terms of the intensity of pain (P < 0.001) and nausea and vomiting (P = 0.001) during the study period. Moreover, a significant difference was found between groups as to the frequency and severity of nausea, vomiting, and retching. The amount and duration of postoperative vomiting and nausea were significantly lower in the intervention group compared to the control group. In addition, lemon inhalation aromatherapy decreased the frequency of anti-emetic drug administration in the recovery room (P = 0.04) and 16 h post-surgery (P = 0.03). Conclusions: This study indicated that aromatherapy reduced pain intensity, postoperative nausea, vomiting, and retching, as well as the incidence of anti-emetic drug administration. Therefore, using lemon inhalation aromatherapy to relieve pain and reduce nausea and vomiting is suggested for lower extremity fracture patients who have undergone surgery. Trial registration: This study was registered in the Iranian Registry of Clinical Trail (Number = 57,331, IRCT20130616013690N10, approved 24/07/2021) (https://www.irct.ir/trial/57331). [ABSTRACT FROM AUTHOR]

Introduction: Equal access to healthcare is a fundamental principle in the fully tax‐financed Danish healthcare system. This study reveals whether this system lives up to the principle of equal access when it comes to the rehabilitation of patients who have major lower extremity amputations. Methods: With the aim of exploring possible inequality in rehabilitation for patients having major lower extremity amputation in Denmark, a nationwide electronic survey was conducted in the autumn of 2020, which included all hospitals and municipalities in Denmark. Results: Eighty six percent of hospitals (n = 19) and 97% (n = 95) of municipalities responded. Of the 32% (n = 6) of hospitals and 78% (n = 74) of municipalities that provided prosthesis rehabilitation, the majority (hospitals 50% /municipalities 91%) provided prostheses for <10 patients in 2019, and 36% reported having competencies at only a general level among physiotherapists performing prosthetic training. Psychosocial rehabilitation modalities were lacking overall. Conclusions: This national study documents pronounced geographic inequality in access to qualified rehabilitation services for the relatively few patients undergoing lower extremity amputations in Denmark. The decentralised organisation of amputation rehabilitation makes it difficult to build and maintain specialist competencies among healthcare professionals. Inconsistent availability of psychosocial rehabilitation modalities of all kinds found in this study points to a need for action particularly among patients not in prosthetic rehabilitation where palliative needs should also be considered. [ABSTRACT FROM AUTHOR]

Background: It was always challenging to accurately and effectively reconstruct the complicated defects with three-dimensional tissue deficits in the extremities. Muscle-chimeric perforator flap is an excellent choice for repairing those complicated wound. However, problems like donor-site morbidity and time-consuming intramuscular dissection still exist. This purpose of this study was to present a novel design of the thoracodorsal artery perforator (TDAP) chimeric flap for the customized reconstruction of complex three-dimensional tissue defects in the extremities. Methods: From January 2012 to June 2020, 17 patients with complex three-dimensional deficits in the extremities were retrospectively analyzed. All patients in this series underwent extremity reconstruction using latissimus dorsi (LD)-chimeric TDAP flap. Three different types of LD-chimeric TDAP flaps were performed. Results: A total of seventeen TDAP chimeric flaps were successfully harvested for the reconstruction of those complex three-dimensional defects in extremities. Among them, Design Type A flaps were used in 6 cases, Design Type B flaps were performed in 7 cases, and Design Type C flaps were used in the remaining 4 cases. The sizes of the skin paddles ranged from 6 cm × 3 cm to 24 cm × 11 cm. Meanwhile, the sizes of the muscle segments ranged from 3 cm × 4 cm to 33 cm × 4 cm. All the flaps survived. Nevertheless, one case required re-exploration owing to venous congestion. Moreover, the primary closure of the donor site was successfully achieved in all patients, and the mean follow-up time was 15.8 months. Most of the cases displayed satisfactory contour. Conclusion: The LD-chimeric TDAP flap is available for the reconstruction of complicated defects with three-dimensional tissue deficits in the extremities. It provided a flexible design for customized coverage of complex soft tissue defects with limited donor site morbidity. [ABSTRACT FROM AUTHOR]

Purpose: Venous thromboembolism (VTE) is a significant complication following lower limb arthroplasty (LLA). There is a paucity of evidence with regard to air travel following LLA. Orthopaedic surgeons are often asked by patients regarding air travel following LLA, and there is a need for evidence to guide these patients. Methods: This was a retrospective cohort study. We identified two cohorts, one travelling to and from the hospital by air and another, by land. All patients received routine preoperative and post-operative care, and thromboprophylaxis, as per our hospital guidelines. We collected baseline demographics, ASA score and incidence of VTE at 90 days using local patient records and a national joint registry. We also recorded data on flight time and overland distance of travel. Results: Two hundred and forty-three patients travelled by air; mean flight time was 74 min. In total, 5498 patients travelled a mean 25.3 miles over land to the hospital. No differences in baseline demographics or ASA score were observed. Four patients developed a VTE in the flight group, with 32 patients suffering a VTE in the control group. There was a significant difference in the VTE rate between the flight and control groups (p < 0.05); the relative risk of developing a VTE in the flight group was 2.85. Conclusions: In our cohort, perioperative short haul air travel is associated with an increased risk of VTE at 90 days following LLA. Orthopaedic surgeons must ensure that their patients are cognizant of the risks associated with perioperative air travel and take measures to minimise these risks. [ABSTRACT FROM AUTHOR]

Aims Supervised exercise is a guideline-recommended treatment in intermittent claudication (IC). Hospital-based supervised exercise programmes (SEPs) are underutilized, while home-based structured exercise programmes (HSEPs) have attracted interest. The results from HSEP in IC are inconsistent and may confer no benefit over walk advice (WA) and be less effective than SEP. The aim of the study was to compare the effectiveness of best medical treatment, including Nordic pole WA alone, or WA + SEP or WA + HSEP for patients with IC. Methods and results This three-armed, multicentre randomized clinical trial enrolled patients with IC; all patients received best medical treatment including walking poles and the advice of regular Nordic pole walking (WA). For HSEP and SEP, additional exercise programmes were provided. The primarily investigated hypothesis was a non-inferiority analysis of SEP vs. HSEP regarding the 6-min walk test (6MWT) maximum distance, with a pre-defined non-inferiority margin of 50 m. Supporting outcomes included muscle endurance tests and the walking impairment questionnaire. Outcomes were assessed at baseline, 3, 6, and 12 months by a blinded evaluator. Altogether 166 patients (mean age 72 years; 59% males) were randomized. In HSEP and SEP, 24 and 26% patients, respectively, were fully exercise adherent. All three groups improved pain-free walking distance over time, but there were no significant intergroup differences. The intergroup 6MWT difference between SEP and HSEP from 0 to 12 months was –11.6 m, 95% confidence interval: –36.4 to 13.0 m (i.e. within the pre-specified non-inferiority margin). Conclusion The HSEP was non-inferior to SEP in patients with IC. There were no significant differences observed between the three groups at 1 year. Registration ClinicialTrials.gov: NCT02341716. [ABSTRACT FROM AUTHOR]

Background A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown. Purpose The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization. Study design Literature Review Methods PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data. Results Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use. Conclusion Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use. Level of evidence 3a [ABSTRACT FROM AUTHOR]

Background A large number of patient reported outcome measures (PROMs) have been developed for specific lower extremity orthopaedic pathologies. However, a consensus as to which PROMs are recommended for use in evaluating treatment outcomes for patients with hip, knee, ankle and/or foot pathology based on the strength of their psychometric properties is lacking. Objective To identify PROMs that are recommended in systematic reviews (SRs) for those with orthopaedic hip, knee, foot, and ankle pathologies or surgeries and identify if these PROMs are used in the literature. Study design Umbrella Review Methods PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for SRs through May 2022. A second search was done to count the use of PROMs in seven representative journals from January 2011 through May 2022. SRs that recommended the use of PROMs based on their psychometric properties were included in the first search. SRs or PROMs not available in the English were excluded. The second search included clinical research articles that utilized a PROM. Case reports, reviews, and basic science articles were excluded. Results Nineteen SRs recommended 20 PROMs for 15 lower extremity orthopaedic pathologies or surgeries. These results identified consistency between recommended PROMs and utilization in clinical research for only two of the 15 lower extremity pathologies or surgeries. This included the use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Copenhagen Hip and Groin Outcome Score to assess outcomes (HAGOS) for those with knee osteoarthritis and groin pain, respectively. Conclusion A discrepancy was found between the PROMs that were recommended by SRs and those used to assess clinical outcomes in published research. The results of this study will help to produce more uniformity with the use of PROMs that have the most appropriate psychometric properties when the reporting treatment outcomes for those with extremity pathologies. Level of evidence 3a [ABSTRACT FROM AUTHOR]

Background: Preservative-free chloroprocaine (CP) 1% is being investigated for short surgeries but lacks immediate postoperative analgesia. Adding opioids to local anesthetic increases the quality of spinal anesthesia with prolongation of postoperative analgesia. Aim: The aim of this study is to compare the postoperative analgesic efficacy of intrathecal nalbuphine versus intrathecal fentanyl as an adjuvant to chlorprocaine 1% for short surgical lower limb procedures. Materials and Methods: After ethical committee approval, a prospective randomized double-blind comparative study was conducted on 90 patients of the American Society of Anesthesiologists classes 1 and 2, aged between 18 and 60 years who were scheduled for elective short surgical lower limb procedures. Group CP (n = 30) received CP 1% 40 mg (4 ml) plus saline (0.5 ml), Group CP with fentanyl (CF) (n = 30) received CP 1% 40 mg (4 ml) plus fentanyl 25 mcg (0.5 ml), and Group CP with nalbuphine (CN) (n = 30) received CP 1% 40 mg (4 ml) plus nalbuphine 0.8 mg (0.5 ml) intrathecally. After performing subarachnoid block, the parameters observed were - Onset, height, duration of sensory and motor blockade, duration of postoperative analgesia, hemodynamics, and adverse effects between the three groups noted. Results: The onset of sensory and motor block (min) is faster in Group CF (4.2 ± 0.2, 3.4 ± 0.4) compared to Group CN (4.8 ± 0.4, 3.7 ± 0.4) and Group CP (6.2 ± 0.4, 4 ± 0.4) (P < 0.001). The total sensory duration and motor duration are prolonged in Group CN (96.5 ± 5.2, 90 ± 3.9) compared to Group CF (94 ± 4, 87 ± 4.5) and Group CP (77 ± 3, 74 ± 4.5) (P < 0.001). The duration of postoperative analgesia was prolonged in Group CN (130 ± 5.3) compared to Group CF (111 ± 6.2) and Group C (93 ± 4.2) (P < 0.001). Conclusion: We conclude that intrathecal nalbuphine prolongs postoperative analgesia maximally compared to intrathecal fentanyl as an adjuvant to CP 1% for short surgical lower limb procedures. [ABSTRACT FROM AUTHOR]

Simple Summary: This study investigated osteoradionecrosis (ORN), a complication after radiotherapy, in 198 patients with extremity soft tissue sarcoma (STS). The incidence rate of extremity ORN was 3.5%, mostly located in lower extremities. Clinical presentations included chronic ulcers, soft tissue necrosis, sinus discharge, bone nonunion, and pathological fractures. The ORN group had a significantly higher total radiation dose and greater use of intraoperative periosteal stripping. Repeat surgeries and subsequent soft tissue reconstruction or limb amputation were performed as treatments. Careful surveillance should be taken to manage the risk of ORN in extremity STS patients. Osteoradionecrosis (ORN) is a major complication after radiotherapy. Most studies on ORN have focused on patients with mandibular lesions, with few studies including patients with extremity soft tissue sarcoma (STS). We included 198 patients with extremity STS who underwent limb-sparing surgery and adjuvant radiotherapy between 2004 and 2017. The incidence rate of extremity ORN was 3.5% (7/198), with most lesions (6/7) located in the lower extremities. The mean follow-up time was 62 months. Clinical presentations included chronic ulcers, soft tissue necrosis, sinus discharge, bone nonunion, and pathological fractures. Compared with the non-ORN group, the ORN group had a significantly higher total radiation dose (68 Gy vs. 64 Gy, p = 0.048) and greater use of intraoperative periosteal stripping (p = 0.008). Repeat surgeries and subsequent soft tissue reconstruction or limb amputation were performed as treatments. The risk and management of ORN in patients with extremity STS was ignored previously. Because the disease is complex and affects both clinicians and patients, careful surveillance should be undertaken. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of fracture and surgery of the hip and lower extremities is still high. Long postoperative bed rest can potentially increase the incidence of various complications that may increase patients' morbidity and mortality rate after hip and lower extremities surgery. This literature review aimed to identify the effects of early mobilization on hip and lower extremity postoperative. Methods: Search for articles on several databases such as ProQuest, ScienceDirect, CINAHL, Medline, Wiley Online, and Scopus, using the Boolean operator tools with "AND" and "OR" words by combining several keywords according to the literature review topic, with inclusion criteria of those published in the last three years (2019–2021), using a quantitative design, written in English and full-text articles. A total of 435 articles were obtained, screened, and reviewed so that there were 16 (sixteen) eligible articles. Results: There were 11 (eleven) effects of early mobilization, that is, shorter the length of stay, lower postoperative complication, lower the pain, increase walking ability, increase quality of life, decrease the rate of readmission, decrease mortality rate, lower the total hospitalization cost, higher number of physical therapy sessions prior to discharge, increase in satisfaction, and no fracture displacement or implant failure. Conclusion: This literature review showed that early mobilization is safe and effective in postoperative patients to reduce the risk of complications and adverse events. Nurses and health workers who care for patients can implement early mobilization and motivate patients to cooperate in undergoing early mobilization. [ABSTRACT FROM AUTHOR]

Objectives: Unplanned hospital readmission is a leading source of hospital resource expenditure, and preventing readmission may improve both patient quality of life and healthcare costs. The factors influencing hospital readmission after lower extremity bypass (LEB) for chronic limb-threatening ischemia (CLTI) remain incompletely investigated. Methods: A regional, multi-institutional database was retrospectively reviewed for all patients who underwent LEB for CLTI between 1995 to 2020. The primary outcome was unplanned hospital readmission up to 30 days following bypass. Results: A total of 1315 patients underwent LEB across all institutions, of whom 843 (64.1%) underwent bypass for CLTI. The 30-day hospital readmission rate was 25.3%, and the leading causes of readmission were wound-related complications (51.6%). There was no difference in age, sex, or race between readmitted and non-readmitted patients. Conduit type and bypass target were also similar between groups. Readmitted patients more frequently underwent LEB for tissue loss (58.2% vs 50.2%, P = 0.042). On multivariable analysis, wound infection (odds ratio [OR] 9.1, 95% confidence interval [CI] 6.2-13.2, P < 0.001) and non-infectious wound complications (OR 2.0, 95% CI 1.0-3.9, P = 0.041) were independently associated with hospital readmission. Factors not associated with hospital readmission included patient age, conduit type, distal bypass target, and other medical comorbidities. Conclusions: One quarter of patients are readmitted within 30 days following lower extremity bypass for chronic limb-threatening ischemia. Efforts to mitigate wound infection and non-infectious wound complications may decrease rates of unplanned hospital readmission. [ABSTRACT FROM AUTHOR]

The incidence of diabetes‐related lower‐extremity complications is increasing globally, yet the condition in developing countries, particularly those in sub‐Saharan Africa, is unclear. This study determined the prevalence and determinants of lower extremity amputations among type I and type II diabetic patients at health facilities in the Volta Region, Ghana. This was a multicenter‐based study involving 473 diabetic patients. Sociodemographic, lifestyle, medical, biochemical, and anthropometric data were obtained systematically with a pretested structured questionnaire. The prevalence rate of lower extremity amputations (LEAs) was 1.9%. LEAs were linked to the male gender (unadjusted odds ratio [UOR] = 5.86; 95% confidence interval [CI] = 1.44‐23.82; P = 0.013), smokers (UOR = 10.12; 95% CI = 2.63‐38.91; P =.001), type I diabetic patients (UOR = 4.74; 95% CI = 1.24‐18.10; P =.023), family history of diabetes mellitus (UOR = 9.18; 95% CI = 2.25‐37.46; P =.002), diabetic foot ulcers (adjusted odds ratio [AOR] = 8.62; 95% CI = 1.58‐47.62; P =.013) and obesity (AOR = 6.20; 95% CI = 1.00‐38.04; P =.049). This study showed a relatively low prevalence rate compared to previous studies within Ghana. However, it is a major concern in public health that needs to be addressed since diabetes‐related LEAs are connected to global major morbidity and mortality. [ABSTRACT FROM AUTHOR]

The correction of valgus leg malalignment in children using implant-mediated growth guidance is widely used and effective. Despite the minimal invasive character of the procedure, a relevant number of patients sustain prolonged pain and limited mobility after temporary hemiepiphysiodesis. Our aim was to investigate implant-associated risk factors (such as implant position and screw angulation), surgical- or anesthesia-related risk factors (such as type of anesthesia, use, and duration), and pressure of tourniquet or duration of surgery for these complications. Thirty-four skeletally immature patients with idiopathic valgus deformities undergoing hemiepiphysiodesis plating from October 2018–July 2022 were enrolled in this retrospective study. Participants were divided into groups with and without prolonged complications (persistent pain, limited mobility of the operated knee between five weeks and six months) after surgery. Twenty-two patients (65%) had no notable complications, while twelve patients (35%) had prolonged complications. Both groups differed significantly in plate position relative to physis (p = 0.049). In addition, both groups showed significant differences in the distribution of implant location (p = 0.016). Group 1 had a shorter duration of surgery than group 2 (32 min vs. 38 min, p = 0.032) and a lower tourniquet pressure (250 mmHg vs. 270 mmHg, p = 0.019). In conclusion, simultaneous plate implantation at the femur and tibia and metaphyseal plate positioning resulted in prolonged pain and a delay of function. In addition, the amplitude of tourniquet pressure or duration of surgery could play a factor. [ABSTRACT FROM AUTHOR]

Prosthetic research seems focused on measuring gait-related outcomes that may not adequately measure real-world benefits of prosthetic interventions. Systematically cataloguing a comprehensive range of outcomes is an important steppingstone towards developing a holistic way to measure the benefits of prosthetic interventions for future health economic evaluations. The purpose of this research was to identify and catalogue the outcomes measured in lower-limb prosthetic research using the International Classification of Functioning, Disability, and Health (ICF) framework and a custom clinical framework, and thereby describe the existing research focus and identify evidence gaps. A structured literature search identified systematic reviews of lower-limb prosthetic interventions. Reported outcomes were extracted from included studies and linked to the ICF- and clinical-frameworks. Of the 1297 extracted outcomes, 1060 were linked to the ICF framework. Most outcomes linked to second- (63.8%) or third-level categories (33.4%), such as Gait Pattern Functions (b770, 49.8%). Most of these outcomes (31.2%) describe temporospatial, kinematic or kinetic gait measures as categorised by the clinical framework. Lower-limb prosthetic research is focused on laboratory-based measures of gait. There are evidence gaps describing participation in real-world activities – important outcomes to inform policy and investment decisions that determine the prosthetic interventions available for people with limb-loss. Cataloguing the outcomes used in prosthetic research to the International Classification of Functioning, Disability, and Health (ICF) allows important evidence gaps to be illuminated given the holistic description of function and disability. Establishing a comprehensive list of prosthetic outcomes, described using an internationally recognised framework with unified and consistent language, is an important steppingstone towards developing a core outcome set (COS) for prosthetic interventions and informing the benefits measured in future prosthetic health economic evaluations (HEEs). Being able to measure the benefits of a prosthesis that are most important to prosthesis users and funders has potential to fundamentally change future HEEs that influence funding policies, and ultimately the prostheses made available to people living with limb-loss. [ABSTRACT FROM AUTHOR]

Introduction: The most common method of choice for orthopedic lower extremity surgery is intrathecal anesthesia. Despite the benefits of using spinal anesthesia, this method has complications such as headache in the acute postoperative period. Therefore, this study aims to compare Madin and Parmadin methods. The incidence of PDPH (Post-Dural-puncture headache) in patients undergoing orthopedic lower limb surgery was performed by spinal anesthesia. Materials and Methods: This double-blind clinical trial was performed on 60 orthopedic surgery patients referred to Pimayeh Hospital in Jahrom. Inclusion criteria included expressing consent to participate in the study, ASA class 1 and 2, no migraine and chronic headaches, no cardiovascular disease, no coagulation disease. Patients accidentally throwing coins into two groups 1) Medin And 2) paramedins were divided. Vital signs were recorded before and after spinal anesthesia at 5, 15, 30, 45, 60, and 90 minutes during surgery and in recovery. PDPH was collected in patients after surgery for 7 days and once a day by an uninformed person in the form of a questionnaire. After collecting data, the data were statistically analyzed using SPSS software version 21. To report descriptive statistics, qualitative variables were reported using frequency and percentage, and quantitative data were reported using mean and standard deviation. Analysis of variance with repeated measures and Chi-square test were used. P <0.05 will be considered as a significant level. Results: A total of 60 patients undergoing orthopedic surgery were evaluated by spinal anesthesia in the age range of 16 to 90 years (in two groups of 30). In pre-spinal anesthesia, immediately after spinal anesthesia, 5 minutes, 15 minutes and 30 minutes after spinal anesthesia, and in recovery, there was no significant difference between median and paramedic groups in mean systolic and diastolic blood pressure. (05/0> P). In the periods before spinal anesthesia, immediately after spinal anesthesia and 5 minutes after spinal anesthesia, there was a significant difference in mean heart rate between Medin and Paramedin groups (P <0.05). On the first and fourth days, the incidence of PDPH was higher in the paramedin group than in the medin group. But the results of statistical analysis showed that there was no significant difference between the two groups in the incidence of PDPH at different times (p <0.05). Conclusion: Although different benefits have been mentioned for each of Madin and Paramedin methods, but in relation to the incidence of headache, in this study, no significant difference was reported between Madin and Paramedin groups. Therefore, with more studies and more studies related to patient satisfaction, the best method can be used in choosing intrathecal anesthesia technique. [ABSTRACT FROM AUTHOR]

Guided imagery distracts patients from disturbing feelings and thoughts, positively affects emotional well-being, and reduces pain by producing pleasing mental images. This study aimed to determine the effects of guided imagery on postoperative pain management in patients undergoing lower extremity surgery. This randomized controlled study was conducted between April 2018 and May 2019. This study included 60 patients who underwent lower extremity surgery. After using guided imagery, the posttest mean Visual Analog Scale score of patients in the intervention group was found to be 2.56 (1.00 ± 6.00), whereas the posttest mean score of patients in the control group was 4.10 (3.00 ± 6.00), and the difference between the groups was statistically significant (p <.001). Guided imagery reduces short-term postoperative pain after lower extremity surgery. [ABSTRACT FROM AUTHOR]

Introduction: Changes in autonomic nervous system (ANS) balance associated with endovascular interventions may potentially cause haemodynamic abnormalities that lead to periprocedural cardiovascular complications. This study aimed to determine the relationships between changes in ANS balance and impedance cardiography (ICG) parameters after endovascular leg revascularization. Material and methods: Before the procedure, and 1, 3 and 5h after the intervention, 5-min examinations of both ANS balance and ICG parameters were performed using a Task Force Monitor in 42 patients undergoing endovascular leg revascularization. Results: When compared to patients with intermittent claudication, individuals with chronic limb-threatening ischaemia had a significantly shorter R-R interval and lower stroke volume (SV) and left ventricle ejection time (LVET) at the beginning of the study. During the 5h after endovascular leg revascularization, significant fluctuations were noted in the following: heart rate, frequency-domain parameters of heart rate variability, baroreflex effectiveness indices, and ICG parameters, such as total peripheral resistance, SV, LVET, and ejection rate. The deltas of ANS parameters correlated with the deltas of ICG parameters in the respective periods of measurement. Conclusions: Dynamic fluctuations in ICG and ANS parameters that occurred in patients who had undergone endovascular leg revascularization might potentially affect the risk of the occurrence of a cardiovascular event in the periprocedural period. The correlations between the ANS and ICG parameters suggest that haemodynamic oscillations after endovascular leg revascularization are mediated by changes in ANS activity, most probably through a sympathoexcitatory effect of the procedure related to changes in skeletal muscle perfusion. [ABSTRACT FROM AUTHOR]

Purpose: Aim of this study was to compare the use of split-thickness skin graft (STSG) with and without additional MatriDerm® application in a predominantly one-step procedure for the treatment of severe traumatic soft tissue defects of the lower limb. Methods: This retrospective study included patients treated in a European level I trauma center between June 2013 and July 2018 in terms of a severe traumatic soft tissue defect of the lower extremity using STSG alone or in combination with the acellular dermal substitute MatriDerm®. The healing of the soft tissue defect was measured by assessment of the take rate. Outcome quality of the scar tissue was assessed using the Vancouver Scar Scale. Results: A total of 147 cases were included in this study. The overall healing rate (number of patients with take rate ≥ 75%) was 88/147 (60%) and did not demonstrate significant differences between the treatment groups (p = 0.15). Despite the difference in wound complexity between the treatment groups, there was no difference regarding the scar tissue quality 12 months postoperatively. In about 25% of all cases, a post-operative event was mentioned that had to be revised surgically. Conclusion: Surgical treatment with STSG and additional MatriDerm® application can be recommended as satisfactory alternative for dermis replacement in patients with severe skin defects, independent of age. The additional MatriDerm® use allows for bridging of exposed ligaments, tendons, vessels or bones without relevant differences in cosmetical outcome. [ABSTRACT FROM AUTHOR]

Background: Treatment of chronic limb threatening ischemia (CLTI) poses a significant clinical challenge despite recent medical advancements. Chronic total occlusion (CTO) lesions make endovascular approaches to CLTI particularly challenging. Open proximal exposure with retrograde access and stenting (OPERAS) aims to solve this challenge through retrograde subintimal crossing of a CTO with direct visualization of proximal re-entry into the true lumen. We describe this novel technique and present its efficacy in eight patients. Methods: We conducted a retrospective case series at a single tertiary academic center. Data for patients who received OPERAS intervention included demographics, peri-operative details, and follow-up information. Statistical analysis was performed on length of stay, major post-operative complications, further intervention, clinical progression at 1 year, and amputation-free survival at 1 year. Immediate technical failure (ITF) and limb-based patency (LBP) at 1 year were calculated. Results: Nine limbs underwent OPERAS between January 2019 and March 2020. Inflow was achieved with common femoral artery endarterectomy. All limbs underwent balloon angioplasty and stenting of the SFA, and seven underwent the same procedure in the popliteal artery. ITF was 0% for all nine cases. There were no major post-operative complications, and ankle-brachial index significantly improved pre-and post-operatively (P <.001). Eight limbs (88.9%) sustained amputation-free survival at 1 year, and overall LBP was 67% at 1 year. Conclusion: Our study presents a hybrid revascularization option to address severe, anatomically complex limbs (GLASS III) that lack a single autogenous conduit for open surgical revascularization. OPERAS addresses a main point of technical failure of subintimal techniques by directly visualizing the wire in the true lumen. Our data suggest that OPERAS can be effective to: (1) improve technical success of luminal re-entry following a subintimal approach; (2) address inflow concurrently with severe femoropopliteal disease; and (3) can be utilized when distal tissue loss is involved. [ABSTRACT FROM AUTHOR]

To explore the perspectives of children with CP, their parents or carers, and health professionals on factors affecting expectations and perceptions of surgical outcomes for lower limb orthopaedic surgery. Semi-structured interviews were conducted with 10 healthcare professionals, 10 children and young people with CP, and 8 parents. Interview data were analysed by content analysis supported by the Framework Approach using the International Classification of Functioning, Disability, and Health (ICF-CY). A comprehensive list of 10 factors including facilitators, barriers, motivational and demotivational factors were identified and categorized into two overreaching themes (Environmental and Personal factors): interdisciplinary collaboration, communication and information resources, holistic care, and shared goal setting are reported as environment facilitators of outcomes expectations. In contrast, reported barriers include lack of time and resources and divergent expectations. Personal motivators include family encouragement, patient's self-determination, and previous experiences, whereas personal demotivators include fear of a new environment. The recognition of potential factors influencing expectations and perceptions of surgical outcomes could assist clinical reasoning when planning surgical interventions for ambulant children with CP. If these factors are integrated into the healthcare practice, it will most likely enhance the positive stakeholders' experiences postoperatively. Understanding relevant stakeholders' experiences offer a positive contribution to holistic and person-centred approaches in healthcare. People with cerebral palsy and their caregivers require adequate information on surgery and post-surgical rehabilitation regime in order to reach informed decisions. Previous experiences can influence surgical expectations and subsequent perceptions of the outcome. [ABSTRACT FROM AUTHOR]

Background and purpose -- Intramedullary bone-lengthening nails have become increasingly popular. The 2 most used and successful nails are the FITBONE and the PRECICE nails. Uniform reporting is lacking on complications of intramedullary bone-lengthening nails. The purpose was therefore to assess and categorize the complications of lower limb bone-lengthening nails and investigate risk factors. Patients and methods -- We performed a retrospective review of patients operated on with intramedullary lengthening nails at 2 hospitals. We included only lower limb lengthening with FITBONE and PRECICE nails. Recorded patient data was patient demographics, nail information, and any complication. Complications were graded according to severity and origin classification. Complication risk factors were assessed with modified Poisson regression. Results -- 314 segments in 257 patients were included. The FITBONE nail was predominantly used (75%), and most of the lengthenings were performed in the femur (80%). 53% of the patients had complications. 269 complications were identified in 175 segments (144 patients). Device-related complications were most frequent (0.3 complications/segment), followed by joint complications (0.2 complications/segment). An increased relative risk was found for complications in the tibia compared with the femur and for age groups above 30 years compared with the 10-19 years group. Conclusion -- Complications with intramedullary bonelengthening nails were more frequent than has previously been reported, with 53% of patients sustaining a complication. Future studies need to document the complications meticulously so that the true risk can be established. [ABSTRACT FROM AUTHOR]