Abstract:
BACKGROUND:Wound necrosis is a potentially devastating complication of complex knee reconstruction. Laser-assisted indocyanine green angiography (LA-ICGA) is a technology that has been described in the plastic surgery literature to provide an objective assessment of skin perfusion in the operating room. This novel technology uses a plasma protein bound dye (ICG) and a camera unit that is calibrated to view the frequency emitted by the dye. The intention of this technology is to offer real-time visualization of blood flow to skin and soft tissue in a way that might help surgeons make decisions about closure or coverage of a surgical site based on blood flow, potentially avoiding soft tissue reconstruction while preventing skin necrosis or wound breakdown after primary closures, but its efficacy is untested in the setting of complex TKA. QUESTIONS/PURPOSES:The purpose of this study was to evaluate perfusion borders and tension ischemia in a series of complex knee reconstructions to guide optimal wound management. METHODS:Beginning in mid-2011, an LA-ICGA system was used to evaluate soft tissue viability in knee reconstruction procedures that were considered high risk for wound complications. Seven patients undergoing complex primary or revision TKA from 2011 to 2013 were included. These patients were chosen as a convenience sample of knee reconstruction procedures for which we obtained consultation with the plastic surgery service. The perfusion of skin and soft tissue coverage was evaluated intraoperatively for all patients with the LA-ICGA system, and the information was used to guide wound management. Followup was at a mean of 9 months (range, 6-17 months), no patients were lost to followup, and the main study endpoint was uneventful healing of the surgical incision. RESULTS:All seven closures went on to heal without necrosis. One patient, however, was subsequently revised for a deep periprosthetic infection 4 months after their knee reconstruction and underwent flap coverage at the time of that revision. CONCLUSIONS:Implementation of LA-ICGA provides an objective intraoperative assessment of soft tissue perfusion. This technology may help guide the surgeon's decisions about wound closure in real-time to accommodate the perfusion challenges unique to each patient. Specifically, patients with medical risk factors for poor perfusion or wound healing (such as diabetes, peripheral vascular disease, tobacco use, corticosteroid therapy, infection) or anatomical/surgical risk factors (ie, previous surgery about the reconstruction site, trauma wounds, or reconstruction of severe deformity) may benefit from objective intraoperative information regarding perfusion of the wound site. Furthermore, LA-ICGA could be used to prospectively evaluate the physiologic impact of different wound closure techniques. LEVEL OF EVIDENCE:Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Wyles CC,Taunton MJ,Jacobson SR,Tran NV,Sierra RJ,Trousdale RTdoi
10.1007/s11999-014-3612-zsubject
Has Abstractpub_date
2015-01-01 00:00:00pages
82-9issue
1eissn
0009-921Xissn
1528-1132journal_volume
473pub_type
杂志文章abstract::Comminuted fractures of the femoral shaft, especially when combined with fractures of the hip, may be difficult to treat. A four-sided titanium alloy locking nail with transfixing screws was designed in 1967 and allows compression of the fracture site. If necessary, the nail may be inserted without intraoperative roen...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-11-01 00:00:00
abstract:UNLABELLED:Internal hemipelvectomy is performed for pelvic sarcomas when the tumor can be safely resected without sacrificing the entire extremity. Wide exposure and awareness of major neurovascular structures are crucial to the success of this surgery. Various modifications on the standard utilitarian approach have be...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-009-0843-5
更新日期:2009-10-01 00:00:00
abstract::To study the revascularization pattern of nontraumatic osteonecrosis, superselective angiography of the femoral medical circumflex artery was done twice on 13 hips for which no treatment had been given. Angiographic evaluation of the hips with early-stage osteonecrosis not visible on radiographs showed the absence of ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199604000-00019
更新日期:1996-04-01 00:00:00
abstract::This Classic Article is a reprint of the original work by T. W. Huntington, Case of bone transference. Use of a segment of fibula to supply a defect in the tibia. An accompanying biographical sketch of T. W. Huntington is available at DOI 10.1007/s11999-012-2495-0 . The classic article is 1905 and is reprinted courtes...
journal_title:Clinical orthopaedics and related research
pub_type: 传,古典文章,历史文章,杂志文章
doi:10.1007/s11999-012-2496-z
更新日期:2012-10-01 00:00:00
abstract::Malleolar fractures are one of the most common fractures faced in orthopaedic surgery. The results from a consecutive series of 144 malleolar fractures during a 10-year period that were classified and treated according to the AO system are presented. Assessment of outcome was done using the scoring system of Baird and...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1997-08-01 00:00:00
abstract::The etiology of aseptic loosening of prosthetic joint replacement components is unclear. Implant materials have been considered biologically inert, but recently studies indicate that inflammatory reactions directed against the implanted materials may contribute to aseptic loosening. Data suggesting a progression from ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199605000-00008
更新日期:1996-05-01 00:00:00
abstract::Some authors suggest the use of larger (36 and 40 mm) femoral heads against highly cross-linked polyethylene acetabular liners will reduce the prevalence of early dislocation after primary total hip arthroplasty (THA). We prospectively followed 61 consecutive patients at high risk for dislocation to determine the prev...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000238851.31368.e7
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:Sarcoma care is highly litigated in medical malpractice claims. Understanding the reasons for litigation and legal outcomes in sarcoma care may help physicians deliver more effective and satisfying care to patients while limiting their legal exposure. However, few studies have described malpractice litigatio...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000001340
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Avascular meniscal injuries are largely incapable of healing; the most common treatment remains partial meniscectomy despite the risk of subsequent osteoarthritis. Meniscal responses to injury are partially mediated through synovial activity and strategies have been investigated to encourage healing through ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1007/s11999-011-1824-z
更新日期:2011-10-01 00:00:00
abstract::Fifty consecutive patients treated with chymopapain injection for a clinical and radiographic diagnosis of herniated nucleus pulposus were evaluated prospectively. All patients had a prechymopapain computed tomography (CT) scan and a three-month postinjection CT scan. In addition, ten patients (20%) had a six-month po...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-06-01 00:00:00
abstract::Lauge-Hansen's system of classification of ankle fractures has been of pioneering importance and when correctly employed has improved the results of conservative treatment. Weber's classification scheme introduced by AO is simpler and more suited for surgical than nonoperative therapy. Both systems have deficiencies. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-10-01 00:00:00
abstract::The optimal method of fixation during periacetabular osteotomy is unknown. Periacetabular osteotomies were created on both sides of six whole pelves from fresh cadavers and were fixed randomly either with three long 4.5-mm cortical screws from the iliac crest to the osteotomized fragment (iliac fixation) or with two s...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200210000-00032
更新日期:2002-10-01 00:00:00
abstract::Over the years, orthopedic surgery has become more involved in the care of the rheumatoid patient. A more active and aggressive attitude by orthopedic surgeons has thrown new light on the handling of the rheumatoid patient. Currently, the surgical treatment of rheumatoid arthritis is evaluated not only by the outcome ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1984-12-01 00:00:00
abstract:BACKGROUND:The ideal pedicle entry point for the thoracic spine is described as the base of the superior facet at the junction of the lateral and middle thirds of the pedicle. Investigators have reported its accuracy in curves less than 90 degrees . QUESTIONS/PURPOSES:Our aim was to measure the accuracy of this entry ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1280-1
更新日期:2010-07-01 00:00:00
abstract::High doses of both calcium antagonists and magnesium lead to disorders in the early phase of calcification. Analogous to known mechanisms of calcification outside the bone, the calcium overload of cellular suborganelles, which may play a role in enchondral ossification, is assumed to be prevented or delayed by calcium...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1990-09-01 00:00:00
abstract::Zenoderm (Ethicon Ltd., Edinburgh, Scotland) is porcine skin dermis specially treated so as to be weakly antigenic when implanted. Its use as an extradural spinal and nerve root membrane to reduce postoperative adhesions after laminectomy was tested in 22 rabbits with laminectomy in the second and fourth lumbar verteb...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-02-01 00:00:00
abstract::To evaluate magnetic resonance imaging (MRI) of meniscal, ligamentous, and bony abnormalities in patients without clinical symptoms, scans were performed on 74 asymptomatic volunteers without histories or symptoms of knee injury. Before review by three radiologists in an independent and blinded fashion, the scans were...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-09-01 00:00:00
abstract:BACKGROUND:Periprosthetic joint infection (PJI) following total joint arthroplasty is a serious complication that causes severe morbidity and adds a major financial burden to the healthcare system. Although there is plenty of research on the alpha-defensin (AD) test, a meta-analysis consisting of only prospective studi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000001225
更新日期:2020-06-01 00:00:00
abstract::Augmented reality is a display technique that combines supplemental information with the real world environment. Augmented reality systems are on the verge of being used everyday in medical training, preoperative planning, preoperative and intraoperative data visualization, and intraoperative tool guidance. The basic ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199809000-00014
更新日期:1998-09-01 00:00:00
abstract::Insertion of distal interlocking screws in femoral nails can be technically demanding and may entail substantial exposure. A method of insertion of femoral interlocking screws that uses a laser guiding system in addition to the standard image intensifier was used in an attempt to improve the accuracy of distal screw p...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-08-01 00:00:00
abstract:BACKGROUND:The failure rate of tendon-bone healing after repair of rotator cuff tears remains high. A variety of biologic- and cell-based therapies aimed at improving rotator cuff healing have been investigated, and stem cell-based techniques have become increasingly more common. However, most studies have focused on t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-015-4218-9
更新日期:2015-05-01 00:00:00
abstract::The aseptically loosened prosthesis provided a means for investigating the in vivo and in vitro activity of the cells associated with the loosening process in seven dogs. The cells were isolated and maintained in culture for sufficient periods of time so that their biologic activity could be studied as well as the eff...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1990-12-01 00:00:00
abstract:BACKGROUND:Soft tissue sarcomas are often inappropriately excised without adequate preoperative planning. Inappropriate (unplanned) excisions may adversely affect local recurrence, distant metastasis, patient survival, and /or postoperative function once properly evaluated. QUESTIONS/PURPOSES:We asked whether the clin...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1392-7
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:Sacrectomy may offer curative potential for primary sarcomas of the sacrum. However, it is unclear whether and to what extent sacrectomies achieve local control. QUESTIONS/PURPOSE:We therefore determined the curative potential, walking ability, continence control, and quality of life for children after sacr...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-011-2199-x
更新日期:2012-05-01 00:00:00
abstract:BACKGROUND:Pasteurized autograft is regarded as a biologic reconstructive option for managing bone defects after tumor resection; however, reports on long-term outcomes from large patient series are scarce. Contrary to previous favorable reports, we have observed many patients with failures, in particular as the durati...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999.0000000000000100
更新日期:2018-09-01 00:00:00
abstract::Roentgen stereophotogrammetry allows one to localize the position of an object in space using roentgen rays. For orthopaedic purposes it was developed 35 years ago by Göran Selvik, and since that time many investigators have refined the radiostereometric calculations and evaluative software. Many uses and mathematical...
journal_title:Clinical orthopaedics and related research
pub_type: 历史文章,杂志文章
doi:10.1097/01.blo.0000224001.95141.fe
更新日期:2006-07-01 00:00:00
abstract::Magnetic resonance venography is a recently developed, noninvasive means of visualizing the proximal veins of the lower extremity and pelvis. Magnetic resonance venography is compared with standard contrast venography in the diagnosis of proximal deep vein thrombosis after total joint arthroplasty. Two hundred seven e...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章
doi:10.1097/00003086-199610000-00029
更新日期:1996-10-01 00:00:00
abstract:BACKGROUND:Studies of primary total joint arthroplasty (TJA) show a correlation between hospital volume and outcomes; however, the relationship of volume to outcomes in revision TJA is not well studied. QUESTIONS/PURPOSES:We therefore asked: (1) Are 90-day readmissions more likely at low-volume hospitals relative to h...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000000684
更新日期:2019-05-01 00:00:00
abstract::A retrospective study during a 3-year interval revealed that four of 112 patients had intertrochanteric fractures that were irreducible by the usual closed manipulation and traction techniques at the time of surgery. Each of these patients' preoperative radiographs showed a fracture line that bisected the lesser troch...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199706000-00027
更新日期:1997-06-01 00:00:00
abstract::Recent technologic advances in bone mineral densitometry have resulted in increasingly precise and accurate methods of estimating bone mineral density. Dual-photon absorptiometry has been made obsolete by the introduction of dual-energy radiography, a development that is likely to result in more widespread use of dens...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1991-10-01 00:00:00