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  • 1
    Online Resource
    Online Resource
    Effect of Lymphaticovenous Anastomosis on Muscle Edema, Limb, and Subfascial Volume in Lower Limb Lymphedema: MRI Studies
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American College of Surgeons Vol. 235, No. 2 ( 2022-08), p. 227-239
    Details
    In: Journal of the American College of Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 235, No. 2 ( 2022-08), p. 227-239
    Abstract: Although satisfactory volume reduction in secondary unilateral lower limb lymphedema after lymphaticovenous anastomosis (LVA) in the affected limb has been well reported, alleviation of muscle edema and the impact of LVA on the contralateral limb have not been investigated. STUDY DESIGN: This retrospective cohort study enrolled patients who underwent supermicrosurgical LVA between November 2015 and January 2017. Pre- and post-LVA muscle edema were assessed using fractional anisotropy (FA) and apparent diffusion coefficient (ADC). The primary endpoint was changes in limb/subfascial volume assessed with magnetic resonance volumetry at least 6 months after LVA. RESULTS: Twenty-one patients were enrolled in this study. Significant percentage reductions in post-LVA muscle edema were found in the affected thigh (83.6% [interquartile range = range of Q1 to Q3; 29.8–137.1] [FA] , 53.3% [27.0–78.4] [ADC] ) as well as limb (21.7% [4.4–26.5]) and subfascial (18.7% [10.7–39.1] ) volumes. Similar findings were noted in the affected lower leg: 71.8% [44.0–100.1] (FA), 59.1% [45.8–91.2] (ADC), 21.2% [6.8–38.2], and 28.2% [8.5–44.8] , respectively (all p 〈 0.001). Significant alleviation of muscle edema was also evident in the contralateral limbs (thigh: 25.1% [20.4–57.5] [FA] ; 10.7% [6.6–17.7] [ADC] ; lower leg: 47.1% [35.0–62.8] [FA] ; 14.6% [6.5–22.1] [ADC] ; both p 〈 0.001), despite no statistically significant difference in limb and subfascial volumes. CONCLUSIONS: Our study found significant reductions in muscle edema and limb/subfascial volumes in the affected limb after LVA. Our findings regarding edema in the contralateral limb were consistent with possible lymphedema-associated systemic influence on the unaffected limb, which could be surgically relieved.
    Type of Medium: Online Resource
    ISSN: 1072-7515
    URL: Article
    DOI: 10.1097/XCS.0000000000000236
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 2
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    Online Resource
    The Multiple-U Technique: A Novel Microvascular Anastomosis Technique That Guarantees Everted Anastomosis Sites with Solid Intima-to-Intima Contact
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Plastic & Reconstructive Surgery Vol. 149, No. 5 ( 2022-05), p. 981e-984e
    Details
    In: Plastic & Reconstructive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 149, No. 5 ( 2022-05), p. 981e-984e
    Abstract: The key to successful microvascular anastomosis is achieving intima-to-intima contact, which is not always easy. In this article, the authors propose the multiple-U technique, which is a novel microvascular anastomosis technique that characterizes easy and reliable intima-to-intima contact. The technique was performed on patients who underwent free flap reconstruction for head and neck defects at the Kaohsiung Chang Gung Memorial Hospital from September 1, 2020, to November 30, 2020. The immediate patency test results for all vessel anastomoses were positive, and the postoperative recovery courses of the patients were without any vascular complications. In conclusion, the multiple-U technique is a widely available technique that guarantees everted anastomosis sites and solid intima-to-intima contact. This technique can be performed on both arterial and venous anastomoses regardless of vessel size and wall thickness.
    Type of Medium: Online Resource
    ISSN: 0032-1052
    URL: Article
    DOI: 10.1097/PRS.0000000000009025
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2037030-1
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  • 3
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    Online Resource
    Functional Evaluation of Ankle Joint After 1-Stage Secondary Debulking Procedure After Flap Reconstruction
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Annals of Plastic Surgery Vol. 87, No. 3 ( 2021-9), p. 331-336
    Details
    In: Annals of Plastic Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 87, No. 3 ( 2021-9), p. 331-336
    Abstract: Free or local flaps that are used to reconstruct the lower limb often result in poor functional outcome because of bulkiness of the flap and scar contracture over ankle joint region. The aim of this study was to evaluate the functional results of ankle joint after 1-stage secondary debulking procedure for lower limb trauma. Material and Methods From January of 2002 to October of 2018, debulking procedures were performed for 66 patients after flap reconstructions of the lower limb. Thirty-eight patients (group 1) of foot injury without ankle joint involvement and 20 patients (group 2) with ankle joint involvement were included. Range of motion (ROM) of ankle joint before and after debulking procedure was measured after 6 months of follow-up. Results After debulking procedure, all the patients were able to dress in their preinjury shoes without any difficulty and with ease of ambulation. For all patients, with or without ankle involvement, the postdebulking ROM versus predebulking ROM improved significantly ( P 〈 0.01). The ROM improvements for patients with ankle involvement were significantly better then patients without ankle involvement ( P = 0.032). Conclusions One-stage debulking procedure can provide long-term constant, reliable, thin skin coverage for the lower limb after flap reconstruction with improved ankle ROM. This allows better functional results, especially for lower limb trauma patients with initial ankle involvement.
    Type of Medium: Online Resource
    ISSN: 1536-3708 , 0148-7043
    URL: Article
    DOI: 10.1097/SAP.0000000000002711
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2063013-X
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  • 4
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    Online Resource
    Impact of Evidence‐Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of the American Heart Association Vol. 8, No. 13 ( 2019-07-02)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 13 ( 2019-07-02)
    Abstract: The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence‐based processes of care for acute ischemic stroke ( AIS ) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. Methods and Results Use of 8 AIS processes of care were considered: reperfusion therapy in eligible patients; acute stroke unit care; antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation; dysphagia assessment; and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0–2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or “defect‐free” care, was associated with improved outcome (odds ratio, 1.40; 95% CI, 1.18–1.65) and better survival (odds ratio, 2.23; 95% CI , 1.62–3.09). Defect‐free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0–1) (odds ratio, 1.22; 95% CI , 1.04–1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and individual rates. Conclusions Use of evidence‐based care is associated with improved clinical outcome in AIS . Strategies are required to address regional variation in the use of proven AIS treatments. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique Identifier: NCT 02162017.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.119.012640
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2653953-6
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