China
Africa
Explore chapters and articles related to this topic
Potential of Thermal Imaging to Detect Complications in Diabetes
Published in U. Snekhalatha, K. Palani Thanaraj, Kurt Ammer, Artificial Intelligence-Based Infrared Thermal Image Processing and Its Applications, 2023
U. Snekhalatha, K. Palani Thanaraj, Kurt Ammer
The rank correlation coefficient of the two subject groups, namely the control group and the diabetic group is provided in Figures 6.9 and 6.10, respectively. Interpretation of the correlogram or correlation matrix allows us to analyze the relationship between each pair of numeric variables of the dataset. We could observe that there is a strong correlation between the contralateral regions of the angiosome in the control group compared to the diabetic group. This suggests that plantar skin temperatures show a non-uniform temperature distribution in DM which could be due to neuropathy or an early indication of diabetic ulcer. Thus, IRT could be a good prognostic tool in the detection of foot problems.
Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
How would your revascularisation plan change if angiography showed mild disease above the knee, but heavily calcified and multiple stenoses in all three crural vessels? The anterior tibial runs to the foot.There are three options: Endovascular, surgical, and a hybrid procedure.Revascularisation should follow the concept of angiosome, which is an area of skin and underlying tissues vascularised by a source artery. For instance, the big toe is supplied by the anterior tibial artery, and the posterior tibial artery supplies the heel. Every effort should be made to revascularise the artery according to the area of tissue loss. The concept is not only crucial to vascular specialists, but also plastic surgeons for the creation of perforator flaps.A total revascularisation plan should be implemented in the setting of significant tissue loss (Rutherford 6 wound), to optimise the blood supply as much as possible to the foot.
Complex lower extremity revascularization
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
In healthy patients with normal anatomy, it can be assumed that there is significant collateralization between the tibial vessels and also at the pedal loop. In diabetic patients and especially those with renal failure, the flow typically becomes compartmentalized. Although there may still be some collaterals, they are typically not of the same quality as in the normal anatomy. The concept of angiosomes of the foot then becomes important if each of these areas are isolated or nearly isolated (Figure 25.18). It may significantly affect the choice of which tibial artery to revascularize. An idealistic view of the angiosome concept assumes that there are separate areas that must each be treated. The truth is that there is significant variation from patient to patient and the angiosome concept can be used as a guide but is not a guarantee. If you focus on the wound-related artery, the odds are that perfusion will be improved in the correct location. There are multiple disadvantages of the angiosome concept including the variability, the fact that it does not really work with the peroneal artery because the collaterals cannot be assessed, and that it may not be important for patients with rest pain or very small wounds. There are multiple retrospective studies suggesting that direct revascularization to the correct angiosomes results in better wound healing. There are other studies suggesting that it does not make a difference in a large majority of patients.
The shark flap: a modified internal mammary artery perforator flap for composite defects in head and neck reconstruction
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Anna Scarabosio, Alessandro Tel, Filippo Contessi Negrini, Roberta Albanese, Massimo Robiony, Piercamillo Parodi
This preliminary report presents new strategies to the reconstruction of complex head and neck defects which can be treated by using composite design flaps. The chance to be able to customize a secondary, random-based area, perpendicularly oriented to the main vascular axis of the IMAP, may be useful particularly in head and neck because of its spatial complexity. The Authors suggest that this type of design can be considered reliable, reproducible and scalable for many types of reconstruction of the head and neck region. In addition, the supplementary, random-based, skin paddle attached to the IMAP flap extends reconstructive possibilities for this technique even for defects of larger size and located more medially. However, a more specific vascular study of the anatomic angiosome performed on higher numbers will be necessary to support this idea and define the underlying anatomical principles. In addition, it has surely to be mentioned that this was not the only viable strategy to cover this defect. Other options may be: first the submental flap which would enable the reconstruction of the initial defect avoiding the utilization of a second flap; second, the supraclavicular flap and, finally, the anterior supraclavicular artery perforator (a-SAP) flap based on the anterior supraclavicular vessels.
The impact of an angiosome-targeted revascularization on healing rate, limb salvage and survival in critical limb threatening ischemia
Published in Acta Chirurgica Belgica, 2022
Alexander Croo, Timothy Versyck, Alec Duinslaeger, Charlotte Harth, Frank Vermassen, Caren Randon
An angiosome is an anatomic unit of tissue consisting of skin, subcutaneous tissue, fascia, muscle and bone fed by a specific source artery arising from one of the 3 crural vessels and drained by a corresponding vein. The foot is divided into 6 angiosomes originating from the three main crural arteries. The anterior tibial artery (ATA) and peroneal artery (PA) both supply one angiosome, whereas the posterior tibial artery (PTA) supplies three angiosomes. The ATA supplies the dorsal side of the foot and toes, the PA covers the lateral ankle and lateral heel and the PTA perfuses the plantar surface of the foot and medial heel and ankle. Neighboring angiosomes are connected to each other by a network of small collateral arteries, called choke vessels, ensuring circulation to an angiosome if its source artery is occluded. However, the collateral network is usually reduced in patients with CLTI and especially in diabetics [4].
An early complication in the donor site of the medial sural artery perforator flap: necrosis of the medial head of gastrocnemius
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Hui-Ju Tsou, Chih-Peng Tu, Yu-Fan Chen, Wen-Teng Yao
Dusseldorp et al. recently defined a new classification of the intra-muscular branching pattern of the medial sural artery [10]. There are four types: type I of a single branch, type IIA of dual branching with high take-off point above the tibial plateau, type IIB of dual branching with low take-off point below the tibial plateau, and type III of three or more branches. In type IIA, one of the dual-branch that is not dissected during flap harvest could be preserved due to the high take-off point. However, in type IIB, due to the low take-off point, the other branch that is not dissected would be sacrificed as well if the pedicle is dissected up to the origin of the medial sural artery. In the latter case, as in type I branching pattern, once the pedicle is elevated, the proximal blood supply of the medial gastrocnemius muscle is compromised. Therefore, the remaining blood supply from adjacent angiosome becomes extraordinarily important.