1/13. The medial gastrocnemius muscle flap in the treatment of wound complications following total knee arthroplasty.There is greater potential for wound healing complication in rheumatoids, diabetics, and other patients with peripheral vascular disease. Local wound care in areas of avascularity and skin necrosis has poor results, especially if an ulcer is greater than 2 cm in diameter. Gastrocnemius muscle flap coverage of persistent wounds and areas of skin necrosis following total knee arthroplasty should be considered early in the course of such a complication.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/13. Combination of massive mucinosis, dermatomyositis, pyoderma gangrenosum-like ulcer, bullae and fatal intestinal vasculopathy in a young female.Cutaneous mucinosis secondary to autoimmune collagen vascular disease is well recognized, but manifestation as cellulitis-like massive cutaneous mucinosis preceding dermatomyositis is unusual. Here we report a 21-year-old Taiwanese woman with a large, rapid onset, painful erythematous, edematous plaque, which histopathologically revealed septal panniculitis with fat necrosis and massive mucin deposition. Incapacitated muscle weakness of proximal extremities, generalized edema, heliotrope erythema, and Gottron's papules developed in a short period of time with high titers of serum muscle enzyme. Serological titers of ANA, anti-dsDNA, anti-ENA panels, and erythrocyte sedimentation rate, however, all showed unremarkable results. diagnosis of dermatomyositis was confirmed by electromyographic findings of myopathy. As the disease progressed, large, deep cutaneous ulceration and vesiculobullous lesions also developed. In spite of aggressive treatment, the patient died 9 months after the disease onset, probably due to the complication of gastrointestinal ischemia and perforation.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/13. Severe refractory fingertip ulcerations in a patient with scleroderma: successful treatment with sildenafil.Systemic sclerosis (scleroderma) is a multisystem fibrotic disease that commonly manifests with severe Raynaud's phenomenon and slow-healing cutaneous ulcerations. Reduced nitric oxide levels have been proposed to play a role in the pathogenesis of vascular disease in scleroderma, and therefore sildenafil (which increases nitric oxide levels) is an attractive therapeutic prospect. We describe a patient with limited cutaneous systemic sclerosis who presented with severe nonhealing finger ulcerations despite conventional management, who showed marked improvement with oral sildenafil.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/13. Systemic lupus erythematosus and concurrent cytomegalovirus vasculitis: diagnosis by antemortem skin biopsy.A 45-year-old woman with a 4-year history of systemic lupus erythematosus (SLE) developed fever, decreased visual acuity and skin ulceration. A biopsy of a cutaneous ulcer demonstrated small vessel vasculitis with characteristic cytomegalovirus (CMV) inclusions in the vascular endothelium. The presence of CMV was confirmed by dna hybridization immuno-histochemistry. retinal artery vasculitis, previously associated with flares of her SLE, was also noted on ophthalmologic examination. Our case demonstrates that CMV infection can mimic the cutaneous manifestations of collagen vascular disease and that early identification can be made by biopsy of suspicious skin lesions.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/13. Preoperative assessment of the peripheral vascular disease patient for free tissue transfers.lower extremity reconstruction or salvage in patients with severe peripheral vascular disease is a unique challenge, requiring knowledge of the vascular anatomy, including the location of intraluminal irregularities and stenoses. In a retrospective study that includes four case reports, the authors describe the impressive ability of the Duplex imaging system, to assist in the proper selection of recipient vessels and of those areas within the vessels most suitable for anastomoses.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
6/13. Use of injectable collagen to treat chronic diabetic foot ulcers.A significant portion of the population suffer from diabetic foot ulcers. While conservative treatment is often successful, many diabetic patients with accompanying peripheral vascular disease and neuropathy are under constant medical care for chronic, recurring foot ulcers. A new injectable biomaterial, Keragen Implant, was evaluated on two patients with bilateral diabetic ulcers. The implanted lesions healed completely during the months following treatment. Control lesions treated by conventional means remained open and ulcerated.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/13. Diabetic osteomyelitis: long-term attempts at salvage with eventual mortality.Long-term complications of diabetes mellitus with respect to the lower extremities are well known to the podiatric profession. The author presents a case of a diabetic with multisystem pathology who underwent several salvage procedures for osteomyelitis and later expired from cardiovascular disease. The multi-system nature of diabetes necessitates a team approach in management of the acutely ill diabetic patient.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/13. 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) |
9/13. Clostridial myonecrosis in a patient undergoing oxacillin therapy for exacerbation of chronic foot ulcers and osteomyelitis. A case report.gas gangrene developed from a chronic foot ulcer in the absence of periferal vascular disease or diabetes mellitus in a hospitalized patient undergoing parenteral antibiotic therapy. Within a 6 hour period the patient developed profound toxemia necessitating emergency and life saving leg amputation. Classically clostridial myonecrosis is diagnosed by the clinical course and the gram stain. In this case, 2 preoperative gram stains failed to show gram-positive rods. At the time of surgery, frank fasical and muscle necrosis in the peroneal compartment dictated extending the below knee amputation to above the knee. In retrospect demonstration of clostridial species and myonecrosis in the pathological specimen confirmed the clinical impression. The identified organism, clostridium sporogenes has rarely been implicated as a cause of gas gangrene.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/13. Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change.The diagnosis of diabetic neuroarthropathy of the foot can be difficult. A series of 96 patients (116 extremities) who had diabetes and peripheral neuropathy with bone and joint changes was reviewed. Typically, the patients were middle-aged or older, were taking insulin, and had had diabetes for more than 10 years. Retinopathy, nephropathy, and peripheral vascular disease were often present. There were abnormalities of vibratory sensation (94%) and of the gastrosoleus reflex (88%). The finding of specific radiographic abnormalities assisted but did not reliably differentiate neuropathy from infection. Three patterns of radiographic changes were noted: (1) at the metatarsophalangeal and interphalangeal joints, usually with underlying ulceration; (2) at the tarsometatarsal joints; and (3) in the anterior pillar-medial column of the foot, with talus, talonavicular, navicular, or naviculocuneiform destruction. Ulceration and infection in patients with patterns (2) and (3) were rare. When correlated, the demographic features, mode of presentation, physical signs, specific radiographic abnormalities, and patterns of change were distinctive and allowed the diagnosis of this complication of diabetes to be readily made.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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