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Limb salvage in extensive leg gangrene
EMILIO CALABRESE MD.
International Center for Limb Salvage
www.gfmer.ch/ICLS/Homepage.htm
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Diarrhea produced by prolonged antibiotic treatmentRehydration was needed and control of diarrhea had to be achieved
before revascularization procedures could be initiated
11/5/2008 4Occlusion of superficial femoral artery
Popliteal artery reconstituted by collaterals just above the knee
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September 1, 1998Operative field with plastic sealing of the gangrenous area
The bypass had to be performed through a tunnel
underneath the ulcerated areas
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Cristiana Quattrone MD as surgeon and Vittorio Petralia RN
involved in a limb salvage procedure
11/5/2008 21One-year after the bypass a proximal graft stenosis developed
It was treated by PTA and stenting with two coronary stents
Vein graft
stenosisThe vein graft has
been dilated and
stented
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June 29, 1999
X-ray 4-day after coronary stents insertionNote: more recent data suggest that this type of stent should not be used in this
superficial postion because they are balloon-expandable, not self-expandable,
and are subject to external pressure.
In fact these stents crashed and eventually occluded
11/5/2008 28January 17, 2001
A hybrid procedure is performed
isolating the femoral artery at the groin in the angio suite
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Conclusions
Extensive gangrene of the leg can be sometimes be treated with a venous bypass in proximity of damaged areas
Uncovered tendons can be surrounded by granulation tissue and may ultimately heal
Antibiotic abuse may cause severe side effects
Long term limb salvage can be achieved
When a bypass eventually fails, PTA and stenting could still be done, opening either the bypass itself or the native vessels