Browsing by keyword "Society for Vascular Surgery Lower Extremity Guidelines Committee"
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ACR Appropriateness Criteria((R)) Suspected Lower Extremity Deep Vein ThrombosisSuspected lower extremity deep venous thrombosis is a common clinical scenario which providers seek a reliable test to guide management. The importance of confidently making this diagnosis lies in the 50% to 60% risk of pulmonary embolism with untreated deep vein thrombosis and subsequent mortality of 25% to 30%, balanced with the risks of anticoagulation. The ACR Appropriateness Criteria Expert Panel on Vascular Imaging reviews the current literature regarding lower extremity deep venous thrombosis and compared various imaging modalities including ultrasound, MR venography, CT venography, and catheter venography. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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NPWTi allows safe delayed free flap repair of Gustilo IIIb injuries: A prospective case seriesIntroduction: Free flap lower extremity repair is associated with a high complication rate ( > 31%); higher rates are observed in more severe patients. In cases requiring prior systemic/local stabilization, delayed repair increases complication rate (+10% at 7 days): Negative-pressure Wound Therapy (NPWT) decreases complications but only when applied for less than 7 days. Recent limited evidence suggests that augmentation of NPWT with instillation for wound irrigation (NPWTi) might safely extend such window. This study hypothesizes that, through the combined cleansing effect of NPWT and instillation, NPWTi allows safe (low complication rate) delayed free flap repair in severe patients with Gustilo IIIb injuries (GIIIb). Methods: A prospective case series was designed (inclusion criteria: GIIIb requiring microsurgical repair, severe patient/injury condition preventing immediate/early repair; exclusion criteria: allergy to NPWTi dressing). Patients received NPWTi (suction: 125 mmHg continuous; irrigation: NaCl 0.9%) until considered clinically ready for repair. Preoperative/postoperative complications (dehiscence, wound infection, bone non-union, osteomyelitis, flap failure) were monitored with clinical signs, imaging, and serum markers (CRP, WBC). Results: Four patients (male: N = 4, female N = 1; Age: 59 [44-75] years-old) were treated. NPWTi was applied for 15.2 [9-28] days. No complication (0%) was observed preoperatively or postoperatively. Delayed repair occurred by latissimus dorsi musculocutaneous flap (N = 3), and anterolateral thigh flap (N = 2). All patients walked weight-bearing 12 [6-20] weeks after injury. Conclusions: NPWTi seems to allow safe delayed free flap repair in patients with severe lower extremity injuries unable to undergo immediate/early repair.
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Two cases of acute anterolateral compartment syndrome following inversion ankle injuriesIntroduction: Compartment syndrome is a limb threatening, and sometimes life-threatening medical condition. It usually occurs in high energy lower extremity injuries, commonly in the younger patient with classic signs and symptoms. Pain out of proportion to exam is one of the key elements in diagnosis. A high vigilance for signs and symptoms of this condition should be present on most physicians' radars who treat emergency conditions, as this case report demonstrates, the mechanism and story are not always classic. Presentation of cases: Two cases of young, healthy adults who underwent fasciotomy for compartment release for compartment syndrome isolated to the anterolateral compartment, but who did not sustain a high energy trauma, but rather a twisting ankle injury. Conclusion: Compartment syndrome can occur in young, healthy, active patients with a lower energy twisting injury and without fracture. A high level of suspicion on the clinicians' part will prevent adverse outcomes to the patient.
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Two cases of acute anterolateral compartment syndrome following inversion ankle injuriesIntroduction: Compartment syndrome is a limb threatening, and sometimes life-threatening medical condition. It usually occurs in high energy lower extremity injuries, commonly in the younger patient with classic signs and symptoms. Pain out of proportion to exam is one of the key elements in diagnosis. A high vigilance for signs and symptoms of this condition should be present on most physicians' radars who treat emergency conditions, as this case report demonstrates, the mechanism and story are not always classic. Presentation of cases: Two cases of young, healthy adults who underwent fasciotomy for compartment release for compartment syndrome isolated to the anterolateral compartment, but who did not sustain a high energy trauma, but rather a twisting ankle injury. Conclusion: Compartment syndrome can occur in young, healthy, active patients with a lower energy twisting injury and without fracture. A high level of suspicion on the clinicians' part will prevent adverse outcomes to the patient.
