Defining reproducible criteria for lower extremity salvage following severe high-energy trauma continues to be one of the most challenging and controversially discussed fields in orthopaedic surgery. At present, however, the difficult performance, limited availability and number of valid reconstructive options for complex injury types, i. e. simultaneous osteoligamentous trauma with neurovascular lesions and severe soft tissue defects ("composite/compound multilayer defects") represent the decisive prognostic injury components triggering and determining the fate of the limb. Consequently, due to the complex injury pattern of the extremity and the overall situation of multiple injured patient the treatment and decision making has to be made in a priority-adapted algorithm. In this treatment algorithm interdisciplinary cooperation with vascular and plastic surgeons is of tremendous importance. Although the number of severely injured patients remains stable in the last decade, changes in the treatment algorithms result from increased survival rates of multiple injured patients and improved modern reconstructive options leading to continuously increasing rates of salvaged limbs. This paper aimed to systematically review the current literature for lower extremity injuries in order to unravel the different surgical treatment options and provide guidelines for decision making with corresponding treatment algorithms for limb salvage. Furthermore, the experiences in the management of mangled extremities in our centre are presented and illustrated/underscored with different cases.
- MeSH
- algoritmy MeSH
- lidé MeSH
- polytrauma * etiologie patofyziologie chirurgie MeSH
- poranění cév chirurgie MeSH
- poranění dolní končetiny * etiologie patofyziologie chirurgie MeSH
- poranění měkkých tkání chirurgie MeSH
- poranění periferního nervu chirurgie MeSH
- replantace * škodlivé účinky metody MeSH
- skóre závažnosti úrazu MeSH
- záchrana končetiny * škodlivé účinky metody MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
A sensitive and selective analytical technique is described for the determination of N-acetylaspartic acid in body fluids using stable isotope dilution in combination with positive chemical ionization mass spectrometry with selected ion monitoring. Control mean and ranges have been established: in urine 19.5 and 6.6-35.4 mumol/mmol creat.; in plasma 0.44 and 0.17-0.81 mumol/L; in cerebrospinal fluid 1.51 and 0.25-2.83 mumol/L; and in amniotic fluid 1.27 and 0.30-2.55 mumol/L. In a patient with Canavan disease, N-acetylaspartic acid concentration was elevated 80-fold in urine and 20-fold in plasma compared to the control means. A subsequent pregnancy of the mother was monitored and the N-acetylaspartic acid concentration in the amniotic fluid was within the control range and a healthy child was born.
- MeSH
- amidohydrolasy * nedostatek MeSH
- indikátorové diluční techniky * MeSH
- kojenec MeSH
- kyselina asparagová * analogy a deriváty analýza moč MeSH
- lidé MeSH
- plodová voda * chemie MeSH
- prenatální diagnóza * MeSH
- referenční hodnoty MeSH
- těhotenství MeSH
- tělesné tekutiny * chemie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
131 s. : il., tab. ; 24 cm
