The effectiveness of the bone bridge transtibial amputation technique

Kahle, Jason T.; Highsmith, M. Jason; Kenney, John; Ruth, Tim; Lunseth, Paul A.; Ertl, Janos P.

doi:10.1177/0309364616679318

Cited by 13 publications

(5 citation statements)

References 26 publications

(67 reference statements)

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“…Shaneyfelt and Centor [13] evaluated the strength of evidence in cardiology clinical practice guidelines and found 48% of the guidelines were based on low-quality evidence. Similar studies in dermatologic oncology [3], comorbidities in chronic conditions [14], orthopedic surgery [15], fibromyalgia [16], pediatric obesity [17], and wound care [18] have all demonstrated a need for improvement in the strength of evidence for clinical practice guidelines. In this study, we evaluate the strength of the evidence supporting the recommendations constituting the American Academy of Dermatology clinical practice guidelines.…”

Section: Introductionmentioning

confidence: 97%

Evaluation of the Level of Evidence Supporting the Recommendations Constituting the American Academy of Dermatology Clinical Practice Guidelines: Cross-Sectional Analysis

Courtney¹

2020

JMIR Dermatol

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Background Clinical practice guidelines are evidence-based recommendations used by physicians to improve patient care. These guidelines provide the physician with an assessment of the benefits and harms of a treatment and its alternatives. Therefore, it is essential that the clinical practice guidelines be based on the strongest available evidence. Numerous studies in a variety of different fields of medicine have demonstrated that recommendations supported by weak evidence are a common theme in clinical practice guidelines. A clinical guideline based solely on weak evidence has the capability to reduce the quality of care provided by physicians. Objective Our primary objective is to evaluate the levels of evidence supporting the recommendations constituting the American Academy of Dermatology clinical practice guidelines. Methods Using a cross-sectional study design, authors SM and RO located all current clinical practice guidelines on the American Academy of Dermatology website on June 10, 2017, and December 11, 2019. Each recommendation and its corresponding evidence rating were extracted in a duplicate and blinded fashion. A consensus meeting was planned a priori to resolve disagreements in extractions or stratifications. Results In total, 6 clinical guidelines and their subsections were screened and 899 recommendations were identified. Our final data set included 841 recommendations, as 58 recommendations contained no level of evidence and were excluded from calculations. Many recommendations were supported by a moderate level of evidence and therefore received a B rating (346/841, 41.1%). Roughly one-third of the recommendations were supported by a strong level of evidence and were given an A rating (n=307, 36.5%). The clinical practice guideline with the highest overall strength of evidence was regarding the treatment of acne, which had 17 of 35 (48.6%) recommendations supported by strong evidence and only 2 (5.7%) supported by weak evidence. The clinical practice guideline with the fewest recommendations supported by strong evidence was melanoma (13/63, 20.6%). Conclusions Clinical practice guidelines that lack strong supporting evidence could negatively affect patient care, and dermatologists should be mindful that not all recommendations are supported by the strongest level of evidence. An increased quantity of quality research needs to be performed in the field of dermatology to improve the evidence supporting the American Academy of Dermatology clinical practice guidelines.

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Section: Introductionmentioning

confidence: 97%

Evaluation of the Level of Evidence Supporting the Recommendations Constituting the American Academy of Dermatology Clinical Practice Guidelines: Cross-Sectional Analysis

Courtney¹

2020

JMIR Dermatol

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“…In addition, such an intersection substantially complicates the formation of a rational relationship between these anatomical formations in the future organ of support and movement. In recent years, researchers have focused on such particular issues of amputations as predicting wound healing [1], treatment of pain [2][3][4][5][6][7][8], and various modifications of known amputation methods. Unfortunately, such fundamental questions as stump healing, features of reparative processes, and factors influencing their course were not reflected in these works.…”

Section: Introductionmentioning

confidence: 99%

Reparative Regeneration at the End of Bone Filing After Ostoplastic Amputation

et al. 2021

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The aim: To study the role and place of bone grafting in the formation of bone stump after amputation. Materials and methods: 3 series of experiments were carried out on 44 rabbits with amputation of the thigh in the middle third and stump grafting using osteoplastic hermetic closure of the canal with a thin cortical plate (series I), closure of the canal with a spongy bone (series II), and loose closure of the canal with a cortical graft located at the entrance to the canal at an angle of 30° (ІІІ series). Observation period: 1, 3, 6 months. Histological examination method with vascular filling with 10% mascara-gelatin mixture. Results: In series I, in the majority of observations, a stump of a cylindrical shape with a bone locking plate of an osteon-beam structure and normalization of intraosseous microcirculation was formed. A slight displacement of the graft caused a violation of microcirculation. In series II, organotypic stumps were formed in all observations. In series III, incomplete closure of the bone marrow cavity led to sharp microcirculatory disorders and the course of the reparative process with pathological bone remodeling. Conclusions: The parameters of the favorable course of the reparative process and the formation of the organotypic bone stump are the safety of its cylindrical shape, the presence of a compact bone structure, normalization of intraosseous microcirculation.

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“…A lot of works have been devoted to the limb amputations. Recently, the problems of wound healing prognosis [1,4], pain syndrome [9,11,12], amputation techniques in various modifications have been intensively studied [5,7,8,10]. Unfortunately, in these works such important issues as bone stump healing, factors affecting the process of reparative regeneration and stump muscles state were not reflected.…”

Section: Introductionmentioning

confidence: 99%

Functional and morphological state of the amputation stump muscles after various methods of the stump plasty

Шевчук

Bezsmertnyi

et al. 2017

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An assessment of the nature of histochemical and morphological processes in limb stump muscles after various methods of the amputation plasty was given. There were five series of experiments carried out on 55 dogs with the amputation of the hind limb in the middle third of the thigh. There was fascioplasty, myoplasty with suture of the antagonist muscles performed, as well as myodesis with the muscle tension of 916–962 μN, 980–1100 μN, and 650–800 μN. The observation periods consisted of 3 days, 4 weeks, 8 months. The histochemical reactions for determining of succinate dehydrogenase (SDG), NAD·N-dehydrogenase (NAD·H-DH), beta-hydroxybutyrate dehydrogenase (β-HBDG) and lactate dehydrogenase (LDG) were performed on the fresh muscle pieces. The histological examination of the muscles was also carried out. By the end of the observation period, only single unchanged muscular fibers were detected by fascio- and myoplasty. Most of them were replaced by the coarse fibrous connective tissue with fat cells. There was a significant increase in LDG activity (glycolysis) and growth of SDG (Krebs cycle). The activity of NAD·H-DH was high, and the level of β-HBDG significantly reduced. By myodesis with the muscle tension of 916–962 μN the degenerative-dystrophic processes were less significant. There was the decrease in the intensity of the terminal oxidation and oxidation of the ketone bodies observed. The activity of the Krebs cycle increased, and glycolysis grew up. By muscles tension of 980–1100 μN and 650–800 μN there were changes similar to those by fascio- and myoplasty observed.

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The effectiveness of the bone bridge transtibial amputation technique

Cited by 13 publications

References 26 publications

Evaluation of the Level of Evidence Supporting the Recommendations Constituting the American Academy of Dermatology Clinical Practice Guidelines: Cross-Sectional Analysis

Evaluation of the Level of Evidence Supporting the Recommendations Constituting the American Academy of Dermatology Clinical Practice Guidelines: Cross-Sectional Analysis

Reparative Regeneration at the End of Bone Filing After Ostoplastic Amputation

Functional and morphological state of the amputation stump muscles after various methods of the stump plasty

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