Lower extremity peripheral nerve injuries can be highly morbid to patients and challenging problems for reconstructive surgeons to manage.Nerve transfers have recently emerged as a promising technique in the treatment...Lower extremity peripheral nerve injuries can be highly morbid to patients and challenging problems for reconstructive surgeons to manage.Nerve transfers have recently emerged as a promising technique in the treatment of these injuries.The nerve-transfer paradigm is predicated on the use of an expendable,unaffected nerve as a donor of axons to restore motor or sensory function in the target end organ.Distal transfers close to the end motor or sensory organ may allow for earlier and more robust reinnervation compared to more proximal primary repair or grafting.However,as clinical data on outcomes and rigorous comparative studies remain scarce,reconstructive surgeons must rely on principle-based treatment including a detailed understanding of lower extremity neuromuscular anatomy,gait mechanics,and nerve physiology to develop an appropriate treatment plan for each patient with the goal of functional limb restoration and independent gait.In this article,we review current concepts of lower extremity nerve transfers,including techniques and outcomes according to indication.展开更多
Lower extremity injury and deformity can result from a number of etiologies. Regardless of the underlying cause, the decision to pursue amputation or reconstruction of a lower limb is challenging for both patients and...Lower extremity injury and deformity can result from a number of etiologies. Regardless of the underlying cause, the decision to pursue amputation or reconstruction of a lower limb is challenging for both patients and practitioners.This decision is largely dependent on the patient's premorbid health and function, functional goals and preferences,and characteristics and viability of the affected limb. The role of adaptive devices following surgery should never be underestimated. Advances in prostheses and orthoses have provided patients with a wider range of options to consider when deciding between limb reconstruction and amputation. The primary goals of any adaptive device are to improve function, prevent recurrence or ulceration of the defect, and allow for use of conventional footwear and/or clothing.When a lower extremity amputation is indicated, selection of the correct level is of critical importance in order to optimize healing potential and function. Each distinct level has certain inherent prosthetic and orthotic considerations. Likewise,the application of an adaptive device following reconstruction of the lower extremity also has demonstrable benefits and must be tailored to the specific defect and procedure performed. Knowledge of available prosthetic and orthotic options is of considerable importance for the reconstructive surgeon tasked with limb salvage or resurfacing an amputated extremity. This article reviews considerations of various types of lower extremity amputation and reconstruction, and provides a framework for the role of adaptive devices following surgery.展开更多
Advancements in microsurgical techniques have allowed for the salvage of extremities that would otherwise be amputated.Despite these improvements,mangling injuries of the lower extremity with concomitant open fracture...Advancements in microsurgical techniques have allowed for the salvage of extremities that would otherwise be amputated.Despite these improvements,mangling injuries of the lower extremity with concomitant open fracture continue to present a challenge for reconstructive surgeons.These injuries are further complicated by circumstances in which a single vessel is perfusing the foot after trauma(Gustilo 3C injuries).Although the foot may remain perfused in this instance,free flap coverage of open fractures with concomitant vascular injury requires careful planning to maintain a viable foot.The surgeon must adapt surgical plans based on both preoperative and intraoperative findings.In this review,we discuss current concepts and reconstructive techniques for performing free flap reconstruction in single-vessel lower extremities.展开更多
文摘Lower extremity peripheral nerve injuries can be highly morbid to patients and challenging problems for reconstructive surgeons to manage.Nerve transfers have recently emerged as a promising technique in the treatment of these injuries.The nerve-transfer paradigm is predicated on the use of an expendable,unaffected nerve as a donor of axons to restore motor or sensory function in the target end organ.Distal transfers close to the end motor or sensory organ may allow for earlier and more robust reinnervation compared to more proximal primary repair or grafting.However,as clinical data on outcomes and rigorous comparative studies remain scarce,reconstructive surgeons must rely on principle-based treatment including a detailed understanding of lower extremity neuromuscular anatomy,gait mechanics,and nerve physiology to develop an appropriate treatment plan for each patient with the goal of functional limb restoration and independent gait.In this article,we review current concepts of lower extremity nerve transfers,including techniques and outcomes according to indication.
文摘Lower extremity injury and deformity can result from a number of etiologies. Regardless of the underlying cause, the decision to pursue amputation or reconstruction of a lower limb is challenging for both patients and practitioners.This decision is largely dependent on the patient's premorbid health and function, functional goals and preferences,and characteristics and viability of the affected limb. The role of adaptive devices following surgery should never be underestimated. Advances in prostheses and orthoses have provided patients with a wider range of options to consider when deciding between limb reconstruction and amputation. The primary goals of any adaptive device are to improve function, prevent recurrence or ulceration of the defect, and allow for use of conventional footwear and/or clothing.When a lower extremity amputation is indicated, selection of the correct level is of critical importance in order to optimize healing potential and function. Each distinct level has certain inherent prosthetic and orthotic considerations. Likewise,the application of an adaptive device following reconstruction of the lower extremity also has demonstrable benefits and must be tailored to the specific defect and procedure performed. Knowledge of available prosthetic and orthotic options is of considerable importance for the reconstructive surgeon tasked with limb salvage or resurfacing an amputated extremity. This article reviews considerations of various types of lower extremity amputation and reconstruction, and provides a framework for the role of adaptive devices following surgery.
文摘Advancements in microsurgical techniques have allowed for the salvage of extremities that would otherwise be amputated.Despite these improvements,mangling injuries of the lower extremity with concomitant open fracture continue to present a challenge for reconstructive surgeons.These injuries are further complicated by circumstances in which a single vessel is perfusing the foot after trauma(Gustilo 3C injuries).Although the foot may remain perfused in this instance,free flap coverage of open fractures with concomitant vascular injury requires careful planning to maintain a viable foot.The surgeon must adapt surgical plans based on both preoperative and intraoperative findings.In this review,we discuss current concepts and reconstructive techniques for performing free flap reconstruction in single-vessel lower extremities.
