Objective To investigate the clinical effect of the one-stage arteriovenous shunt on the extensive arterial ischemic disease of the lower extremities. Methods The one-stage arteriovenous shunts in the lower extremities were applied to 90 patients with extensive arterial ischemic diseases, including arterial occlusive disease (AODs,62 patients) and thromboangiitis obliterans (TAOs,28 patients). By the retrospective analysis on the clinical materials and the follow-up of the postoperative patients, the immediate and the longterm surgical outcomes were summarized. Results During the hospitalization, 88 patients achieved a remarkable surgical effectiveness, with an immediate surgical effectiveness rate of 97.7% (88/90), but 2 patients failed in the operation and had to undergo amputation of the lower limb. Of the 72 patients who were followed up for 0.5-5 years after the arteriovenous shunt operation, 64 could have a sufficient blood supply to the lower extremities, with a longterm effectiveness rate of 88.9% (64/72); however, 8 patients had to undergo transplantation of the greater omentum or amputation of the lower limb. Conclusion The one-stage arteriovenous shunt performedon the lower extremities for an extensive arterial ischemic disease is a simpler and more effective surgical protocol for reconstruction of the circulation of the patient who is not suitable for the operation of arterial bypass.
ObjectiveTo evaluate the value of clinical application of determination of lower venous pressure in the diagnosis and treatment of deep venous thrombosis (DVT). MethodsThe 90 patients with DVT of unilateral lower limb who were admitted by using color Doppler or deep veins of lower limb angiography in our hospital during the period of 2013 July to 2014 June were selected and as the research object (case group), 37 cases were male, 53 cases were female; the age was 18-84 years old, mean age was 59.48 years old. According to the development of disease, 90 cases were divided into acute 30 cases, subacute 30 cases, and chronic 30 cases; and according to the pathological types were divided into the central type in 30 cases, 30 cases of peripheral type, and 30 cases of mixed type. At the same time the without lower extremity DVT volunteers of 20 cases were selected as normal control group, including male 9 cases, female 11 cases; age was 21-65 years old, average age was 38.7 years old. The static venous pressure (P0), dynamic venous pressure (P00), and decreased pressure ratio (Pd) of double lower limbs of participants in 2 groups were determinated and comparative analyzed. ResultsThe P0 and P00 of patients with different development of disease and pathological types of the case group were higher than those of the normal control group (P < 0.01), and the Pd was lower than that of the normal control group (P < 0.01). In case group, the P0 and P00 of acute phase were higher than those of the normal control group (P < 0.01), the P0 of central type was higher than that of the peripheral type and mixed type (P < 0.01), and the Pd central type was lower than that of mixed type (P < 0.01). The above 3 indexes' differences of double lower limbs in the normal control group had no statistical significance (P > 0.01). In case group, the P0 and P00 of ipsilateral limb in different development of disease and pathological types were higher than those of the healthy limb, and the Pd were lower than that of the healthy limb (P < 0.01). ConclusionsLower extremity venous pressure measurements can be used in clinical detection for early lower limb DVT, and can be used as the objective index of clinical evaluation curative effect for the treatment of DVT. It is a simple and practical clinical detection method.
Objective To provide the anatomic basis for defect repair of the knee, leg, foot and ankle with great saphenous venosaphenous neurocutaneous vascular island flaps. Methods The origin, diameter, branches, distribution and anatomoses of the saphenous artery and saphenous neurocutaneous vascular were observed on 20 sides of adult leg specimens and 4 fresh cadaver voluntary legs. Another4 fresh cadaver voluntary legs were radiogeaphed with a soft X-ray system afterthe intravenous injection of Vermilion and cross-sections under profound fascial, otherhand, micro-anatomic examination was also performed in these 4 fresh cadaver legs. The soft tissue defects in lower extremity,upper extremity, heel or Hucou in handwere repaired with the proximal or distal pedicle flaps or free flaps in 18 patients(12 males and 6 females,aging from 7 to 3 years). The defect was caused by trauma, tumour, ulcer and scar.The locations were Hucou (1 case), upper leg(3 cases), lower extremity and heal (14 cases). Of then, 7 cases were complicatedby bone exposure, 3 cases by tendon exposure and 1 case by steel expouse. the defect size were 4 cm×4 cm to 7 cm×13 cm. The flap sizes were 4 cm×6 cm to 8 cm×15 cm, which pedicle length was 8-11 cm with 2.-4.0 cm fascia and 12 cm skin at width. Results Genus descending genicular artery began from 9.33±0.81 cm away from upper the condylus medialis, it branched saphenous artery accompanying saphenous nerve descendent. And saphenous artery reached the surface of the skin 7.21±0.82 cm away from lower the condylus medialis,and anastomosed with the branches of tibialis posterior artery, like “Y” or “T” pattern. The chain linking system of arteries were found accompanying along the great saphenous vein as saphenous nerve, and then a axis blood vessel was formed. The small artery of only 00-0.10 mm in diameter, distributed around the great saphenousvein within 58 mm and arranged parallelly along the vein like water wave in soft X-ray film. All proximal flaps,distal pedicle flaps and free flaps survived well. The appearance, sensation and function were satisfactory in 14 patientsafter a follow-up of 6-12 months. Conclusion The great saphenous vein as well as saphenous neurocutaneous has a chain linking system vascular net. A flap with the vascular net can be transplanted by free, by reversed pedicle, or by direct pedicle to repair the wound of upper leg and foot. A superficial vein-superficial neurocutaneous vascular flap with abundance blood supply and without sacrificing a main artery is a favouriate method in repair of soft tissue defects in foot and lower extremity.
ObjectiveTo discuss the diagnosis, treatment and clinical characteristics of open vascular injuries in the lower extremities and summarize our experiences. Methods To review the records of patients sustained an open injuries to the lower extremities vessel between 1999 and 2001 retrospectively. The clinical, operative findings and prognosis were collected and studied.ResultsAll 25 patients received emergency surgical treatment to repair the vascular injuries. It included 18 with isolated arterial injuries and 7 with combined arteriovenous injuries. Saphenous vein grafts were placed in 5 patients and vascular prostheses were placed in 5 patients with arterial injuries.Twentyfour patients were cured (96%), and 1 graft obstruction occurred (could not be contacted 40 days after operation). ConclusionOpen vascular injuries in the lower extremities should be diagnosed and treated as early as possible. The aim of the operation is to repair or reconstruct the injured vessel and to lower the mortality and morbidity rate.
Objective To analyze the relation between the mode of delivery and postpartum lower extremity deep venous thrombosis （DVT）， and discuss the therapy methods. Methods The clinical data of 48 patients with postpartum lower extremity DVT from 2006 to 2012 in this hospital were analyzed retrospectively. Results There were 15 897 patients with the delivery， of whom were 10 097 cases of cesarean section and 5 800 cases of spontaneous delivery， the incidence rate of lower extremity DVT in the patients with cesarean section was significantly higher than that in the patients with spontaneous delivery〔0.41% （41/10 097） versus 0.12% （7/5 800）， χ2=9.94，P＜0.005〕. The higher incidence rate of cesarean section， the higher incidence rate of lower extremity DVT， which was a positive correlation between them （rs=0.87，P＜0.05）. Forty-three cases were only treated by drug therapy， 2 cases were performed operation combined with drug therapy， and 5 cases were placed the inferior vena cava filter. Forty-eight cases were cured and discharged. Conclusions The incidence rate of lower extremity DVT of cesarean section is higher as compared with the spontaneous delivery. The thrombolysis and （or） anticoagulation therapy is an effective way in the treatment for DVT. Controlling indications of cesarean section and early postpartum out-of-bed can decrease the DVT.
ObjectiveTo explore the feasibility and technical essentials of soft tissue defect reconstruction of the lower extremity using the distally based anteromedial thigh flap (dAMT) pedicled with perforating vessels from rectus femoris branch. MethodsBetween July 2008 and December 2015, 6 patients underwent defect reconstruction of the lower extremity using the dAMT flap pedicled with perforating vessels from rectus femoris branch. There were 4 males and 2 females with an average age of 34 years (range, 4-55 years). The etiologies included liposarcoma in 1 case, malignant fibrous histocytoma in 1 case, post-burn scar contracture around the ankle in 1 case, and post-burn scar contracture around the knee in 3 cases. The disease duration ranged from 3 to 28 months (mean, 13 months). After resection of lesion tissues, the defect size ranged from 13 cm×7 cm to 24 cm×12 cm. The flap size ranged from 15 cm×8 cm to 24 cm×12 cm. The length of the pedicle ranged from 10 to 25 cm (mean, 19.8 cm). The distance from the flap pivot point to the superolateral border of the patella ranged from 8 to 13 cm (mean, 11.3 cm). The donor sites were directly sutured. ResultsAll flaps survived postoperatively without any complications. All wounds at the donor and the recipient sites healed primarily. The patients were followed up from 5 to 36 months (mean, 17.8 months). The color, texture, and thickness of the flaps were similar to those of the surrounding skin. No tumor recurrence was observed. The range of motion of flexion and extension of the joint were greatly improved in the patients with scar contracture. ConclusionIf the rectus femoris branch gives off cutaneous branch to the anteromedial thigh region and arises from the descending branch of the lateral circumflex femoral artery, a dAMT flap could be raised to reconstruct soft tissue defects of the lower extremity.
Objective To observe the effect of autologous peripheral blood stem cells(PBSC) transplantation in the treatment of ischemic lower extremity disorders. Methods Therapeutic group:fortyfive patients received recombinant human granulocyte colony-stimulating factor 450 to 600 U/d by hypodermic injection for 5 days to mobilize stem cells.On the 6th day,PBSC were collected by COBE 6.1 Spectra Version and were injected into ischemic lower extremity. Control group:33 patients were treated with dilating vessels drugs. After operation some indexes were evaluated. Results After operation, these indexes were improved. Skin temperature and TcpO2 were improved obviously, being statistically significant difference(P＜0.05). Conclusion Autologous PBSC transplantation might be a safe and effective method for treating lower extremity ischemic disorder. It could improve the quality of life of many patients as amputation of lower extremity of foot might be avoided or reduced.
In order to improve the motion fluency and coordination of lower extremity exoskeleton robots and wearers, a pace recognition method of exoskeleton wearer is proposed base on inertial sensors. Firstly, the triaxial acceleration and triaxial angular velocity signals at the thigh and calf were collected by inertial sensors. Then the signal segment of 0.5 seconds before the current time was extracted by the time window method. And the Fourier transform coefficients in the frequency domain signal were used as eigenvalues. Then the support vector machine (SVM) and hidden Markov model (HMM) were combined as a classification model, which was trained and tested for pace recognition. Finally, the pace change rule and the human-machine interaction force were combined in this model and the current pace was predicted by the model. The experimental results showed that the pace intention of the lower extremity exoskeleton wearer could be effectively identified by the method proposed in this article. And the recognition rate of the seven pace patterns could reach 92.14%. It provides a new way for the smooth control of the exoskeleton.
Objective To explore the treatment of thromboangitis obliterans (TAO) of lower extremities. Methods From March 1994 to February 2009, 24 cases (26 limbs) affected by chronic ischemia were diagnosed as TAO by Doppler ultrasound and DSA, CTA or MRA. According to the different levels of the extensive and diffuse arterial occlusion, the revascularization was performed in the ways: 19 cases (21 limbs) underwent venous arterialization, 3 cases (3 limbs) underwent endovascular therapy, and 2 cases (2 limbs) underwent thrombectomy. Results After the venous arterialization, 19 cases (21 limbs) were followed up for 1 to 14.5 years. Apart from the 5 limbs amputation (23.8%), the postoperative results of the most limbs were satisfactory (61.9%). The ABI before therapy (0.38±0.11) was significantly lower than that 6 months after therapy (0.79±0.08), Plt;0.05. In 3 cases (3 limbs) underwent endovascular therapy, one case failed and then received the venous arterialization. Two cases (2 limbs) finished thrombectomy successfully. After endovascular therapy and thrombectomy, these 4 cases were followed up for 1 to 4 years without the amputation. ConclusionIn order to improve the curative effect, it is important to choose the suitable therapeutic strategy according to the different levels of the extensive and diffuse arterial occlusion. The venous arterialization is an effective treatment for TAO of lower extremities.
This paper interprets 2017 European Society of Cardiology (ESC) peripheral arterial disease diagnosis and treatment guidelines on lower extremity arterial disease, and in order to provide reference for clinical practice.