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Tourniquets do not increase the total blood loss or reamputation risk in transtibial amputations

World Journal of Orthopedics 2017年第1期8卷 62-67页

作者： Christian Wied Peter T Tengberg Gitte Holm Thomas Kallemose Nicolai B Foss Anders Troelsen Morten T Kristensen Depart-ment of Orthopedic Surgery Copenhagen University Hospital Hvidovre Clinical research Centre Copenhagen University Hospital Hvidovre Department of Anesthesiology and Intensive Care Copenhagen University Hospital Hvidovre Physical Medicine and rehabilita-tion research--Copenhagen Department of Physical TherapyCopenhagen University Hospital Hvidovre

AIM To investigate the total blood loss(TBL) and the safety with respect to the re-amputation rate after transtibial amputation(TTA) conducted with and without a tourniquet. METHODS The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between January 2013 and April 2015. All patients with a primary TTA were assessed for inclusion if the amputation was performed because of arteriosclerosis or diabetic complications. All patients underwent a standardized TTA procedure that was performed approximately 10 cm below the knee joint and performed with sagittalflaps. The pneumatic tourniquet, when used, was inflated around the femur to a pressure of 100 mmH g above the systolic blood pressure. The number of blood transfusions within the first four postoperative days was recorded. The intraoperative blood loss(OBL), which is defined as the volume of blood lost during surgery, was determined from the suction volume and by the weight difference of the surgical dressings. The trigger for a blood transfusion was set at a decrease in the Hgb level re performed with pooled red blood cells containing 245 m L per portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d. reSULTS Seventy-four out of 86 consecutive patients who underwent TTA within the two-year study period were included in the analysis. Of these, 38 were operated on using a tourniquet and 36 were operated on without using a tourniquet. There were no significant preoperative differences between the groups. The patients in both groups had a postoperative decrease in their Hgb level compared with preoperative baseline values. The patients operated on using a tourniquet received approximately three millilitres less blood transfusion per kilogram body weight compared with patients o

关键词： Total blood loss Intraoperative blood loss Transtibial amputation Lower extremity amputation Pneumatic tourniquet re-amputation

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Lower extremity amputations and long-term outcomes in diabetic foot ulcers:A systematic review

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World Journal of Diabetes 2020年第9期11卷 391-399页

作者： Ayeshmanthe Rathnayake Apoorva Saboo Usman H Malabu Henrik Falhammar Department of Medicine Townsville University HospitalTownsville 4814QueenslandAustralia School of Medicine and Dentistry James Cook UniversityTownsville 4811QueenslandAustralia Department of Endocrinology Metabolism and DiabetesKarolinska University HospitalStockholm 17176Sweden Department of Molecular Medicine and Surgery Karolinska InstitutetStockholm 17176Sweden

BACKGROUNDDiabetes mellitus causes a large majority of non-traumatic major and minoramputations globally. Patients with diabetes are clinically complex with amultifactorial association between diabetic foot ulcers (DFU) and subsequentlower extremity amputations (LEA). Few studies show the long-term outcomeswithin the cohort of DFU-associated *** highlight the long-term outcomes of LEA as a result of ***/MEDLINE and Google Scholar were searched for key terms, “diabetes”,“foot ulcers”, “amputations” and “outcomes”. Outcomes such as mortality, reamputation,re-ulceration and functional impact were recorded. Peer-reviewedstudies with adult patients who had DFU, subsequent amputation and follow upof at least 1 year were included. Non-English language articles or studiesinvolving children were *** total of 22 publications with a total of 2334 patients were selected against theinclusion criteria for review. The weighted mean of re-amputation was 20.14%,29.63% and 45.72% at 1, 3 and 5 years respectively. The weighted mean of mortality at 1, 3 and 5 years were 13.62%, 30.25% and 50.55% respectively withsignificantly higher rates associated with major amputation, re-amputation andischemic *** LEA, level of the LEA and patient comorbidities were significant riskfactors contributing to re-ulceration, re-amputation, mortality and depreciatedfunctional status.

关键词： Lower extremity amputations Long-term outcomes Diabetic foot ulcers Quality of life re-amputation Diabetes

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