Outcome of complex vascular and orthopedic injuries of the lower extremity

Article Abstract:

Complicated vascular and orthopedic injuries of the leg can result in amputation rates as high as 78 percent, even when the vascular injury is repaired. On the other hand, aggressive attempts to save the leg are associated with high rates of chronic disability and even death; it is therefore important that patients be carefully selected for this treatment. A study was undertaken of 32 patients with complex vascular and orthopedic injuries undergoing leg-salvage surgery. The purpose of the study was to identify factors that might predict outcome, and determine the appropriateness of salvage versus immediate amputation. Eighty-one percent of the patients were male and the average age was 27.4 years. In most cases (91 percent), the injury was a result of blunt trauma following a car, motorcycle, or industrial accident, or a fall. Twenty-one patients (66 percent) had major injury to the soft tissue, 38 percent had nerve injury and 47 percent had distant injury involving the head, spine, pelvis or abdomen. A team approach including vascular, orthopedic and plastic surgery was employed. There was one death as a result of another body injury and sepsis (contamination or poisoning of the system by infection). Nine patients (28 percent) eventually required amputation and 13 patients (56 percent) with salvaged legs had lasting neurologic or functional disability. The most significant factor associated with amputation was development of infection; this occurred despite use of antibiotics before and after surgery. The delay in amputation significantly extended the patients' hospitalizations. It is recommended that if there is documentation of nerve transection, early amputation should be carried out. To limit the chance of infection, tissue debridement (removal of dead tissue), intravenous antibiotics and early coverage of the open wound are recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Injuries, Prevention, Leg, Blood vessels, Leg injuries, Amputations of leg, Leg amputation, Fractures, Open, Open fractures

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Preexisting disease as a predictor of the outcome of colectomy

Article Abstract:

Over the past 25 years, major progress has been made in improving survival of patients who undergo colectomy (excision of part or all of the colon). Colectomy is performed to treat colon cancer or other intestinal conditions such as diverticular disease, volvulus and bowel perforation. It has been generally accepted that elderly patients have a poor outcome in surgery. Based on their clinical experience, the authors suggest that the presence of preexisting disease, not age alone, is the best predictor of a patient's outcome following colectomy. This observation prompted a retrospective review of 310 patients who underwent colectomy over the past six years. Patients were grouped by age: 84 patients were 75 years or older, 128 were between 60 and 75 years, and 98 were less than 60 years. Overall mortality was 13 percent in the eldest group, 2 percent in the middle group, and 1 percent in the youngest group. Two or more associated diseases were found in 37 percent of the eldest group, 24 percent of the middle group and 2 percent of the youngest group. The death rate among patients with two or more associated diseases who were in the oldest age group was 31 percent, compared with 7 percent for the middle age group and no deaths in the youngest group. These findings suggest that the risk of colectomy is not increased by advanced age alone. The number of concomitant diseases that exist in patients over the age of 60 can be useful in predicting the outcome of patients who undergo colon resection. The authors suggest that if a patient has two or more preexisting diseases and is over 75 years of age, removal of malignant polyps via colonoscopy may be followed by surveillance colonoscopy rather than colectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aged, Elderly, Prognosis, Surgery, Colorectal diseases, Intestinal diseases, Colectomy

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