Abstract:
BACKGROUND:The extent of tissue loss amenable to primary healing after revascularization is unknown. Salvage of limbs with large soft-tissue defects with exposed tendon, joint, or bone lies beyond the limits of conventional techniques. We report our results using free tissue transfer as an adjunct to lower extremity vascular reconstruction in patients with complex ischemic or infected wounds. METHODS:Retrospective chart review of patient and wound characteristics. RESULTS:From January 1992 to June 1996, 585 procedures were performed in 544 patients, including 27 free flaps in 26 patients: 17 free flaps combined with distal bypass (7 staged, 10 simultaneous) and 10 isolated free flaps. Flap donor sites included radial forearm (8), latissimus dorsi (7), rectus abdominus (9), and scapula (3). Surgical indications included extensive ischemic/neurotrophic ulcers, and nonhealing vein graft harvest incision or transmetatarsal amputation site. Mean area of tissue loss was 70 cm2, mean ulcer duration was 5 months, and 92% of patients had exposed tendon, joint, or bone. During a mean follow-up of 14 months, 2 patients died of cardiopulmonary disease and 3 flaps failed, resulting in below-knee amputation. Six flaps were revised for graft stenosis (1), venous thrombosis (1), or flap edge necrosis (4). Limb salvage rate was 70% at 24 months by life-table analysis. Functional ambulation was achieved in 21 of 24 (88%) patients, including 7 of 8 with diabetes, end-stage renal disease, and heel ulcers. CONCLUSION:In select ambulatory patients with large soft-tissue defects and exposed deep structures, functional limb salvage is obtainable in more than 80% of patients. For lesions not amenable to vascular reconstruction with conventional methods of wound coverage, free tissue transfer extends the limits of limb salvage and is a viable alternative to amputation.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Gooden MA,Gentile AT,Mills JL,Berman SS,Demas CP,Reinke KR,Hunter GC,Westerband A,Greenwald Ddoi
10.1016/s0002-9610(97)00175-xsubject
Has Abstractpub_date
1997-12-01 00:00:00pages
644-8; discussion 648-9issue
6eissn
0002-9610issn
1879-1883pii
S000296109700175Xjournal_volume
174pub_type
杂志文章abstract::In this 6-year study of 101 limbs requiring surgical intervention for upper-extremity vascular trauma, most patients were male, young, and injured by penetrating objects. Injured vessels included 13 axillary/subclavian, 23 brachial, 40 radial, and 25 ulnar arteries. Concomitant injuries included nerve injury in 50 cas...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80313-7
更新日期:1990-08-01 00:00:00
abstract::Part II of this two-part article (See The American Journal of Surgery 1992; 164: 85-9) reviews the current definition of the role of immunosuppressive therapy in inflammatory bowel disease (IBD) and the use of antibiotics in IBD, as well as summarizes the uses of the new agents on the horizon for the treatment of IBD....
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/s0002-9610(05)80381-2
更新日期:1992-08-01 00:00:00
abstract::The application of systems analysis and flow charting technics to abdominal incision and closure allow a complete display of objectives and alternatives. A route of alternatives has been chosen and supported by the best available principles in the surgical literature. The choices include an unconventional large bite m...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(76)90160-4
更新日期:1976-04-01 00:00:00
abstract:BACKGROUND:The insertion and subsequent removal of chest tubes are frequently performed procedures. We hypothesize that routine chest radiographs obtained after chest tube removal to confirm the absence of any post-procedure complications have little impact on clinical management. MATERIALS AND METHODS:A 5-year retros...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(99)00260-3
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Because of the increase in the geriatric population, an increasing number of elderly patients are being treated for colorectal cancer. The purpose of this study was to evaluate perioperative morbidity and mortality in this population. METHODS:A retrospective chart review was performed for patients 80 years ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.12.022
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:Saline-linked electric cautery (SLC) is introduced as an effective device to reduce blood loss in liver surgery. The aim of the current study was to evaluate the safety and efficacy of a 2-surgeon technique using SLC and the Cavitron Ultrasonic Surgical Aspirator (CUSA; Valleylab, Boulder, CO) in living dono...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2008.01.019
更新日期:2009-02-01 00:00:00
abstract:BACKGROUND:Colonic inertia (CI) is a disturbance of colonic motility characterized by severe constipation and abdominal pain. This study was conducted to assess the results of total abdominal colectomy (TAC) in the management of CI. METHODS:A retrospective chart review of 55 patients who underwent TAC for CI was condu...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(01)00820-0
更新日期:2001-12-01 00:00:00
abstract:BACKGROUND:Few patients with priapism require inpatient management unless they are refractory to intracavernosal therapy. Their risk factors and outcomes are poorly characterized. METHODS:This is a retrospective analysis of the Nationwide Inpatient Sample (1998-2006). Priapism patients were identified and analyzed ove...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2010.03.017
更新日期:2011-04-01 00:00:00
abstract:PURPOSE:We examined the efficacy of extended lymph node dissection for prolonging survival in macroscopically or histologically proven incurable gastric cancer. PATIENTS AND METHODS:We analyzed clinico-pathologic data on 119 patients with serosally invasive gastric cancer who underwent noncurative gastrectomy, with re...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/S0002-9610(99)80147-0
更新日期:1995-02-01 00:00:00
abstract::A retrospective study of colostomy closures was prompted by recent reports detailing frequent postoperative complications. In a series of 125 intraperitoneal colostomy closures there was a low incidence of complications. There were no anastomotic breakdowns, fistulas, or deaths. We conclude that closure of a well heal...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(78)90205-2
更新日期:1978-07-01 00:00:00
abstract:PURPOSE:To investigate the frequency, presentation, clinical management, and prognosis of appendiceal carcinoid tumors in children. METHOD:A review of our institution's experience over 50 years. RESULTS:Twenty-two patients below the age of 20 presented with appendiceal carcinoid tumor. The mean age at presentation wa...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(99)80025-7
更新日期:1995-12-01 00:00:00
abstract::A series of 168 patients who underwent 177 inguinal lymph node dissections from 1979 to 1989 were retrospectively reviewed to determine the incidence and severity of postoperative complications as well as the perioperative risk factors associated with them. Operative mortality was 0%, whereas the incidence of moderate...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)81181-x
更新日期:1992-11-01 00:00:00
abstract:BACKGROUND:Many women with breast cancer recurrence previously treated with breast-conservation therapy desire repeat lumpectomies. We hypothesized that women undergoing mastectomy for breast cancer recurrence would show superior survival. METHODS:Patients who previously received breast-conservation therapy diagnosed ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2008.06.018
更新日期:2008-10-01 00:00:00
abstract::The following report illustrates a rare case of small bowel obstruction which occurred when a large phytobezoar, which had formed in a proximal jejunal diverticulum, dislodged and migrated distally. Obstruction and subsequent perforation resulted when the phytobezoar passed into the narrow terminal ileum and lodged ju...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.02.018
更新日期:2008-01-01 00:00:00
abstract:INTRODUCTION:We sought to determine if lymph node harvesting and survival for CRC were comparable between laparoscopic and open resections in a community hospital setting. METHODS:A retrospective chart review of patients at two community hospitals who underwent open or laparoscopic resection for CRC between January 20...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2017.03.012
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Prognosis after resection for intrahepatic cholangiocarcinoma (ICC) remains unsatisfactory. There remains no effective therapy after recurrent ICC. OBJECTIVE:The current study sought to evaluate risk factors associated with recurrent ICC and possible therapies after resection. METHOD:A review of data from ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2008.12.035
更新日期:2011-02-01 00:00:00
abstract:BACKGROUND:The feasibility and safety of low-pressure pneumoperitoneum in laparoscopic cholecystectomy remain unclear. METHODS:A meta-analysis of randomized controlled trials comparing low-pressure with standard-pressure pneumoperitoneum was performed. RESULTS:A total of 1,263 patients were included. Low-pressure pne...
journal_title:American journal of surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.amjsurg.2013.09.027
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Approximately 30% to 50% of appendicitis in children is already perforated at presentation. The optimal management of these children remains controversial. METHODS:Ninety-six children (aged 2 to 16 years) were treated for perforated appendicitis. Seventy-one underwent immediate appendectomy and drainage of ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2003.08.027
更新日期:2003-12-01 00:00:00
abstract::Wounds will readily acquire bacteria, unless protective measures are taken. The bacterial protection afforded by conventional absorbent cellulose dressings has been shown to be limited, particularly in the presence of serous exudate that may compromise dressing integrity. In addition, dressings may shed particles that...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/0002-9610(94)90006-x
更新日期:1994-01-01 00:00:00
abstract::Herein, we have described the surgical management of 23 patients with chronic intestinal ischemia. The patients presented most commonly with postprandial pain and weight loss. Diagnosis was confirmed by angiography, including lateral aortography. Surgery included bypass with Dacron being the most common graft material...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(84)90301-5
更新日期:1984-07-01 00:00:00
abstract:BACKGROUND:This study utilizes the American College of Surgeons National Surgical Quality Improvement Program database to better understand the impact of obesity on perioperative surgical morbidity in abdominal wall reconstruction (AWR). METHODS:We reviewed the 2005 to 2010 American College of Surgeons National Surgic...
journal_title:American journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.amjsurg.2013.08.047
更新日期:2014-04-01 00:00:00
abstract::Over a ten year period, four patients with inflammation or perforation of non-Meckelian, small intestinal diverticula were treated on the surgical services of Bellevue Hospital. This entity remains uncommon but may be increasing in incidence. The patients presented with a short history of severe abdominal pain, usuall...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(76)90364-0
更新日期:1976-11-01 00:00:00
abstract:BACKGROUND:Students report that their operating room experience during specialty clerkships has been less than satisfactory. To deal with this and other problems in a 1-week cardiothoracic clerkship, a video conference system was introduced. METHODS:Three teaching strategies were used: a seminar dealing with the disea...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(96)00387-x
更新日期:1997-04-01 00:00:00
abstract::A plan is advocated for the management of the dominant breast mass with use of local anesthesia in the outpatient setting as the primary diagnostic tool, but with selection of certain patients for immediate general anesthesia biopsy in the "conventional" manner. Experience with this plan in 2,492 patients during a per...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(76)90030-1
更新日期:1976-05-01 00:00:00
abstract:BACKGROUND:The morbidity and mortality conference (M&M) is a key component of the performance improvement process. The audience response system (ARS) has been shown to improve audience participation and promote more truthful responses in various settings. We implemented the ARS in our trauma M&M and evaluated the respo...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2008.05.015
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:This study investigated the use of ultrasound (US) as a first-line diagnostic tool. METHODS:All women attending our breast center underwent bilateral whole-breast US in addition to all other investigations, and results were documented prospectively and preoperatively. RESULTS:Of 796 patients with breast can...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2004.06.032
更新日期:2004-10-01 00:00:00
abstract:BACKGROUND:The aim of this study was to assess the impact of previous abdominal surgery (PAS) on single-port laparoscopic colectomy (SPLC). METHODS:We studied 429 consecutive patients who underwent SPLC in our department from May 2009 to December 2013. Patients were divided into 2 groups: those with PAS (PAS group) an...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2014.06.015
更新日期:2015-06-01 00:00:00
abstract::Aspiration of foreign bodies in children can lead to illness and even death if not recognized and treated promptly. Seventy-six patients were referred to our hospital for suspected foreign body aspiration. The following is a retrospective review of their diagnosis and treatment. There was no foreign body found at bron...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(89)90208-0
更新日期:1989-12-01 00:00:00
abstract::A patient with acute amebic dilatation of the colon and multiple intrahepatic abscesses was successfully treated by a combination of medical and surgical therapy. Creation of a loop ileostomy and blow-hole colostomy facilitated complete healing of the colon. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(80)90317-7
更新日期:1980-03-01 00:00:00
abstract:BACKGROUND:Trauma in pregnancy remains an important but understudied public health issue. We aimed to determine the prevalence of interpersonal violence in our pregnant trauma population (including pediatric) over the last 20 years, from our Level I trauma center. METHODS:We conducted a descriptive, retrospective char...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2017.07.003
更新日期:2017-10-01 00:00:00