1/7. The reversal sural artery neurocutaneous island flap in composite lower extremity wound reconstruction.Reconstruction of the lower third of the leg and the forefoot remains a challenge due to a lack of regional muscle units and minimal subcutaneous tissues. Reverse island flaps have been applied to similar reconstructive problems in the upper extremity. Recently, the reverse sural artery neurocutaneous island flap has been utilized to reconstruct complex wounds of the lower extremity and forefoot in young and middle-aged individuals. We present our use of the flap in a patient cohort 65 years of age or older. Unique among this group was the high prevalence of diabetes and peripheral vascular disease. Nonetheless, the reverse sural artery neurocutaneous island flap proved a safe and reliable means of achieving wound closure.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/7. Leg ulcers due to hyperhomocysteinemia.Chronic leg ulcers are rare in young adults and generally indicate a vascular cause. We report a case of a 26-year-old man with leg ulcers of eight months duration. Doppler study indicated venous incompetence and a postphlebitic limb. However, as the distribution and number of ulcers was not consistent with stasis alone and no features of collagen vascular disease were noted, a hyperviscosity state was considered and confirmed with significantly elevated homocysteine level in the serum. Administration of vitamins B1, B2, B6 and B12, trimethyl-glycine, mecobalamine, folic acid and povidone iodine dressings with culture-directed antibiotic therapy led to a satisfactory healing of ulcers over a period of one month. hyperhomocysteinemia must be considered in the differential diagnosis of leg ulcers in young individuals.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/7. pyoderma gangrenosum with cutaneous T-cell lymphoma manifested as lower extremity ulcers--case reports.patients with extensive lower extremity ulcerations initially thought to be vascular disease were subsequently proved to have pyoderma gangrenosum and malignant lymphoma. Both patients died of sepsis; one patient exhibited hypogammaglobulinemia involving immunoglobulins IgA, IgG, and IgE; in the second patient, a polyclonal excess involving IgA and IgE was present.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/7. Bilateral extensive skin necrosis of the lower limbs following prolonged epidural blockade.skin necrosis has not been described as a complication following epidural sympathetic blockade. We report a case of bilateral extensive skin necrosis of the lower limbs after a 48-hour lumbar epidural blockade in a 71-year-old patient with right hemiplegia and mitral valve regurgitation, without any preoperative clinical evidence of peripheral vascular disease or diabetes, who underwent transurethral prostatectomy.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/7. Chronic leg ulcers and Klinefelter's syndrome.Venous and arterial leg ulcers have been reported in patients with Klinefelter's syndrome. We report a case of Klinefelter's syndrome associated with chronic leg and foot ulcers and thrombophlebitis. Both venous and arterial vascular disease seems to be associated with Klinefelter's syndrome and should be considered in men presenting with chronic leg and foot ulcers.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/7. Vascular ulcers in scleroderma.Seven patients with scleroderma and either livedo reticularis or atrophie blanche lesions had ulcers of the lower extremity. Livedoid vasculitis, periarteritis nodosa, or endarteritis obliterans lesions were associated with the ulcers. Five patients had livedoid vasculitis, one patient had associated lupus panniculitis, and one patient had rheumatoid arthritis. Four patients had elevated ESRs, four had positive antinuclear antibody tests, and two had positive tests for rheumatoid factor. patients with scleroderma and livedoid vasculitis or livedo reticularis and ulcers should be examined to rule out underlying vascular disease or endarteritis obliterans.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/7. limb salvage with microvascular free flap reconstruction using simultaneous polytetrafluoroethylene graft for inflow.Microvascular free flaps have been successfully used to cover defects of the lower extremity. In patients with peripheral vascular disease and lower extremity defects, revascularization with in situ or reversed saphenous vein bypass graft combined with microvascular tissue transfer can salvage a limb that would otherwise be amputated. However, some of these patients may not have autologous vein available for the bypass procedure. We present a case of a 69-year-old man who underwent revascularization with a long polytetrafluoroethylene (PTFE) graft and a simultaneous microvascular free flap reconstruction using the PTFE graft as the inflow. The patient had undergone coronary artery bypass graft with saphenous vein and experienced a nonhealing wound of the distal saphenous vein harvest site and exposure of 8 cm of tibia. Angiogram revealed a significant stenosis of the common iliac artery, occluded superficial femoral artery, faint filling of the profunda femoris artery, and a faintly reconstituted posterior tibial artery. Because the patient had no available saphenous vein for bypass, he underwent an axillary-profunda and profunda-posterior tibial artery bypass with PTFE. A rectus abdominus microvascular free flap with direct anastomosis of the inferior epigastric artery to the PTFE was used to cover the exposed bone. The patient currently ambulates without difficulty. limb salvage using bypass with PTFE combined with simultaneous microvascular free flap reconstruction is possible in selected patients.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |