Medial gastrocnemius muscle flap for the reconstruction of unhealed amputation stumps.

OBJECTIVE: Unhealed amputation stumps after transtibial amputation are common and often require reamputation futher up the leg. The aim of our study is to describe our experience with medial gastrocnemius muscle flap coverage following a transtibial amputation. METHOD: We retrospectively examined the records of patients who had an unhealed transtibial amputation stump who were then treated with a medial gastrocnemius muscle flap. RESULTS: We identified seven patients, all had diabetes mellitus and an initial amputation by the long posterior flap technique. All of the flap reconstructions of the amputation stumps ultimately survived. A mild knee flexion contracture was seen in two amputees, whereas full range of motion in the knee was observed in the remaining five amputees. None have required further surgical intervention. CONCLUSION: Medial head of gastrocnemious flap is an option for the reconstruction of the unhealed stump, particularly in the cases where stump shortening will not be feasible.

Survival evaluation of the patients with diabetic major lower-extremity amputations.

PURPOSE: The purpose of this study was to evaluate the survival after major lower-limb amputation, at a level either below (BKA) or above (AKA) the knee, in diabetic patients. METHODS: A total of 140 diabetic patients who underwent major lower-limb amputation during the period of 2001-2011 were enrolled in the study. The patients were grouped as below-knee and above-knee amputations. The differences in survival by age, gender, amputation level and revision surgery were investigated. The clinical follow-up periods and the results of the patients with major lower-limb amputation were retrospectively assessed. RESULTS: The mean follow-up period was 24.87 months (range 0.06-120 months). The mortality rate of series was 32.8 % for 1 year and 70 % for 5 years. One-year mortality rate was 24.6 % and 5-year mortality rate was 66.3 % in below-knee group, 1-year mortality rate was 43.3 % and 5-year mortality rate was 83.3 % in above-knee group. The difference between mortality rates of these groups was significant (p: 0.019). There was no statistically significant difference according to age and gender (p: 0.543 and 0.568). The previous minor amputations were found to have no effect on mortality (p: 0.471). CONCLUSION: Routine utilization of diabetes follow-up, screening and treatment programs with a multidisciplinary approach might be mandatory to handle early multisystem involvement-prevent major amputation, and increase survival rate in diabetic patients. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

Gamma probe guided surgery for osteoid osteoma: is there any additive value of quantitative bone scintigraphy?

Objetivo. El objetivo de este estudio es evaluar la eficiencia de la sonda gammadetectora en la cirugía radioguiada del osteoma osteoide y la aplicabilidad del análisis cuantitativo obtenido a partir de las imágenes de la gammagrafía ósea preoperatoria. Material y métodos. Este estudio incluye a 12 pacientes con osteoma osteoide quienes fueron tratados con cirugía radioguiada por sonda gammadetectora después de la gammagrafía ósea preoperatoria. Se compararon las relaciones de contraste calculadas entre el nidus y el hueso sano adyacente en la gammagrafía ósea y los porcentajes de reducción de cuentas tras la extirpación quirúrgica del nidus. Los pacientes fueron sometidos a seguimiento para detectar recurrencia o complicaciones postoperatorias. Resultados. La relación media de contraste entre el nidus y el hueso sano adyacente fue de 43,6% (rango de 33-53%). Tras la excisión del nidus, se estimó mediante la sonda una reducción media de 55,8% (rango de 28-73%) en las cuentas detectadas en el área de tumor. No había ninguna correlación entre ambas relaciones (r = 0,46, p = 0,13). Se alcanzó una curación completa en 11 pacientes (92%) con una única operación, durante el período de observación postoperativo. Ninguno de los pacientes tuvo alguna complicación menor o mayor durante o después de la cirugía. Conclusiones. Debido a su elevada eficacia clínica y al bajo número de complicaciones quirúrgicas, la aplicación de la sonda gammadetectora en la cirugía del osteoma osteoide es un método efectivo y seguro. más extensivamente en la práctica diaria(AU)

Objective. The aim of this study is to evaluate the efficiency of gamma probe guided osteoid osteoma surgery and the applicability of quantitative analyses obtained from preoperative bone scan images. Material and methods. This study involved 12 osteoid osteoma patients who were treated with gamma probe guided surgery after preoperative bone scan. The calculated contrast ratios between nidus and adjacent healthy bone from preoperative bone scan and the calculated percentages of count reduction after resection of nidus during intraoperative gamma probe application were compared. Patients were followed up for any recurrence or complications. Results. The mean contrast ratio between nidus and adjacent healthy bone calculated from preoperative bone scan was 43.6% (range 33-53%). Following the nidus excision, an average of 55.8% (range 28-73%) count reduction was estimated with gamma probe in the tumor area. There was no correlation between preoperative scintigraphic contrast ratio and intraoperative gamma probe count reduction ratio (r = 0.46, p = 0.13). Complete cure was achieved in 11 (92%) patients with single operation, during the postoperative follow up period. None of the patients had any major or minor complications during or after the surgery. Conclusions. Due to high clinical success and low complication rate in osteoid osteoma surgery, gamma probe application is an effective and safe method that should be used more extensively in daily practice(AU)

Gamma probe guided surgery for osteoid osteoma: is there any additive value of quantitative bone scintigraphy?

OBJECTIVE: The aim of this study is to evaluate the efficiency of gamma probe guided osteoid osteoma surgery and the applicability of quantitative analyses obtained from preoperative bone scan images. MATERIAL AND METHODS: This study involved 12 osteoid osteoma patients who were treated with gamma probe guided surgery after preoperative bone scan. The calculated contrast ratios between nidus and adjacent healthy bone from preoperative bone scan and the calculated percentages of count reduction after resection of nidus during intraoperative gamma probe application were compared. Patients were followed up for any recurrence or complications. RESULTS: The mean contrast ratio between nidus and adjacent healthy bone calculated from preoperative bone scan was 43.6% (range 33-53%). Following the nidus excision, an average of 55.8% (range 28-73%) count reduction was estimated with gamma probe in the tumor area. There was no correlation between preoperative scintigraphic contrast ratio and intraoperative gamma probe count reduction ratio (r = 0.46, p = 0.13). Complete cure was achieved in 11 (92%) patients with single operation, during the postoperative follow up period. None of the patients had any major or minor complications during or after the surgery. CONCLUSIONS: Due to high clinical success and low complication rate in osteoid osteoma surgery, gamma probe application is an effective and safe method that should be used more extensively in daily practice.