Kuiken Todd A
Full Text Available Abstract Background Surgical treatment of neuromas involves excision of neuromas proximally to the level of grossly "normal" fascicles; however, proximal changes at the axonal level may have both functional and therapeutic implications with regard to amputated nerves. In order to better understand the retrograde "zone of injury" that occurs after nerve transection, we investigated the gross and histologic changes in transected nerves using a rabbit forelimb amputation model. Methods Four New Zealand White rabbits underwent a forelimb amputation with transection and preservation of the median, radial, and ulnar nerves. After 8 weeks, serial sections of the amputated nerves were then obtained in a distal-to-proximal direction toward the brachial plexus. Quantitative histomorphometric analysis was performed on all nerve specimens. Results All nerves demonstrated statistically significant increases in nerve cross-sectional area between treatment and control limbs at the distal nerve end, but these differences were not observed 10 mm more proximal to the neuroma bulb. At the axonal level, an increased number of myelinated fibers were seen at the distal end of all amputated nerves. The number of myelinated fibers progressively decreased in proximal sections, normalizing at 15 mm proximally, or the level of the brachial plexus. The cross-sectional area of myelinated fibers was significantly decreased in all sections of the treatment nerves, indicating that atrophic axonal changes proceed proximally at least to the level of the brachial plexus. Conclusions Morphologic changes at the axonal level extend beyond the region of gross neuroma formation in a distal-to-proximal fashion after nerve transection. This discrepancy between gross and histologic neuromas signifies the need for improved standardization among neuroma models, while also providing a fresh perspective on how we should view neuromas during peripheral nerve surgery.
van Zeeland, Y.R.A.; Hernandez-Divers, S.J.; Blasier, M.W.; Vila-Garcia, G.; Delong, D.; Stedman, N.L.
Vet Rec. 2006 Dec 2;159(23):782-5. Carpal myxosarcoma and forelimb amputation in a ferret (Mustela putorius furo). van Zeeland YR, Hernandez-Divers SJ, Blasier MW, Vila-Garcia G, Delong D, Stedman NL. Department of Small Animal Medicine, Faculty of Veterinary Medicine, University of Utrecht, Utrecht
... machine components are hazardous? The following types of mechanical components present amputation hazards: s Point of operation —the area of a machine where it performs work on material. s Power-transmission apparatuses — flywheels, pulleys, belts, chains, couplings, spindles, cams, ...
... critical care management. A well-fitting and functional prosthesis can speed rehabilitation. Causes Traumatic amputations usually result ... More Bleeding Cuts and puncture wounds Leg or foot amputation Shock Patient Instructions Foot amputation - discharge Leg ...
Schnur, David; Meier, Robert H
The best level of amputation must take into consideration the newest socket designs, methods of prosthetic suspension, and technologically advanced components. In some instances stump revision should be considered, to provide a better prosthetic fitting and function. Targeted reinnervation is a new neural-machine interface that has been developed to help improve the function of electrically powered upper prosthetic limbs. Osseointegrated implants for prosthetic suspension offer amputees an alternative to the traditional socket suspension, and are especially useful for transfemoral and transhumeral levels of amputation. Cadaver bone can be used to lengthen an extremely short residual bony lever arm.
Objective. Amputation through the diaphysis of the femur at the most peripheral level possible. The stump, covered with soft tissue flaps, is free from pain. It can be fitted with a total contact prosthetic socket. The hip joint is preserved with its full range of motion.Indications. When no possibility to amputate at a more distal level through the tibia or the knee joint exists.Contraindications. When it is possible to amputate at a more distal level.Surgical technique. Symmetrical flaps in the frontal plane are recommended. Asymmetrical flaps and flaps in the sagittal plane can also be made. Their muscles are fixed to each other (myodesis) or the bone end by means of transosseous sutures (myopexy). The ischial nerve has to be shortened about 2 inches proximal to the end of the femur.In peripheral vascular diseases, this procedure is not suitable. An alternative technique is suggested.In chronic osteomyelitis (e.g., after intramedullary nailing), the ventral half of the femur can be removed and the medullary cavity cleansed and filled with a muscular flap in order to maintain length. Lengthening procedures of the femur are discussed.Postoperative management. Avoid active or passive movement of the stump for the first 2 weeks in order not to disturb healing of the muscle sutures. Physical therapy, prosthetic fitting after 4–6 weeks, according to the expected functional level 0–4. Aids: crutches, wheel chair, adjustable bed, modified hand-controlled automobile.The walking ability of a patient with a double amputation above the knee is severely limited and in patients with peripheral artery disease remains the exception.
Ovadia, Steven A; Askari, Morad
Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions.
Pinzur, M S
The author presents in a condensed way an overview of the principles of limb amputations and further treatment of patients who underwent such a procedure. The metabolic cost of walking, load transfer, and wound healing are reviewed in a concise manner. Particular attention is given to blood supply to the wound and methods to determine adequate perfusion with a clear analysis of the pro and cons of the Doppler method. Pediatric amputations, because of their specificity, are considered apart. Disarticulation of limbs is the method of choice in children, because of it retains growth potential of the bone and prevents bony overgrowth of the stump. The article discusses the main indications for limb amputations: trauma, peripheral vascular disease, musculoskeletal tumors and gas gangrene. In every case the specificity of the amputation is considered by the author. Postoperative care is also presented, with a short description of possible complications. Pain is the most common and treatment strategies should be similar to those used in treating patients with major reflex sympathetic causalgia. Edema, joint contracture, wound failure and dermatologic problems are all shortly reviewed. The last part of the article treats with the principles of prosthetics in both the upper and lower limb. These principles are presented basing on the level of amputation: for the upper limb hand, transradial, transhumeral amputations and shoulder disarticulation. For the lower limb foot and ankle, transtibial and transfemoral amputations are considered.
Ebskov, L B; Schroeder, T V; Holstein, P E
The number of amputations performed for vascular disease in Denmark has decreased from 1777 (34.5 per 100,000 population) in 1983 to 1288 (25.0 per 100,000) in 1990, a reduction of 28 per cent. This decline coincided with an increase in vascular surgical activity of up to 100 per cent, including ...
Is salamander limb regeneration really perfect? Anatomical and morphogenetic analysis of forelimb muscle regeneration in GFP-transgenic axolotls as a basis for regenerative, developmental, and evolutionary studies.
Diogo, R; Nacu, E; Tanaka, E M
The axolotl Ambystoma mexicanum is one of the most commonly used model organisms in developmental and regenerative studies because it can reconstitute what is believed to be a completely normal anatomical and functional forelimb/hindlimb after amputation. However, to date it has not been confirmed whether each regenerated forelimb muscle is really a "perfect" copy of the original muscle. This study describes the regeneration of the arm, forearm, hand, and some pectoral muscles (e.g., coracoradialis) in transgenic axolotls that express green fluorescent protein (GFP) in muscle fibers. The observations found that: (1) there were muscle anomalies in 43% of the regenerated forelimbs; (2) however, on average in each regenerated forelimb there are anomalies in only 2.5% of the total number of muscles examined, and there were no significant differences observed in the specific insertion and origin of the other muscles analyzed; (3) one of the most notable and common anomalies (seen in 35% of the regenerated forelimbs) was the presence of a fleshy coracoradialis at the level of the arm; this is a particularly outstanding configuration because in axolotls and in urodeles in general this muscle only has a thin tendon at the level of the arm, and the additional fleshy belly in the regenerated arms is strikingly similar to the fleshy biceps brachii of amniotes, suggesting a remarkable parallel between a regeneration defect and a major phenotypic change that occurred during tetrapod limb evolution; (4) during forelimb muscle regeneration there was a clear proximo-distal and radio-ulnar morphogenetic gradient, as seen in normal development, but also a ventro-dorsal gradient in the order of regeneration, which was not previously described in the literature. These results have broader implications for regenerative, evolutionary, developmental and morphogenetic studies.
Hirai, M; Tokuhiro, A; Takechi, H
Stump problems in amputations resulting from employment related injuries were investigated in 397 cases in the Chugoku and Shikoku districts of Japan between 1987 and 1991. Ninety-seven patients (24%) had stump problems which interfered the prosthetic fitting. Stump problems of the upper extremity were seen in about 9% (17 amputees), two thirds of which were skin troubles. Stump problems of the lower extremity were seen in about 37% (80 amputees). Certain complaints were associated with specific methods of amputation; abnormal keratosis in Syme's amputation, equinus deformity in Chopart's amputation, reduced muscle power in above the knee (A/K) amputation and joint dysfunction in below the knee (B/K) amputation. Adequate prosthetic fitting was achieved by the modification of the socket and alignment in almost all amputees with stump problems. In only two cases, Chopart's amputation required subsequent Syme's amputation due to equinus deformity with abnormal keratosis. In almost every case, stump problems are avoidable by means of surgeons' deliberate evaluation of the affected limb and adequate choice of the amputation level.
Wang, Xia; Clarke, Julia A
Previous work has shown that the relative proportions of wing components (i.e., humerus, ulna, carpometacarpus) in birds are related to function and ecology, but these have rarely been investigated in a phylogenetic context. Waterbirds including "Pelecaniformes," Ciconiiformes, Procellariiformes, Sphenisciformes, and Gaviiformes form a highly supported clade and developed a great diversity of wing forms and foraging ecologies. In this study, forelimb disparity in the waterbird clade was assessed in a phylogenetic context. Phylogenetic signal was assessed via Pagel's lambda, Blomberg's K, and permutation tests. We find that different waterbird clades are clearly separated based on forelimb component proportions, which are significantly correlated with phylogeny but not with flight style. Most of the traditional contents of "Pelecaniformes" (e.g., pelicans, cormorants, and boobies) cluster with Ciconiiformes (herons and storks) and occupy a reduced morphospace. These taxa are closely related phylogenetically but exhibit a wide range of ecologies and flight styles. Procellariiformes (e.g., petrels, albatross, and shearwaters) occupy a wide range of morphospace, characterized primarily by variation in the relative length of carpometacarpus and ulna. Gaviiformes (loons) surprisingly occupy a wing morphospace closest to diving petrels and penguins. Whether this result may reflect wing proportions plesiomorphic for the waterbird clade or a functional signal is unclear. A Bayesian approach detecting significant rate shifts across phylogeny recovered two such shifts. At the base of the two sister clades Sphenisciformes + Procellariiformes, a shift to an increase evolutionary rate of change is inferred for the ulna and carpometacarpus. Thus, changes in wing shape begin prior to the loss of flight in the wing-propelled diving clade. Several shifts to slower rate of change are recovered within stem penguins.
Is salamander hindlimb regeneration similar to that of the forelimb? Anatomical and morphogenetic analysis of hindlimb muscle regeneration in GFP-transgenic axolotls as a basis for regenerative and developmental studies.
Diogo, R; Murawala, P; Tanaka, E M
The axolotl Ambystoma mexicanum is one of the most used model organisms in developmental and regenerative studies because it is commonly said that it can reconstitute a normal and fully functional forelimb/hindlimb after amputation. However, there is not a publication that has described in detail the regeneration of the axolotl hindlimb muscles. Here we describe and illustrate, for the first time, the regeneration of the thigh, leg and foot muscles in transgenic axolotls that express green fluorescent protein in muscle fibers and compare our results with data obtained by us and by other authors about axolotl forelimb regeneration and about fore- and hindlimb ontogeny in axolotls, frogs and other tetrapods. Our observations and comparisons point out that: (1) there are no muscle anomalies in any regenerated axolotl hindlimbs, in clear contrast to our previous study of axolotl forelimb regeneration, where we found muscle anomalies in 43% of the regenerated forelimbs; (2) during axolotl hindlimb regeneration there is a proximo-distal and a tibio-fibular morphogenetic gradient in the order of muscle regeneration and differentiation, but not a ventro-dorsal gradient, whereas our previous studies showed that in axolotl forelimb muscle regeneration there are proximo-distal, radio-ulnar and ventro-dorsal morphogenetic gradients. We discuss the broader implications of these observations for regenerative, evolutionary, developmental and morphogenetic studies.
Woodacre, Timothy; Marshall, Morwena
Wakeboarding is a sport increasing in popularity in the UK and the rest of the world. It is known to be associated with a high incidence of relatively minor injuries to the participating sportsperson. The authors present the case of a traumatic hand amputation to an associated third party and highlight the potential for serious injuries to all those directly involved with the sport. The authors demonstrate the successful application of military principles to a traumatic amputation in a civilian setting. PMID:22693318
Matthews, D; Sukeik, M; Haddad, F
Amputation in athletes has a substantial impact on lifestyle and sporting activity, as well as self-perception and quality of life. The impact of limb loss on athletic ability will vary depending on the cause of amputation and the anatomical location of the amputation. The use of sporting activity for rehabilitation of amputees was first introduced in 1944 at Stoke Mandeville Hospital. The first international paralympic games were founded in 1960. Following these events the opportunity to participate in sport following limb loss has increased significantly. Sport participation has been aided by the development of sporting prostheses, however multiple factors will determine the exact prosthesis used. These include the nature of the sporting activity as well as the level of the amputation. The biomechanics involved in walking and running are altered following the loss of a limb or part thereof. This can cause subsequent degenerative changes within the remaining joints on the amputated limb as well as the contralateral limb. Factors affecting return to sporting activity are multivariate and inter-related, including patient factors, surgical factors, nature and level of the sporting activity and prosthetic factors. The authors review current literature, detail predictive factors of return to sport and the physical and psychosocial impact on patients following limb amputation.
Mohamed, I A; Ahmed, A R; Ahmed, M E
One hundred and seventy patients with major lower limb amputation (MLLA) presenting to The National Prosthetic-Orthotic Centre (NPOC) in Khartoum over a 1-year period were studied. There were 141 males and 29 females giving a M:F ratio of 4.9: 1.0, with mean age of 37 years (range 5-72 years). Forty-one patients (24%) underwent amputation of diabetic septic foot, 30 patients (17.6%) underwent amputation as a result of trauma from road traffic accidents and Madura foot, and war injuries accounted for 29 amputations (17%). One hundred and eleven patients had below knee amputation (BKA), 52 had above knee amputation (AKA) and seven patients had Syme's amputation. Diabetic amputees had higher rate of revisional surgery compared with others because of sepsis and/or flap necrosis. Stump pain was reported by amputees with excessive scarring of the stump and those with undue prominence of bony ends. There are two types of prostheses provided by the NPOC for both BKA and AKA: the peg leg and the conventional prostheses. The Syme's amputees were fitted with either simple hoof or articulated prostheses with solid ankle cushion heel (SACH). The peg leg consists of a leather lined side bearing metal socket connected to a rocker base by side steels. It is used by the country natives as it suits different weather and job conditions, particularly farming, and it can be repaired locally. The urban population use the conventional prostheses which is lighter in weight, can be put on and taken off easily and is cosmetically acceptable. However, these prostheses are more expensive and require frequent repair or replacement. The functional outcome of patient's rehabilitation with the prostheses was significantly affected by the level and indication of amputation. Those with BKA and those amputated because of trauma or Madura foot experienced better functional outcome compared with the diabetics, independent of age. 50% of patients with the AKA and 19% of those with BKA reported poor
Long, Jeri; Hall, Virginia
Acute limb ischemia is a complication of severe peripheral arterial disease that can be a threatening limb as well as life. Multiple procedures exist today to help revascularize extremities; however, even with the latest technologies, surgical amputation of the limb may still be necessary. Cryoamputation, or physiologic amputation, is a method used to treat patients who are hemodynamically unstable for the operating room and who are in need of urgent amputation owing to arterial ischemia. This procedure is used in the rare instance where not only a persons' limb is threatened, but also their life. This is a case study regarding one patient who presented to the hospital with limb-threatening ischemia who became hemodynamically unstable owing to the rhabdomyolysis associated with the ischemia of his lower extremity. Cryoamputation was used to stabilize the patient and prevent further deterioration, so that he could safely undergo surgical amputation of the limb without an increase in mortality risk. Cryoamputation must be followed by formal surgical amputation when the patient is hemodynamically stabilized. It is not a limb salvaging, procedure but it is a life-saving procedure. This case study demonstrates the usefulness of the procedure and discusses the technique used for cryoamputation.
Kasten, M. R.; Sunshine, M. D.; Secrist, E. S.; Horner, P. J.; Moritz, C. T.
Objective. Intraspinal microstimulation (ISMS) is a promising method for activating the spinal cord distal to an injury. The objectives of this study were to examine the ability of chronically implanted stimulating wires within the cervical spinal cord to (1) directly produce forelimb movements, and (2) assess whether ISMS stimulation could improve subsequent volitional control of paretic extremities following injury. Approach. We developed a technique for implanting intraspinal stimulating electrodes within the cervical spinal cord segments C6-T1 of Long-Evans rats. Beginning 4 weeks after a severe cervical contusion injury at C4-C5, animals in the treatment condition received therapeutic ISMS 7 hours/day, 5 days/week for the following 12 weeks. Main results. Over 12 weeks of therapeutic ISMS, stimulus-evoked forelimb movements were relatively stable. We also explored whether therapeutic ISMS promoted recovery of forelimb reaching movements. Animals receiving daily therapeutic ISMS performed significantly better than unstimulated animals during behavioural tests conducted without stimulation. Quantitative video analysis of forelimb movements showed that stimulated animals performed better in the movements reinforced by stimulation, including extending the elbow to advance the forelimb and opening the digits. While threshold current to elicit forelimb movement gradually increased over time, no differences were observed between chronically stimulated and unstimulated electrodes suggesting that no additional tissue damage was produced by the electrical stimulation. Significance. The results indicate that therapeutic intraspinal stimulation delivered via chronic microwire implants within the cervical spinal cord confers benefits extending beyond the period of stimulation, suggesting future strategies for neural devices to promote sustained recovery after injury.
Blom, Rianne M; Guglielmi, Valeria; Denys, D.
Patients with body integrity identity disorder (BIID) experience a strong desire for amputation from very early on. BIID patients are often dismissed when they share their wish for amputation with surgeons. Consequently, patients resort to self-amputation, including complications and sometimes death
K. Rojaramani Kumbha
Full Text Available Advanced Technology and early detection of disease by recent improvements in investigation modalities lead to decreased incidents of amputations while Road Traffic Accidents (RTA increase. Furthermore, it leads to variation and decreased morbidity, mortality and accidents (crush injuries, and better equipped and trained staff, specialist services, diabetic food, rehabilitation centres, and giving good support physically and psychologically for Amputated patients. OBJECTIVE To know incidence rates of Emergency Amputation who attended causality with advanced disease and severe Trauma. METHODOLOGY The study is done over a period of one year i.e. between June 2015 to June 2016 who attended causality with advanced and severe disease affecting the limbs either due to diabetes, trauma or vascular diseases. RESULTS During one-year period, total 6,371 patients attended for general surgery OP. In those, 187 patients needed emergency surgery which included both major and minor operations. Among those, 81 patients were amputated. CONCLUSION As per our available records and observation, even though there is increased literacy and access to advanced technology, there is still increased incidence of patients undergoing amputations due to diseases. Therefore, there is a need to improve awareness and importance of early detection of diabetes, hazards of smoking, and regular general health checkups for patients at root level. With that we can treat diabetes and/or any disease in time. So there must be awareness in peripheral health staff i.e. PHC, subcentres, and community health centres about early detection of disease which in turn improves the quality of life of the patient. Due to diabetes slight injury to the glucose laden tissue may cause chronic infection and ulcer formation.(1 The tumours are seen commonly in the age group of 20-40 years after bone fusion, bones affected commonly are those around the knee (lower end of knee, upper end of tibia. A lytic
Full Text Available Abstract Background Tetrapods exhibit great diversity in limb structures among species and also between forelimbs and hindlimbs within species, diversity which frequently correlates with locomotor modes and life history. We aim to examine the potential relation of changes in developmental timing (heterochrony to the origin of limb morphological diversity in an explicit comparative and quantitative framework. In particular, we studied the relative time sequence of development of the forelimbs versus the hindlimbs in 138 embryos of 14 tetrapod species spanning a diverse taxonomic, ecomorphological and life-history breadth. Whole-mounts and histological sections were used to code the appearance of 10 developmental events comprising landmarks of development from the early bud stage to late chondrogenesis in the forelimb and the corresponding serial homologues in the hindlimb. Results An overall pattern of change across tetrapods can be discerned and appears to be relatively clade-specific. In the primitive condition, as seen in Chondrichthyes and Osteichthyes, the forelimb/pectoral fin develops earlier than the hindlimb/pelvic fin. This pattern is either retained or re-evolved in eulipotyphlan insectivores (= shrews, moles, hedgehogs, and solenodons and taken to its extreme in marsupials. Although exceptions are known, the two anurans we examined reversed the pattern and displayed a significant advance in hindlimb development. All other species examined, including a bat with its greatly enlarged forelimbs modified as wings in the adult, showed near synchrony in the development of the fore and hindlimbs. Conclusion Major heterochronic changes in early limb development and chondrogenesis were absent within major clades except Lissamphibia, and their presence across vertebrate phylogeny are not easily correlated with adaptive phenomena related to morphological differences in the adult fore- and hindlimbs. The apparently conservative nature of this
Rasmussen, Marie L R; Prause, Jan U; Toft, Peter B
Purpose: To characterize the quality of phantom pain, its intensity and frequency following eye amputation. Possible triggers and relievers of phantom pain are investigated. Methods: The hospital database was searched using surgery codes for patients who received ocular evisceration, enucleation......, orbital exenteration or secondary implantation of an orbital implant in the period between 1993 and 2003. A total of 267 patients were identified and invited to participate; of these, 173 agreed to participate. These patients’ medical records were reviewed. A structured interview focusing on pain...... was conducted by a trained interviewer. Results: Of the 173 patients in the study, 39 experienced phantom pain. The median age of patients who had experienced phantom pain was 45 years (range: 19–88). Follow-up time from eye amputation to participation in the investigation was 4 years (range: 2–46). Phantom...
Lewis, Leroy C.; Trammell, David R.
A disposable rabbit for transferring radioactive samples in a pneumatic transfer system comprises aerated plastic shaped in such a manner as to hold a radioactive sample and aerated such that dissolution of the rabbit in a solvent followed by evaporation of the solid yields solid waste material having a volume significantly smaller than the original volume of the rabbit.
Lewis, L.C.; Trammell, D.R.
A disposable rabbit for transferring radioactive samples in a pneumatic transfer system comprises aerated plastic shaped in such a manner as to hold a radioactive sample and aerated such that dissolution of the rabbit in a solvent followed by evaporation of the solid yields solid waste material having a volume significantly smaller than the original volume of the rabbit.
nociception and pain : analysis through imaging. Proc Natl Acad Sci U S A 1999;96:7668-74. 44. Casey KL, Minoshima S, Morrow TJ, Koeppe RA. Comparison of...trials. Eur J Pain 2006;10:77-88. 95. Dotson RM. Clinical neurophysiology laboratory tests to assess the nociceptive system in humans. J Clin...Award Number: W81XWH-11-1-0815 TITLE: Pathophysiology of Post Amputation Pain PRINCIPAL INVESTIGATOR: Dr. R. Norman Harden CONTRACTING
Full Text Available Replantation of ring avulsion injuries is a challenge because of the long segment damage to the vessels and intrinsic damage caused to soft tissues at the proximal edge of the amputation. Eight patients with total ring avulsion amputations underwent microsurgical replantation in the period 1994 to 2002. Arterial repair was done by direct vessel suture in three patients, interposition vein grafts in two and cross anastomosis of the digital arteries in three patients. Venous anastomosis was carried out by mobilization and direct suture in seven patients and vessel transfer from the adjacent finger in one patient. Seven of the eight replantations were successful, while one patient had a partial failure. At a minimum follow-up of one year, these patients showed good functional and cosmetic recovery. All successful patients were happy with the outcome and none have requested for amputation, even those whose results were not functionally adequate. However, in addition to technical factors, it is important to evaluate the patient's motivation to undergo not only the long surgery, but also multiple secondary procedures and regular supervised physiotherapy. We also describe a simple method which prevents the soft tissues inside the degloved digit from becoming wrapped around the K wire during bony fixation, thus making one step of this technically challenging procedure a little easier.
Spoor, C F; Badoux, D M
A hitherto-unknown atavistic muscle in the dog initiated a review of the literature on the homologies and nomenclature of the forelimb flexors in carnivores and man. A consequence is that we recommend a revision of the nomenclature in the Nomina Anatomica Veterinaria (Ithaca, New York, 1983) so that it is in agreement with the Nomina Anatomica (Wilkins, Baltimore, 1983). This revision mainly consists of the incorporation of the terms M. palmaris longus and Mm. flexores breves manus.
Hoang, Nguyen T.; Staudenmaier, R.; Hoehnke, C.
Reconstruction of an irreparably amputated thumb in multiple digit amputations using amputated fingers can considerably improve hand function and allows creation of a newly transplanted thumb with acceptable cosmetic and functional attributes. However, the surgery is challenging and rarely reported. We report six cases using this procedure in patients with crushed thumbs unsuitable for replantation. In four of the patients, the remnant of the index finger was replanted on the thumb stump and ...
Krishna N. Pundi
Conclusion: Forequarter amputation can be judiciously used for patients with recurrent or metastatic breast cancer. Patients with recurrent disease without evidence of distant metastases may be considered for curative amputation, while others may receive palliative benefit; disappointingly our patient achieved neither of these outcomes. In the long term, these patients may still have significant psychological problems.
Freire, J; Schiappacasse, C; Heredia, A; Martina, JD; Geertzen, JHB
This case report presents a 51 year old female patient who had a train accident in 1999. She suffered bilateral trans-tibial and bilateral trans-radial amputations. In this paper, the evolution of the right trans-radial amputation where eventually a Krukenberg procedure was performed, is described a
Full Text Available Abstract Background Lower extremity amputations are costly and debilitating complications in patients with diabetes mellitus (DM. Our aim was to investigate changes in the amputation rate in patients with DM at the Karolinska University Hospital in Solna (KS following the introduction of consensus guidelines for treatment and prevention of diabetic foot complications, and to identify risk groups of lower extremity amputations that should be targeted for preventive treatment. Methods 150 diabetic and 191 nondiabetic patients were amputated at KS between 2000 and 2006; of these 102 diabetic and 99 nondiabetic patients belonged to the catchment area of KS. 21 diabetic patients who belonged to KS catchment area were amputated at Danderyd University Hospital. All patients' case reports were searched for diagnoses of diabetes, vascular disorders, kidney disorders, and ulcer infections of the foot. Results There was a 60% reduction in the rate of amputations performed above the ankle in patients with DM during the study period. Patients with DM who underwent amputations were more commonly affected by foot infections and kidney disorders compared to the nondiabetic control group. Women with DM were 10 years older than the men when amputated, whereas men with DM underwent more multiple amputations and had more foot infections compared to the women. 88% of all diabetes-related amputations were preceded by foot ulcers. Only 30% of the patients had been referred to the multidisciplinary foot team prior to the decision of amputation. Conclusions These findings indicate a reduced rate of major amputations in diabetic patients, which suggests an implementation of the consensus guidelines of foot care. We also propose further reduced amputation rates if patients with an increased risk of future amputation (i.e. male sex, kidney disease are identified and offered preventive treatment early.
Pasquina, Paul F; Miller, Matthew; Carvalho, A J; Corcoran, Michael; Vandersea, James; Johnson, Elizabeth; Chen, Yin-Ting
It has been estimated that more than 1.6 million individuals in the United States have undergone at least one amputation. The literature abounds with research of the classifications of such injuries, their etiologies, epidemiologies, treatment regimens, average age of onset (average age of amputation), and much more. The subpopulation that is often overlooked in these evaluations, however, is comprised of individuals who have suffered multiple limb loss. The challenges faced by those with single-limb loss are amplified for those with multiple limb loss. Pain, lifestyle adjustment, and quality of life return are just a few key areas of concern in this population. Along with amputations resulting from trauma, many individuals with multiple amputations have endured them as a result of dysvascular disease. Over recent years, amputations as a result of dysvascular disease have risen to comprise more than 80 % of new amputations occurring in the United States every year. This compares to just 54 % of total current prevalence. Those with diabetes comorbid with dysvascular disease make up 74 % of those with dysvascular amputations, and these individuals with diabetes comorbid with dysvascular disease have a 55 % chance of enduring an amputation of their contralateral limb within 2-3 years of their initial amputation. With the well-documented aging of the nation's population and the similarly skyrocketing prevalence of dysvascular disease and diabetes, it can be expected that the number of individuals with multiple limb loss will continue to increase in the United States. This article outlines the recommended measures of care for this particular subpopulation, including pain management, behavioral health considerations, strategies for rehabilitation for various levels and variations of multiple limb loss, and the assistive technology and adaptive equipment that might be available for these individuals to best enable them to continue healthy, fulfilling lives following
Cooper, Lisa Noelle; Dawson, Susan D; Reidenberg, Joy S; Berta, Annalisa
The forelimb of cetaceans (whales, dolphins, and porpoises) has been radically modified during the limb-to-flipper transition. Extant cetaceans have a soft tissue flipper encasing the manus and acting as a hydrofoil to generate lift. The neuromuscular anatomy that controls flipper movement, however, is poorly understood. This study documents flipper neuromuscular anatomy and tests the hypothesis that antebrachial muscle robustness is related to body size. Data were gathered during dissections of 22 flippers, representing 15 species (7 odontocetes, 15 mysticetes). Results were compared with published descriptions of both artiodactyls and secondarily aquatic vertebrates. Results indicate muscle robustness is best predicted by taxonomic distribution and is not a function of body size. All cetaceans have atrophied triceps muscles, an immobile cubital joint, and lack most connective tissue structures and manus muscles. Forelimbs retain only three muscle groups: triceps (only the scapular head is functional as the humeral heads are vestigal), and antebrachial extensors and flexors. Well-developed flexor and extensor muscles were found in mysticetes and basal odontocetes (i.e., physeterids, kogiids, and ziphiids), whereas later diverging odontocetes (i.e., monodontids, phocoenids, and delphinids) lack or reduce these muscles. Balaenopterid mysticetes (e.g., fin and minke whales) may actively change flipper curvature, while basal odontocetes (e.g., sperm and beaked whales) probably stiffen the flipper through isometric contraction. Later diverging odontocetes lack musculature supporting digital movements and are unable to manipulate flipper curvature. Cetacean forelimbs are unique in that they have lost agility and several soft tissue structures, but retain sensory innervations.
Hudson, Penny E; Corr, Sandra A; Payne-Davis, Rachel C; Clancy, Sinead N; Lane, Emily; Wilson, Alan M
Despite the cheetah being the fastest living land mammal, we know remarkably little about how it attains such high top speeds (29 m s(-1)). Here we aim to describe and quantify the musculoskeletal anatomy of the cheetah forelimb and compare it to the racing greyhound, an animal of similar mass, but which can only attain a top speed of 17 m s(-1). Measurements were made of muscle mass, fascicle length and moment arms, enabling calculations of muscle volume, physiological cross-sectional area (PCSA), and estimates of joint torques and rotational velocities. Bone lengths, masses and mid-shaft cross-sectional areas were also measured. Several species differences were observed and have been discussed, such as the long fibred serratus ventralis muscle in the cheetah, which we theorise may translate the scapula along the rib cage (as has been observed in domestic cats), thereby increasing the cheetah's effective limb length. The cheetah's proximal limb contained many large PCSA muscles with long moment arms, suggesting that this limb is resisting large ground reaction force joint torques and therefore is not functioning as a simple strut. Its structure may also reflect a need for control and stabilisation during the high-speed manoeuvring in hunting. The large digital flexors and extensors observed in the cheetah forelimb may be used to dig the digits into the ground, aiding with traction when galloping and manoeuvring.
N. S. Ahmed
Full Text Available The study included detection of the sites of ossification centers and their sequence of appearance in the forelimb bones of indigenous sheep fetuses by using double staining method with younger specimens and radiography or maceration methods with old specimens, as well as, histological study with some ages. The results showed that the primary ossification centers of the forelimb in indigenous sheep fetuses appeared firstly in the diaphyses of radius and ulna, humerus, scapula, metacarpus, phalanges and lastly in the carpal bone at an estimated age of 43, 45, 46, 47, 49 - 56 and 90-118 days old respectively. The results of statistical analysis of the total lengths of scapula, humerus, radius, ulna and metacarpus with the lengths of their ossified parts through the 7th – 15th weeks of fetus age, showed presence of significant differences in the average of these measurements among most of studied weeks. Also there was a significant differences in the average of relative increase in the total length and length of ossified part of diaphysis of studied bones during the 7th week in comparison to the same average in the other studied weeks (8th-15th week of indigenous sheep fetuses age.
Sun, Lian-Wen; Wang, Chao; Xie, Tian; Pu, Fang; Sun, Yao; Fan, Yu-Bo
To understand the tail-suspension model to simulate weightlessness better, this study was to investigate the relationship of the amount of body weight supported by forelimbs between the tilt angles of rat in the model. Normal rat had at least two basic postures. One was standing or walking, in which the forelimbs bear 44.6% of the body weight; the other one was resting, in which 23.9% of body weight was placed on the forelimbs. As for tail-suspended rat, body-weight distribution on forelimbs was linearly related to tilt angle. The linear relationship was y = -0.7423x + 70.849, R2 = 0.9269. The tilt angle should be approximately 35 degrees if normal standing load of 44.6% body weight was placed on the forelimbs. On the other hand, it should be approximately 63 degrees if normal resting load of 23.9% of body weight was placed on forelimbs. Furthermore, the body load on forelimbs in tail-suspension model became much larger if the period of different postures was considered. Therefore, it should be careful if forelimbs are used to be as convenient internal control in tail-suspended rats.
Teshima, Takahiro; Hata, Takashi; Nezu, Yoko; Michishita, Masaki; Matsumoto, Hirotaka; Mizutani, Hisashi; Takahashi, Kimimasa; Koyama, Hidekazu
A 9-year-old spayed female domestic shorthair cat presented with a skin lesion of the left tarsus. The lesion was biopsied and, based on the microscopic appearance and immunohistochemical characteristics, histiocytic sarcoma was diagnosed. Amputation was performed with improved demeanor seen postoperatively. However, between 44 and 60 days following the surgery, relapse of skin lesions appeared in multiple locations, including at the previous amputation site, and euthanasia was elected. This is the first report of a histiocytic sarcoma treated with amputation in a cat.
Meier, Robert H; Melton, Danielle
This article provides a generalized overview of amputation classifications and the idealized outcomes for upper and lower amputations at their respective levels. The following levels are discussed: above knee/transfemoral, below knee/transtibial, above elbow/transhumeral, below elbow/transradial, and bilateral for upper and lower extremities. This classification defines a framework for clinicians to share with patients so that they understand the potential for their expected functional outcomes regarding mobility and activities of daily living, both with and without a prosthesis. Moreover, it addresses some of the vocational and avocational needs of the individual regarding amputation.
Karmarkar, Amol M.; Graham, James E.; Reistetter, Timothy A.; Amit Kumar; Jacqueline M. Mix; Paulette Niewczyk; Granger, Carl V.; Ottenbacher, Kenneth J.
The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the ...
Meier, Robert H; Heckman, Jeffrey T
Providing rehabilitation services for the person with an amputation has become more difficult in today's health care environment. Amputation rehabilitation calls for specialized, multidisciplinary rehabilitation training. In examining the principles of amputation rehabilitation, one must understand the lessons learned from the Veterans Affairs Amputation System of Care and return to the founding principles of rehabilitation medicine. Persons with amputations must be reevaluated in a tight program of follow-up care.
An in-depth analysis of the course of events leading to 49 delayed amputation of the lower extremity in 47 patients with open lower limb fractures is presented. Seventeen amputations were performed within one month mainly for vascular reasons. Eleven were between one month and one year, due to persistent sepsis and 21 amputations were performed more than a year after the original injury for infected non-union. Below-knee amputation was done in 32 limbs, above-knee amputation in 13 limbs and Symes' amputation in 4 limbs. The delay in timing of the amputation was analysed with respect to the nature of the injury, the primary treatment and the Mangled Extremity Severity Score (MESS). The MESS score was computed for all injuries and a score of 7 or more predicted an early amputation. We suggest that in all severe lower limb injuries, particularly in Type III C fractures with associated neurological injury, the benefits of an early amputation be considered as an alternative to a limb salvage procedure.
Ng, Vincent Y; Berlet, Gregory C
Multiple clinical pathways lead to lower extremity amputation, including trauma, dysvascular disease, congenital defects, and malignancy. However, the principles of successful amputation-careful preoperative planning, coordination of a multidisciplinary team, and good surgical technique-remain the same. Organized rehabilitation and properly selected prostheses are integral components of amputee care. In the civilian setting, amputation is usually performed as a planned therapy for an unsalvageable extremity, not as an emergency procedure. The partial loss of a lower limb often represents a major change in a person's life, but patients should be encouraged to approach amputation as the beginning of a new phase of life and not as the culmination of previous treatment failures.
Hoang, Nguyen T; Staudenmaier, R; Hoehnke, C
Reconstruction of an irreparably amputated thumb in multiple digit amputations using amputated fingers can considerably improve hand function and allows creation of a newly transplanted thumb with acceptable cosmetic and functional attributes. However, the surgery is challenging and rarely reported. We report six cases using this procedure in patients with crushed thumbs unsuitable for replantation. In four of the patients, the remnant of the index finger was replanted on the thumb stump and in another two patients, an amputated middle finger and ring finger were used. The patients had a minimum followup of 12 months (mean, 18 months; range, 12-45 months). All newly transplanted thumbs survived resulting in the patients having satisfactory postoperative hand function and appearance.
Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java ... of the most frequently asked questions. Ideas about management are one of the frequent topics of conversation ...
Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders
BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. With use of individual data linkage, 92,785 primary knee arthroplasties performed from 1997 to 2013 were identified. Of these, 258...... for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed...
Pasquina, Paul F.; Miller, Matthew; CARVALHO, A. J. de; Corcoran, Michael; Vandersea, James; Johnson, Elizabeth; Chen, Yin-Ting
It has been estimated that more than 1.6 million individuals in the United States have undergone at least one amputation. The literature abounds with research of the classifications of such injuries, their etiologies, epidemiologies, treatment regimens, average age of onset (average age of amputation), and much more. The subpopulation that is often overlooked in these evaluations, however, is comprised of individuals who have suffered multiple limb loss. The challenges faced by those with sin...
Freire, J; Schiappacasse, C; Heredia, A; Martina, J D; Geertzen, J H B
This case report presents a 51 year old female patient who had a train accident in 1999. She suffered bilateral trans-tibial and bilateral trans-radial amputations. In this paper, the evolution of the right transradial amputation where eventually a Krukenberg procedure was performed, is described as is its good functional outcome after rehabilitation treatment. After this first procedure the patient also asked for the Krukenberg procedure for her left arm.
Freire, J.; Schiappacasse, C; Heredia, A.; Martina, JD; Geertzen, JHB
This case report presents a 51 year old female patient who had a train accident in 1999. She suffered bilateral trans-tibial and bilateral trans-radial amputations. In this paper, the evolution of the right trans-radial amputation where eventually a Krukenberg procedure was performed, is described as is its good functional outcome after rehabilitation treatment. After this first procedure the patient also asked for the Krukenberg procedure for her left arm.
Amol M. Karmarkar
Full Text Available The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501. The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4 and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days and lowest functional rating at discharge (average 79.4. Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25 generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research.
Miller, Andrew J; Rivlin, Michael; Kirkpatrick, William; Abboudi, Jack; Jones, Christopher
Distal fingertip amputations are common injuries in work- and non-work-related accidents. There is a paucity of evidence to support use of any one treatment. We conducted a study to better understand how surgeon and patient factors influence the treatment preferences for distal fingertip amputations among a cross section of US and international hand surgeons. We sent a 16-question survey to the American Association for Hand Surgery and reciprocal international hand societies and analyzed the response data using a logistic regression model. We hypothesized that hand surgeons' treatment preferences would be varied and influenced by surgeon and patient demographics. One hundred ninety-eight hand surgeons (62% US, 38% international) responded to the survey. For each clinical scenario (Allen levels 2, 3, and 4 and volar oblique amputations), there were wide variations in treatment preferences. Wound care was less likely performed by surgeons with more than 30 years of experience or plastic surgery backgrounds. Replantation was less likely performed by US surgeons and private practice surgeons. Pedicle and homodigital flaps were more commonly performed internationally. Surgeons in practice for less than 5 years were more likely to perform skeletal shortening. For all levels and orientations of fingertip amputation queried, there is a wide range of treatment preferences. Our survey results highlight the need for a prospective randomized trial to elucidate the most effective treatments for fingertip amputations.
Rasmussen, Marie L R; Ekholm, Ola; Prause, Jan U
Purpose: To evaluate eye-amputated patients’ health-related quality of life, perceived stress, self-rated health, job separation because of illness or disability and socioeconomic position. Methods: Patients were recruited from a tertiary referral centre situated in Copenhagen. Inclusion criteria......-administered questionnaire containing health-related quality of life (SF-36), the perceived stress scale and answered questions about self-rated health, job changes because of illness or disability and socioeconomic status. These results were compared with findings from the Danish Health Interview Survey 2005. Results......% of the study population has retired or changed to a part-time job because of eye disease. The percentage of eye amputated patients, who were divorced or separated, was twice as high as in the general population. Conclusion: The impact of an eye amputation is considerable. The quality of life, perceived stress...
Staats, T B
Recent advances in the evaluation of the amputation stump, the materials that are available for prosthetic application, techniques of improving socket fit, and prosthetic finishings promise to dramatically improve amputee function. Precision casting techniques for providing optimal fit of the amputation stump using materials such as alginate are described. The advantages of transparent check sockets for fitting the complicated amputation stump are described. Advances in research that promise to provide more functional prosthetic feet and faster and more reliable socket molding are the use of CAD-CAM (computer aided design-computer aided manufacturing) and the use of gait analysis techniques to aid in the alignment of the prosthesis after socket fitting. Finishing techniques to provide a more natural appearing prosthesis are described. These advances will gradually spread to the entire prosthetic profession.
Lee, Scott A.; Thomas, Joshua D.
In this paper, we examine a first-year torque and angular acceleration problem to address a possible use of the forelimbs of Tyrannosaurus rex. A 1/40th-scale model (see Fig. 1) is brought to the classroom to introduce the students to the quandary: given that the forelimbs of T. rex were too short to reach its mouth, what function did the forelimbs serve? This issue crosses several scientific disciplines including paleontology, ecology, and physics, making it a great starting point for thinking "outside the box." Noted paleontologist Kenneth Carpenter has suggested that the forelimbs of T. rex were an integral part of its predatory behavior. Given the large teeth of T. rex, it is assumed that they killed with their teeth. Lipkin and Carpenter1 have suggested that the forelimbs were used to hold a struggling victim (which had not been dispatched with the first bite) while the final, lethal bite was applied. If that is the case, then the forelimbs must be capable of large angular accelerations α in order to grab the animal attempting to escape. The concepts of the typical first-year physics course are sufficient to test this hypothesis by solving α =τ /I . Naturally, students love solving any problem related to Tyrannosaurus rex!
Full Text Available Consistent preferences in the use of right/left forelimbs are not exclusively present in humans. Functional asymmetries in forelimb use have been widely documented in a variety of vertebrate and invertebrate species. A matter of debate is whether non-human species exhibit a degree and consistency of functional forelimb asymmetries comparable to human handedness. The comparison is made difficult by the variability in hand use in humans and the few comparable studies conducted on other species. In spite of this, interesting continuities appear in functions such as feeding, object manipulation and communicative gestures. Studies on invertebrates show how widespread forelimb preferences are among animals, and the importance of experience for the development of forelimb asymmetries. Vertebrate species have been extensively investigated to clarify the origins of forelimb functional asymmetries: comparative evidence shows that selective pressures for different functions have likely driven the evolution of human handedness. Evidence of a complex genetic architecture of human handedness is in line with the idea of multiple evolutionary origins of this trait.
Full Text Available Penile amputation is an uncommon injury for which immediate surgical replantation is warranted. Microsurgical replantation is the “standard” method for penile replantation. Early replantation yields a high success and low complication rate. We report a case of a 34-year-old male who presented with amputation at the proximal penile shaft which was successfully replanted using microsurgical techniques. Minor skin necrosis was noted post-operatively which was debrided and covered with skin graft. Follow-up at 6 months showed satisfactory cosmetic appearance, normal voiding, return of sensations and erectile function. The level of evidence was V.
Full Text Available Penile amputation is an uncommon urological emergency. Although rare, traumatic amputation of penis is a challenging injury to treat. However, modern microsurgical reconstruction techniques have improved success rate of penile replantation and become the procedure of choice for managing these patients. Herein, we report on a case of penile amputation following an industrial accident.
In 102 leg amputations for arterial occlusion including 84 below-knee (BK), 16 above-knee (AD) and 2 through-knee (TK) amputations, the amputation level was determined by means of clinical criteria. The healing results and the selection of levels were then compared with sealed preoperative measur...
The article presents the level of the evidence that exists in the literature on rehabilitation of people after lower and upper limb amputation. We found that there is not much high-quality evidence available in this field of rehabilitation.
Ohishi, Hiroko; Ichikawa, Jun; Matsuzaki, Ryuichi; Kyuhou, Shin ichi; Matsuura-Nakao, Kazuko; Seki, Tomomi; Gemba, Hisae
Seven rats were well trained to move lever to the left by right forelimb at self-pace (self-paced forelimb movements). Cortical field potentials associated with self-paced forelimb movements were recorded by electrodes implanted chronically on the surface and at a 2.0 mm depth in the forelimb motor cortex on the left side. A surface-negative, depth-positive potential starting about 1.0 s prior to the movement was recorded in the rostral part of the forelimb motor cortex. Further we found that the premovement potential was eliminated by the cerebellar hemispherectomy on the right side. This suggests the participation of the cerebellar hemisphere in preparing the activity of the motor cortex before self-paced forelimb movements in rats, by cerebello-thalamo-cortical projections.
Wolinsky, Philip R; Webb, Lawrence X; Harvey, Edward J; Tejwani, Nirmal C
A mangled extremity is defined as a limb with injury to three of four systems in the extremity. The decision to salvage or amputate the injured limb has generated much controversy in the literature, with studies to support advantages of each approach. Various scoring systems have proved unreliable in predicting the need for amputation or salvage; however, a recurring theme in the literature is that the key to limb viability seems to be the severity of the soft-tissue injury. Factors such as associated injuries, patient age, and comorbidities (such as diabetes) also should be considered. Attempted limb salvage should be considered only if a patient is hemodynamically stable enough to tolerate the necessary surgical procedures and blood loss associated with limb salvage. For persistently hemodynamically unstable patients and those in extremis, life comes before limb. Recently, the Lower Extremity Assessment Project study attempted to answer the question of whether amputation or limb salvage achieves a better outcome. The study also evaluated other factors, including return-to-work status, impact of the level of and bilaterality of the amputation, and economic cost. There appears to be no significant difference in return to work, functional outcomes, or the cost of treatment (including the prosthesis) between the two groups. A team approach with different specialties, including orthopaedics, plastic surgery, vascular surgery and trauma general surgery, is recommended for treating patients with a mangled extremity.
Sommerville, Scott M. M.; Patton, James T.; Luscombe, Jonathan C.; Grimer, Robert J.
We describe the management and outcome of a 62-year old lady who developed severe osteoarthritis of the hip, nine years after a hindquarter amputation for radiation-induced sarcoma of the contralateral pelvis. The difficulties of stabilising the pelvis intraoperatively and the problems of postoperative rehabilitation are outlined. The operation successfully relieved her pain and restored limited mobility. PMID:17496994
Scott M. M. Sommerville
Full Text Available We describe the management and outcome of a 62-year old lady who developed severe osteoarthritis of the hip, nine years after a hindquarter amputation for radiation-induced sarcoma of the contralateral pelvis. The difficulties of stabilising the pelvis intraoperatively and the problems of postoperative rehabilitation are outlined. The operation successfully relieved her pain and restored limited mobility.
Fitzgibbons, Peter; Medvedev, Gleb
Upper extremity amputation is an uncommon but often necessary procedure. It can be required as a result of trauma, infection, or malignancy. Amputation is a life-changing procedure. Careful planning for it must not only include the level of amputation and assurance of durable soft-tissue coverage of the amputation site, but it must also consider patients' goals and occupations, as well as social factors affecting amputees. The choice of prosthesis is an individual matter, but new technology permits lighter and more multifunctional prostheses. Targeted muscle reinnervation can be used to achieve improved myoelectric signaling and possibly decrease limb pain following amputation. Rehabilitation is crucial to achieving favorable results.
Marshall, Kemba L
Using laboratory animal medicine as an established resource, companion animal veterinarians have access to many physiologic and basic science studies that we can now merge with our clinical impressions. By working with reference laboratories, companion animal veterinarians are poised to accelerate our knowledge of the normal rabbit rapidly. The aim of this article is to discuss normal hematopoiesis and infectious and metabolic diseases that specifically target the hemolymphatic system. Additionally, photographic representation of cell types is provided.
Full Text Available In search of a solution to the long standing problems encountered in traditional brain computer interfaces (BCI, the lateral descending tracts of the spinal cord present an alternative site for taping into the volitional motor signals. Due to the convergence of the cortical outputs into a final common pathway in the descending tracts of the spinal cord, neural interfaces with the spinal cord can potentially acquire signals richer with volitional information in a smaller anatomical region. The main objective of this study was to evaluate the feasibility of extracting motor control signals from the corticospinal tract (CST of the rat spinal cord. Flexible substrate, multi-electrode arrays (MEA were implanted in the CST of rats trained for a lever pressing task. This novel use of flexible substrate MEAs allowed recording of CST activity in behaving animals for up to three weeks with the current implantation technique. Time-frequency and principal component analyses (PCA were applied to the neural signals to reconstruct isometric forelimb forces. Computed regression coefficients were then used to predict isometric forces in additional trials. The correlation between measured and predicted forces in the vertical direction averaged across six animals was 0.67 and R-squared value was 0.44. Force regression in the horizontal directions was less successful, possibly due to the small amplitude of forces. Neural signals above and near the high gamma band made the largest contributions to prediction of forces. The results of this study support the feasibility of a spinal cord computer interface (SCCI for generation of command signals in paralyzed individuals.
Sohn, Min-Woong; Budiman-Mak, Elly; Oh, Elissa H; Park, Michael S; Stuck, Rodney M; Stone, Neil J; Pearce, William B
The association between BMI and amputation risk is not currently well known. We used data for a cohort of diabetic patients treated in the US Department of Veterans Affairs Healthcare System in 2003. Men aged amputation risk and amputation-free survival during the next 5 years (2004-2008). Compared to overweight individuals (BMI 25-29.9 kg/m(2)), the risks of amputation and treatment failure (amputation or death) were higher for patients with BMI amputations (HR = 0.53; 95% CI, 0.39-0.73) during follow-up as overweight individuals. While the amputation risk continued to decrease for higher BMI, amputation-free survival showed a slight upturn at BMI >40 kg/m(2). The association between obesity and amputation risk in our data shows a pattern consistent with "obesity paradox" observed in many health conditions. More research is needed to better understand pathophysiological mechanisms that may explain the paradoxical association between obesity and lower-extremity amputation (LEA) risk.
Maximo, Claudia; Olalla Saad, Sara T; Thome, Eleonora; Queiroz, Ana Maria Mach; Lobo, Clarisse; Ballas, Samir K
In this study, we describe four new patients with sickle cell disease who had limb amputations. Two of the patients had sickle cell anemia [Hb S (HBB: c.20A > T) (β(S)/β(S))] with refractory leg ulcers that required amputations. The third patient had sickle cell trait with an extensive leg ulcer that was associated with epidermoid carcinoma. The fourth patient had amputations of both forearms and feet due to a misdiagnosis of dactylitis. Review of the literature showed that the indications for amputations in sickle cell disease included three distinct categories: mythical beliefs, therapeutic and malpractice. All therapeutic amputations were for severely painful, large, recalcitrant leg ulcers that failed non-interventional therapies. Amputation resulted in pain relief and better quality of life. Phantom neuropathic pain was not a major issue post-operatively. It was absent, transient or well controlled with antidepressants. Limb function was restored post-amputation with prosthetic artificial limbs, wheelchairs or crutches. Malpractice amputations were due to misdiagnosis or to cryotherapy by exposing the painful limb to ice water resulting in thrombosis, gangrene and amputation. We strongly suggest that leg amputations should be considered in the management of certain patients with severe extensive refractory leg ulcers, and topical cryotherapy should never be used to manage sickle cell pain.
Atesalp, A S; Erler, K; Gür, E; Köseğlu, E; Kirdemir, V; Demiralp, B
Landmine explosions cause most of the war injuries in the battlefield. Amputations resulting from severe injuries reveal serious problems despite the improvements in surgery. Bilateral lower limb amputations have more impact than unilateral on social life. Some 29 cases with lower limb amputations due to landmine injuries were treated in the Department of Orthopaedics and Traumatology, Gülhane Military Medical Academy between January 1992 and December 1996. Amputation levels were as follows: 1 case had hip disarticulation and a trans-femoral amputation, 6 had bilateral trans-femoral amputations, 6 had trans-femoral and trans-tibial amputations, 12 had bilateral trans-tibial amputations, 1 had trans-femoral and Chopart amputations and the remaining 3 cases had trans-tibial and Chopart amputations. The initial treatment was done for all cases in the first 6-8 hours after injury at the field hospitals. Aggressive debridement, excision and primary closure were performed. None of the stumps required reamputations and/or revision. No case had gas gangrene or tetanus. Postoperative, pre-prosthetic training programme which ranged between 30-120 days with an average 48 days; and prosthesis fitting and adequate post-prosthetic training programme which ranged 32-126 (average 94) days was applied. All the cases were followed-up with a mean of 38.5 months (14-72 months). Nine (9) cases (31%) returned to their previous occupation, while 20 (69%) cases had to change their jobs.
Abu-Seida, Ashraf M
Polymelia was rarely recorded in birds; therefore, this report records the clinical and radiographic findings in a case of polymelia in a 7-mo-old layer Fayoumi chicken and the outcome of its amputation. The hen had two pericloacal extra limbs located caudal to the normal ones in an inverted position. The extra limbs were immovable and loosely attached to the underlying tissues. The supernumerary limbs had normal skin with ill-developed feathers. The extra limbs were fused proximally and crossed distally. Plain radiographic examination showed unequal numbers of bones and digits in both extra limbs. The right extra limb had a femur and tarsometatarsus while the left extra one had femur, tibiotarsus, and tarsometatarsus bones. The extra limbs appeared smaller than the normal ones and had neither muscles nor tendons. Amputation of the extra limbs under local infiltration analgesia was easy, safe, and curative.
Panyi, Lilla Krisztina; Lábadi, Beatrix
Rehabilitation of lower limb amputees and the fitting of their prosthesis depend highly on the psychological adjustment process and motivational state of the patient. The loss of a limb is extremely challenging and can cause various physical and psychological problems. Depression, anxiety, decreased well-being and quality of life, body image dissatisfaction and changes in self-concept and identity are frequent after lower limb amputation. In the interest of adjustment patients have to cope with the emerging changes and difficulties in their lifes as well as the problems in psychological functioning. It is important for them to accept the alterations in their body and identity, and integrate them in a new self-concept in which process motivation is a fundamental issue. The aim of this article is to review the literature on psychological consequences of lower limb amputation, and to propose an integrative way of rehabilitation for lower limb amputees.
Brumley, Michele R; Robinson, Scott R
Perinatal mammals show spontaneous movements that often appear random and uncoordinated. Here, we examined if spontaneous limb movements are responsive to a proprioceptive manipulation by applying a weight unilaterally to a forelimb of postnatal day 0 (P0; day of birth) and P1 rats. Weights were calibrated to approximate 0%, 25%, 50%, or 100% of the average mass of a forelimb, and were attached at the wrist. P0 and P1 pups showed different levels of activity during the period of limb weighting, in response to weight removal, and during the period after weighting. Pups exposed to 50% and 100% weights showed proportionately more activity in the nonweighted forelimb during the period of weighting, suggesting a threshold for evoking proprioceptive changes. Findings suggest that newborn rats use movement-related feedback to modulate spontaneous motor activity, and corroborate studies of human infants that have suggested a role for proprioception during early motor development.
Pundi, Krishna N.; AlJamal, Yazan N.; Ruparel, Raaj K.; Farley, David R.
Introduction: Localized excision combined with radiation and chemotherapy represents the current standard of care for recurrent breast cancer. However, in certain conditions a forequarter amputation may be employed for these patients. Presentation of case: We present a patient with recurrent breast cancer who had a complicated treatment history including multiple courses of chemotherapy, radiation, and local surgical excision. With diminishing treatment options, she opted for a forequarter...
Warburton, Natalie M; Harvey, Kathryn J; Prideaux, Gavin J; O'Shea, James E
Tree-kangaroos are a unique group of arboreal marsupials that evolved from terrestrial ancestors. The recent discovery of well-preserved specimens of extinct tree-kangaroo species (genus Bohra) within Pleistocene cave deposits of south-central Australia provides a unique opportunity to examine adaptive evolution of tree-kangaroos. Here, we provide the first detailed description of the functional anatomy of the forelimb, a central component of the locomotor complex, in the extant Dendrolagus lumholtzi, and compare its structure and function with representatives of other extant marsupial families. Several features were interpreted as adaptations for coping with a discontinuous, uneven and three-dimensional arboreal substrate through enhanced muscular strength and dexterity for propulsion, grasping, and gripping with the forelimbs. The forelimb musculoskeletal anatomy of Dendrolagus differed from terrestrial kangaroos in the following principal ways: a stronger emphasis on the development of muscles groups responsible for adduction, grasping, and gripping; the enlargement of muscles that retract the humerus; and modified shape of the scapula and bony articulations of the forelimb bones to allow improved mobility. Many of these attributes are convergent with other arboreal marsupials. Tree-kangaroos, however, still retain the characteristic bauplan of their terrestrial ancestors, particularly with regard to skeletal morphology, and the muscular anatomy of the forelimb highlights a basic conservatism within the group. In many instances, the skeletal remains of Bohra have similar features to Dendrolagus that suggest adaptations to an arboreal habit. Despite the irony of their retrieval from deposits of the Nullarbor "Treeless" Plain, forelimb morphology clearly shows that the species of Bohra were well adapted to an arboreal habitat.
Beug, Shawn; Vascotto, Sandy G; Tsilfidis, Catherine
Red-spotted newts are capable of regenerating various structures and organs through the process of epimorphic regeneration. Receptor tyrosine kinases (RTKs) and their ligands are important for normal cellular development and physiology but most have not yet been characterised during regeneration. We have isolated a newt orthologue of Growth arrest-specific 6 (NvGas6), and examined its expression during forelimb regeneration and within a blastema cell line (B1H1). During limb regeneration, NvGas6 expression increases upon amputation, peaks during maximal blastema cell proliferation, and is subsequently downregulated during redifferentiation. Transcripts are localised to the wound epithelium and distal mesenchymal cells during dedifferentiation and proliferative phases, and scattered within redifferentiating tissues during later stages. In B1H1 cultures, NvGas6 is upregulated under reduced serum conditions and myogenesis. Treatment with mimosine and colchicine or exposure to heat shock or anoxia results in upregulation of NvGas6 expression. Taken together, our findings suggest that during regeneration, NvGas6 expression may be upregulated in response to cellular stress.
Stapanian, Martin A.; Stapanian, Adrienne M.P.; Staley, Keith E.
We describe reconstructive surgeries, therapy, prostheses, and adaptations for a patient who experienced bilateral amputation of all five fingers of both hands through the proximal phalanges in January 1992. The patient made considerable progress in the use of his hands in the 10 mo after amputation, including nearly a 120% increase in the active range of flexion of metacarpophalangeal joints. In late 1992 and early 1993, the patient had "on-top plasty" surgeries, in which the index finger remnants were transferred onto the thumb stumps, performed on both hands. The increased web space and functional pinch resulting from these procedures made many tasks much easier. The patient and occupational therapists set challenging goals at all times. Moreover, the patient was actively involved in the design and fabrication of all prostheses and adaptations or he developed them himself. Although he was discharged from occupational therapy in 1997, the patient continues to actively find new solutions for prehension and grip strength 18 yr after amputation.
Stapanian, Martin A; Stapanian, Adrienne M P; Staley, Keith E
We describe reconstructive surgeries, therapy, prostheses, and adaptations for a patient who experienced bilateral amputation of all five fingers of both hands through the proximal phalanges in January 1992. The patient made considerable progress in the use of his hands in the 10 mo after amputation, including nearly a 120% increase in the active range of flexion of metacarpophalangeal joints. In late 1992 and early 1993, the patient had "on-top plasty" surgeries, in which the index finger remnants were transferred onto the thumb stumps, performed on both hands. The increased web space and functional pinch resulting from these procedures made many tasks much easier. The patient and occupational therapists set challenging goals at all times. Moreover, the patient was actively involved in the design and fabrication of all prostheses and adaptations or he developed them himself. Although he was discharged from occupational therapy in 1997, the patient continues to actively find new solutions for prehension and grip strength 18 yr after amputation.
Dial, Terry R; Carrier, David R
Precocial development, in which juveniles are relatively mature at hatching or birth, is more common among vertebrates than altricial development, and is likely to be the basal condition. Altricial development characterizes many birds and mammals and is generally viewed as an alternate strategy, promoting fast growth rates, short developmental periods and relatively poor locomotor performance prior to attaining adult size. Many aquatic birds such as Anseriformes (ducks, geese and swans), Charadriformes (gulls and terns) and Gruiformes (rails) undergo distinctive developmental trajectories, in that hatchlings are able to run and swim the day they hatch, yet they do not begin to fly until fully grown. We hypothesized that there should be tradeoffs in apportioning bone and muscle mass to the hindlimb and forelimb that could account for these patterns in locomotor behavior within the mallard (Anas platyrhynchos). Growth of the musculoskeletal system in the forelimbs and hindlimbs was measured and compared with maximal aquatic and terrestrial sprint speeds and aerial descent rates throughout the 2-month-long mallard ontogenetic period. At 30 days post hatching, when body mass is 50% of adult values, hindlimb muscle mass averages 90% and forelimb muscle mass averages 10% of adult values; similarly, bone growth (length and width) in the hindlimbs and forelimbs averages 90 and 60% of adult values, respectively. The attainment of mallard locomotor performance parallels the morphological maturation of forelimb and hindlimb morphometrics - hindlimb performance initiates just after hatching at a relatively high level (~50% adult values) and gradually improves throughout the first month of development, while forelimb performance is relatively non-existent at hatching (~10% adult values), experiencing delayed and dramatic improvement in function, and maturing at the time of fledging. This divergence in ontogenetic strategy between locomotor modules could allow developing
Høiness, P; Røise, O
18 patients treated with primary or secondary amputations after severe lower limb open fractures were studied. All limbs had clinical signs of a compromised circulation at the primary evaluation. The various injuries are described and discussed with respect to the general guidelines for primary amputation. The Mangled Extremity Severity Score (MESS) and Nerve, Ischemia, Soft tissues, Skeletal, Shock, Age (NISSSA) scores were calculated. In view of the described injuries, primary amputation was indicated in ten patients according to the general recommendations, 11 patients according to NISSSA and 15 patients according to MESS. Delayed amputation leads t a significantly (p = 0.005) higher number of operative procedures than early amputation (9.2 vs. 2.9 treatments). The decision of whether to amputate or not should be based on sound clinical judgement, but injury scores such as MESS and NISSSA may be helpful.
Ishida, Akimasa; Tamakoshi, Keigo; Hamakawa, Michiru; Shimada, Haruka; Nakashima, Hiroki; Masuda, Tadashi; Hida, Hideki; Ishida, Kazuto
Intensive use of the impaired forelimb promotes behavioral recovery and induces plastic changes of the central nervous system after stroke. However, the optimal onset of intensive use treatment after stroke is controversial. In this study, we investigated whether early forced impaired limb use (FLU) initiated 24h after intracerebral hemorrhage (ICH) of the internal capsule affected behavioral recovery and histological damage. Rats were subjected to ICH via low-dose collagenase infusion or sham stroke. One day after surgery, the ipsilateral forelimbs of half of the ICH and sham rats were casted for a week to induce the use of their contralateral forelimbs. Behavioral assessments were performed on days 10-12 and 26-28 after the surgery and followed by histological assessments. Improvements in skilled reaching and coordinated stepping function were found in the FLU-treated group in comparison with the untreated group after ICH. Additionally, FLU-treated ICH animals showed more normal and precise reaching and stepping movements as compared with ICH control animals. In contrast, FLU did not have a significant impact on gross sensory-motor functions such as the motor deficit score, contact placing response and spontaneous usage of the impaired paw. The volume of tissue lost and the number of spared corticospinal neurons in lesioned motor cortex were not affected by early FLU after ICH. These findings demonstrate the efficacy of early focused use of an impaired limb after internal capsule hemorrhage.
Unless the original Syme amputation technique has been precisely followed, an amputation stump capable of tolerating little or no end-bearing will frequently result. Such a stump must be fitted with a below knee type of prosthesis as if the patient were a below-knee amputee. Even though it is not designed for other than a below-knee amputation, the socket can be modified to provide a satisfactory prosthesis for a Quasi-Syme stump.
Yamada, Satoshi; Tadano, Shigeru; Fujisaki, Kazuhiro
The presence of the residual stresses in bone tissue has been noted and the authors have reported that there are residual stresses in bone tissue. The aim of our study is to measure the residual stress distribution in the cortical bone of the extremities of vertebrates and to describe the relationships with the osteon population density. The study used the rabbit limb bones (femur, tibia/fibula, humerus, and radius/ulna) and measured the residual stresses in the bone axial direction at anterior and posterior positions on the cortical surface. The osteons at the sections at the measurement positions were observed by microscopy. As a result, the average stresses at the hindlimb bones and the forelimb bones were 210 and 149 MPa, respectively. In the femur, humerus, and radius/ulna, the residual stresses at the anterior position were larger than those at the posterior position, while in the tibia, the stress at the posterior position was larger than that at the anterior position. Further, in the femur and humerus, the osteon population densities in the anterior positions were larger than those in the posterior positions. In the tibia, the osteon population density in the posterior position was larger than that in the anterior position. Therefore, tensile residual stresses were observed at every measurement position in the rabbit limb bones and the value of residual stress correlated with the osteon population density (r=0.55, P<0.01).
Alyson J. Littman, PhD
Full Text Available Little is known about the relationship between lower-limb amputation (LLA and subsequent changes in body weight. We conducted a retrospective cohort study using clinical and administrative databases to identify and follow weight changes in 759 males with amputation (partial foot amputation [PFA], n = 396; transtibial amputation [TTA], n = 267; and transfemoral amputation [TFA], n = 96 and 3,790 men without amputation frequency-matched (5:1 on age, body mass index, diabetes, and calendar year from eight Department of Veterans Affairs medical care facilities in the Pacific Northwest. We estimated and compared longitudinal percent weight change from baseline up to 39 mo of follow-up in men with and without amputation. Weight gain in the 2 yr after amputation was significantly more in men with an amputation than without, and in men with a TTA or TFA (8%–9% increase than in men with a PFA (3%–6% increase. Generally, percent weight gain peaked at 2 yr and was followed by some weight loss in the third year. These findings indicate that LLA is often followed by clinically important weight gain. Future studies are needed to better understand the reasons for weight gain and to identify intervention strategies to prevent excess weight gain and the deleterious consequences that may ensue.
Linda Resnik, PT, PhD, OCS
Full Text Available We describe prosthetic limb prescription in the first year following lower-limb amputation and examine the relationship between amputation level, geographic region, and prosthetic prescription. We analyzed 2005 to 2010 Department of Veterans Affairs (VA Inpatient and Medical Encounters SAS data sets, Vital Status death data, and National Prosthetic Patient Database data for 9,994 Veterans who underwent lower-limb amputation at a VA hospital. Descriptive statistics and bivariates were examined. Cox proportional hazard models identified factors associated with prosthetic prescription. Analyses showed that amputation level was associated with prosthetic prescription. The hazard ratios (HRs were 1.41 for ankle amputation and 0.46 for transfemoral amputation compared with transtibial amputation. HRs for geographic region were Northeast = 1.49, Upper Midwest = 1.26, and West = 1.39 compared with the South (p < 0.001. African American race, longer length of hospital stay, older age, congestive heart failure, paralysis, other neurological disease, renal failure, and admission from a nursing facility were negatively associated with prosthetic prescription. Being married was positively associated. After adjusting for patient characteristics, people with ankle amputation were most likely to be prescribed a prosthesis and people with transfemoral amputation were least likely. Geographic variation in prosthetic prescription exists in the VA and further research is needed to explain why.
Full Text Available Aim of investigation — to analyze the results of treatment of patients with atherosclerotic gangrene of a limb, to identify the causes of adverse outcomes amputation. Materials and methods: We analyzed the results of examination and treatment of 218 patients with atherosclerotic gangrene of the limb. Good outcome of amputation was considered the primary surgical wound healing of the stump. Suppuration, secondary healing, re-amputation and death we attributed to the adverse results of amputation. Results: The adverse outcomes of amputation due to technical errors in surgery, properly chosen level, inadequate drainage of the wound stump, an unsuccessful operation on the arteries of a limb, inadequate empirical antibiotic therapy, patient's age, functional capabilities of myocardium, the duration of critical ischemia, as well as the lack of psychological adaptation of patients before amputation. Conclusion: To decide the need for amputation in patients with atherosclerotic gangrene follows the assessment of possible vascular reconstructive surgery. In determining the level of amputation is necessary to objectively assess the degree of disruption of regional blood flow using multilevel manometry and laser Dopplerflowmetry. In preparation for amputation should be paid special attention to the correction of rheological and coagulation properties of blood, normalization of the functional state of the myocardium, as well as specialized psychotherapeutic training for timely and adequate psychological adaptation of the patient
Resnik, Linda; Borgia, Matthew
We describe prosthetic limb prescription in the first year following lower-limb amputation and examine the relationship between amputation level, geographic region, and prosthetic prescription. We analyzed 2005 to 2010 Department of Veterans Affairs (VA) Inpatient and Medical Encounters SAS data sets, Vital Status death data, and National Prosthetic Patient Database data for 9,994 Veterans who underwent lower-limb amputation at a VA hospital. Descriptive statistics and bivariates were examined. Cox proportional hazard models identified factors associated with prosthetic prescription. Analyses showed that amputation level was associated with prosthetic prescription. The hazard ratios (HRs) were 1.41 for ankle amputation and 0.46 for transfemoral amputation compared with transtibial amputation. HRs for geographic region were Northeast = 1.49, Upper Midwest = 1.26, and West = 1.39 compared with the South (p amputation were most likely to be prescribed a prosthesis and people with transfemoral amputation were least likely. Geographic variation in prosthetic prescription exists in the VA and further research is needed to explain why.
Partial finger amputation affects patients from the functional as well as from the aesthetic point of view. In accordance with the number of amputated fingers, abilities and capabilities of the hand are reduced and the patient's self-image is altered. The amputated part of the finger can be replaced by an aesthetic silicone prosthesis, which is individually coloured and fitted. In anaplastology, as the field of aesthetic prosthetics is nowadays called, several different approaches to prosthes...
Al-Qattan, M M
Twenty patients with congenital upper limb amputations caused by constriction rings were reviewed to classify the pattern of these amputations. In the 20 patients studied, 31 upper limbs had congenital amputations. The pattern of amputation was classified into three types. Proximal upper limb amputation was considered type I and was only seen in one limb. The most common pattern of amputation was digital amputation associated with "coning" or "superimposition" of the digits (type II) and was seen in 20 hands. Type II amputations were subclassified according to the involvement of all, ulnar, radial, or central digits by the constriction ring. In type III amputations (N = 10 limbs), there was no associated coning or superimposition of the digits. This type of amputation was subclassified into type IIIA (multiple-digit amputations within the same hand) and type III B (single-digit amputation). Associated anomalies are reviewed and the pathogenesis of constriction rings is discussed.
Chateau, Henry; Camus, Mathieu; Holden-Douilly, Laurène; Falala, Sylvain; Ravary, Bérangère; Vergari, Claudio; Lepley, Justine; Denoix, Jean-Marie; Pourcelot, Philippe; Crevier-Denoix, Nathalie
Circling increases the expression of distal forelimb lameness in the horse, depending on rein, diameter and surface properties of the circle. However, there is limited information about the kinetics of horses trotting on circles. The aim of this study was to quantify ground reaction force (GRF) and moments in the inside and outside forelimb of horses trotting on circles and to compare the results obtained on different ground surfaces. The right front hoof of six horses was equipped with a dynamometric horseshoe, allowing the measurement of 3-dimensional GRF, moments and trajectory of the centre of pressure. The horses were lunged at slow trot (3 m/s) on right and left 4 m radius circles on asphalt and on a fibre sand surface. During circling, the inside forelimb produced a smaller peak vertical force and the stance phase was longer in comparison with the outside forelimb. Both right and left circling produced a substantial transversal force directed outwards. On a soft surface (sand fibre), the peak transversal force and moments around the longitudinal and vertical axes of the hoof were significantly decreased in comparison with a hard surface (asphalt). Sinking of the lateral or medial part of the hoof in a more compliant surface enables reallocation of part of the transversal force into a proximo-distal force, aligned with the limb axis, thus limiting extrasagittal stress on the joints.
Toledo, Néstor; Bargo, M Susana; Vizcaíno, Sergio F
Early Miocene sloths are represented by a diversity of forms ranging from 38 to 95 kg, being registered mainly from Santacrucian Age deposits in southern-most shores of Patagonia, Argentina. Their postcranial skeleton differs markedly in shape from those of their closest living relatives (arboreal forms of less than 10 kg), Bradypus and Choloepus. In order to gain insight on functional properties of the Santacrucian sloths forelimb, musculature was reconstructed and a comparative, qualitative morphofunctional analysis was performed, allowing proposing hypotheses about biological role of the limb in substrate preferences, and locomotor strategies. The anatomy of the forelimb of Santacrucian sloths resembles more closely extant anteaters such as Tamandua and Myrmecophaga, due to the robustness of the elements, development of features related to attachment of ligaments and muscles, and conservative, pentadactylous, and strong-clawed manus. The reconstructed forelimb musculature was very well developed and resembles that of extant Pilosa (especially anteaters), although retaining the basic muscular configuration of generalized mammals. This musculature allowed application of powerful forces, especially in adduction of the forelimb, flexion and extension of the antebrachium, and manual prehension. These functional properties are congruent with both climbing and digging activities, and provide support for proposed Santacrucian sloths as good climbing mammals, possibly arboreal or semiarboreal, being also capable diggers. Their climbing strategies were limited, thus these forms relied mainly on great muscular strength and curved claws of the manus to move cautiously on branches.
Sydekum, Esther; Ghosh, Arko; Gullo, Miriam; Baltes, Christof; Schwab, Martin; Rudin, Markus
Thoracic spinal cord injured rats rely largely on forelimbs to walk, as their hindlimbs are dysfunctional. This increased limb use is accompanied by expansion of the cortical forelimb sensory representation. It is unclear how quickly the representational changes occur and whether they are at all related to the behavioral adaptation. Using blood oxygenation level dependent functional mangetic resonance imaging (BOLD-fMRI) we show that major plastic changes of the somato-sensory map can occur as early as one day after injury. The extent of map increase was variable between animals, and some animals showed a reduction in map size. However, at three or seven days after injury a significant enhancement of the forelimb representation was evident in all the animals. In a behavioral test for precise limb control, crossing of a horizontal ladder, the injured rats relied almost entirely on their forelimbs; they initially made more mistakes than at 7 days post injury. Remarkably, in the individual animals the behavioral performance seen at seven days was proportional to the physiological change present at one day after injury. The rapid increase in cortical representation of the injury-spared body part may provide the additional neural substrate necessary for high level behavioral adaptation.
Khan, P A; Tsilfidis, C; Liversage, R A
A central theme concerning the epimorphic regenerative potential of urodele amphibian appendages is that limb regeneration in the adult parallels larval limb development. Results of previous research have led to the suggestion that homeobox containing genes are "re-expressed" during the epimorphic regeneration of forelimbs of adult Notophthalmus viridescens in patterns which retrace larval limb development. However, to date no literature exists concerning expression patterns of any homeobox containing genes during larval development of this species. The lack of such information has been a hindrance in exploring the similarities as well as differences which exist between limb regeneration in adults and limb development in larvae. Here we report the first such results of the localization of Hox C6 (formerly, NvHBox-1) in developing and regenerating forelimbs of N. viridescens larvae as demonstrated by whole-mount in situ hybridization. Inasmuch as the pattern of Hox C6 expression is similar in developing forelimb buds of larvae and epimorphically regenerating forelimb blastemata of both adults and larvae, our results support the paradigm that epimorphic regeneration in adult newts parallels larval forelimb development. However, in contrast with observations which document the presence of Hox C6 in both intact, as well as regenerating hindlimbs and tails of adult newts, our results reveal no such Hox C6 expression during larval development of hindlimbs or the tail. As such, our findings indicate that critical differences in larval hindlimb and tail development versus adult expression patterns of this gene in these two appendages may be due primarily to differences in gene regulation as opposed to gene function. Thus, the apparent ability of urodeles to regulate genes in such a highly co-ordinated fashion so as to replace lost, differentiated, appendicular structures in adult animals may assist, at least in part, in better elucidating the phenomenon of epimorphic
de Chaumont, Arthus; Pierret, Charles; Janvier, Frédéric; Goudard, Yvain; de Kerangal, Xavier; Chapuis, Olivier
Mucormycosis is a rare but serious opportunistic fungal infection. Several clinical forms have been described, including cutaneous localization that is frequently associated with soft tissue trauma or burns. We report a case of cutaneous mucormycosis in a diabetic patient with severe occlusive arterial disease. The diagnosis was made early with mold growth on an amputation wound and the presence of nonseptate hyphae on direct microscopic examination, later identified on culture as Lichtheimia ramosa. Aggressive treatment, including the control of underlying diseases, systemic and local amphotericin B, and extensive surgical debridement permitted successful outcomes.
Burch, Sara H
The forelimbs of nonavian theropod dinosaurs have been the subject of considerable study and speculation due to their varied morphology and role in the evolution of flight. Although many studies on the functional morphology of a limb require an understanding of its musculature, comparatively little is known about the forelimb myology of theropods and other bipedal dinosaurs. Previous phylogenetically based myological reconstructions have been limited to the shoulder, restricting their utility in analyses of whole-limb function. The antebrachial and manual musculature in particular have remained largely unstudied due to uncertain muscular homologies in archosaurs. Through analysis of the musculature of extant taxa in a robust statistical framework, this study presents new hypotheses of homology for the distal limb musculature of archosaurs and provides the first complete reconstruction of dinosaurian forelimb musculature, including the antebrachial and intrinsic manual muscles. Data on the forelimb myology of a broad sample of extant birds, crocodylians, lizards, and turtles were analyzed using maximum likelihood ancestral state reconstruction and examined together with the osteology of the early theropod Tawa hallae from the Late Triassic of New Mexico to formulate a complete plesiomorphic myology for the theropod forelimb. Comparisons with previous reconstructions show that the shoulder musculature of basal theropods is more similar to that of basal ornithischians and sauropodomorphs than to that of dromaeosaurids. Greater development of the supracoracoideus and deltoideus musculature in theropods over other bipedal dinosaurs correlates with stronger movements of the forelimb at the shoulder and an emphasis on apprehension of relatively large prey. This emphasis is further supported by the morphology of the antebrachium and the intrinsic manual musculature, which exhibit a high degree of excursion and a robust morphology well-suited for powerful digital flexion
Littman, Alyson J; Thompson, Mary Lou; Arterburn, David E; Bouldin, Erin; Haselkorn, Jodie K; Sangeorzan, Bruce J; Boyko, Edward J
Little is known about the relationship between lower-limb amputation (LLA) and subsequent changes in body weight. We conducted a retrospective cohort study using clinical and administrative databases to identify and follow weight changes in 759 males with amputation (partial foot amputation [PFA], n = 396; transtibial amputation [TTA], n = 267; and transfemoral amputation [TFA], n = 96) and 3,790 nondisabled persons frequency-matched (5:1) on age, body mass index, diabetes, and calendar year from eight Department of Veterans Affairs medical care facilities in the Pacific Northwest. We estimated and compared longitudinal percent weight change from baseline during up to 39 mo of follow-up in participants with and without amputation. Weight gain in the 2 yr after amputation was significantly more in men with an amputation than without, and in men with a TTA or TFA (8%-9% increase) than in men with a PFA (3%-6% increase). Generally, percent weight gain peaked at 2 yr and was followed by some weight loss in the third year. These findings indicate that LLA is often followed by clinically important weight gain. Future studies are needed to better understand the reasons for weight gain and to identify intervention strategies to prevent excess weight gain and the deleterious consequences that may ensue.
van Battum, P; Schaper, N; Prompers, L
The incidence of minor amputation may vary significantly, and determinants of minor amputation have not been studied systematically. We evaluated minor amputation rate, the determinants of minor amputation and differences in amputation rate between European centres....
Kerr, Peter J; Donnelly, Thomas M
Viral diseases of rabbits have been used historically to study oncogenesis (e.g. rabbit fibroma virus, cottontail rabbit papillomavirus) and biologically to control feral rabbit populations (e.g. myxoma virus). However, clinicians seeing pet rabbits in North America infrequently encounter viral diseases although myxomatosis may be seen occasionally. The situation is different in Europe and Australia, where myxomatosis and rabbit hemorrhagic disease are endemic. Advances in epidemiology and virology have led to detection of other lapine viruses that are now recognized as agents of emerging infectious diseases. Rabbit caliciviruses, related to rabbit hemorrhagic disease, are generally avirulent, but lethal variants are being identified in Europe and North America. Enteric viruses including lapine rotavirus, rabbit enteric coronavirus and rabbit astrovirus are being acknowledged as contributors to the multifactorial enteritis complex of juvenile rabbits. Three avirulent leporid herpesviruses are found in domestic rabbits. A fourth highly pathogenic virus designated leporid herpesvirus 4 has been described in Canada and Alaska. This review considers viruses affecting rabbits by their clinical significance. Viruses of major and minor clinical significance are described, and viruses of laboratory significance are mentioned.
Matthes, I; Beirau, M; Ekkernkamp, A; Matthes, G
Approximately 61,000 amputations are performed in Germany per year. In most cases the lower limbs are affected. The reasons for amputations are arteriosclerosis, diabetes mellitus, severe infections, tumors and complex trauma to the extremities. A decision must be made concerning whether a salvage procedure or amputation is appropriate, specially after trauma. In cases where the need for amputation is clear, the site of amputation needs to be planned in advance with the aim of creating a stump which allows sufficient prosthetic attachment. Adjuvant pain therapy is mandatory, especially in order to avoid subsequent phantom pain. The type of prosthetic restoration is influenced by the grade of mobility and personal requirements of patients. Moreover, aftercare and adjusted rehabilitation are recommended.
Sinha, Richa; van den Heuvel, Wim J. A.; Arokiasamy, Perianayagam; van Dijk, Jitse P.
The objectives of this study are to investigate the relationship between adjustments to amputation and artificial limb, and quality of life (QoL), and to analyse the influence of sociodemographic, medical and amputation-related factors on this relationship. Patients with unilateral and noncongenital
Matthew F Bonnan
Full Text Available The earliest eutherian mammals were small-bodied locomotor generalists with a forelimb morphology that strongly resembles that of extant rats. Understanding the kinematics of the humerus, radius, and ulna of extant rats can inform and constrain hypotheses concerning typical posture and mobility in early eutherian forelimbs. The locomotion of Rattus norvegicus has been extensively studied, but the three-dimensional kinematics of the bones themselves remains under-explored. Here, for the first time, we use markerless XROMM (Scientific Rotoscoping to explore the three-dimensional long bone movements in Rattus norvegicus during a normal, symmetrical gait (walking. Our data show a basic kinematic profile that agrees with previous studies on rats and other small therians: rats maintain a crouched forelimb posture throughout the step cycle, and the ulna is confined to flexion/extension in a parasagittal plane. However, our three-dimensional data illuminate long-axis rotation (LAR movements for both the humerus and the radius for the first time. Medial LAR of the humerus throughout stance maintains an adducted elbow with a caudally-facing olecranon process, which in turn maintains a cranially-directed manus orientation (pronation. The radius also shows significant LAR correlated with manus pronation and supination. Moreover, we report that elbow flexion and manus orientation are correlated in R. norvegicus: as the elbow angle becomes more acute, manus supination increases. Our data also suggest that manus pronation and orientation in R. norvegicus rely on a divided system of labor between the ulna and radius. Given that the radius follows the flexion and extension trajectory of the ulna, it must rotate at the elbow (on the capitulum so that during the stance phase its distal end lies medial to ulna, ensuring that the manus remains pronated while the forelimb is supporting the body. We suggest that forelimb posture and kinematics in Juramaia, Eomaia, and
Boesgaard, Martin; Vesterager, Mette; Zenner, Erik
The stream cipher Rabbit was first presented at FSE 2003, and no attacks against it have been published until now. With a measured encryption/decryption speed of 3.7 clock cycles per byte on a Pentium III processor, Rabbit does also provide very high performance. This paper gives a concise...... description of the Rabbit design and some of the cryptanalytic results available....
Amputation of a mangled extremity is repugnant to the patient and the surgeon. However, prolonged unsuccessful attempts at salvage are costly, highly morbid, and sometimes lethal. Much discussion has taken place regarding which criteria predict successful salvage, and predictive indices have been proposed in an attempt to identify limbs for which attempted salvage is unlikely to succeed. The Mangled Extremity Severity Score, or MESS, system is the most thoroughly validated of the various classification systems, but at present there is no predictive scale that can be used with confidence to determine whether to amputate or attempt to salvage a mangled lower extremity. Therefore, these systems should serve only as guides to supplement the surgeon's clinical judgment and experience. Although salvage for severe injuries below the knee can be difficult and the functional outcome unpredictable, prosthetic function after transtibial amputation is generally good. Conversely, prosthetic function after transfemoral or transradial amputation is often poor, while salvage of some useful function for injuries above the knee is often successful. When limb loss is inevitable, immediate amputation is desirable. If obvious criteria for primary amputation are not met, however, it is reasonable to consider an initial salvage attempt, observation, and subsequent early secondary amputation.
Siniscalchi, M; Padalino, B; Lusito, R; Quaranta, A
Evidence for behavioural and brain lateralisation is now widespread among the animal kingdom; lateralisation of limb use (pawedness) occurs in several mammals including both feral and domestic horses. We investigated limb preferences in 14 Quarter Horse during different motor tasks (walking, stepping on and off a step, truck loading and unloading). Population lateralisation was observed in two tasks: horses preferentially used their left forelimb during truck loading and stepping off a step. The results also revealed that horses showed higher scores for anxious behaviours during truck loading suggesting that the use of the left forelimb in this task may reflect the main role of the right hemisphere in control of behaviour during stressful situation.
The membrane-anchored metalloproteinase-regulator RECK has been characterized as a tumor suppressor. Here we report that mice with reduced Reck-expression show limb abnormalities including right-dominant, forelimb-specific defects in postaxial skeletal elements. The forelimb buds of low-Reck mutants have an altered dorsal ectoderm with reduced Wnt7a and Igf2 expression, and hypotrophy in two signaling centers (i.e., ZPA and AER that are essential for limb outgrowth and patterning. Reck is abundantly expressed in the anterior mesenchyme in normal limb buds; mesenchyme-specific Reck inactivation recapitulates the low-Reck phenotype; and some teratogens downregulate Reck in mesenchymal cells. Our findings illustrate a role for Reck in the mesenchymal-epithelial interactions essential for mammalian development.
Østergaard, Elisabeth Bomholt
& Maclachlan 2004). Antallet af benamputationer i Danmark er steget, og skyldes i Vesten hovedsagelig (85-90%) karsygdomme, hvoraf ca. 1/3 skyldes diabetes. To af Danmarks otte folkesygdomme er netop hjertekarsygdomme og type 2-diabetes (SIF 2005), som for en stor del skyldes livsstil. I Danmark har mellem 200.000...... og 300.000 mennesker type 2- diabetes og forekomsten er kraftigt stigende og forekommer i stadig yngre aldersgrupper (Dansk Sygeplejeråd 2006) med amputation som mulig konsekvens. Formål Opnå indsigt i hvad der kan medvirke til, at mennesker kan føle sig hele igen efter en benamputation, føle sig...
Evgeniou, Evgenios; Iyer, Srinivasan
Flexor tenosynovitis is an aggressive closed-space infection of the digital flexor tendon sheaths of the hand. We present a case of pyogenic flexor tenosynovitis in an immunocompromised patient and discuss the importance of early diagnosis and referral to a specialist hand surgery unit. A 61-year-old man visited his general practitioner because of swelling and tenderness of his left index finger. The patient was discharged on oral antibiotics but returned 4 days after because of deterioration of his symptoms and was referred to a plastic surgery unit. A diagnosis of flexor tenosynovitis was made and the patient required multiple debridements in theatre, resulting in the amputation of the infected finger. Pyogenic flexor tenosynovitis is a relatively common but often misdiagnosed hand infection. Patients with suspected flexor tenosynovitis should be referred and treated early to avoid significant morbidity, especially when risk factors for poor prognosis are present.
Salah Y. Habel
Full Text Available Foot ulceration in diabetic patients is a frequent complication of diabetes mellitus (DM, necessitating hospitalization for control of infection, wound care and glycemic control. These patients are at risk for potential loss of the involved limb as well as for future loss of the contralateral limb. Diabetic foot is the consequence of peripheral neuropathy complicated by infrapopliteal peripheral vascular disease. Most of the patients present with chronic plantar ulceration and with cellulitis or an abscess. In a significant number of patients, it is observed that the frequency of life or limb threatening infection is less with an intact skin cover. Limb salvage employs the use of culture specific antibiotics, sharp debridement or a minor amputation, wound care and/or skin cover as the situation demands.
Вячеслав Владимирович Суханов
Full Text Available Cultural space of any state is formed by a population that is within its borders. In this article, the author introduces a new cultural definitions «cultural impotence» and «cultural amputation», justifying their use, both in terms of population of the Russian Federation and the European Union and America. The article analyzes the state of society and the cultural factors that influence the development of society in Russia, there are options to bring the country out of a deep cultural crisis. Also established a close relationship between the domestic policy of the state and development of culture.DOI: http://dx.doi.org/10.12731/2218-7405-2013-2-1
Vigaru, Bogdan C; Lambercy, Olivier; Schubring-Giese, Maximilian; Hosp, Jonas A; Schneider, Melanie; Osei-Atiemo, Clement; Andreas R. Luft; Gassert, Roger
Animal models are widely used to explore the mechanisms underlying sensorimotor control and learning. However, current experimental paradigms allow only limited control over task difficulty and cannot provide detailed information on forelimb kinematics and dynamics. Here we propose a novel robotic device for use in motor learning investigations with rats. The compact, highly transparent, three degree-of-freedom manipulandum is capable of rendering nominal forces of 2 N to guide or perturb rat...
Sunshine, Michael D.; Cho, Frances S.; Lockwood, Danielle R.; Fechko, Amber S.; Kasten, Michael R.; Moritz, Chet T.
Objective. Intraspinal microstimulation (ISMS) is a promising method for reanimating paralyzed limbs following neurological injury. ISMS within the cervical and lumbar spinal cord is capable of evoking a variety of highly-functional movements prior to injury, but the ability of ISMS to evoke forelimb movements after cervical spinal cord injury is unknown. Here we examine the forelimb movements and muscles activated by cervical ISMS both before and after contusion injury. Approach. We documented the forelimb muscles activated and movements evoked via systematic stimulation of the rodent cervical spinal cord both before injury and three, six and nine weeks following a moderate C4/C5 lateralized contusion injury. Animals were anesthetized with isoflurane to permit construction of somatotopic maps of evoked movements and quantify evoked muscle synergies between cervical segments C3 and T1. Main results. When ISMS was delivered to the cervical spinal cord, a variety of responses were observed at 68% of locations tested, with a spatial distribution that generally corresponded to the location of motor neuron pools. Stimulus currents required to achieve movement and the number of sites where movements could be evoked were unchanged by spinal cord injury. A transient shift toward extension-dominated movements and restricted muscle synergies were observed at three and six weeks following injury, respectively. By nine weeks after injury, however, ISMS-evoked patterns were similar to spinally-intact animals. Significance. The results demonstrate the potential for cervical ISMS to reanimate hand and arm function following spinal cord injury. Robust forelimb movements can be evoked both before and during the chronic stages of recovery from a clinically relevant and sustained cervical contusion injury.
Lindsay, W A; McDonell, W; Bignell, W
Intracompartmental muscle pressures were recorded from the right and left forelimbs (extensor carpi radialis, triceps brachii) of healthy horses maintained in left lateral recumbency while under deep halothane anesthesia for 180 to 240 minutes. Cardiac output, blood pressure, blood gases, and acid-base status were monitored throughout the anesthesia, and electrolyte levels (Ca2+, P+, K+, Cl-, Na+) and enzyme activities (aspartate aminotransferase (AST), creatine phosphokinase (CPK), and blood lactate) were monitored for 7 days. Postanesthetic forelimb lameness was produced in 5 of the 6 horses with this prolonged anesthetic regime. This lameness was associated with muscle plaque formation and clinical signs which were similar to the forelimb lameness sometimes seen in horses after surgical anesthesia. Plasma protein, serum calcium, plasma sodium, and blood urea nitrogen concentrations did not change, whereas significantly increased hematocrit, plasma potassium, and serum inorganic phosphate values were seen at the end of anesthesia, along with a decrease in plasma chloride values. Blood lactate, serum AST, and serum CPK activities were significantly high in the postanesthetic period, although the sequence of the changes differed. Intracompartmental muscle pressures were higher in the left forelimb adjacent to the floor (contact limb), and in the instance of the triceps of the contact limb, the pressures were sufficiently high (greater than 30 mm of Hg) that they may have compromised capillary blood flow. However, these high intracompartmental muscle pressures did not persist when positional changes of the horses were introduced at the end of the anesthetic period. There was no correlation between the severity of postanesthetic lameness and any of the measured values. The results demonstrate an experimentally induced postanesthetic lameness which was primarily related to the development of a myositis. Although the causative factors of this myositis may be multiple
Giljov, Andrey; Karenina, Karina; Malashichev, Yegor
Background Acquisition of upright posture in evolution has been argued to facilitate manual laterality in primates. Owing to the high variety of postural habits marsupials can serve as a suitable model to test whether the species-typical body posture shapes forelimb preferences in non-primates or this phenomenon emerged only in the course of primate evolution. In the present study we aimed to explore manual laterality in marsupial quadrupeds and compare them with the results in the previously...
Schmidt, M; Fischer, M S
Movements of forelimb joints and segments during walking in the brown lemur (Eulemur fulvus) were analyzed using cineradiography (150 frames/sec). Metric gait parameters, forelimb kinematics, and intralimb coordination are described. Calculation of contribution of segment displacements to stance propulsion shows that scapular retroversion in a fulcrum near the vertebral border causes more than 60% of propulsion. The contribution by the shoulder joint is 30%, elbow joint 5%, and wrist joint 1%. Correlation analysis was applied to reveal the interdependency between metric and kinematic parameters. Only the effective angular movement of the elbow joint during stance is speed-dependent. Movements of all other forelimb joints and segments are independent of speed and influence, mainly, linear gait parameters (stride length, stance length). Perhaps the most important result is the hitherto unknown and unexpected degree of scapular mobility. Scapular movements consist of ante-/retroversion, adduction/abduction, and scapular rotation about the longitudinal axis. Inside rotation of the scapula (60 degrees -70 degrees ), together with flexion in the shoulder joint, mediates abduction of the humerus, which is not achieved in the shoulder joint, and is therefore strikingly different from humeral abduction in man. Movements of the shoulder joint are restricted to flexion and extension. At touch down, the shoulder joint of the brown lemur is more extended compared to that of other small mammals. The relatively long humerus and forearm, characteristic for primates, are thus effectively converted into stride length. Observed asymmetries in metric and kinematic behavior of the left and right forelimb are caused by an unequal lateral bending of the spinal column.
Hovgaard, C; Angermann, P; Hovgaard, D
120 patients with amputation of at least 1 of the 4 ulnar fingers were admitted to hospital. In none was replantation considered to be possible because of serious damage to the soft tissues and bone. 12 (3-18) years after the accident 80 percent of the patients assessed their condition as good or fair, even those with proximal amputation or loss of 2 or 3 fingers. Our observations do not support replantation when only one of the second-to-fifth fingers have been amputated.
Kurdibaylo, S F
Anthropometric and biochemical research was conducted on 94 subjects with various levels of lower limb amputation. The purpose of the work was to investigate the features of obesity progression and disorders of cholesterin metabolism, as well as to develop adequate training exercises. Anthropometric research was conducted by calipermetry; the biochemical research was done by various methods to determine exempt and total cholesterin and triglycerides in the blood serum. The research establishes the frequency of obesity progression relative to the level of amputation, as well as the features of the excessive body mass. Type 11A hyperlipoproteidemia was evident. It is characterized by rapid progress of atherosclerotic vascular disease and coronary disease (CD). Cyclic and acyclic exercises were developed for prophylaxis and therapy. Anthropometric research on the determination of body fat mass was conducted on 68 subjects with various levels of lower limb amputation. The nondirect method of measuring skin folds of several parts of the body was used to determine the extent of lipogenesis. Biochemical research of cholesterin metabolism was conducted on 26 subjects with lower limb amputation (a different group). Anthropometric research revealed an increase of body fat mass directly related to the level of amputation. The largest amount of fat in the body mass was noted for the subjects with bilateral transfemoral (above-knee) amputation or transfemoral plus transtibial (below-knee) amputation. Both groups averaged 25.9%. The body fat mass increased chiefly in the subcutaneous fat. Increase of the internal fat mass was less noticeable. The frequency of obesity progression in subjects with unilateral transtibial amputation equaled 37.9%; in subjects with transfemoral amputation, 48.0%; and in subjects with bilateral transfemoral or transfemoral plus transtibial amputation, 64.2%. Young subjects demonstrated obesity progression during the first year after amputation
Maria Angélica Miglino
Full Text Available The asinine species was originated thousands of years ago from the same branch of domestic equine. Asinines have been undergoing a great adaptation resulting in different characteristics observed in their populations around the world. In the northeastern region of Brazil, they play an essential role in the economy of local families. Due to a large number of locomotor disorders and a lack of professional care for these animals, a radiographic study of the distal forelimb region of the asinine was carried out in order to gather information for the improvement of clinical and surgical practices in this species, and to explain their low susceptibility to locomotor disorders compared to that of the domestic equine. The angiographic examination revealed the main arterial vessels committed to the blood supply of the forelimbs in these animals, providing evidence of the vascular pattern of the median and palmar common digital arteries, which originated a great number of collateral branches, mainly to the distal phalanx. The distal forelimbs in donkeys have shown great vascular anastomosis, promoting additional blood supply to the deep endosteum and periosteum regions, probably as a response to the physical activity developed by these animals.
Fujiwara, Shin-ichi; Hutchinson, John R
Forelimb posture has been a controversial aspect of reconstructing locomotor behaviour in extinct quadrupedal tetrapods. This is partly owing to the qualitative and subjective nature of typical methods, which focus on bony articulations that are often ambiguous and unvalidated postural indicators. Here we outline a new, quantitatively based forelimb posture index that is applicable to a majority of extant tetrapods. By determining the degree of elbow joint adduction/abduction mobility in several tetrapods, the carpal flexor muscles were determined to also play a role as elbow adductors. Such adduction may play a major role during the stance phase in sprawling postures. This role is different from those of upright/sagittal and sloth-like creeping postures, which, respectively, depend more on elbow extensors and flexors. Our measurements of elbow muscle moment arms in 318 extant tetrapod skeletons (Lissamphibia, Synapsida and Reptilia: 33 major clades and 263 genera) revealed that sprawling, sagittal and creeping tetrapods, respectively, emphasize elbow adductor, extensor and flexor muscles. Furthermore, scansorial and non-scansorial taxa, respectively, emphasize flexors and extensors. Thus, forelimb postures of extinct tetrapods can be qualitatively classified based on our quantitative index. Using this method, we find that Triceratops (Ceratopsidae), Anhanguera (Pterosauria) and desmostylian mammals are categorized as upright/sagittally locomoting taxa.
Full Text Available Interactions between distinct motor cortical areas are essential for coordinated motor behaviors. In rodents, the motor cortical forelimb areas are divided into at least two distinct areas: the rostral forelimb area (RFA and the caudal forelimb area (CFA. The RFA is thought to be an equivalent of the premotor cortex in primates, whereas the CFA is believed to be an equivalent of the primary motor cortex. Although reciprocal connections between the RFA and the CFA have been anatomically identified in rats, it is unknown whether there are functional connections between these areas that can induce postsynaptic spikes. In this study, we used an in vivo Channelrhodopsin-2 photostimulation method to trace the functional connections between the mouse RFA and CFA. Simultaneous electrical recordings were utilized to detect spiking activities induced by synaptic inputs originating from photostimulated areas. This method, in combination with anatomical tracing, demonstrated that the RFA receives strong functional projections from layer 2/3 and/or layer 5a, but not from layer 5b, of the CFA. Further, the CFA receives strong projections from layer 5b neurons of the RFA. The onset latency of electrical responses evoked in remote areas upon photostimulation of the other areas was approximately 10 ms, which is consistent with the synaptic connectivity between these areas. Our results suggest that neuronal activities in the RFA and the CFA during movements are formed through asymmetric reciprocal connections.
Dalton, Kevin P; Nicieza, Inés; Balseiro, Ana; Muguerza, María A; Rosell, Joan M; Casais, Rosa; Álvarez, Ángel L; Parra, Francisco
Outbreaks of rabbit hemorrhagic disease have occurred recently in young rabbits on farms on the Iberian Peninsula where rabbits were previously vaccinated. Investigation identified a rabbit hemorrhagic disease virus variant genetically related to apathogenic rabbit caliciviruses. Improved antivirus strategies are needed to slow the spread of this pathogen.
Borkosky, Sara L; Roukis, Thomas S
The reliability and durability of partial first ray amputation in patients with diabetes and peripheral neuropathy has recently been questioned. In an effort to determine the repeat amputation rate after a partial first ray amputation associated with diabetes mellitus and peripheral neuropathy at our institution, we performed an 11-year retrospective review. A total of 59 patients (40 males and 19 females), with a mean age of 63 (range 39 to 97) years, were included. The mean follow-up was 33.8 (range 1 to 123) months, with initial incision healing occurring in all 59 patients. Despite the initial healing, 69% developed a mean of 3.1 subsequent foot ulcerations at a mean of 10.5 months, 36% required ancillary surgical procedures, and more than 90% of patients were prescribed multiple courses of antibiotics at a mean of 26.6 clinic visits during the follow-up period. A total of 25 patients (42.4%) underwent more proximal repeat amputation at a mean of 25 (range 1 to 97) months after the initial partial first ray amputation. The results of our retrospective review revealed that nearly 1 of every 2 patients with diabetes and peripheral neuropathy who undergo a partial first ray amputation will progress to a more proximal repeat amputation, despite initial healing. These data question the reliability and durability of this level of amputation as a primary procedure in this patient population. A more proximal level amputation, such as a balanced transmetatarsal, might provide a better functional and reliable residual weightbearing foot and should be considered at the initial presentation. This is especially true given that nearly one half of the patients died during the follow-up period. However, this remains a matter for conjecture because of the limited data available; therefore, additional prospective investigations are warranted.
Britton, J P; Barrie, W. W.
Over a period of 10 years, 149 amputations were performed for lower limb ischaemia in 119 diabetic patients. Thirty patients required amputation of the second limb. Ninety per cent of the patients were over the age of 60 years. Sixty four ischaemic limbs were treated by primary local amputation or debridement--29 healed successfully, 30 proceeded to a higher amputation. The incidence of multiple local operations was high. A below knee amputation was performed in 56 limbs--7 failed to heal and...
Warner, Nafisseh S; Warner, Matthew A; Moeschler, Susan M; Hoelzer, Bryan C
Acute pain following amputation can be challenging to treat due to multiple underlying mechanisms and variable clinical responses to treatment. Furthermore, poorly controlled preoperative pain is a risk factor for developing chronic pain. Evidence suggests that epidural analgesia and peripheral nerve blockade may decrease the severity of residual limb pain and the prevalence of phantom pain after lower extremity amputation. We present the perioperative analgesic management of a patient with gangrene of the bilateral upper and lower extremities as a result of septic shock and prolonged vasopressor administration who underwent four-limb amputation in a single procedure. A multimodal analgesic regimen was utilized, including titration of preoperative opioid and neuropathic pain agents, perioperative intravenous, epidural and peripheral nerve catheter infusions, and postoperative oral medication titration. More than 8 months postoperatively, the patient has satisfactory pain control with no evidence for phantom limb pain. To our knowledge, there have been no publications to date concerning analgesic regimens in four-limb amputation.
Gebuhr, Peter Henrik; Jørgensen, J P; Vollmer-Larsen, B;
Leg amputation levels were decided in 24 patients suffering from atherosclerosis, using the conventional techniques of segmental blood pressure and radioisotope skin clearance. The skin microcirculation was measured and recorded before operation with a laser doppler flowmeter. A high correlation ...
Diogo, Rui; Linde-Medina, Marta; Abdala, Virginia; Ashley-Ross, Miriam A
Most textbooks and research reports state that the structures of the tetrapod forelimbs and hindlimbs are serial homologues. From this view, the main challenge of evolutionary biologists is not to explain the similarity between tetrapod limbs, but instead to explain why and how they have diverged. However, these statements seem to be related to a confusion between the serial homology of the vertebrate pelvic and pectoral appendages as a whole, and the serial homology of the specific soft- and hard-tissue structures of the tetrapod forelimbs and hindlimbs, leading to an even more crucial and puzzling question being overlooked: why are the skeletal and particularly the muscle structures of the forelimb and hindlimb actually so strikingly similar to each other? Herein we provide an updated discussion of these questions and test two main hypotheses: (i) that the similarity of the limb muscles is due to serial homology; and (ii) that tetrapods that use hindlimbs for a largely exclusive function (e.g. bipedalism in humans) exhibit fewer cases of similarity between forelimbs and hindlimbs than do quadrupedal species. Our review shows that of the 23 arm, forearm and hand muscles/muscle groups of salamanders, 18 (78%) have clear 'topological equivalents' in the hindlimb; in lizards, 14/24 (58%); in rats, 14/35 (40%); and in modern humans, 19/37 (51%). These numbers seem to support the idea that there is a plesiomorphic similarity and subsequent evolutionary divergence, but this tendency actually only applies to the three former quadrupedal taxa. Moreover, if one takes into account the total number of 'correspondences', one comes to a surprising and puzzling conclusion: in modern humans the number of forelimb muscles/muscle groups with clear 'equivalents' in the hindlimb (19) is substantially higher than in quadrupedal mammals such as rats (14), lizards (14) and even salamanders (18). These data contradict the hypothesis that divergent functions lead to divergent
Leow, M E; Pho, R W; Pereira, B P
In summary, the impact and value of esthetic prostheses on amputee rehabilitation and their long-term use were demonstrated in this study to have no correlation with the severity of injury and level of amputation. All patients with traumatic amputation should be given equal opportunity to receive prostheses if the service is readily available. Whether use of prostheses is temporary or long-term, they help patients cope with the traumatic life experience of limb loss.
Salah, Mohammed Murshid; Khalid, Khalid N
This study reports four cases of hand avulsion at the proximal wrist level and multiple digits amputation were received in plastic and hand surgery unit during the year 2007–2008. All patients were male labors between 22–30 years old, and the amputation due to machine injuries. Successful replantation were achieved, after a period of follow up with occupational therapy all patients regain good functional and cosmetic results. This study proves the strong indication of replantation of multiple...
ceptionally difficult to manage .11,12 There have been numerous studies published examining major amputations caused by extremity trauma during the OIF, OEF...Disarticulation, knee disarticulation, elbow disarticulation, wrist disarticulation 1 0 Total 366 30 (of all amputees) J Trauma Acute Care Surg Volume 73...to amputation, Injury Severity Score (ISS), age, rank, number of trauma admissions, and number of troops deployed. RESULTS: There were 1,221 amputees
Christopher Olusanjo Akosile
Full Text Available Purpose: The aims of this study were to determine the QoL of Nigerians with lower limb amputation and to investigate the influence of some clinical and socio-demographic variables on it. Method: Forty-seven individuals with lower limb amputation participated in this study. Participants’ age, gender, marital status, occupation, time since amputation, level of amputation, affected limb and use of prosthesis were recorded. Quality of life was then measured using the WHO QOL-BREF. Data were analysed using mean and standard deviation, Mann-Whitney U test and Kruskal-Wallis test at 0.05 alpha levels. Results: Participants’ overall health and QoL scores were 3.6(SD 0.9 and 3.9(SD 0.7 respectively. Male subjects had significantly higher scores than females in the domains of physical health (p = 0.007, social relationships (p = 0.024 and overall health (p = 0.012. Prosthesis-wearing subjects scored significantly higher in the domains of physical health (p = 0.015, psychological health (p = 0.008 and environment (p = 0.011 and overall health (0.033, than those not wearing prosthesis. Level of amputation, leg dominance and pre-amputation occupational category had no significant influence on participants’ QoL. Conclusion: The findings of this study suggest that the QoL of individuals with lower limb amputation in Nigeria is moderate. The only factors which have significant influence on some QoL domains are gender and use of prosthesis.Implications: Individuals with lower limb amputation, particularly females and those not wearing prosthesis, require special attention. Clinicians should identify barriers to the use of prosthesis so as to enhance their quality of life.
Setacci, F; Sirignano, P; De Donato, G; Galzerano, G; Cappelli, A; Palasciano, G; Setacci, C
Diabetic foot (DF) continues to present a significant challenge to the vascular surgeon. Despite great advances in the treatment of DF, including open revascularization and endovascular techniques, significant numbers of amputations are still performed. The effect of aggressive revascularization on ultimate limb salvage rates continues to be debated. In the US the amputation rate has increased from 19 to 30 per 100000 persons years over the last two decades primarily due to an increase in diabetes and advancing age. Despite advances in cardiovascular treatment, in patients over 85 year of age an amputation rate of 140 per 100000 persons/year has been reported with a primary amputation (PA) still carrying an excessively high mortality rate of 13-17%. Amputation has been historically regarded as a life saving therapeutic measure. At the time the advances of surgical techniques in revascularization, diagnostic modalities and effectiveness in antimicrobial agents have unintentionally designated amputation to be the last treatment option. Nowadays we have a variety of therapeutic options to correct, modify, or circumvent the obstructive vascular pathology, such as angioplasty, atherectomy, stenting, stent graft and the traditional open surgical approach using endarterectomy, patch angioplasty, or bypass revascularization and even sympathectomy to enhance cutaneous perfusion to the toes. However it is understandable that many older patients who have received multiple limb preservation procedures have spent most of the remaining days of their lives in and out of the hospital or in a long-term care facility where high technical and sophisticated wound care techniques can be provided.
Lindholt, Jes Sanddal; Bøvling, Søren; Fasting, H;
In June 1988 a Department of Vascular Surgery was established in the county of Viborg, Denmark. In this retrospective study of the periods 1986-87 and 1989-90, we have observed a significant rise in the number of patients evaluated by a vascular surgeon before amputation, from 19 to 49...... surgical activity. The frequency of major amputations in the county in 1986-87 of 40.9 per 100,000 per year declined by 25% to 30.9 per 100,000 per year in 1989-90. We conclude that vascular surgery reduces the number of major lower limb amputations and consequently all patients threatened with amputation......%. At the same time the number of major lower limb amputations significantly decreased. This reduction was most marked in 1990 probably due to a rise of 43% in the number of distal reconstructions. The distribution between below knee, through knee and mid-thigh amputation was unaffected by the increased vascular...
Wang, Fangyong; Hong, Yi
[Purpose] To study the characteristics and treatment strategy for patients with paraplegia and lower extremity amputation. [Subjects] Six cases were selected from among the patients admitted to the China Rehabilitation Research Center from 1991 to 2014. The criteria for the six cases were spinal cord injury with amputation immediately or in a short time (1 week) after the trauma. [Methods] General information, clinical diagnosis, treatment, rehabilitation and other data were analyzed. [Results] All the six cases were injured by high energy or complex energy accidents: two cases by falls after high voltage electric shock, one by an oil pipeline explosion, one by the impact of a falling tower crane and received high energy traffic accident injuries (one was hit by a train, and the other was hit by a truck at high speed). All the six cases had thoracic and lumbar vertebral injuries and complete paraplegia. Amputation stump infection occurred in four cases. After comprehensive rehabilitation treatment, patients' functional independence measure (FIM) scores improved significantly, but American Spinal Injury Association (ASIA) scores and ASIA Impairment Scale (AIS) grades showed no significant improvement. [Conclusion] When formulating the clinical treatment and rehabilitation for spinal cord injury with amputation patients, simultaneous consideration of the characteristics of the spinal cord injury and amputation is needed to develop an individualized strategy. For spinal cord injury with limb amputation patients, prostheses should allow the improvement of patients' self-care ability.
Foster, Kathleen L; Higham, Timothy E
The range of inclines and perch diameters in arboreal habitats poses a number of functional challenges for locomotion. To effectively overcome these challenges, arboreal lizards execute complex locomotor behaviors involving both the forelimbs and the hindlimbs. However, few studies have examined the role of forelimbs in lizard locomotion. To characterize how the forelimbs and hindlimbs differentially respond to changes in substrate diameter and incline, we obtained three-dimensional high-speed video of green anoles (Anolis carolinensis) running on flat (9 cm wide) and narrow (1.3 cm) perches inclined at 0, 45 and 90 deg. Changes in perch diameter had a greater effect on kinematics than changes in incline, and proximal limb variables were primarily responsible for these kinematic changes. In addition, a number of joint angles exhibited greater excursions on the 45 deg incline compared with the other inclines. Anolis carolinensis adopted strategies to maintain stability similar to those of other arboreal vertebrates, increasing limb flexion, stride frequency and duty factor. However, the humerus and femur exhibited several opposite kinematic trends with changes in perch diameter. Further, the humerus exhibited a greater range of motion than the femur. A combination of anatomy and behavior resulted in differential kinematics between the forelimb and the hindlimb, and also a potential shift in the propulsive mechanism with changes in external demand. This suggests that a better understanding of single limb function comes from an assessment of both forelimbs and hindlimbs. Characterizing forelimb and hindlimb movements may reveal interesting functional differences between Anolis ecomorphs. Investigations into the physiological mechanisms underlying the functional differences between the forelimb and the hindlimb are needed to fully understand how arboreal animals move in complex habitats.
Christensen, Jan; Ipsen, Thomas; Doherty, Patrick;
, years of education, as well as duration and severity of phantom pain were found to be determining factors for HRQoL among veterans with lower-limb amputation. Conclusions The identified physical and social determinants were similar to those found in civilian traumatic amputees. More high quality......Purpose Most veterans live for many years after their war-related traumatic lower-limb amputation, which is why understanding which factors influence health-related quality of life (HRQoL) remains important to their long-term management. The objective of this study was to perform a review...... of the literature to summarize any evidence on the physical and social determinants for HRQoL in veterans with uni- or bilateral lower-limb amputation(s). Method MEDLINE, EMBASE, PEDro, CINAHL, Scopus and Cochrane databases were searched systematically for eligible studies. Inclusion criteria were: traumatic lower...
Geertzen, Jan; van der Linde, Harmen; Rosenbrand, Kitty; Conradi, Marcel; Deckers, Jos; Koning, Jan; Rietman, Hans S.; van der Schaaf, Dick; van der Ploeg, Rein; Schapendonk, Johannes; Schrier, Ernst; Duijzentkunst, Rob Smit; Spruit-van Eijk, Monica; Versteegen, Gerbrig; Voesten, Harrie
Background: Surgeons still use a range of criteria to determine whether amputation is indicated. In addition, there is considerable debate regarding immediate postoperative management, especially concerning the use of immediate/delayed fitting' versus conservative elastic bandaging. Objectives: To p
Wied, Christian; Tengberg, Peter T; Holm, Gitte
with sagittal flaps. The pneumatic tourniquet, when used, was inflated around the femur to a pressure of 100 mmHg above the systolic blood pressure. The number of blood transfusions within the first four postoperative days was recorded. The intraoperative blood loss (OBL), which is defined as the volume...... portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d. RESULTS: Seventy-four out of 86 consecutive patients who underwent TTA within...
Sinha, Richa; van den Heuvel, Wim J A; Arokiasamy, Perianayagam; van Dijk, Jitse P
The objectives of this study are to investigate the relationship between adjustments to amputation and artificial limb, and quality of life (QoL), and to analyse the influence of sociodemographic, medical and amputation-related factors on this relationship. Patients with unilateral and noncongenital lower limb amputation who were using artificial limb were interviewed (n=368) using structured questionnaires. The Trinity Amputation and Prosthesis Experience Scales (TAPES) were used to assess adjustments to amputation and artificial limb and the MOS Short-Form Health Survey (SF-36) was used to assess the physical (PCS) and mental (MCS) component summary of QoL. Absence of comorbidity and residual stump pain, being employed, young age, less functional restriction, being more adjusted to limitation, increased social adjustment and less restriction in athletic activity were related to better PCS scores. Absence of comorbidity and phantom limb pain, nonuse of assistive device, being more adjusted to limitation, increased social adjustment and being less functionally restricted were related to higher MCS scores. Comorbidity had a modifying effect on both PCS and MCS scores. In addition, age, being employed and residual stump pain had a modifying influence on PCS, whereas assistive device use and phantom limb pain had a modifying influence on MCS. Our findings show that TAPES subscales have a modifying effect on the associations between several background (sociodemographic and amputation characteristics) and QoL (PCS and MCS). This indicates that adjustments to amputation and artificial limb are the key determinants of QoL in individuals following lower limb amputation.
Tintle, Scott M; Donohue, Michael A; Shawen, Scott; Forsberg, Jonathan A; Potter, Benjamin K
Symptomatic neuroma formation after trauma-related transtibial amputations remains a clinical problem. The sural nerve is frequently overlooked in its vulnerable subcutaneous location in the posterior myofasciocutaneous flap and commonly leads to chronic pain and decreased prosthesis use. The standard sural traction neurectomy may actually predispose the sural neuroma to form in a region that becomes symptomatic with prosthesis wear. The proposed modified proximal sural traction neurectomy using a standard or extended posterior flap begins with identification of the sural nerve in the subcutaneous tissue of the distal flap in identical fashion to a standard sural neurectomy. In the proximal posterior flap, a limited anterior approach is then performed and gentle traction on the distal end of the sural nerve aids in the identification of the most proximally accessible portion of the medial sural cutaneous nerve. After locating the medial sural cutaneous nerve proximally, a neurectomy at this location is performed, allowing the retraction of the nerve into a healthy tissue bed substantially more proximal than with a standard sural neurectomy. This technique ensures that the resulting neuroma does not form directly at the distal end of the residual limb where it is, in our experience, more likely to become symptomatic.
Wilbek, T E; Jansen, R B; Jørgensen, B
Aim: To describe the number of minor lower extremity amputations and mortality for diabetes patients treated by a specialized multidisciplinary foot care team. Methods: A retrospective descriptive study of medical records from patients with diabetes treated with minor amputations at the Copenhagen...... Wound Healing Center (CWHC) at Bispebjerg Hospital from 1996-2013. Results: 777 diabetes patients treated with minor amputations were included. 77% were males and 23% were females. 80% had T2 diabetes and 20% had T1 diabetes. 89% of the patients had a foot ulcer at first contact. There was a total of 1...... 231 minor amputations. The amputations were mainly trans-metatarsal amputations and partial amputations of toes. There was an increase in the number of minor amputations, but there was also an increase in the number of referred diabetes patients, thus the ratio of amputations per admitted diabetes...
Mayo, Amanda; Berbrayer, David
Spina bifida is associated with foot deformities, which may lead to foot ulcers, osteomyelitis, and limb amputation. Calcanectomy and Symes amputations have been reported successful in spina bifida. There is lack of evidence for transtibial amputations. This case describes a 27-yr-old woman with L4 level spina bifida who underwent bilateral transtibial amputations. She ambulated with bilateral ankle foot orthoses and canes until age 22. At age 22, she had bilateral foot reconstructive surgeries complicated by nonunion, ulcerations, and osteomyelitis. She was using a wheelchair by age 25. She had elective bilateral transtibial amputations at age 27 for progressive osteomyelitis. Four weeks after amputations, she was fit with bilateral prostheses. On completion of 2 mos of rehabilitation, she ambulated with a cane. This case demonstrates good functional outcomes after transtibial amputations in a young spina bifida patient. Prosthetic fitting should be considered for similar, previously high functioning spina bifida patients with transtibial amputation(s).
Lee, Scott A.; Thomas, Joshua
The function of the forelimb of Tyrannosaurus rex remains a controversial topic since it was too short to transfer food directly to the mouth. Since Tyrannosaurus rex was bipedal, the forelimb was not involved in locomotion. Suggestions for its possible use include providing an initial push for a laying animal to stand or to hold position during mating. We report numerical calculations performed to determine the moment of inertia of the forearm and the torques generated by the muscles of the arm, based on three-dimensional representations of the forelimb. Our results imply that the forelimb was capable of very high angular accelerations, on the order of 130 radians/s2. This corresponds to a tangential acceleration of the manus on the order of 90 m/s2 or about 9g, indicating that the manus could be moved extremely quickly to control a struggling prey animal immediately before the death blow was delivered by the teeth of Tyrannosaurus rex. Rather than a pathetic vestigial organ, these calculations suggest that the forelimbs were an integral part of the predation tactics of Tyrannosaurus rex.
Mi Sun Jung
Full Text Available Background First suggested by Brent in 1979, the pocket principle is an alternative methodfor patients for whom a microsurgical replantation is not feasible. We report the successfulresults of a modified palmar pocket method in adults.Methods Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantationusing palmar pocketing. All patients were adults who sustained a complete fingertip amputationfrom the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crushor avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmarpocketing method following a composite graft in these patients and prepared the pocket in thesubcutaneous layer of the ipsilateral palm.Results Of a total of 10 cases, nine had complete survival of the replantation and one had20% partial necrosis. All of the cases were managed to conserve the fingernails, which led toacceptable cosmetic results.Conclusions A composite graft and palmar pocketing in adult cases of fingertip injuryconstitute a simple, reliable operation for digital amputation extending from the tip to thelunula. These methods had satisfactory results.
Chalya Phillipo L
Full Text Available Abstract Background Major limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where the prosthetic services are poor. The purpose of this study was to outline the patterns, indications and short term complications of major limb amputations and to compare our experience with that of other published data. Methods This was a descriptive cross-sectional study that was conducted at Bugando Medical Centre between March 2008 and February 2010. All patients who underwent major limb amputation were, after informed consent for the study, enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS version 11.5 computer software. Results A total of 162 patients were entered into the study. Their ages ranged between 2–78 years (mean 28.30 ± 13.72 days. Males outnumbered females by a ratio of 2:1. The majority of patients (76.5% had primary or no formal education. One hundred and twelve (69.1% patients were unemployed. The most common indication for major limb amputation was diabetic foot complications in 41.9%, followed by trauma in 38.4% and vascular disease in 8.6% respectively. Lower limbs were involved in 86.4% of cases and upper limbs in 13.6% of cases giving a lower limb to upper limb ratio of 6.4:1 Below knee amputation was the most common procedure performed in 46.3%. There was no bilateral limb amputation. The most common additional procedures performed were wound debridement, secondary suture and skin grafting in 42.3%, 34.5% and 23.2% respectively. Two-stage operation was required in 45.4% of patients. Revision amputation rate was 29.6%. Post-operative complication rate was 33.3% and surgical site infection was the most common complication accounting for 21.0%. The mean length of hospital stay was 22.4 days and mortality
Asherson, G. L.; Rose, M. Elaine
The finding that the serum of apparently healthy rabbits fixed complement with rabbit liver and kidney has been confirmed. Experimental infection of rabbits with Eimeria stiedae, the cause of hepatic coccidiosis, led to a rise in the titre of serum complement-fixing factors. The rise was statistically significant 14, 21 and 28 days after infection. The factors were regarded as antibodies because they behaved as macroglobulins on diethylaminoethyl—cellulose chromatography and sucrose gradient centrifugation, and as autoantibodies because they fixed complement with the kidney of the rabbits in which they occurred. The antibody reacted with widely distributed antigen(s) with high activity in brain and low activity in skeletal muscle. The possibility that coccidial infection may be responsible for the natural autoantibody of rabbits is discussed. PMID:13965167
Namgoong, Sik; Jung, Suyoung; Han, Seung-Kyu; Jeong, Seong-Ho; Dhong, Eun-Sang; Kim, Woo-Kyung
Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal (GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels.
Solagberu, B A
In developing countries, amputations have been performed due to trauma and infections; whereas in developed counties, trauma, diabetes and peripheral vascular diseases are the usual indications. Current practice in Nigeria suggests a change of relative indications, hence, this study. A five-year (July 1994 to June 1999) review of amputation records from the medical records, operating theatre, wards and physiotherapy department was carried out retrospectively. Amputation types, age, sex and indications were analysed. Fifty-eight amputations were performed in 56 patients (47 males, nine females, M: F = 5.2 : 1, age range 7-70 years, mean 33.3 +/- S.D 18.2). There were 42 lower and 16 upper limbs. Trauma accounted for 48.3%; followed by diabetes (29.3%), tumours (12.1%), infections (8.6%) and one indeterminate cause (1.7%). There was bias for sex, age and type of extremity as trauma was the commonest indication in male patients aged 30 years and below (and in the upper limb) whereas diabetes predominated in female patients above 30 years (and in the lower limb). Infection, as an indication for amputation, has now become a rear guard indication. Diabetes, previously uncommon, now appears in the forefront. These findings call for early detection and aggressive management of diabetic foot lesions.
Hazmy, W; Mahamud, M; Ashikin, N; Jamilah, S; Yee, L E; Shong, H K
We conducted a retrospective study of 3 years duration beginning from the 1st January 1997 to the 31st December 1999 in order to identify the epidemiology of major limb amputations in Seremban Hospital. Two hundred and four patients were included in this study out of which 65.7% were male and 34.3% were female. The mean age of the amputees was 39.7 years old. Non traumatic amputations constitute 85.8% of the cases mainly due to diabetic ulcers or gangrene (91%) followed by peripheral vascular disease (7%) and malignancy (2%). Traumatic amputations represent 14.2% of the cases with road-traffic accident as the major cause (82.8%) followed by industrial accident (17.2%). Lower limb amputations were performed in 97.5% of the cases with below knee amputations as the commonest procedure (72%), followed by above knee amputations (27%) and Syme amputations (1%). Five patients had upper limb amputations done. Four of them were below elbow amputations while one had forequarter amputation done of the left shoulder. Of note, there were increasing number of amputations done over the last three years with alarming increasing trends of traumatic amputation. The three main risk factors for major limb amputations are diabetes mellitus, male gender and road traffic accident.
Janis, Christine M; Figueirido, Borja
Carnivorous mammals use their forelimbs in different ways to capture their prey. Most terrestrial carnivores have some cursorial (running) adaptations, but ambush predators retain considerable flexibility in their forelimb movement, important for grappling with their prey. In contrast, predators that rely on pursuit to run down their prey have sacrificed some of this flexibility for locomotor efficiency, in the greater restriction of the forelimb motion to the parasagittal plane. In this article, we measured aspects of the forelimb anatomy (44 linear measurements) in 36 species of carnivorous mammals of known predatory behavior, and used multivariate analyses to investigate how well the forelimb anatomy reflects the predatory mode (ambush, pursuit, or pounce-pursuit). A prime intention of this study was to establish morphological correlates of behavior that could then be applied to fossil mammals: for this purpose, five individuals of the recently extinct thylacine (Thylacinus cynocephalus) were also included as unknowns. We show that the three different types of predators can be distinguished by their morphology, both in analyses where all the forelimb bones are included together, and in the separate analyses of each bone individually. Of particular interest is the ability to distinguish between the two types of more cursorial predators, pursuit and pounce-pursuit, which have previously been considered as primarily size-based categories. Despite a prior consideration of the thylacine as a "pounce-pursuit" or an "ambush" type of predator, the thylacines did not consistently cluster with any type of predatory carnivores in our analyses. Rather, the thylacines appeared to be more generalized in their morphology than any of the extant carnivores. The absence of a large diversity of large carnivorous mammals in Australia, past and present, may explain the thylacine's generalized morphology.
Jessica Mary LIVINGSTON-THOMAS; Andrew Wilson HUME; Tracy Ann DOUCETTE; Richard Andrew TASKER
Aim:Constraint-induced movement therapy (CIMT),which forces use of the impaired arm following unilateral stroke,promotes functional recovery in the clinic but animal models of CIMT have yielded mixed results.The aim of this study is to develop a refined endothelin-1 (ET-1) model of focal ischemic injury in rats that resulted in reproducible,well-defined lesions and reliable upper extremity impairments,and to determine if an appetitively motivated form of rehabilitation (voluntary forced use movement therapy; FUMT)would accelerate post-ischemic motor recovery.Methods:Male Sprague Dawley rats (3 months old) were given multiple intracerebral microinjections of ET-1 into the sensorimotor cortex and dorsolateral striatum.Sham-operated rats received the same surgical procedure up to but not includingthe drill holes on the skull.Functional deficits were assessed using two tests of forelimb placing,a forelimb postural reflex test,a forelimb asymmetry test,and a horizontal ladder test.In a separate experiment ET-1 stroke rats were subjected to daily rehabilitation with FUMT or with a control therapy beginning on post-surgery d 5.Performance and post-mortem analysis of lesion volume and regional BDNF expression were measured.Results:Following microinjections of ET-1 animals exhibited significant deficits in contralateral forelimb function on a variety of tests compared with the sham group.These deficits persisted for up to 20 d with no mortality and were associated with consistent lesion volumes.FUMT therapy resulted in a modest but significantly accelerated recovery in the forelimb function as compared with the control therapy,but did not affect lesion size or BDNF expression in the ipsilesional hemisphere.Conclusion:We conclude that refined ET-1 microinjection protocols and forcing use of the impaired forelimb in an appetitively motivated paradigm may prove useful in developing strategies to study post-ischemic rehabilitation and neuroplasticity.
Full Text Available The posture and mechanics of the forelimbs of Brachiosaurus brancai were analysed with the help of biomechanical models. Peak forces in the joints due to acceleration of the fraction of body weight carried on the shoulder joints are critical in models with completely straight, column-like limbs and a rigid shoulder girdle. During fast walking, either the forelimbs were flexed at the elbows during the middle of the support phase or the apparently rigid shoulder girdle allowed movements of the shoulder joints relative to the trunk. The overall construction of Brachiosaurus was related to an extreme task, browsing high above the ground. Consequently, versatility was very restricted. Die Stellung und die Mechanik der Vorderbeine von Brachiosaurus brancai wurden mit Hilfe von biomechanischen Modellen untersucht. Kraftspitzen aufgrund von Beschleunigungen des von den Schultern getragenen Anteils der Körpermasse erscheinen in Modellen mit völlig geraden, säulenförmigen Vorderbeinen und einem unbeweglichen Schultergürtel problematisch. Während des schnellen Gehens waren entweder die Vorderbeine in der Mitte der Stützphase in den Ellenbogengelenken gebeugt oder der scheinbar rigide Schultergürtel erlaubte Bewegungen der Schultergelenke relativ zum Brustkorb. Die Gesamtkonstruktion von Brachiosaurus war auf die Ausübung einer extremen Tätigkeit, die Nahrungsaufnahme in großer Höhe, ausgerichtet. Die Konsequenz war eine geringe Vielseitigkeit. doi:10.1002/mmng.1999.4860020103
Clayton, H M; Mullineaux, D R
Reasons for Performing Study: Equine gait analysis has focused on 2D analysis in the sagittal plane, while descriptions of 3D kinetics and ground reaction force could provide more information on the Equine gait analysis. Hypothesis or Objectives: The aim of this study was to characterize the 3D torques and powers of the forelimb joints at trotting. Methods: Eight sound horses were used in the study. A full 3D torque and power for elbow, carpus, fetlock, pastern and coffin joints of right forelimb in horses at trot were obtained by calculating the inverse kinetics of simplified link segmental model. Results: Over two third of energy (70%) generated by all joints come from stance phase, and most of energy generated was by elbow joint both in stance (77%) and sway (88%) phases. Energy absorbed by all joints during stance (40%) and sway (60%) phases respectively is not a big difference. During stance phase, all most two third of energy (65%) absorbed was by fetlock joint, while over two third of energy (74%) abso...
Betty M Booker
Full Text Available The molecular events leading to the development of the bat wing remain largely unknown, and are thought to be caused, in part, by changes in gene expression during limb development. These expression changes could be instigated by variations in gene regulatory enhancers. Here, we used a comparative genomics approach to identify regions that evolved rapidly in the bat ancestor, but are highly conserved in other vertebrates. We discovered 166 bat accelerated regions (BARs that overlap H3K27ac and p300 ChIP-seq peaks in developing mouse limbs. Using a mouse enhancer assay, we show that five Myotis lucifugus BARs drive gene expression in the developing mouse limb, with the majority showing differential enhancer activity compared to the mouse orthologous BAR sequences. These include BAR116, which is located telomeric to the HoxD cluster and had robust forelimb expression for the M. lucifugus sequence and no activity for the mouse sequence at embryonic day 12.5. Developing limb expression analysis of Hoxd10-Hoxd13 in Miniopterus natalensis bats showed a high-forelimb weak-hindlimb expression for Hoxd10-Hoxd11, similar to the expression trend observed for M. lucifugus BAR116 in mice, suggesting that it could be involved in the regulation of the bat HoxD complex. Combined, our results highlight novel regulatory regions that could be instrumental for the morphological differences leading to the development of the bat wing.
Baier, David B; Gatesy, Stephen M
Crocodylians occupy a key phylogenetic position for investigations of archosaur locomotor evolution. Compared to the well-studied hindlimb, relatively little is known about the skeletal movements and mechanics of the forelimb. In this study, we employed manual markerless XROMM (X-ray Reconstruction Of Moving Morphology) to measure detailed 3-D kinematics of the shoulder girdle and forelimb bones of American alligators (Alligator mississippiensis) walking on a treadmill. Digital models of the interclavicle, scapulocoracoid, humerus, radius and ulna were created using a 3-D laser scanner. Models were articulated and aligned to simultaneously recorded frames of fluoroscopic and standard light video to reconstruct and measure joint motion. Joint coordinate systems were established for the coracosternal, glenohumeral and elbow joints. Our analysis revealed that the limb joints only account for about half of fore/aft limb excursion; the remaining excursion results from shoulder girdle movements and lateral bending of the vertebral column. Considerable motion of each scapulocoracoid relative to the vertebral column is consistent with coracosternal mobility. The hemisellar design of the glenohumeral joint permits some additional translation, or sliding in the fore-aft plane, but this movement does not have much of an effect on the distal excursion of the bone. PMID:24102540
Vargas-Peixoto, Dilson; Da-Rosa, Átila Augusto Stock; Gallo de França, Marco Aurélio
This study presents evidence about the biomechanics and forelimbs functionality of the basal sauropodomorph Unaysaurus tolentinoi (upper portion of the SM2 sequence, Santa Maria Supersequence, Upper Triassic from southern Brazil). Maximum and minimum motion angles were inferred in the joints, disregarding the presence and/or thickness of cartilage. Furthermore, processes and external structures of the bones were analyzed in attributing the functionality of forelimbs. Unaysaurus tolentinoi had well-developed grapple ability. However, the preserved elements and their osteological features are not conclusive about strictly bipedalism or quadrupedalism in U. tolentinoi.
Johansen, K; Daines, M; Howey, T; Helfet, D; Hansen, S T
MESS (Mangled Extremity Severity Score) is a simple rating scale for lower extremity trauma, based on skeletal/soft-tissue damage, limb ischemia, shock, and age. Retrospective analysis of severe lower extremity injuries in 25 trauma victims demonstrated a significant difference between MESS values for 17 limbs ultimately salvaged (mean, 4.88 +/- 0.27) and nine requiring amputation (mean, 9.11 +/- 0.51) (p less than 0.01). A prospective trial of MESS in lower extremity injuries managed at two trauma centers again demonstrated a significant difference between MESS values of 14 salvaged (mean, 4.00 +/- 0.28) and 12 doomed (mean, 8.83 +/- 0.53) limbs (p less than 0.01). In both the retrospective survey and the prospective trial, a MESS value greater than or equal to 7 predicted amputation with 100% accuracy. MESS may be useful in selecting trauma victims whose irretrievably injured lower extremities warrant primary amputation.
Canzoneri, Elisa; Marzolla, Marilena; Amoresano, Amedeo; Verni, Gennaro; Serino, Andrea
Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and prosthesis implantation. In order to investigate this issue, we tested BR in a group of upper limb amputees by means of a tactile distance perception task and PPS by means of an audio-tactile interaction task. Subjects performed the tasks with stimulation either on the healthy limb or the stump of the amputated limb, while wearing or not wearing their prosthesis. When patients performed the tasks on the amputated limb, without the prosthesis, the perception of arm length shrank, with a concurrent shift of PPS boundaries towards the stump. Conversely, wearing the prosthesis increased the perceived length of the stump and extended the PPS boundaries so as to include the prosthetic hand, such that the prosthesis partially replaced the missing limb.
Full Text Available Foot ulceration is a major cause of morbidity amongst patients with diabetes. In severe cases of ulceration, osteomyelitis and amputation can ensue. A distinct lack of agreement exists on the most appropriate level of amputation in cases of severe foot ulceration/infection to provide predictable healing rates. This paper provides an overview of the transmetatarsal amputation (TMA as a limb salvage procedure and is written with the perspective and experiences of the Department of Podiatric Surgery at West Middlesex University Hospital (WMUH. We have reflected on the cases of 11 patients (12 feet and have found the TMA to be an effective procedure in the management of cases of severe forefoot ulceration and infection.
Full Text Available Amputation of the penis is a rare condition reported from various parts of the world as isolated cases or small series of patients; the common aetiology is self-mutilating sharp amputation or an avulsion or crush injury in an industrial accident. A complete reconstruction of all penile structures should be attempted in one stage which provides the best chance for full rehabilitation of the patient. We report here a single case of total amputation of the penis, which was successfully reattached by using a microsurgical technique. After surgery, near-normal appearance and function including a good urine flow and absence of urethral stricture, capabilities of erection and near normal sensitivity were observed.
Schoppen, Tanneke; Boonstra, Antje; Groothoff, JW; van Sonderen, E; Goeken, LN; Eisma, Willem
Objective: To study demographically, amputation-, and employment-related factors that show a relationship to successful job reintegration of patients after lower limb amputation. Design: Cross-sectional study. Setting: University hospital. Patients: Subjects had an acquired unilateral major amputati
Okamoto Auro Mitsuo
Full Text Available We sought to describe the bone bridge technique in adults, and present a variation for use in children, as well as to present its applicability as an option in elective transtibial amputations. This paper presents a prospective study of 15 transtibial amputations performed between 1992 and 1995 in which the bone bridge technique was employed. The patients' ages ranged from 8 to 48 years, with an average of 22.5 years. This technique consisted of the preparation of a cylinder of periosteum extracted from the tibia and with cortical bone fragments attached to it to promote a tibiofibular synostosis on the distal extremity of the amputation stump. We noted that the cortical bone fragments were dispensable when the technique was employed in children, due to the increased osteogenic capacity of the periosteum. This led to a variation of the original technique, a bone bridge without the use of the cortical bone fragments. RESULTS: The average time spent with this procedure, without any significant variation between adults and children, was 171 minutes. The adaptation to the definitive prosthesis was accomplished between 20 and 576 days, with an average of 180 days. Revision of the procedure was necessary in 3 amputations. CONCLUSIONS: This technique may be employed in transtibial amputations in which the final length of the stump lies next to the musculotendinous transition of the gastrocnemius muscle, as well as in the revision of amputation stumps in children, where the procedure has been shown to be effective in the prevention of lesions due to excessive bone growth.
Fernández Montequín, J I; McCook Martínez, J; Lima Santana, B; Velasco Armas, N; Montalvo Diago, J; Mahía Vilas, M
Thirty diabetic patients submitted to a major amputation were tested by humo-celullar assays (retarded hypersensibility assays). Reactive patients were subdivided into two groups: one group was treated postoperatively with antibiotics, and the other group was not treated. Both groups were homogeneous in age, hemoglobin concentrations, hematocrit, total proteins, glucemy and history of sepsis or leukocytosis. Five patients treated with antibiotics (33.3%) presented sepsis, one patient was reamputated and one patient died. Between the not treated patients, only three presented sepsis (20%) without any other complications. Authors conclude that the development of sepsis in reactive, diabetic, amputated patients is independent of antibiotic treatment.
Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and prosthesis implantation. In order to investigate this issue, we tested BR in a group of upper limb amputees by means of a tactile distance perception task and PPS by means of an audio-tactile interaction task. Subjects performed the tasks with stimulation either on the healthy limb or the stump of the amputated limb, while wearin...
Natali, J; Firouz-Abadie, H; Maraval, M; Kieffer, E
During the period 1970-1974, restorative surgery was carried out 324 times in patients with gangrene or severe ischaemia caused by arteritis of the lower limbs. In 67 percent of the cases major excision surgery, such as amputation at the thigh or of the whole leg, was avoided and the support was retained. In 61 cases (19 percent) amputation was necessary either immediately or within a few weeks or months. Death occurred in 47 patients (14 percent) either in the operative period or in the 3 following years.
Hill, William Allen; Brown, Julie Paige
Millions of households in the US own rabbits or rodents, including hamsters, guinea pigs, and gerbils. Activities such as hunting and camping also involve human interactions with wild rabbits and rodents. In many environments, feral rabbits and rodents live in close proximity to humans, domesticated animals, and other wildlife. Education of rodent and rabbit owners and individuals with occupational or recreational exposures to these species is paramount to reduce the prevalence of zoonoses associated with rabbit and rodent exposure.
Jørgensen, M E; Almdal, T P; Faerch, K
Diabetic foot disease and amputations severely reduce quality of life and have major economic consequences. The aim of this study was to estimate time trends in the incidence of lower-extremity amputations in Danish people with diabetes.......Diabetic foot disease and amputations severely reduce quality of life and have major economic consequences. The aim of this study was to estimate time trends in the incidence of lower-extremity amputations in Danish people with diabetes....
admitted with TBI and limb amputation, only 50 percent used a prosthesis and only 33 percent were considered able to use a prosthesis independently in the...to use a prosthesis was related to ataxia; inability to withstand shear or load- ing on the residual limb; bilateral spasticity; contractures...or foot amputation (or in some instances, multiple amputations). We excluded ser- vicemembers whose amputation involved only the fin- ger(s) or toe
This book is a quick and concise introduction to RabbitMQ. Follow the unique case study of Clever Coney Media as they progressively discover how to fully utilize RabbitMQ, containing clever examples and detailed explanations.Whether you are someone who develops enterprise messaging products professionally or a hobbyist who is already familiar with open source Message Queuing software and you are looking for a new challenge, then this is the book for you. Although you should be familiar with Java, Ruby, and Python to get the most out of the examples, RabbitMQ Essentials will give you the push y
Rich, Gregory A
Orthopedic surgery in rabbits poses several unique parameters for the veterinary surgeon. It is imperative for the veterinarian to be knowledgeable about the anatomic features of the surgical repair site and to become familiar with a rabbit's pain and discomfort often associated with orthopedic injuries. Handling the perioperative and postoperative pain and potential GI disturbances are crucial for a successful outcome of the surgical case. This article is designed to help the veterinary surgeon prepare for the orthopedic surgical procedure and the peripheral physiologic needs of the rabbit from presentation through recovery.
Kristensen, Morten Tange; Holm, Gitte; Gebuhr, Peter
INTRODUCTION: The successful outcome of a major amputation depends on several factors, including stump wound healing. The purpose of this study was to examine the criteria upon which the index amputation was based and to identify factors associated with early amputation failure after major non-tr...
HAM, SJ; HOEKSTRA, HJ; EISMA, WH; OLDHOFF, J; KOOPS, HS
The treatment of foot sarcomas is generally a below knee amputation. In selected sarcomas of the forefoot, however, a transtarsal amputation according to Chopart, a calcaneotibial arthrodesis according to Pirogoff, or a supramalleolar amputation according to Syme can be considered the treatment of c
Mahmoudi, Elham; Swiatek, Peter R.; Chung, Kevin C.; Ayanian, John Z.
Background Traumatic finger/thumb amputations are some of the most prevalent traumatic injuries affecting Americans each year. Rates of replantation after traumatic finger/thumb amputation, however, have been steadily declining across U.S. hospitals, which may make these procedures less accessible to minorities and vulnerable populations. The specific aim of this study was to examine racial variation in finger replantation after traumatic finger/thumb amputation. Methods Using a two-level hierarchical model, we retrospectively compared replantation rates for African-American patients with those of Whites, adjusting for patient and hospital characteristics. Patients younger than 65 with traumatic finger/thumb amputation injuries who sought care at a U.S. trauma center between 2007 and 2012 were included in the study sample. Results We analyzed 13,129 patients under 65 years of age with traumatic finger/thumb amputation. Replantation rates declined over time from 19% to 14% (p = 0.004). Adjusting for patient and hospital characteristics, African-Americans (OR=0.81; CI: 0.66–0.99; p = 0.049) were less likely to undergo replantation procedures than Whites, and uninsured patients (OR=0.73; CI: 0.62–0.84; p advancements in microsurgical techniques and the increasing use of reconstructive surgery in other fields, finger/thumb replantation rates are declining in the U.S. and vulnerable populations are less likely to undergo replantation after amputation injuries. Regionalization of care for these injuries may not only provide a higher quality care but also reduce variations in treatment. PMID:26910702
Sara L. Borkosky
Full Text Available Diabetes mellitus with peripheral sensory neuropathy frequently results in forefoot ulceration. Ulceration at the first ray level tends to be recalcitrant to local wound care modalities and off-loading techniques. If healing does occur, ulcer recurrence is common. When infection develops, partial first ray amputation in an effort to preserve maximum foot length is often performed. However, the survivorship of partial first ray amputations in this patient population and associated re-amputation rate remain unknown. Therefore, in an effort to determine the actual re-amputation rate following any form of partial first ray amputation in patients with diabetes mellitus and peripheral neuropathy, the authors conducted a systematic review. Only studies involving any form of partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy but without critical limb ischemia were included. Our search yielded a total of 24 references with 5 (20.8% meeting our inclusion criteria involving 435 partial first ray amputations. The weighted mean age of patients was 59 years and the weighted mean follow-up was 26 months. The initial amputation level included the proximal phalanx base 167 (38.4% times; first metatarsal head resection 96 (22.1% times; first metatarsal-phalangeal joint disarticulation 53 (12.2% times; first metatarsal mid-shaft 39 (9% times; hallux fillet flap 32 (7.4% times; first metatarsal base 29 (6.7% times; and partial hallux 19 (4.4% times. The incidence of re-amputation was 19.8% (86/435. The end stage, most proximal level, following re-amputation was an additional digit 32 (37.2% times; transmetatarsal 28 (32.6% times; below-knee 25 (29.1% times; and LisFranc 1 (1.2% time. The results of our systematic review reveal that one out of every five patients undergoing any version of a partial first ray amputation will eventually require more proximal re-amputation. These results reveal that partial first ray
Full Text Available The aim of this study was to investigate forelimb motor function after cervical spinal cord injury in juvenile and adult rats. Both rats received a left segmental hemisection of the spinal cord after C3-C4 laminectomy. Behavioral evaluation of motor function was monitored and assessed using the New Rating Scale (NRS and Forelimb Locomotor Scale (FLS and by measuring the range of motion (ROM of both the elbow and wrist. Complete left forelimb motor paralysis was observed in both rats. The NRS showed motor function recovery restored to 50.2±24.7% in juvenile rats and 34.0±19.8% in adult rats. FLS was 60.4±26.8% in juvenile rats and 46.5±26.9% in adult rats. ROM of the elbow and wrist were 88.9±20.6% and 44.4±24.1% in juvenile rats and 70.0±29.2% and 40.0±21.1% in adult rats. Thus, the NRS and ROM of the elbow showed a significant difference between age groups. These results indicate that left hemisection of the cervical spinal cord was not related to right-sided motor functions. Moreover, while motor paralysis of the left forelimb gradually recovered in both groups, the improvement was greater in juvenile rats.
Bruins, Ria; Bruins, M.; Geertzen, J.H.B.; Groothoff, J.W.; Schoppen, T.
The objectives of this study were to describe the process of job reintegration, to obtain more detailed information about workplace adjustments, and to assess the positive and negative experiences of amputees (in the Netherlands) who returned to paid work after their lower limb amputation. The study
Audrey T. Tantua, MD
Full Text Available The early postoperative phase after transtibial amputation is characterized by rapid residual limb volume reduction. Accurate measurement of residual limb volume is important for the timing of fitting a prosthesis. The aim of this study was to analyze the reduction of residual limb volume in people with transtibial amputation and to correlate residual limb volume with residual limb circumference. In a longitudinal cohort study of 21 people who had a transtibial amputation, residual limb volume was measured using a laser scanner and circumference was measured using a tape measure 1 wk postamputation and every 3 wk thereafter until 24 wk postamputation. A linear mixed model analysis was performed with weeks postamputation transformed according to the natural logarithm as predictor. Residual limb volume decreased significantly over time, with a large variation between patients. Residual limb volume did not correlate well with circumference. On average, residual limb volume decreased 200.5 mL (9.7% of the initial volume per natural logarithm of the weeks postamputation. The decrease in residual limb volume following a transtibial amputation was substantial in the early postamputation phase, followed by a leveling off. It was not possible to determine the specific moment at which the residual limb volume stabilized.
Full Text Available Amputation is a major health burden on the families, society, and on medical services as well. Traumatic limb amputation is a catastrophic injury and an irreversible act which is sudden and emotionally devastating for the victims. In addition, it causes inability to support self and the family and driving many patients toward various psychiatric disorders. Extensive information regarding the effects of amputation has not been ascertained and therefore it was decided to do a systematic review. The goal of this review was to provide comprehensive information of peer-reviewed papers examining the psychological distress among amputees in India. A search of the literature resulted in a total of 12 articles with varied sample size from 16 to 190. The sample has been largely comprised males with lower limb amputation caused by primarily traumatic ones, i.e., motor vehicle accident, railway track accidents, machinery injury, blasts, etc., The prevalence of psychiatric disorders among amputees has been found to be in the range of 32% to 84% including depression rates 10.4%–63%, posttraumatic stress disorder 3.3%–56.3%, and phantom limb phenomenon 14%–92%. Although the studies reported that symptoms of anxiety and depression become better over the course of time, however surgical treatment providers need to liaise with psychiatrists and psychologists to support and deal with the psychological disturbances.
García-Murray, E; Adán-Rivas, O; Salcido-Calzadilla, H
Amputation of any body part is undoubtedly a traumatic experience leaving a terrible deformity, especially when the part or parts involved are visible and constitute an essential component of someone's facial whole. Bilateral ear amputation and successful subsequent replantation has been reported historically, but not in the modern surgical literature. We report the case of a 27-year-old female who was abducted and suffered a bilateral ear amputation at the hands of one of her captors to speed delivery of ransom money; the severed parts were sent to the parents approximately 2 hours after the amputation had taken place, and the girl was released some 48 hours after the ears were delivered. Microvascular replantation was attempted immediately after admission to the hospital some 2 hours after her release, but failed, and so a non-microvascular replantation was performed and was successful, after approximately 54 hours of ischaemia time. We consider this the first report of a complete bilateral, delayed, non-microvascular, successful ear replantation in a human being in the modern literature.
van der Avoort, D. J. J. C.; Hovius, S. E. R.; Selles, R. W.; van Neck, J. W.; Coert, J. H.
Purpose: The incidence of symptomatic neuroma in finger nerve injuries varies widely in the literature. In this retrospective study, we evaluated the incidence of symptomatic neuroma after repair of digital nerve injuries (neurorrhaphy) and after amputation of one or more fingers. We also determined
This podcast provides health information for amputees on how to take care of yourself after an amputation or other surgery. Created: 2/18/2010 by National Center on Birth Defects and Developmental Disability, Disability and Health Program. Date Released: 2/18/2010.
Bruins, M.; Geertzen, J.H.; Groothoff, J.W.; Schoppen, T.
The objectives of this study were to describe the process of job reintegration, to obtain more detailed information about workplace adjustments, and to assess the positive and negative experiences of amputees (in the Netherlands) who returned to paid work after their lower limb amputation. The study
Atzori, Manfredo; Gijsberts, Arjan; Caputo, Barbara; Muller, Henning
People with transradial hand amputations who own a myoelectric prosthesis currently have some control capabilities via sEMG. However, the control systems are still limited and not natural. The Ninapro project is aiming at helping the scientific community to overcome these limits through the creation of publicly available electromyography data sources to develop and test machine learning algorithms. In this paper we describe the movement classification results gained from three subjects with an homogeneous level of amputation, and we compare them with the results of 40 intact subjects. The number of considered subjects can seem small at first sight, but it is not considering the literature of the field (which has to face the difficulty of recruiting trans-radial hand amputated subjects). The classification is performed with four different classifiers and the obtained balanced classification rates are up to 58.6% on 50 movements, which is an excellent result compared to the current literature. Successively, for each subject we find a subset of up to 9 highly independent movements, (defined as movements that can be distinguished with more than 90% accuracy), which is a deeply innovative step in literature. The natural control of a robotic hand in so many movements could lead to an immediate progress in robotic hand prosthetics and it could deeply change the quality of life of amputated subjects.
Vascotto, Sandy G; Beug, Shawn; Liversage, Richard A; Tsilfidis, Catherine
Epimorphic limb regeneration in the adult newt involves the dedifferentiation of differentiated cells to yield a pluripotent blastemal cell. These mesenchymal-like cells proliferate and subsequently respond to patterning and differentiation cues to form a new limb. Understanding the dedifferentiation process requires the selective identification of dedifferentiating cells within the heterogeneous population of cells in the regenerate. In this study, representational differences analysis was used to produce an enriched population of dedifferentiation-associated cDNA fragments. Fifty-nine unique cDNA fragments were identified, sequenced, and analyzed using bioinformatics tools and databases. Some of these clones demonstrate significant similarity to known genes in other species. Other clones can be linked by homology to pathways previously implicated in the dedifferentiation process. These data will form the basis for further analyses to elucidate the role of candidate genes in the dedifferentiation process during newt forelimb regeneration.
The results of below-knee amputations in 36 war wounded (mean age 35,42) were reviewed. The majority of the patients was wounded by land mines (94.4%). Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation) in 30 (83.3%) amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7%) average 4.61 ± 11.67 days a...
Full Text Available High fat, low carbohydrate ketogenic diets (KD are validated non-pharmacological treatments for some forms of drug-resistant epilepsy. Ketones reduce neuronal excitation and promote neuroprotection. Here, we investigated the efficacy of KD as a treatment for acute cervical spinal cord injury (SCI in rats. Starting 4 hours following C5 hemi-contusion injury animals were fed either a standard carbohydrate based diet or a KD formulation with lipid to carbohydrate plus protein ratio of 3:1. The forelimb functional recovery was evaluated for 14 weeks, followed by quantitative histopathology. Post-injury 3:1 KD treatment resulted in increased usage and range of motion of the affected forepaw. Furthermore, KD improved pellet retrieval with recovery of wrist and digit movements. Importantly, after returning to a standard diet after 12 weeks of KD treatment, the improved forelimb function remained stable. Histologically, the spinal cords of KD treated animals displayed smaller lesion areas and more grey matter sparing. In addition, KD treatment increased the number of glucose transporter-1 positive blood vessels in the lesion penumbra and monocarboxylate transporter-1 (MCT1 expression. Pharmacological inhibition of MCTs with 4-CIN (α-cyano-4-hydroxycinnamate prevented the KD-induced neuroprotection after SCI, In conclusion, post-injury KD effectively promotes functional recovery and is neuroprotective after cervical SCI. These beneficial effects require the function of monocarboxylate transporters responsible for ketone uptake and link the observed neuroprotection directly to the function of ketones, which are known to exert neuroprotection by multiple mechanisms. Our data suggest that current clinical nutritional guidelines, which include relatively high carbohydrate contents, should be revisited.
Bácskai, Tímea; Fu, Yuhong; Sengul, Gulgun; Rusznák, Zoltán; Paxinos, George; Watson, Charles
We identified the motor neurons (MNs) supplying the shoulder girdle and forelimb muscles in the C57BL/6J mouse spinal cord using Fluoro-Gold retrograde tracer injections. In spinal cord transverse sections from C2 to T2, we observed two MN columns (medial and lateral) both with ventral and dorsal subdivisions. The dorsolateral column consisted of the biceps brachii, forearm extensors, forearm flexors, and hand MNs, and the ventrolateral column consisted of the latissimus dorsi, trapezius, teres major, deltoid, and triceps MNs. The supraspinatus muscle MNs were located in the dorsomedial column, and pectoralis major and serratus anterior MNs were located in the ventromedial columns. MNs of the dorsolateral column innervated the biceps brachii in mid-C4 to mid-C7, forearm extensors in caudal C4 to mid-T1, forearm flexors in rostral C5 to mid-T1, and hand muscles in mid-C8 to mid-T2 segments. The MNs innervating the trapezius were located in mid-C2 to mid-C4, triceps brachii in mid-C6 to rostral T1, deltoid in rostral C4 to mid-C6, teres major in rostral C5 to mid-C8, and latissimus dorsi in mid-C5 to caudal C8. In addition, MNs innervating the supraspinatus were located from rostral C4 to caudal C8, pectoralis major in mid-C6 to mid-T2, and serratus anterior in rostral C5 to caudal C7/rostral C8 segments. While the musculotopic pattern of MN groups was very similar to that documented for other species, we found differences in the position and cranio-caudal extent of some MN pools compared with previous reports. The identification of mouse forelimb MNs can serve as an anatomical reference for studying degenerative MN diseases, spinal cord injury, and developmental gene expression.
Full Text Available Various peripheral receptors provide information concerning position and movement to the central nervous system to achieve complex and dexterous movements of forelimbs in primates. The response properties of single afferent receptors to movements at a single joint have been examined in detail, but the population coding of peripheral afferents remains poorly defined. In this study, we obtained multichannel recordings from dorsal root ganglion (DRG neurons in cervical segments of monkeys. We applied the sparse linear regression (SLiR algorithm to the recordings, which selects useful input signals to reconstruct movement kinematics. Multichannel recordings of peripheral afferents were performed by inserting multi-electrode arrays into the DRGs of lower cervical segments in two anesthetized monkeys. A total of 112 and 92 units were responsive to the passive joint movements or the skin stimulation with a painting brush in Monkey 1 and Monkey 2, respectively. Using the SLiR algorithm, we reconstructed the temporal changes of joint angle, angular velocity, and acceleration at the elbow, wrist, and finger joints from temporal firing patterns of the DRG neurons. By automatically selecting a subset of recorded units, the SLiR achieved superior generalization performance compared with a regularized linear regression algorithm. The SLiR selected not only putative muscle units that were responsive to only the passive movements, but also a number of putative cutaneous units responsive to the skin stimulation. These results suggested that an ensemble of peripheral primary afferents that contains both putative muscle and cutaneous units encode forelimb joint kinematics of non-human primates.
Guillermo García Álvarez
Full Text Available Background: Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients. Methods: Eighty-two high-voltage electrically injured patients were admitted to the Department of Plastic and Reconstructive Surgery and Burns of National Arzobispo Loayza Hospital on a 5 year period. A retrospective analysis of the possible related risk factors between amputation and non-amputation patients was performed. Results: A total of 68 patients were enrolled for analysis. Thirteen patients underwent limb amputations. Multivariate analysis of the risk factors between amputation and non-amputation groups showed statistical significance for first 24 hour creatine kinase-isoenzyme MB (CKMB level. A serum CK-MB level above 14,955 U/L predicted high risk of limb amputation with high specificity (84% and sensitivity (77%. Only one patient with a remarkable decrease of creatine kinase (CPKt and CK-MB levels after fasciotomy avoided a major limb amputation. Conclusion: Our results suggest that CPK-MB level is an independent factor for prediction of limb amputation in patients with high-voltage electrical burns. We suggest that the addition of CPK-MB evaluation to clinical symptom screening may be a valuable method for early detection of muscle damage.
Helgeson, Melvin D; Potter, Benjamin K; Burns, Travis C; Hayda, Roman A; Gajewski, Donald A
We studied patients with combat-related injuries that required delayed amputation at least 4 months after the initial injury due to dysfunction, persistent pain, and patient desires. Late amputations were performed 22 times in 22 patients (21 men, 1 woman) since 2003. Fourteen patients underwent transtibial amputation, 5 transfemoral amputations, 1 knee disarticulation, and 2 transradial amputations. The primary indications for late amputation were neurologic dysfunction in 6 patients, persistent or recurrent infection in 6, neurogenic pain in 3, non-neurogenic pain in 5, and a globally poor functional result in 2. Sixteen of 22 patients reported multiple indications for electing to undergo amputation, with an average of 2.1 specific indications per patient. At final clinical follow-up an average of 13 months after amputation, all patients reported subjectively improved function and reported that they would undergo amputation again under similar circumstances. When medically and functionally practicable, every effort is given to limb salvage following severe combat-related extremity injuries. There is no single risk factor that increases the likelihood of delayed amputation, but the combination of complex pain symptoms with neurologic dysfunction appears to increase the risk, particularly if the initial insult is a severe hindfoot injury or distal tibia fracture. With appropriately selected and counseled patients, elective late amputation results in a high degree of patient satisfaction and subjectively improved function.
Full Text Available Introduction. Lower extremity amputation is a surgical procedure resulting in important anatomical, functional, psychological, and social consequences that can influence the quality of life of these patients. The aim of this research was to compare the quality of life of patients with lower extremity amputation and people without amputation taking into account gender differences as well as the amputation level. Material and Methods. The study was designed as a cross-sectional study which included 56 subjects. The patients from the experimental group underwent prosthetic rehabilitation treatment at the Department of Medical Rehabilitation, Clinical Centre of Vojvodina. The experimental group included 28 patients (21 male, 7 female with lower extremity amputation, their average age being 65.36±13.64. The control group consisted of 28 age and gender matching subjects without amputation. Research ANd Development (RAND 36 - Item Health Survey 1.0 (SF - 36 was used to measure the quality of life. Results. The results showed that patients with lower extremity amputation scored lower than the control group on all SF- 36 variables (p0.05. Seventeen (61% patients were with transfemoral, and 11 (39% with transtibial level of amputation. The patients with transtibial amputations scored higher on physical functioning and general health status variables (p<0.05. Conclusion. The patients with lower extremity amputations have numerous limitations compared to the control group, regardless of gender, while the patients with lower level of amputation have a higher level of physical functioning.
Walker, Jay; Bhatnagar, Vibha; Richard, Erin; Sechriest, V. Franklin; Galarneau, Michael
Little research has described the long-term health outcomes of patients who had combat-related amputations or leg-threatening injuries. We conducted retrospective analysis of Department of Defense and Department of Veterans Affairs health data for lower extremity combat-injured patients with (1) unilateral amputation within 90 days postinjury (early amputation, n = 440), (2) unilateral amputation more than 90 days postinjury (late amputation, n = 78), or (3) leg-threatening injuries without amputation (limb salvage, n = 107). Patient medical records were analyzed for four years postinjury. After adjusting for group differences, early amputation was generally associated with a lower or similar prevalence for adverse physical and psychological diagnoses (e.g., pain, osteoarthritis, posttraumatic stress disorder) versus late amputation and/or limb salvage. By contrast, early amputation was associated with an increased likelihood of osteoporosis during the first year postinjury. The prevalence of posttraumatic stress disorder increased for all patient groups over four years postinjury, particularly in the second year. The different clinical outcomes among combat extremity injured patients treated with early amputation, late amputation, or limb salvage highlight their different healthcare requirements. These findings can inform and optimize the specific treatment pathways that address the physical and psychological healthcare needs of such patients over time. PMID:28122002
Lee, Kyung Suk; Lim, Yun sub; Choi, Jaehoon; Kim, Nam Gyun; Kim, Jun Sik
A composite graft for reattachment of an amputated fingertip is a very controversial and challenging procedure. An osteocutaneous composite graft is rarely conducted and has a low success rate following fingertip amputation. A 21-year-old male patient was referred to our emergency clinic with dorsal oblique amputation of the middle, ring and small fingers of the left hand through the distal interphalangeal joint and middle phalanx. The amputated parts of the middle and ring fingers were reattached with osteocutaneous composite grafts. The amputated part of the small finger was revascularised to the ulnar palmar digital artery of the small finger. The composite grafts of the middle and ring fingers and the revascularised small finger survived completely. We suggest that careful patient selection will allow an osteocutaneous composite graft to become an acceptable method for the treatment of fingertip amputation. A large-scale study of osteocutaneous graft of amputated fingertips is required to improve the survival rate.
Hull, J B; Bowyer, G W; Cooper, G J; Crane, J
Traumatic amputation of limbs caused by bomb blast carries a high risk of mortality. This paper describes 73 amputations in 34 deaths from bomb blast in Northern Ireland. The principal aim was to determine the sites of traumatic amputation to provide a biophysical basis for the development of protective measures. Few amputations were through joints; nearly all were through the bone shafts. The most common site in the tibia was the upper third. The distribution of femoral sites resulting from car bombs differed from that characterizing other types of explosion. For car bombs the principal site of amputation was the upper third; for other types of device it was the lower third. It is concluded that flailing is not a notable contributor to limb avulsion. The pattern of amputation is consistent with direct local pressure loads leading to bone fracture; the amputation itself is a secondary event arising from the flow of combustion products.
Barmparas, Galinos; Inaba, Kenji; Teixeira, Pedro G R; Dubose, Joseph J; Criscuoli, Michele; Talving, Peep; Plurad, David; Green, Donald; Demetriades, Demetrios
The purpose of this study was to examine the epidemiology and outcomes of posttraumatic upper (UEA) and lower extremity amputations (LEA). The National Trauma Databank version 5 was used to identify all posttraumatic amputations. From 2000 to 2004 there were 8910 amputated patients (1.0% of all trauma patients). Of these, 6855 (76.9%) had digit and 2055 (23.1%) had limb amputation. Of those with limb amputation, 92.7 per cent (1904/2055) had a single limb amputation. LEA were more frequent than UEA among patients in the single limb amputation group (58.9% vs 41.1%). The mechanism of injury was blunt in 83 per cent; most commonly after motor vehicle collisions (51.0%), followed by machinery accidents (19.4%). Motor vehicle collision occupants had more UEA (54.5% vs 45.5%, P amputation is not uncommon after trauma in the civilian population and is associated with significant morbidity. Although single limb amputation did not impact mortality, the need for multiple limb amputation was an independent risk factor for death.
Raya, Michele A; Gailey, Robert S; Fiebert, Ira M; Roach, Kathyrn E
The purpose of this study was to determine whether measures of impairment (i.e., muscle strength, balance), personal factors (i.e., comorbidities, demographic information) and amputation specific variables (i.e., time since amputation, cause of amputation, level of amputation) were able to predict performance on the six-minute walk test, a measure of activity limitation, in individuals with lower limb amputation. A total of 72 individuals with lower limb amputation ranging in age from 21-83 were tested for balance, limb muscle strength and function. Medical comorbidities were recorded and activity limitation was measured using the six-minute walk test. Data were analyzed and multivariate relationships were examined using multiple linear regression. Impairment variables of strength, balance, subject demographics, time since amputation, cause of amputation and level of amputation were all significant predictors and explained 72% of the variance in the outcome variable. Strength of the hip extensors was the strongest predictor, accounting for 30.9% of the total variance. Multiple factors impact six minute walk scores in individuals with lower limb amputation. Impairments in hip strength and balance appear to be the two most significant. The findings of this study support the use of the six-minute walk test to underscore impairments of the musculoskeletal system that can affect ambulation ability in the amputee.
Grüttner, B; Frohnauer, G; Burgkart, R
Whereas passive prostheses are fitted onto the patient after the amputation of an arm, hand or finger and are mostly cosmetic in function, active prostheses have much more potential. They can transform the movements of other body regions to movement in the artificial limb. Belts or harnesses, for example, effect the direct transfer of the power from the muscle to the prosthesis. The range of movement possible depends upon the level of the amputation, the length of the residual limb, the age of the patient, his body build and fitness. Myoelectrically controlled prostheses possess their own drive and power source. They control movement through the electrical action potentials of the residual limb muscles, which are detected, amplified and transmitted with help of electrodes.
Myers, Keith P.; Holloway, Robert G.; Landau, Mark E.
Summary Traumatic peripheral nerve injuries often complicate extremity trauma, and may cause substantial functional deficits. We have encountered patients who request amputation of such injured extremities, with the goal of prosthetic replacement as a means to restore function. Data on long-term outcomes of limb salvage vs amputation are limited and somewhat contradictory, leaving how to respond to such requests in the hands of the treating physician. We present example cases, drawn from our experience with wounded soldiers in a peripheral nerve injury clinic, in order to facilitate discussion of the ways in which these patients stress the system of medical decision-making while identifying ethical questions central to responding to these requests. PMID:25279253
Cosmetic surgery and voluntary limb amputation share a number of features. Both procedures are patient-driven forms of body shaping that can only be performed by surgeons, and therefore the procedures require the imprimatur of the medical profession to be lawful. Both invoke identity construction as a central legitimating factor that renders the procedures therapeutic. The legal regulation of surgery is subsumed within general principles regulating medical practice, where autonomy and consent are constituted as fundamental authorising principles. The legitimacy of consent to surgical intervention operates unevenly in relation to these two forms of surgery. Amputation of healthy limbs is presumed to be non-therapeutic. Capacity is closely interrogated and minutely scrutinised. Consent to cosmetic surgery, by contrast, is presumed to be a valid expression of autonomy and self-determination.
This case report presents a case of prosthetic rehabilitation of an amputated thumb. It emphasizes that prosthetic replacement is a better option for aesthetic and psychological improvement, particularly in cases where the victim is unwilling to undergo complicated surgical procedures for reconstruction of thumb or where functioning of thumb cannot be restored even by multiple surgeries. In the present case, a 20 years old female patient, with missing thumb of her right hand was rehabilitated...
Burt, Sara A.; Veltman, Jorg; Hakze-van der Honing, Renate; Schmitt, Heike; Poel, van der Wim H.M.
Rabbits have been suggested as a zoonotic source of Hepatitis E virus. Phylogenetic analysis of HEV isolates from farmed, wild and pet rabbits in the Netherlands (23, 0, and 60 % respectively) showed them to be grouped amongst published rabbit HEV sequences and distinct from most human isolates.
Burt, S.A.; Veltman, Jorg; Hakze-van der Honing, Renate; Schmitt, Heike; van der Poel, Wim H.M.
Rabbits have been suggested as a zoonotic source of Hepatitis E virus. Phylogenetic analysis of HEV isolates from farmed, wild and pet rabbits in the Netherlands (23, 0, and 60 % respectively) showed them to be grouped amongst published rabbit HEV sequences and distinct from most human isolates. Dut
Morgan T. Redfield, MSEE
Full Text Available Knowledge of how persons with amputation use their prostheses and how this use changes over time may facilitate effective rehabilitation practices and enhance understanding of prosthesis functionality. Perpetual monitoring and classification of prosthesis use may also increase the health and quality of life for prosthetic users. Existing monitoring and classification systems are often limited in that they require the subject to manipulate the sensor (e.g., attach, remove, or reset a sensor, record data over relatively short time periods, and/or classify a limited number of activities and body postures of interest. In this study, a commercially available three-axis accelerometer (ActiLife ActiGraph GT3X+ was used to characterize the activities and body postures of individuals with transtibial amputation. Accelerometers were mounted on prosthetic pylons of 10 persons with transtibial amputation as they performed a preset routine of actions. Accelerometer data was postprocessed using a binary decision tree to identify when the prosthesis was being worn and to classify periods of use as movement (i.e., leg motion such as walking or stair climbing, standing (i.e., standing upright with limited leg motion, or sitting (i.e., seated with limited leg motion. Classifications were compared to visual observation by study researchers. The classifier achieved a mean +/– standard deviation accuracy of 96.6% +/– 3.0%.
Kim, J; Park, J W; Hong, S W; Jeong, J Y; Gong, H S; Baek, G H
Macrodactyly of the foot is a rare but disabling condition. We present the results of surgery on 18 feet of 16 patients, who underwent ray amputation and were followed-up for more than two years at a mean of 80 months (25 to 198). We radiologically measured the intermetatarsal width and forefoot area pre-operatively and at six weeks and two years after surgery. We also evaluated the clinical results using the Oxford Ankle Foot Questionnaire for children (OxAFQ-C) and the Questionnaire for Foot Macrodactyly. The intermetatarsal width and forefoot area ratios were significantly decreased after surgery. The mean OxAFQ-C score was 42 (16 to 57) pre-operatively, improving to 47 (5 to 60) at two years post-operatively (p = 0.021). The mean questionnaire for Foot Macrodactyly score two years after surgery was 8 (6 to 10). Ray amputation gave a measurable reduction in foot size with excellent functional results. For patients with metatarsal involvement, a motionless toe, or involvement of multiple digits, ray amputation is a clinically effective option which is acceptable to patients.
Redfield, Morgan T; Cagle, John C; Hafner, Brian J; Sanders, Joan E
Knowledge of how persons with amputation use their prostheses and how this use changes over time may facilitate effective rehabilitation practices and enhance understanding of prosthesis functionality. Perpetual monitoring and classification of prosthesis use may also increase the health and quality of life for prosthetic users. Existing monitoring and classification systems are often limited in that they require the subject to manipulate the sensor (e.g., attach, remove, or reset a sensor), record data over relatively short time periods, and/or classify a limited number of activities and body postures of interest. In this study, a commercially available three-axis accelerometer (ActiLife ActiGraph GT3X+) was used to characterize the activities and body postures of individuals with transtibial amputation. Accelerometers were mounted on prosthetic pylons of 10 persons with transtibial amputation as they performed a preset routine of actions. Accelerometer data was postprocessed using a binary decision tree to identify when the prosthesis was being worn and to classify periods of use as movement (i.e., leg motion such as walking or stair climbing), standing (i.e., standing upright with limited leg motion), or sitting (i.e., seated with limited leg motion). Classifications were compared to visual observation by study researchers. The classifier achieved a mean +/- standard deviation accuracy of 96.6% +/- 3.0%.
Full Text Available Abstract Introduction Tetanus is an infectious disease caused by tetanus toxin produced by Clostridium tetani and induces severe neurological manifestations. We treated a patient who developed tetanus during hospitalization for replantation of an amputated finger. To the best of our knowledge, this is the first published case report of such an entity. Case presentation A 49-year-old Japanese man had an amputation of his right middle finger at the distal interphalangeal joint region in an accident at work. His middle finger was successfully replanted, but his fingertip was partially necrotized because of crushing and so additional reconstruction with a reverse digital arterial flap was performed 15 days after the injury. Tetanus developed 21 days after replantation of the middle finger, but symptoms remitted via rapid diagnosis and treatment. Conclusions In replantation after finger trauma with exposure of nerve and blood vessel bundles, concern over injuring nerves and blood vessels may prevent irrigation and debridement from being performed sufficiently; these treatments may have been insufficiently performed in this patient. It is likely that the replanted middle finger partially adhered, and Clostridium tetani colonized the partially necrotized region. Even when there is only limited soil contamination, administration of tetanus toxoid and anti-tetanus immunoglobulin is necessary when the fingers are injured outdoors and the finger nerves and blood vessels are exposed. The drugs should be administered just after replantation if the finger has been amputated. However, if clinicians pay attention to the possibility of tetanus development, treatment can be rapidly initiated.
Self-demand amputees are persons who need to have one or more healthy limbs or digits amputated to fit the way they see themselves. They want to rid themselves of a limb that they believe does not belong to their body-identity. The obsessive desire to have appendages surgically removed to fit an alternative body-image is medically and ethically controversial. My purpose in this paper is to provide a number of normative and professional ethical perspectives on whether or not it is possible to justify surgery for self-demand amputees. In doing so I proceed dialogically, moving between empirical context and normative theory, revealing the taken for granted normative assumptions (what I call the natural attitude--a technical term borrowed from phenomenology) that provide ethical limits to justifying the treatment of self-demand amputees. While I critically examine both Kantian responses against as well as Utilitarian responses for amputation on demand, I conclude that neither normative tradition can fully incorporate an understanding of what it is like to be a self-demand amputee. Since neither theory can justify the apparent non-rational desire of amputation on demand, ethical justification, I argue, falls short of the recognition that there may be a problem. To end, I introduce a meta-ethical idea, "the struggle for recognition," opening up the theoretical possibility of a hermeneutics of recognition before ethical justification that may be more sensitive to the problem of radical embodied difference exemplified by self-demand amputees.
Elinson, Richard P; Walton, Zachary; Nath, Kimberly
Embryos of the direct developing frog, Eleutherodactylus coqui, provide opportunities to examine frog early limb development that are not available in species with tadpoles. We cloned two retinaldehyde dehydrogenase genes, EcRaldh1 and EcRaldh2, to see which enzyme likely supplies retinoic acid for limb development. EcRaldh1 is expressed in the dorsal retina, otic vesicle, pronephros, and pronephric duct, but not in the limb. EcRaldh2 is expressed early at the blastoporal lip and then in the mesoderm in the neurula, so this expression could function in forelimb initiation. Later EcRaldh2 is expressed in the mesoderm at the base of the limbs and in the ventral spinal cord where motor neurons innervating the limbs emerge. These observations on a frog support the functional conservation of EcRaldh2 in forelimb initiation in Osteichthyans and in limb patterning and motor neuron specification in tetrapods.
Carrier, David R; Deban, Stephen M; Fischbein, Timna
The limbs of running mammals are thought to function as inverted struts. When mammals run at constant speed, the ground reaction force vector appears to be directed near the point of rotation of the limb on the body such that there is little or no moment at the joint. If this is true, little or no external work is done at the proximal joints during constant-speed running. This possibility has important implications to the energetics of running and to the coupling of lung ventilation to the locomotor cycle. To test if the forelimb functions as an inverted strut at the shoulder during constant-speed running and to characterize the locomotor function of extrinsic muscles of the forelimb, we monitored changes in the recruitment of six muscles that span the shoulder (the m. pectoralis superficialis descendens, m. pectoralis profundus, m. latissimus dorsi, m. omotransversarius, m. cleidobrachialis and m. trapezius) to controlled manipulations of locomotor forces and moments in trotting dogs (Canis lupus familiaris Linnaeus 1753). Muscle activity was monitored while the dogs trotted at moderate speed (approximately 2 m s(-1)) on a motorized treadmill. Locomotor forces were modified by (1) adding mass to the trunk, (2) inclining the treadmill so that the dogs ran up- and downhill (3) adding mass to the wrists or (4) applying horizontally directed force to the trunk through a leash. When the dogs trotted at constant speed on a level treadmill, the primary protractor muscles of the forelimb exhibited activity during the last part of the ipsilateral support phase and the beginning of swing phase, a pattern that is consistent with the initiation of swing phase but not with active protraction of the limb during the beginning of support phase. Results of the force manipulations were also consistent with the protractor muscles initiating swing phase and contributing to active braking via production of a protractor moment on the forelimb when the dogs decelerate. A similar
Montenegro, Justin R.
Motor learning is measured quantitatively through many behavioral tests. Behavioral models for motor learning observe skill acquisition and performance over a period of time within rodents. One such behavioral test is the skilled forelimb reach-to-grasp test. This skilled forelimb reach-to-grasp test has been extensively used to observe motor learning in behavioral studies and is an appropriate metric that can be used to asses experiments of the motor cortex. In this study, the skilled foreli...
Lazzarini Peter A
Full Text Available Abstract Background Lower extremity amputation results in significant global morbidity and mortality. Australia appears to have a paucity of studies investigating lower extremity amputation. The primary aim of this retrospective study was to investigate key conditions associated with lower extremity amputations in an Australian population. Secondary objectives were to determine the influence of age and sex on lower extremity amputations, and the reliability of hospital coded amputations. Methods Lower extremity amputation cases performed at the Princess Alexandra Hospital (Brisbane, Australia between July 2006 and June 2007 were identified through the relevant hospital discharge dataset (n = 197. All eligible clinical records were interrogated for age, sex, key condition associated with amputation, amputation site, first ever amputation status and the accuracy of the original hospital coding. Exclusion criteria included records unavailable for audit and cases where the key condition was unable to be determined. Chi-squared, t-tests, ANOVA and post hoc tests were used to determine differences between groups. Kappa statistics were used to measure reliability between coded and audited amputations. A minimum significance level of p Results One hundred and eighty-six cases were eligible and audited. Overall 69% were male, 56% were first amputations, 54% were major amputations, and mean age was 62 ± 16 years. Key conditions associated included type 2 diabetes (53%, peripheral arterial disease (non-diabetes (18%, trauma (8%, type 1 diabetes (7% and malignant tumours (5%. Differences in ages at amputation were associated with trauma 36 ± 10 years, type 1 diabetes 52 ± 12 years and type 2 diabetes 67 ± 10 years (p Conclusions This study, the first in over 20 years to report on all levels of lower extremity amputations in Australia, found that people undergoing amputation are more likely to be older, male and have
Schmidt, Manuela; Mehlhorn, Martin; Fischer, Martin S
Studies into the function of structures are crucial for making connections between morphology and behaviour of organisms, but are still rare for the terrestrial Testudinidae. We investigated the kinematics of shoulder girdle and forelimb motion in Hermann's tortoise Testudo hermanni using biplanar X-ray fluoroscopy with a twofold aim: firstly, to understand how the derived shapes of shoulder girdle and carapace together influence rotation of the girdle; and, secondly, to understand how girdle rotation affects forelimb excursion. The total degree of shoulder rotation in the horizontal plane is similar to a species with a less domed shell, but because of the long and nearly vertically oriented scapular prong, shoulder girdle rotation contributes more than 30% to the horizontal arc of the humerus and nearly 40% to the rotational component of step length. The antebrachium and manus, which act as a functional unit, contribute roughly 50% to this component of the step length because of their large excursion almost parallel to the mid-sagittal plane. This large excursion is the result of the complex interplay between humerus long-axis rotation, counter-rotation of the antebrachium, and elbow flexion and extension. A significant proportion of forelimb step length results from body translation that is due to the propulsive effect of the other limbs during their stance phases. Traits that are similar to other tortoises and terrestrial or semi-aquatic turtles are the overall slow walk because of a low stride frequency, and the lateral-sequence, diagonally coupled footfall pattern with high duty factors. Intraspecific variation of carapace shape and shoulder girdle dimensions has a corresponding effect on forelimb kinematics.
US Fish and Wildlife Service, Department of the Interior — Five gallons of rabbit repellent paint were sent to George Wilson to be applied on the trees of the Tewaukon tree plot. Mr. Wilson requires a 3 or 4 in. brush for...
Flach, Rudiger; Haggard, Patrick
In the cutaneous rabbit effect (CRE), a tactile event (so-called attractee tap) is mislocalized toward an adjacent attractor tap. The effect depends on the time interval between the taps. The authors delivered sequences of taps to the forearm and asked participants to report the location of one of the taps. The authors replicated the original CRE…
1. Once there lived an elephant and a lion in the mountains, who both wanted to be the king of the beasts. One day the lion caught a rabbit. Before he ate it, he said, “Do you know I am the king here? ”
Alaverdashvili, M; Whishaw, I Q
Compensatory movements mediate success in skilled reaching for food after stroke to the forelimb region of motor cortex (MtCx) in the rat. The present study asks whether the neural plasticity that enables compensation after motor stroke is preserved in aging. In order to avoid potential confounding effects of age-related negative-learning, rats were trained in a single pellet reaching task during young-adulthood. Subgroups were retested before and after contralateral forelimb MtCx stroke via pial stripping given at 3, 18, or 23 months of age. Over a two-month post-stroke rehabilitation period, end point measures were made of learned nonuse, recovery, retention, and performance ratings were made of reaching movement elements. Prior to stroke, young and aged rats maintained equivalent end point performance but older rats displayed compensatory changes in limb use as measured with ratings of the elements of forelimb movement. Following stroke, the aged groups of rats were more impaired on end point, movement, and anatomical measures. Nevertheless, the aged rats displayed substantial recovery via the use of compensatory movements. Thus, this study demonstrates that the neural plasticity that mediates compensatory movements after stroke in young adults is preserved prior to and following stroke in aging.
Kristensen, Morten Tange; Holm, Gitte; Gebuhr, Peter
INTRODUCTION: The successful outcome of a major amputation depends on several factors, including stump wound healing. The purpose of this study was to examine the criteria upon which the index amputation was based and to identify factors associated with early amputation failure after major non......-traumatic lower-extremity amputation. METHODS: We studied a consecutive one-year series of 36 men and 34 women with a median (25-75% quartiles) age of 72 (63-83) years who were treated in an acute orthopaedic ward; 44 below-knee and 26 above-knee amputees of whom 47 had an American Society of Anesthesiologists...... rating above two. Patient characteristics and other factors potentially influencing early amputation failure within 30 days were evaluated. RESULTS: Eleven patients died (16%) and 11 (16%) had a re-amputation at a higher level, whereas four (6%) had a major revision at the same level within 30 days...
Valerio, Ian L; Hui-Chou, Helen G; Zelken, Jonathan; Basile, Patrick L; Ipsen, Derek; Higgins, James P
Ectopic banking of amputated parts is a recognized technique for delayed replantation of an amputated part when the amputation stump will not permit immediate replantation. This is conventionally performed with the intent of transferring the injured part back to its anatomic position when the amputation stump is more appropriate for replantation. Current warfare conditions have led to a commonly encountered military trauma injury pattern of multiple extremity amputations with protected trunk and core structures. This pattern poses many challenges, including the limit or absence of donor sites for immediate or delayed flap reconstructive procedures. We describe a case in which we ectopically banked the great toe of an amputated lower extremity for delayed thumb reconstruction.
Bhatnagar, Vibha; Richard, Erin; Melcer, Ted; Walker, Jay; Galarneau, Michael
Department of Veterans Affairs (VA) outpatient costs were analyzed for combat Veterans injured in Iraq and Afghanistan from 2001 to 2008. Patients had serious lower-limb injuries (n = 170) or unilateral (n = 460) or bilateral (n = 153) lower-limb amputation(s). Total costs over the follow-up period (2003 to 2012) and annual costs were analyzed. Unadjusted mean costs per year in 2012 U.S. dollars were $7,200, $14,700 and $18,700 for limb injuries and unilateral and bilateral lower-limb amputation(s), respectively (p amputation(s) (p Amputation status was associated with an adjusted 3.12-fold increase in mean prosthetic cost per year (p amputation status (p amputation. Finally, PTSD affected cost for multiple domains of health, highlighting the importance of accurate diagnosis, treatment, and support for PTSD.
Patel, Biren A; Carlson, Kristian J
Vertebrate morphologists often are interested in inferring limb-loading patterns in animals characterized by different locomotor repertoires. Because bone apparent density (i.e. mass per unit volume of bone inclusive of porosities) is a determinant of compressive strength, and thus indicative of compressive loading, recent comparative studies in primates have proposed a structure-function relationship between apparent density of subchondral bone and locomotor behaviours that vary in compressive loading. If such patterns are found in other mammals, then these relationships would be strengthened further. Here, we examine the distal radius of suspensory sloths that generally load their forelimbs (FLs) in tension and of quadrupedal anteaters that generally load their FLs in compression. Computed tomography osteoabsorptiometry was used to visualize the patterns in subchondral apparent density. Suspensory sloths exhibit relatively smaller areas of high apparent density than quadrupedal anteaters. This locomotor-based pattern is analogous to the pattern observed in suspensory and quadrupedal primates. Similarity between xenarthran and primate trends suggests broad-scale applicability for analysing subchondral bone apparent density and supports the idea that bone functionally alters its material properties in response to locomotor behaviours.
Background: Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients. Methods: Eighty-two high-voltage electrically injured patients were admitted to the Department of Plastic and Reconstructive Surg...
Campbell, W. B.; Marriott, S; Eve, R; Mapson, E.; Sexton, S.; Thompson, J F
A consecutive series of 349 primary lower limb amputations for vascular disease, done during 1992-1998, were reviewed for amputation level, revision, complications and death, seeking associations with the American Society of Anesthesiology (ASA) grade and pre-operative co-morbidities of patients. Attempted revascularisation, and seniority of surgeon supervising the amputation were also examined for their possible influence on outcome. There were 312 patients (163 male) aged 39-92 years (media...
Shi, Lucy L; Sargen, Michael R.; Chen, Suephy C.; Arbiser, Jack L.; Pollack, Brian P.
Background: Botulinum toxin type A (BTX-A) injections are an effective treatment for controlling hyperhidrosis at sites of amputation. Hyperesthesia associated with amputated limbs is a major barrier to performing this procedure under local anesthesia. Objective: To present a novel method for improving local anesthesia with BTX-A injections. Methods & Results: A 29-year-old military veteran with a below-the-knee amputation of his right leg was suf...
Anthony J. Metzger, MBE; Alexander W. Dromerick, MD; Christopher N. Schabowsky, MS; Rahsaan J. Holley, MS; Brian Monroe, BS; Peter S. Lum, PhD
The rate of upper-limb amputations is increasing, and the rejection rate of prosthetic devices remains high. People with upper-limb amputation do not fully incorporate prosthetic devices into their activities of daily living. By understanding the reaching behaviors of prosthesis users, researchers can alter prosthetic devices and develop training protocols to improve the acceptance of prosthetic limbs. By observing the reaching characteristics of the nondisabled arms of people with amputation...
E mail address: email@example.com KEYWORDS Extremity injury Mangled extremity Amputation Compartment syndrome Fasciotomy Prosthesis ...definitive repair. For ray amputations of the foot , removing the big toe in most cases is worse than a transmetatarsal amputation due to lack of...from lack of total contact with the prosthesis and requires refitting. Heterotopic ossification (HO), the aberrant formation of mature, lamellar bone in
Otiniano, Max E; Du, Xianglin; Ottenbacher, Kenneth; Black, Sandra A; Markides, Kyriakos S
This study was designed to determine the incidence and prevalence of amputations in diabetic Mexican American elders and to identify correlates of lower extremity amputations. Data for this study came from baseline and two follow-up interviews of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE) conducted in five southwestern states (Texas, California, New Mexico, Colorado and Arizona) in 1993-1994. Of the 3050 subjects aged 65 and older, 690 reported diabetes, and from these, 60 (8%) reported having at least one lower extremity amputation. Losing a leg was the most common type of amputation (53%). Twelve percent of respondents reported a new amputation and 40% of amputees reported a second amputation during follow-up. Mortality among amputees was 46% during a 5-year follow-up. Multiple logistic regression analysis showed that being male and having eye problems, hip fracture and diabetes for 10 or more years were significantly associated with lower extremity amputations at baseline, whereas obesity, stroke and 10 or more years with diabetes were significantly associated with new amputations at 5-year follow-up. Gender and disease history were associated with lower extremity amputations at baseline and follow-up. These variables may be useful in developing patient education and intervention programs.
Ischemia; Peripheral Arterial Disease; Peripheral Vascular Disease; Vascular Disease; Arterial Occlusive Disease; Arteriosclerosis; Atherosclerosis; Cardiovascular Disease; Pathologic Processes; Orthopedic Procedures; Amputation
Full Text Available Aim: The purpose of the study was to assess the cases that were amputated in our clinic due to primary malignant and metastatic bone and soft tissue tumor. Material and Method: 24 cases that were amputated due to primary malignant and metastatic bone and soft tissue tumor between January 1987 and January 2012 were examined retrospectively. The cases were assessed in terms of age, gender, pathological diagnosis, localization, type of amputation, survival and characteristics. The data obtained were transferred to SPSS 15.0 program and analyzed. Normality distributions of the data were analyzed with Shapiro-Wilk test. Results: Of the 24 cases, 17 (70% were men, while 7 (30% were women and the average age was 42 (between 12 and 68. The most common reasons for amputation were skin cancer (25%, Ewing sarcoma (20.8%, Osteosarcoma (16.6% and others (Malignant mesenchymal tumor, chondrosarcoma, synovial sarcoma, metastatic tumor. 16 of these patients had previously received an intervention in a different centre at least once. The most common type of amputation was above-knee amputation (58.3%, below-knee amputation (25% and others (hip disarticulation, below-elbow amputation. 8 patients were found to have skin problems and debridement was performed on 6. 14 cases died within the postoperative first year. Discussion: Amputation can be performed for the treatment of the patient’s other health problems and fast and local controls of advanced malignant extremity tumors.
Banihani, Omaya I; Fox, Janelle A; Gander, Brian H; Grunwaldt, Lorelei J; Cannon, Glenn M
Circumcision is the most common surgical procedure in males in the United States, and minor complications are not uncommon. Major complications like partial penile amputations have been reported with successful replantation. Complete penile amputations in adult males have been described, and successful replantation has been reported with increasing success. We report a case of complete penile amputation at the penopubic junction using a Mogen clamp in a 7-day-old neonate with replantation using postoperative leech therapy. To our knowledge this is the first time leech therapy has been used postoperatively for neonatal penile amputation.
Moshirfar, A; Showers, D; Logan, P; Esterhai, J L
Below the knee amputation after trauma is an appropriate option for many patients with recalcitrant infection and nonunion of the tibia. Patients who have had transtibial amputations have lower energy expenditure, heart rate, and oxygen cost when ambulating with their prostheses than when using a three-point gait with crutches without their artificial limb. Innovative prosthetists have improved each of the five essential components of the limb amputated below the knee: socket, insert, shaft and pylon, foot and ankle assembly, and suspension system. Prosthetists are integral members of the patient's healthcare team. Their recommendations and direct patient care are essential to optimizing the functional ability of patients who have had amputations.
Full Text Available Background: Despite low peri-operative mortality after major lower extremity amputation, long-term mortality remains substantial. Metabolic syndrome is increasing in incidence and prevalence at an alarming rate in the USA. Aim: This study was to determine whether metabolic syndrome predicts outcome after major lower extremity amputation. Patients and Methods: A retrospective review of charts between July 2005 and June 2010. Results: Fifty-four patients underwent a total of 60 major lower extremity amputations. Sixty percent underwent below-knee amputation and 40% underwent above-knee amputation. The 30-day mortality was 7% with no difference in level (below-knee amputation, 8%; above-knee amputation, 4%; P = 0.53. The mean follow-up time was 39.7 months. The 5-year survival was 54% in the whole group, and was independent of level of amputation (P = 0.24 or urgency of the procedure (P = 0.51. Survival was significantly decreased by the presence of underlying chronic kidney disease (P = 0.04 but not by other comorbidities (history of myocardial infarction, P = 0.79; metabolic syndrome, P = 0.64; diabetes mellitus, P = 0.56. Conclusion: Metabolic syndrome is not associated with increased risk of adverse outcomes after lower extremity amputation. However, patients with chronic kidney disease constitute a sub-group of patients at higher risk of postoperative long-term mortality and may be a group to target for intervention.
Full Text Available Purpose: the main approaches to the assignment of physical rehabilitation restorative treatment after lower limb amputations. Material and Methods: theoretical analysis and synthesis of modern scientific and methodological literature data on methods of comprehensive rehabilitation after lower limb amputations. Results: the features of the application of physical rehabilitation after lower limb amputations, tasks and presents the main approaches to the appointment of medical physical training, therapeutic massage and physical therapy in preparation for prosthetics. Conclusions: demonstrated that therapeutic physical training, therapeutic massage and physical therapy are effective means of physical rehabilitation of patients after lower limb amputations.
Full Text Available The results of below-knee amputations in 36 war wounded (mean age 35,42 were reviewed. The majority of the patients was wounded by land mines (94.4%. Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation in 30 (83.3% amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7% average 4.61 ± 11.67 days after wounding. Reamputation was necessary in 6 cases (16.7%. Time period from the beginning of rehabilitation to the fitting of prosthesis, was 36.25 ± 14.97 days for primary amputations, 32 ± 17.8 days for secondary amputations and 68.66 ± 33.52 days for reamputations. There was no significant correlation between the duration of rehabilitation to prosthetic management and the period between wounding and amputation (r = -0.102. The attempt to save the limb after severe below-knee injuries and the secondary amputation afterwards, did not significantly influence the ensuing rehabilitation and prosthetic works.
Rasmussen, Benjamin S B; Yderstraede, Knud B; Carstensen, Bendix;
as well as the incidence of further amputations, subdivided by level of amputation. RESULTS: During the period 1996-2011, a total of 2,832 amputations were performed, of which 1,285 were among patients with diabetes and 1,547 among individuals without diabetes. Relative to persons without diabetes...... in BAA rates among patients with diabetes of 9.8%, and the annual reduction in BKA for patients with diabetes was 15.1%. CONCLUSIONS/INTERPRETATION: The amputation rate in patients with diabetes is still several-fold higher than in persons without diabetes, but the improvements in diabetes care in recent...
Chou, C K; Han, L F; Guy, A W
Each of three adult New Zealand rabbits, 2 male and 1 female albinos, was exposed dorsally or ventrally, to 2450-MHz plane waves for 20 min under each of several field conditions: 1) to continuous waves (CW) at 5 mW/cm2; 2) to pulsed waves (PW) of 1-microsecond width that recurred 700 pps at an average of 5 mW/cm2 and at a peak of 7.1 W/cm2; 3) to PW of 10-microseconds width at a peak of 13.7 W/cm2 that were synchronized with and triggered by the R wave of the electrocardiogram (EKG) at various delay times (0, 100, and 200 ms; and 4) to CW at 80 mW/cm2. Carbon-loaded Teflon electrodes were used to record the EKG from forelimbs of an animal before, during, and after irradiation whilst it was maintained in a constant exposure geometry in a wooden squeeze box. Field induced changes in the heart-beat rate were observed at 80 mW/cm2 but not a lower average power densities, although a peak positive chronotropic effect might have been occasioned by PM introduced at 100 and 200 ms after the R wave peak. No cumulative effect was observed over a period of four months. Thermographic analysis revealed relatively little absorption of microwave energy by the myocardium irrespective of anatomical aspect of exposure.
Full Text Available The objective of this study was to evaluate the epidemiology of diabetic foot infections (DFIs and its predictive factors for lower extremity amputations. A prospective study of 100 patients with DFIs treated at the National University Hospital of Singapore were recruited in the study during the period of January 2005–June 2005. A protocol was designed to document patient's demographics, type of DFI, presence of neuropathy and/or vasculopathy and its final outcome. Predictive factors for limb loss were determined using univariate and stepwise logistic regression analysis. The mean age of the study population was 59.8 years with a male to female ratio of about 1:1 and with a mean follow-up duration of about 24 months. All patients had type 2 diabetes mellitus. Common DFIs included abscess (32%, wet gangrene (29%, infected ulcers (19%, osteomyelitis (13%, necrotizing fasciitis (4% and cellulitis (3%. Thirteen patients were treated conservatively, while surgical debridement or distal amputation was performed in 59 patients. Twenty-eight patients had major amputations (below or above knee performed. Forty-eight percent had monomicrobial infections compared with 52% with polymicrobial infections. The most common pathogens found in all infections (both monomicrobial and polymicrobial were Staphylococcus aureus (39.7%, Bacteroides fragilis (30.3%, Pseudomonas aeruginosa (26.0% and Streptococcus agalactiae (21.0%. Significant univariate predictive factors for limb loss included age above 60 years, gangrene, ankle-brachial index (ABI <0.8, monomicrobial infections, white blood cell (WBC count ≥ 15.0×109/L, erythrocyte sedimentation rate ≥100 mm/hr, C-reactive protein ≥15.0 mg/dL, hemoglobin (Hb ≤10.0g/dL and creatinine ≥150 µmol/L. Upon stepwise logistic regression, only gangrene, ABI <0.8, WBC ≥ 15.0×109/L and Hb ≤10.0g/dL were significant.
<正>Their efforts produced two rabbits out of a litter of eight that went from being a normal, fluffy(蓬松的) white to glowing green in the dark. The rabbits were born at the University of Istanbul as part of a collaboration between scientists from universities in Turkey and Hawaii. The rabbits glow to show that a genetic manipulation technique can work efficiently,
Full Text Available Circumcision is a very common urological practice. Even though it is relatively safe, it is not a complication-free procedure. We describe a patient that underwent a neonatal circumcision complicated by iatrogenic complete glans amputation. Reconstructive repair of a neoglans using a modified traditional method was used. Postoperative followup to 90 days is illustrated. Despite being a simple procedure, circumcision in unprofessional hands can have major complication impacting the emotional and sexual life of patients. Surgical reconstruction is possible with varying satisfactory results.
Full Text Available This is a report on the technique of neoglans reconstruction in a patient with amputated glans penis following guillotine neonatal circumcision. A 4 cm long and 2 cm wide lower lip oral mucosa graft was harvested and used to graft the distal 2 cm of the corporal bodies after 2 cm of the distal penile skin had been excised. One edge of the lower lip oral mucosa graft was anastomosed to the urethral margins distally and proximally to the skin. At six months of followup, patient had both satisfactory cosmetic and functional outcomes.
Mehmet Cemal Kaya
Full Text Available Self-harm behavior is defined as the person’s intentional,direct injuring of some body tissue or the whole body mostoften done without suicidal intentions. Mild types of selfmutilationis seen frequently however more severe onesare rarely seen. Severe self-mutilation is generally a signof a serious psychiatric disorder and it can result in organand/or organ functionality loss. In this study we aimed topresent a schizophrenic patient with repetitive self-mutilation.As a conclusion, practicing clinicians should takeinto consideration the possibility of self-harm behavior inschizophrenia patients especially if they have high riskproperties.Key words: Schizophrenia, self-mutilation, amputation
Alvarez Jorge, A; Martelo Villar, F
Soft-tissue injuries of the hand frequently require flap coverage to preserve structures damaged at the time of injury or to facilitate later reconstruction. The radial forearm flap makes local tissue readily available and offers a simple method of reconstruction. Secondary augmentation of the skin flap by means of tissue expansion appears to be a useful alternative to improve the possibilities of reconstruction. This case report describes a primary reconstruction of a hand with multiple finger amputations using both techniques: Forearm flap and tissue expansion.
Johnson, Robert D; Nielsen, Cynthia L
Legend states that the alligator snapping turtle (Macrochelys temminckii) should be handled with extreme caution as it has jaw strength powerful enough to bite a wooden broomstick in half. Tales of bite injuries from what is the largest freshwater turtle in North America exist anecdotally, yet there are few descriptions of medical encounters for such. The risk of infection from reptilian bites to the hand in an aquatic environment warrants thorough antibiotic treatment in conjunction with hand surgery consultation. We present the first case report of a near total amputation of an index finger in an adolescent boy who had been bitten by a wild "gator snapper."
Verschuren, Jesse Elisabeth; Geertzen, Jan H.; Enzlin, Paul; Dijkstra, Pieter U.; Dekker, Rienk
Purpose: Following a lower limb amputation, people may experience limitations in performing sexual activities. However, only little research efforts have been devoted to unravel how people experience their sexuality after such an amputation. Therefore, the purpose of the current study is to describe
van Eijk, Monica Spruit-; van der Linde, Harmen; Buijck, Bianca; Geurts, Alexander; Zuidema, Sytse; Koopmans, Raymond
BACKGROUND: The main determinants of prosthetic use known from literature apply to the younger patient with lower limb amputation. Studies aimed at identifying determinants of outcome of lower limb amputation in elderly patients with multimorbidity that rehabilitate in skilled nursing facilities (SN
Quilici, Maria Teresa Verrone; Del Fiol, Fernando de Sá; Vieira, Alexandre Eduardo Franzin; Toledo, Maria Inês
The aim of this study was to identify and quantify risk factors for amputation in diabetic patients hospitalized for foot infections. This cross-sectional study comprised 100 patients with diabetic infectious complications in the lower limbs. The variables investigated were related to diabetes, infection, and treatment compliance. Multiple Cox regression analysis was performed to identify the variables independently associated with the outcome of amputation. The most prevalent chronic complications were neuropathy and hypertension. Most patients presented with a neuroischemic foot (86%). The Morisky test showed that 72% were not compliant with diabetes treatment. Regarding patient outcome, 61% progressed to amputation, 14% to debridement, and 9% to revascularization. The results showed a 42% higher risk for progression to amputation in patients with previous use of antimicrobials. Also, the amputation risk was 26% higher for those less compliant with diabetes treatment. An increase of one point in the Wagner ulcer classification criteria corresponded to a 65% increase in the risk of amputation. Undergoing conservative, nonsurgical procedures prior to admission provided a 63% reduction in the risk of amputation. Knowledge of these factors is critical to enable multidisciplinary teams to develop treatment plans for these patients so as to prevent the need for amputation.
Full Text Available Background: Limb amputation has been a common injury occurring in the conflicts in Iraq and Afghanistan. Compared to other injuries, less attention has been given to this serious, disabling wound. Purpose: The article describes the Allied military experience of traumatic limb amputation in Iraq and Afghanistan. It intends to inform health care personnel involved in the care of serving military personnel and veterans about the scale of these casualties. Methods: A literature search of both civilian and military academic databases was conducted. Results: Both the US and UK have incurred very significant numbers of casualties involving traumatic limb amputation, many of whom have suffered multiple limb loss. The rate of blast injuries causing traumatic limb amputation among US forces has increased since the surge of troops in Afghanistan. Dismounted Complex Blast Injury (DCBI consisting of multiple limb amputations with pelvic, abdominal or genito-urinary injuries has been reported as increasing in frequency among US troops in Afghanistan since 2010. Australian Defence Force casualties suffering traumatic limb amputation remain low. Conclusions: Significant casualties involving traumatic limb amputation are likely to continue among Allied troops while current counter-insurgency tactics are continued. Planned troop withdrawals should eventually result in fewer casualties, including reduced numbers of traumatic limb amputation.
Ramdass, Michael J
A rare case of grade IV frostbite is presented resulting in bilateral below knee amputations. This case highlights the importance of early versus late amputation as well as the importance of close collaboration between the rehabilitation, surgical, psychosocial, and public health disciplines in this rare and challenging problem that still may be encountered in the United Kingdom.
Michael J. Ramdass
A rare case of grade IV frostbite is presented resulting in bilateral below knee amputations. This case highlights the importance of early versus late amputation as well as the importance of close collaboration between the rehabilitation, surgical, psychosocial, and public health disciplines in this rare and challenging problem that still may be encountered in the United Kingdom.
Wezenberg, Daphne; de Haan, Arnold; Faber, Willemijn X.; Slootman, Hans J.; van der Woude, Lucas H.; Houdijk, Han
Objective: To investigate whether the aerobic capacity of older adults who underwent a lower limb amputation is associated with the presence, cause (traumatic or vascular), and level of amputation (transtibial or transfemoral). Design: Cross-sectional descriptive. Setting: Human motion laboratory at
Hemakumar Devan, MPhty
Full Text Available Following amputation, people with transfemoral amputation (TFA and transtibial amputation (TTA adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1 amputated and intact leg and (2 amputated and referent leg of nondisabled controls were included (26 articles. Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.
Devan, Hemakumar; Carman, Allan; Hendrick, Paul; Hale, Leigh; Ribeiro, Daniel Cury
Following amputation, people with transfemoral amputation (TFA) and transtibial amputation (TTA) adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1) amputated and intact leg and (2) amputated and referent leg of nondisabled controls were included (26 articles). Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.
Sinha, Richa; van den Heuvel, Wim J. A.; Arokiasamy, Perianayagam
Background: Positive adjustments to amputation and an artificial limb play important roles in the rehabilitation process. Objectives: To study the different facets of adjustments to amputation and an artificial limb in lower limb amputees and to assess the possible role of different background and a
Geertzen, J.H.B.; Martina, J.D.; Rietman, H.S.
Ten years after the ISPO consensus conference on amputation surgery, a search of relevant publications in the Rehabilitation-prosthetics-literature over the years 1990-2000 was performed. The main key-words in this research were: "lower limb, amputation, human and rehabilitation". One hundred and fo
Geertzen, JHB; Martina, JD; Rietman, HS
Ten years after the ISPO consensus conference on amputation surgery, a search of relevant publications in the Rehabilitation-prosthetics-literature over the years 1990-2000 was performed. The main key-words in this research were: "lower limb, amputation, human and rehabilitation". One hundred and fo
More than 25% of those who followed the recommended treatment and rehabilitation programme to prepare the amputation stump, reduced contracture and enhanced physical working abilities were declared to be appropriate for further prostheses. This indicates serious shortcomings in medical treatments during the early post-amputation period.
Verschuren, J. E. A.; Enzlin, P.; Geertzen, J. H. B.; Dijkstra, P. U.; Dekker, R.
Purpose: The purpose of this study was to analyze whether, and by whom sexuality is discussed in amputation departments. The focus was on whether professionals received questions about sexuality from their patients with a lower limb amputation and whether they addressed sexuality themselves, as well
Iris A Otto
Full Text Available Traumatic arm amputations can be treated with replantation or surgical formalization of the stump with or without subsequent prosthetic fitting. In the literature, many authors suggest the superiority of replantation. This systematic review compared available literature to analyze whether replantation is functionally and psychologically more profitable than formalization and prosthetic fitting in patients with traumatic arm amputation.Functional outcome and satisfaction levels were recorded of patients with amputation levels below elbow, through elbow, and above elbow.Functional outcomes of 301 replantation patients and 172 prosthesis patients were obtained. In the replantation group, good or excellent functional scores were reported in 39% of above elbow, 55% of through elbow, and 50% of below elbow amputation cases. Nearly 100% of patients were satisfied with the replanted limb. In the prosthesis group, full use of the prosthesis was attained in 48% of above elbow and in 89% of below elbow amputation patients. Here, 29% of patients elected not to use the prosthesis for reasons including pain and functional superfluity. In both replantation patients and prosthesis wearers, a below elbow amputation yielded better functional results than higher amputation levels.Replantation of a traumatically amputated arm leads to good function and higher satisfaction rates than a prosthesis, regardless of the objective functional outcome. Sensation and psychological well-being seem the two major advantages of replantation over a prosthesis. The current review of the available literature shows that in carefully selected cases replantation could be the preferred option of treatment.
Krans-Schreuder, H.K.; Bodde, M.I.; Schrier, E.; Dijkstra, P.U.; van den Dungen, J.A.; den Dunnen, W.F.; Geertzen, J.H.
Background: Some patients with long-standing, therapy-resistant typed complex regional pain syndrome consider an amputation. There is a lack of evidence regarding the risk of recurrence of the pain syndrome and patient outcomes after amputation. The goal of the present study was to evaluate the impa
Rommers, G. M.; Diepstraten, H. J. M.; Bakker, E.; Lindeman, E.
In The Netherlands, about 50% of all amputations of the lower limb are toes and forefoot amputations. Traumata of toes and mid-foot are rare. Preservation of the foot is the primary goal for treatment. Crush injuries of the foot may be associated with prolonged morbidity. This case study presents an
Kristensen, Morten Tange; Holm, Gitte; Kirketerp-Møller, Klaus;
The aim of this retrospective study was to evaluate factors potentially influencing short- and long-term mortality in patients who had a non-traumatic lower limb amputation in a university hospital. A consecutive series of 93 amputations (16% toe/foot, 33% trans-tibial, 9% through knee and 42...
Qvortrup, K.; Rostgaard, Jørgen; Bretlau, P.
Anatomy, Reissner's membrane, electron microscopy, tubulocisternal endoplasmic reticulum, subsurface cisterns, rabbit......Anatomy, Reissner's membrane, electron microscopy, tubulocisternal endoplasmic reticulum, subsurface cisterns, rabbit...
Rasmussen, Marie Louise Roed
used with an increasing tendency until 2003. The Phantom eye syndrome is frequent among EA patients. Visual hallucinations were described by 42% of the patients. The content were mainly elementary visual hallucinations, with white or colored light as a continuous sharp light or as moving dots. The most...... limitations due to emotional problems and mental health. Patients with the indication painful blind eye are having lower scores in all aspects of health related quality of life and perceived stress than patients with the indication neoplasm and trauma. The percentage of eye amputated which is divorced...
bilateral amputations reported here remain unclear. Th e current case defi nition was repeat- edly refi ned to optimize the sensitivity of the case ...6,144 incident cases of traumatic amputations among 5,694 service members. Over one-third of these service members (n=2,037) had major amputations ...calendar years 2005 through 2011. For surveillance purposes, a case of traumatic amputation was defi ned as an individual with: 1) a hospitalization
Penile amputation is a rare catastrophe and a serious complication of circumcision. Reconstruction of the glans penis may be indicated following amputation. Our report discusses a novel technique for reconfiguration of an amputated glans penis 1 year after a complicated circumcision. A 2-year-old male infant presented to us with glans penis amputation that had occurred during circumcision 1 year previously. The parents complained of severe meatal stenosis with disfigurement of the penis. Peni...
Peter A Lazzarini
Full Text Available To determine trends in the incidence of foot-related hospitalisation and amputation amongst persons with diabetes in Queensland (Australia between 2005 and 2010 that coincided with changes in state-wide ambulatory diabetic foot-related complication management.All data from cases admitted for the principal reason of diabetes foot-related hospitalisation or amputation in Queensland from 2005-2010 were obtained from the Queensland Hospital Admitted Patient Data Collection dataset. Incidence rates for foot-related hospitalisation (admissions, bed days used and amputation (total, minor, major cases amongst persons with diabetes were calculated per 1,000 person-years with diabetes (diabetes population and per 100,000 person-years (general population. Age-sex standardised incidence and age-sex adjusted Poisson regression models were also calculated for the general population.There were 4,443 amputations, 24,917 hospital admissions and 260,085 bed days used for diabetes foot-related complications in Queensland. Incidence per 1,000 person-years with diabetes decreased from 2005 to 2010: 43.0% for hospital admissions (36.6 to 20.9, 40.1% bed days (391 to 234, 40.0% total amputations (6.47 to 3.88, 45.0% major amputations (2.18 to 1.20, 37.5% minor amputations (4.29 to 2.68 (p < 0.01 respectively. Age-sex standardised incidence per 100,000 person-years in the general population also decreased from 2005 to 2010: 23.3% hospital admissions (105.1 to 80.6, 19.5% bed days (1,122 to 903, 19.3% total amputations (18.57 to 14.99, 26.4% major amputations (6.26 to 4.61, 15.7% minor amputations (12.32 to 10.38 (p < 0.01 respectively. The age-sex adjusted incidence rates per calendar year decreased in the general population (rate ratio (95% CI; hospital admissions 0.949 (0.942-0.956, bed days 0.964 (0.962-0.966, total amputations 0.962 (0.946-0.979, major amputations 0.945 (0.917-0.974, minor amputations 0.970 (0.950-0.991 (p < 0.05 respectively.There were significant
Full Text Available Circumcision is one of the oldest and most commonly performed surgical procedures. Unfortunately, various complications may occur during circumcision, ranging from trivial to tragic such as penile amputation which is a serious complication and a challenging injury to treat. We describe two cases of non-microsurgical successful reattachment of a distal penile glans which were amputated during circumcision. In the first case, a 5-year-old child underwent circumcision by an urologist under local anesthesia. In the second one, a 3-year-old child underwent circumcision by a general practitioner who used to make circumcision. In this article, the literature is reviewed; results and potential complications of this surgery are also discussed. Glans sensation was present, early morning erection was maintained, and there was an erectile response during penile manipulation in both cases. Although circumcision is not technically difficult, it should be taken seriously. The use of microsurgical reattachment is not always possible, especially in pediatric cases; it also requires special equipment and training.
Barri L. Schnall, MPT
Full Text Available The biomechanical responses to load carriage, a common task for dismounted troops, have been well studied in nondisabled individuals. However, with recent shifts in the rehabilitation and retention process of injured servicemembers, there remains a substantial need for understanding these responses in persons with lower-limb amputations. Temporal-spatial and kinematic gait parameters were analyzed among 10 male servicemembers with unilateral transtibial amputation (TTA and 10 uninjured male controls. Participants completed six treadmill walking trials in all combinations of two speeds (1.34 and 1.52 m/s and three loads (none, 21.8, and 32.7 kg. Persons with TTA exhibited biomechanical compensations to carried loads that are comparable to those observed in uninjured individuals. However, several distinct gait changes appear to be unique to those with TTA, notably, increased dorsiflexion (deformation of the prosthetic foot/ankle, less stance knee flexion on the prosthetic limb, and altered trunk forward lean/excursion. Such evidence supports the need for future work to assess the risk for overuse injuries with carried loads in this population in addition to guiding the development of adaptive prosthetic feet/components to meet the needs of redeployed servicemembers or veterans/civilians in physically demanding occupations.
Full Text Available Psychological aspects of adjustment to amputation are varied and not addressed in the present treatment regime. There is no research evidence available of psychological intervention and outcome in Indian scenario. One hundred and seventy-three consecutive patients with limb amputations were randomly assigned to psychotherapeutic intervention module (PIM, study group (n=90 and treatment as usual group (TAU, control group (n=83. Patients with psychotic disorder were excluded from the study. Carroll Rating Scale for Depression (CRSD, State-Trait Anxiety Inventory (STAI, Amputees Body Image Scale (ABIS, and Impact of Event Scale (IES along with specially designed information schedule were administered individually. Structured psychotherapeutic module was developed for the intervention. Patients in PIM group were given six therapy sessions, addressing the specific areas of concern. All patients were evaluated on the same tools after two months of therapy. Analysis showed that after treatment a significant reduction in scores was noted on CRSD, STAI, ABIS, and IES in the PIM group. On the TAU group a significant reduction was seen only in the ABIS. The psychological intervention module proposed by authors was efficacious in alleviating the psychological distress, depression, and anxiety and thus was vastly superior to the conventional method of management of amputees.
Houdek, Matthew T; Kralovec, Michael E; Andrews, Karen L
The hemipelvectomy, most commonly performed for pelvic tumor resection, is one of the most technically demanding and invasive surgical procedures performed today. Adequate soft tissue coverage and wound complications after hemipelvectomy are important considerations. Rehabilitation after hemipelvectomy is optimally managed by a multidisciplinary integrated team. Understanding the functional outcomes for this population assists the rehabilitation team to counsel patients, plan goals, and determine discharge needs. The most important rehabilitation goal is the optimal restoration of the patient's functional independence. Factors such as age, sex, etiology, level of amputation, and general health play important roles in determining prosthetic use. The three main criteria for successful prosthetic rehabilitation of patients with high-level amputation are comfort, function, and cosmesis. Recent advances in hip and knee joints have contributed to increased function. Prosthetic use after hemipelvectomy improves balance and decreases the need for a gait aid. Using a prosthesis helps maintain muscle strength and tone, cardiovascular health, and functional mobility. With new advances in prosthetic components, patients are choosing to use their prostheses for primary mobility.
Srivastava, Kalpana; Chaudhury, Suprakash
Psychological aspects of adjustment to amputation are varied and not addressed in the present treatment regime. There is no research evidence available of psychological intervention and outcome in Indian scenario. One hundred and seventy-three consecutive patients with limb amputations were randomly assigned to psychotherapeutic intervention module (PIM, study group) (n = 90) and treatment as usual group (TAU, control group) (n = 83). Patients with psychotic disorder were excluded from the study. Carroll Rating Scale for Depression (CRSD), State-Trait Anxiety Inventory (STAI), Amputees Body Image Scale (ABIS), and Impact of Event Scale (IES) along with specially designed information schedule were administered individually. Structured psychotherapeutic module was developed for the intervention. Patients in PIM group were given six therapy sessions, addressing the specific areas of concern. All patients were evaluated on the same tools after two months of therapy. Analysis showed that after treatment a significant reduction in scores was noted on CRSD, STAI, ABIS, and IES in the PIM group. On the TAU group a significant reduction was seen only in the ABIS. The psychological intervention module proposed by authors was efficacious in alleviating the psychological distress, depression, and anxiety and thus was vastly superior to the conventional method of management of amputees.
Full Text Available Aparna Swaminathan,1 Sreekanth Vemulapalli,1,2 Manesh R Patel,1,2 W Schuyler Jones1,2 1Department of Medicine, Duke University Medical Center, Durham, NC, USA; 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA Abstract: Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE amputation (LEA, although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. Keywords: peripheral artery disease, lower extremity amputation, mortality
Full Text Available Direct interfacing of transected peripheral nerves with advanced robotic prosthetic devices has been proposed as a strategy for achieving natural motor control and sensory perception of such bionic substitutes, thus fully functionally replacing missing limbs in amputees. Multi-electrode arrays placed in the brain and peripheral nerves have been used successfully to convey neural control of prosthetic devices to the user. However, reactive gliosis, micro hemorrhages, axonopathy and excessive inflammation, currently limit their long-term use. Here we demonstrate that enticement of peripheral nerve regeneration through a non-obstructive multi-electrode array, after either acute or chronic nerve amputation, offers a viable alternative to obtain early neural recordings and to enhance long-term interfacing of nerve activity. Non restrictive electrode arrays placed in the path of regenerating nerve fibers allowed the recording of action potentials as early as 8 days post-implantation with high signal-to-noise ratio, as long as 3 months in some animals, and with minimal inflammation at the nerve tissue-metal electrode interface. Our findings suggest that regenerative on-dependent multi-electrode arrays of open design allow the early and stable interfacing of neural activity from amputated peripheral nerves and might contribute towards conveying full neural control and sensory feedback to users of robotic prosthetic devices. .
Carmona, G A; Lacraz, A; Hoffmeyer, P; Assal, M
Between 1990 and 2010 the incidence of major lowerlimb amputations (by definition any level of amputation above the foot) in the canton of Geneva was 10.02 per 100,000 inhabitants/ year. The analysis of various population groups revealed that the presence of diabetes increased the relative risk of amputation by a factor of 20, and age 65 years or older by a factor of 9. During this 21 years period we observed a gradual decline in the incidence of amputation and an increased age at the time of amputation, despite the increasing prevalence of diabetes and an aging population. This was a reflection on the efforts of primary and secon- dary prevention, initiated in the 1980s in which Geneva was a pioneer.
Rose, H G; Schweitzer, P; Charoenkul, V; Schwartz, E
Traumatic leg amputation, but not arm amputation, in World War II combat veterans has been associated with subsequent increased ischemic heart disease mortality. In a pilot project we examined a group of 19 high-risk Vietnam War veterans with bilateral above-knee amputations in comparison with a control group with unilateral below-elbow amputations. Nine of the 19 above-knee amputees were hypertensive (p = 0.05) and obese by hydrostatic weighing (p less than 0.001). Obesity was strongly associated with hypertension, decreased glucose tolerance, and marked hyperinsulinemia. Cigarette smoking, blood lipid abnormalities, and decreased cardiovascular fitness were not implicated as significant risk factors. Long-term risks of amputation may be related to metabolic and hemodynamic sequelae of excessive maturity-onset weight gain in young men immobilized by loss of lower limbs.
Senter, Phil; Robins, James H
The inclination of the scapular blade and the resting pose of the forelimb in dinosaurs differ among reconstructions and among skeletal mounts. For most dinosaurian taxa, no attempt has previously been made to quantify the correct resting positions of these elements. Here, we used data from skeletons preserved in articulation to quantify the resting orientations of the scapula and forelimb in dinosaurs. Specimens were included in the study only if they were preserved lying on their sides; for each specimen the angle between forelimb bones at a given joint was included in the analysis only if the joint was preserved in articulation. Using correlation analyses of the angles between the long axis of the sacrum, the first dorsal centrum, and the scapular blade in theropods and Eoraptor, we found that vertebral hyperextension does not influence scapular orientation in saurischians. Among examined taxa, the long axis of the scapular blade was found to be most horizontal in bipedal saurischians, most vertical in basal ornithopods, and intermediate in hadrosauroids. We found that in bipedal dinosaurs other than theropods with semilunate carpals, the resting orientation of the elbow is close to a right angle and the resting orientation of the wrist is such that the hand exhibits only slight ulnar deviation from the antebrachium. In theropods with semilunate carpals the elbow and wrist are more flexed at rest, with the elbow at a strongly acute angle and with the wrist approximately at a right angle. The results of our study have important implications for correct orientations of bones in reconstructions and skeletal mounts. Here, we provide recommendations on bone orientations based on our results.
Full Text Available The inclination of the scapular blade and the resting pose of the forelimb in dinosaurs differ among reconstructions and among skeletal mounts. For most dinosaurian taxa, no attempt has previously been made to quantify the correct resting positions of these elements. Here, we used data from skeletons preserved in articulation to quantify the resting orientations of the scapula and forelimb in dinosaurs. Specimens were included in the study only if they were preserved lying on their sides; for each specimen the angle between forelimb bones at a given joint was included in the analysis only if the joint was preserved in articulation. Using correlation analyses of the angles between the long axis of the sacrum, the first dorsal centrum, and the scapular blade in theropods and Eoraptor, we found that vertebral hyperextension does not influence scapular orientation in saurischians. Among examined taxa, the long axis of the scapular blade was found to be most horizontal in bipedal saurischians, most vertical in basal ornithopods, and intermediate in hadrosauroids. We found that in bipedal dinosaurs other than theropods with semilunate carpals, the resting orientation of the elbow is close to a right angle and the resting orientation of the wrist is such that the hand exhibits only slight ulnar deviation from the antebrachium. In theropods with semilunate carpals the elbow and wrist are more flexed at rest, with the elbow at a strongly acute angle and with the wrist approximately at a right angle. The results of our study have important implications for correct orientations of bones in reconstructions and skeletal mounts. Here, we provide recommendations on bone orientations based on our results.
Amitrano, Fernando N; Gutierrez-Nibeyro, Santiago D; Schaeffer, David J
OBJECTIVE To determine and compare the effect of hoof boots (HBs) and shoes with a toe extension on stance duration, ground reaction force, and sole length in contact with the ground in nonlame horses during walking. ANIMALS 6 nonlame Standardbreds. PROCEDURES Force plate gait analyses of the forelimbs were performed while the horses were walking barefoot before manipulation of feet (baseline), while the horses were walking fitted with HBs, while the horses were walking shod with toe-extension shoes, and while the horses were walking barefoot after shoe removal. Horses underwent radiography of both forelimb feet to determine the sole length in contact with the ground when barefoot, wearing HBs, and shod with toe-extension shoes. Stance duration, ground reaction force, and sole length were compared among the various walking sessions. RESULTS Compared with baseline findings, stance duration increased significantly when horses were fitted with HBs (7%) or toe-extension shoes (5%). Peak forelimb ground reaction force was similar among walking sessions; however, time of braking force peak was significantly greater during the stance phase only when horses wore HBs. Also, the sole length in contact with the ground was significantly longer in horses fitted with HBs (14.3 cm) or shod with the toe-extension shoes (17.6 cm), compared with that for one of the barefoot hooves (12.7 cm). CONCLUSIONS AND CLINICAL RELEVANCE In nonlame horses, use of HBs prolonged the stance time and time of braking force peak, which is indicative of a slower deceleration phase during limb impact with the ground. Also, the use of HBs prolonged the deceleration phase of the stride and increased the sole length in contact with the ground.
Every year of the Chinese lunar calendar corresponds with an animal. The rat,ox, tiger, rabbit, dragon, snake, horse,sheep, monkey, rooster, dog and pig make up the Chinese zodiac, which repeats in a12-year cycle. This year’s Chinese NewYear rings in the Year of the Rabbit.
Serrano, J; Gousiou, E; van der Bij, E; Wlostowski, T; Daniluk, G; Lipinski, M
White Rabbit (WR) is a multi-laboratory, multi- company collaboration for the development of a new Ethernet-based technology which ensures sub-nanosecond synchronisation and deterministic data transfer. The project uses an open source paradigm for the development of its hardware, gateware and software components. This article provides an introduction to the technical choices and an explanation of the basic principles underlying WR. It then describes some possible applications and the current status of the project. Finally, it provides insight on current developments and future plans.
Kapidzić-Duraković, Suada; Karabegović, Azra; Halilbegović, Emir; Cićkusić, Amela; Osmanović, Nusret; Kudumović, Zijada
Multidimensional Inventory Check List of Symptoms (SCL-90-r) is based on self-evaluation and it has been used for determination of level of: somatisation, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobias, paranoia and psychosis at persons which are exposed to long term emotional and physical stress. Our goal was to determine relations of physical trauma and psychological changes at persons with lower extremities amputations and to determine factors which influence those changes. Thirty seven persons with lower extremities amputations were examined. The sample included 26 (70.2 %) veterans and 11 (29.7 %) civilians with diseases related amputations. They voluntarily filled Check List of Symptoms SCL-90-r. Symptoms Inventory includes 9 dimensions of primary symptoms: SCL1-somatisation, SCL2-obsessive-compulsive symptoms, SCL3-interpersonal sensitivity, SCL4-depression, SCL5-anxiety, SCL6-hostility, SCL7-phobias, SCL8-paranoia, SCL9-psychosis and SCL10-extra scale. Inventory includes 90 statements, each evaluated with five-level scale of disorder. Every answer is graded with 0-4 points. Thirty seven persons with lower extremities amputations and average chronological age 46.2 +/- 10.92 years were analyzed. Considering marital status 30 (81.1 %) of them were married, 4 (10.8 %) were not married and 3 (8.1 %) were widowers. Considering level of amputation 27 of them (73.0 %) had amputation below knee, 5 (13.5 %) of them amputation above knee and 5 of them (13.5 %) foot amputation. SCL-90-r in both groups determined high level of sensitivity, anxiety, hostility and paranoia. Veterans showed higher level of paranoia comparing to civilians (p<0.002), and younger veterans and married ones had higher level of paranoia comparing to other veterans (p<0.01). Persons with amputations below and above knee showed higher level of paranoia comparing those with foot amputation (p<0.001). Persons with lower extremities amputations have
Anna Paula Martins de Carvalho
Full Text Available The estuarine dolphin, Sotalia guianensis, is one of the most abundant cetacean species in Brazil. Determination of age and of aspects associated with the development of this species is significant new studies. Counts of growth layer groups in dentin are used to estimate age of these animals, though other ways to evaluate development are also adopted, like the measurement of total length (TL. This study presents a procedure to evaluate the development of the estuarine dolphin based on the ossification pattern of forelimbs. Thirty-seven estuarine dolphins found in the state of Espírito Santo, Brazil, were examined. Age was estimated, TL was measured and ossification of epiphyses was examined by radiography. We analyzed results using the Spearman correlation. Inspection of radiographs allowed evaluation of the significance of the correlation between age and development of the proximal (r = 0.9109 and distal (r = 0.9092 radial epiphyses, and of the distal ulnar epiphyses (r = 0.9055. Radiographic analysis of forelimbs proved to be an appropriate method to evaluate physical maturity, and may be a helpful tool to estimate age of these animals in ecological and population studies.
Takeshita, Hikari; Yamamoto, Koichi; Nozato, Satoko; Inagaki, Tadakatsu; Tsuchimochi, Hirotsugu; Shirai, Mikiyasu; Yamamoto, Ryohei; Imaizumi, Yuki; Hongyo, Kazuhiro; Yokoyama, Serina; Takeda, Masao; Oguro, Ryosuke; Takami, Yoichi; Itoh, Norihisa; Takeya, Yasushi; Sugimoto, Ken; Fukada, So-ichiro; Rakugi, Hiromi
The conventional forelimb grip strength test is a widely used method to assess skeletal muscle function in rodents; in this study, we modified this method to improve its variability and consistency. The modified test had lower variability among trials and days than the conventional test in young C57BL6 mice, especially by improving the variabilities in male. The modified test was more sensitive than the conventional test to detect a difference in motor function between female and male mice, or between young and old male mice. When the modified test was performed on male mice during the aging process, reduction of grip strength manifested between 18 and 24 months of age at the group level and at the individual level. The modified test was similar to the conventional test in detecting skeletal muscle dysfunction in young male dystrophic mice. Thus, the modified forelimb grip strength test, with its improved validity and reliability may be an ideal substitute for the conventional method. PMID:28176863
Full Text Available Bone abnormalities are common in theropod dinosaur skeletons, but before now no specimen was known with more than four afflicted bones of the pectoral girdle and/or forelimb. Here we describe the pathology of a specimen of the theropod dinosaur Dilophosaurus wetherilli with eight afflicted bones of the pectoral girdle and forelimb. On its left side the animal has a fractured scapula and radius and large fibriscesses in the ulna and the proximal thumb phalanx. On its right side the animal has abnormal torsion of the humeral shaft, bony tumors on the radius, a truncated distal articular surface of metacarpal III, and angular deformities of the first phalanx of the third finger. Healing and remodeling indicates that the animal survived for months and possibly years after its ailments began, but its right third finger was permanently deformed and lacked the capability of flexion. The deformities of the humerus and the right third finger may be due to developmental osteodysplasia, a condition known in extant birds but unreported in non-avian dinosaurs before now.
Jeffery Nick D
Full Text Available Abstract Background Clinical spinal cord injury in domestic dogs provides a model population in which to test the efficacy of putative therapeutic interventions for human spinal cord injury. To achieve this potential a robust method of functional analysis is required so that statistical comparison of numerical data derived from treated and control animals can be achieved. Results In this study we describe the use of digital motion capture equipment combined with mathematical analysis to derive a simple quantitative parameter – 'the mean diagonal coupling interval' – to describe coordination between forelimb and hindlimb movement. In normal dogs this parameter is independent of size, conformation, speed of walking or gait pattern. We show here that mean diagonal coupling interval is highly sensitive to alterations in forelimb-hindlimb coordination in dogs that have suffered spinal cord injury, and can be accurately quantified, but is unaffected by orthopaedic perturbations of gait. Conclusion Mean diagonal coupling interval is an easily derived, highly robust measurement that provides an ideal method to compare the functional effect of therapeutic interventions after spinal cord injury in quadrupeds.
梁庆卫; 杨璞; 曹永辉; 陈良军
通过对海龟前肢运动特点的分析和研究,对扑翼进行受力分析,充分利用惯性与流体力的作用,基于Unigraphics 软件,实现前肢扑翼驱动机构的虚拟样机设计,简述此机构的周期运动过程,通过计算与仿真得出其粗略的推进力曲线及驱动电机参数,验证了机构的合理性.%By analyzing and studying the moving characteristic of turtle's forelimb,making full use of the role of inertia and fluid force, forelimb flapping actuator virtual prototype design the periodic motion process of this body, is sketched. The rough curve of pro-pulsion and the drive motor parameters are obtained and it is verify that the design is reasonable by calculation and simulation.
Senter, Phil; Juengst, Sara L
Bone abnormalities are common in theropod dinosaur skeletons, but before now no specimen was known with more than four afflicted bones of the pectoral girdle and/or forelimb. Here we describe the pathology of a specimen of the theropod dinosaur Dilophosaurus wetherilli with eight afflicted bones of the pectoral girdle and forelimb. On its left side the animal has a fractured scapula and radius and large fibriscesses in the ulna and the proximal thumb phalanx. On its right side the animal has abnormal torsion of the humeral shaft, bony tumors on the radius, a truncated distal articular surface of metacarpal III, and angular deformities of the first phalanx of the third finger. Healing and remodeling indicates that the animal survived for months and possibly years after its ailments began, but its right third finger was permanently deformed and lacked the capability of flexion. The deformities of the humerus and the right third finger may be due to developmental osteodysplasia, a condition known in extant birds but unreported in non-avian dinosaurs before now.
Ozal, E; Us, M H; Bingöl, H; Oz, B S; Kuralay, E; Tatar, H
The management of lower extremity trauma with vasculary involvement should be directed toward to the salvage of the extremity or to the primary amputation according to the additional pathologies, parameters of the patient and the extremity. We investigated the efficiency of Mangled Extremity Severity Score (MESS) system which is proposed as an grading system to evaluate the change to extremity salvage or the risk for onset of systemic complications. 81 patients with lower extremity trauma were analyzed according to MESS criteria. 79 of the patients were men and mean age was 23 +/- 4. Fourteen patients had higher MESS score. (MESS > 7). Seven of them were older than 50 years. Primary amputation was performed in four of these 7 patients. Vascular repair was performed in three of patients. Multiorgan failure was developed in two of them and both patients died. Secondary amputation was performed to another patients underwent vasculary repair who had MESS > 7 score. Primary amputation was not performed directly in young patients who had MESS > 7. Secondary amputation was required in two of these patients. MESS scoring system can easily predict amputation in older patients but may cause unnecessary amputation in young patients.
Molines-Barroso, Raúl J; Lázaro-Martínez, José L; Álvaro-Afonso, Francisco J; Sanz-Corbalán, Irene; García-Klepzig, José L; Aragón-Sánchez, Javier
The aim of this article was to assess the ability to predict reulceration in people with diabetes and a history of minor amputation according to the formula proposed by Miller et al. A retrospective study was performed on 156 consecutive records of patients with a recent history of simple or multiple forefoot amputation. The sample was divided according to Miller's formula into patients at low risk of reulceration and those at high risk; those were further divided into two subgroups according to whether or not the first segment of the forefoot had been amputated. Forty-eight (47·1%) individuals suffered forefoot reulceration, showing a median reulceration-free survival time of 8 months [interquartile range (IR) 3·6-14·8]. Nephropathy (P = 0.005) and Miller's formula (P = 0.028) were risk factors for reulceration-free survival time in the univariate analysis. The pattern relating to the first segment amputated [hazard ratio (HR) 2·853; P = 0·004; 95% confidence interval (CI) 1·391-5·849] and nephropathy (HR 2·468; P = 0.004; 95% CI 1.328-4.587) showed a significant hazard ratio in the multivariate Cox model. Participants with first segment amputation and one other amputation showed an association with the probability of reulceration in comparison with any other specific type of minor amputation.
Sheehan, Riley C; Beltran, Eduardo J; Dingwell, Jonathan B; Wilken, Jason M
Over 50% of individuals with lower limb amputation fall at least once each year. These individuals also exhibit reduced ability to effectively respond to challenges to frontal plane stability. The range of whole body angular momentum has been correlated with stability and fall risk. This study determined how lateral walking surface perturbations affected the regulation of whole body and individual leg angular momentum in able-bodied controls and individuals with unilateral transtibial amputation. Participants walked at fixed speed in a Computer Assisted Rehabilitation Environment with no perturbations and continuous, pseudo-random, mediolateral platform oscillations. Both the ranges and variability of angular momentum for both the whole body and both legs were significantly greater (pangular momentum range or variability during unperturbed walking. The range of frontal plane angular momentum was significantly greater for those with amputation than for controls for all segments (pangular momentum ranges were greater for patients with amputation. However, for the prosthetic leg, angular momentum ranges were less for patients than controls. Patients with amputation were significantly more affected by the perturbations. Though patients with amputation were able to maintain similar patterns of whole body angular momentum during unperturbed walking, they were more highly destabilized by the walking surface perturbations. Individuals with transtibial amputation appear to predominantly use altered motion of the intact limb to maintain mediolateral stability.
Furtado, S; Grimer, R J; Cool, P; Murray, S A; Briggs, T; Fulton, J; Grant, K; Gerrand, C H
Patients who have limb amputation for musculoskeletal tumours are a rare group of cancer survivors. This was a prospective cross-sectional survey of patients from five specialist centres for sarcoma surgery in England. Physical function, pain and quality of life (QOL) outcomes were collected after lower extremity amputation for bone or soft-tissue tumours to evaluate the survivorship experience and inform service provision. Of 250 patients, 105 (42%) responded between September 2012 and June 2013. From these, completed questionnaires were received from 100 patients with a mean age of 53.6 years (19 to 91). In total 60 (62%) were male and 37 (38%) were female (three not specified). The diagnosis was primary bone sarcoma in 63 and soft-tissue tumour in 37. A total of 20 tumours were located in the hip or pelvis, 31 above the knee, 32 between the knee and ankle and 17 in the ankle or foot. In total 22 had hemipelvectomy, nine hip disarticulation, 35 transfemoral amputation, one knee disarticulation, 30 transtibial amputation, two toe amputations and one rotationplasty. The Toronto Extremity Salvage Score (TESS) differed by amputation level, with poorer scores at higher levels (p amputation level is linked to physical function, but not QOL or pain measures. Pain and physical function significantly impact on QOL. These results are helpful in managing the expectations of patients about treatment and addressing their complex needs.
Majid Moini; Mohammad R Rasouli; Ali Khaji; Farshad Farshidfar; Pedram Heidari
Obiective: To determine the patterns of traumatic extremity injuries leading to amputation in Iran.Methotis: Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation.This project was conducted in 8 major cities during 2000-2004.Results: of 17 753 traumatic Patients,164 (0.92%) had injuries to the extremities that resulted in the limb amputation.Of these,143 (87.2%) were men.The patient's mean age was 29.0 years±15.4 years and the highest incidence was seen in the age group of 21 to 30 years (34.1%).One hundred and four cases were occupational accidents (63.4%).Blunt trauma was in 54.9% of the cases.The most common reasons for amputation were respectively stabbings (37.8%) and crush injuries (31.7%).Amputation of hand fingers was the most frequent type of amputation (125 cases,76.2%).One patient died from severe associated injuries.Conclusions: This study shows the patterns of traumatic limb amputation in Iran,a developing country.Resuits of this study may be used in preventive strategic planning.
McLeod, Jacob M; Brantigan, Charles O; Alix, Kristen; Kruse, Dustin L; Stone, Paul A
Antiphospholipid syndrome is a hypercoagulable disease that can present foot and ankle surgeons with a unique challenge in treating patients who present with thrombosis and ischemia despite having normal pedal pulses. Appropriate perioperative management is imperative in these patients, because limb- and life-threatening complications can occur postoperatively, despite aggressive anticoagulation. We present the case of a 46-year-old male who underwent a transmetatarsal amputation and, despite aggressive therapy, developed a myriad of complications postoperatively. At 10 months postoperatively, the patient was doing well in an accommodative orthotic with minimal pain while receiving continued aggressive therapy and follow-up examinations by a number of specialists to treat his antiphospholipid syndrome.
Full Text Available The thumb contributes over 50% hand function, which is generally divided into motional, sensory and cosmetic functions. Optimal management of thumb loss necessitates individual consideration of surgical versus prosthetic options, in relation to the needs and circumstances of each patient. This paper presents a case of prosthetic pollicization of an amputated thumb and emphasizes on the fact that the prosthetic replacement has a definite edge over surgical procedures, where amputees refuse to undergo more complicated surgical procedures. The patient was rehabilitated successfully by a noninvasive and cost-effective approach by using high temperature-vulcanized (HTV silicone material and retaining the prosthesis with medical adhesives. On 3 months recall appointment, no complications were found. The prosthesis was in good shape, without need for any repairs.
Bazzini, G; Orlandini, D; Moscato, T A; Nicita, D; Panigazzi, M
The need for standardized instruments for clinical measurements has become pressing in the fields of occupational rehabilitation and ergonomics. This is particularly the case for instruments that allow a quantitative evaluation of upper limb function, and especially hand function in patients who have undergone an amputation and then application of an upper limb prosthesis. This study presents a review of the main tests used to evaluate hand function, with a critical analysis of their use in subjects with an upper limb prosthesis. The tests are divided into: tests to evaluate strength, tests to evaluate co-ordination and dexterity, tests of global or overall function, and tests proposed specifically for subjects with an upper limb prosthesis. Of the various tests presented, the authors give their preference to the Bimanual Functional Assessment, Abilhand and/or the ADL Questionnaire, because of the practical usefulness, clinimetric features, simplicity and ease of administration of these tests.
Full Text Available Objectives: To evaluate the functional outcome, morbidity, and viability of foot salvage in diabetic patients. Materials and methods: This prospective case series was conducted from March 2007 to December 2012 at the department of surgery Pakistan Ordnance Factories Hospital, Wah Cantt, Pakistan. 123 males and 26 female patients were included in the study. All the patients were treated after getting admitted in the hospital and wounds were managed with daily dressings, nursing care and debridement of necrotic tissue with adequate antibiotic coverage. Results: In total, 149 patients (mean age: 56±7.52 years with 171 amputations were included in the study. The mean duration of diabetes mellitus (DM was 9±4.43 years. Ninety-seven percent of the patients were diagnosed with type 2 DM. Wound debridement was performed under general anesthesia in 48 (33.2% patients, whereas local anesthesia was used for the rest of the patients after having good glycemic control and improvement in general health. The most common pathogen isolated from the infected wounds was Staphylococcus aureus in approximately 46% cases. Regarding the types of amputation, partial toe amputation was performed in 21 (12.2% cases, second-toe amputation in 60 (35% cases, hallux amputation in 41 (24% cases, multiple toe amputations in 29 (17% cases, bilateral feet involvement was observed in 16 (9.3% cases, and transmetatarsal amputation was performed in 4 (2.3% cases. The wounds healed well except in 19 cases where amputation had to be revised to a more proximal level. Thirty-nine patients died during the study period: 3 died of wound-related complications and 36 died of systemic complications. Conclusion: With the ever-increasing epidemic of DM, the number of patients with diabetic foot ulcers has also significantly risen. Early surgical management with good glycemic control and foot care with close monitoring can decrease amputations and thus foot salvage can be successfully
Ziad M Hawamdeh
Full Text Available Ziad M Hawamdeh1, Yasmin S Othman2, Alaa I Ibrahim31Department of Physical Therapy, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan; 2Department of Orthotics and Prosthetics, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan; 3Lecturer, Department of Physical Therapy for Pediatrics and Pediatric surgery, Faculty of Physical Therapy, Cairo University, Giza, EgyptObjective: This study aimed to assess the prevalence of anxiety and depression among Jordanian lower limb amputees with different clinical characteristics and sociodemographic data (gender, marital status, social support, income, type and level of amputation, and occupation.Methods: Participants were 56 patients with unilateral lower limb amputation with mean duration (8.4 ± 5.75 years. They were recruited from inpatient and outpatient clinics of Jordan University hospital, Royal Farah Rehabilitation Center, and Al-basheer hospital in Amman, Jordan. Participants responded to a questionnaire that included a battery of questions requesting brief information about sociodemographic variables and characteristics of amputation. The level of depression and anxiety in each participating patient was assessed by the Hospital Anxiety and Depression Scale (HADS.Results: The prevalence of anxiety and depressive symptoms were 37% and 20%, respectively. Factors associated with high prevalence of psychological symptoms included female gender, lack of social support, unemployment, traumatic amputation, shorter time since amputation, and amputation below the knee. These findings were confirmed by a significant reduction of anxiety and depression scores in patients who received social support, patients with amputation due to disease, and patients with amputation above the knee. Presence of pain and use of prosthesis had no effect on the prevalence.Conclusions: The findings of the present study highlight the high incidence of psychiatric disability and
Iosa, Marco; Paradisi, Francesco; Brunelli, Stefano; Delussu, Anna Sofia; Pellegrini, Roberto; Zenardi, Daniele; Paolucci, Stefano; Traballesi, Marco
Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.
Odzébé, A W S; Bouya, P A; Otiobanda, G F; Banga Mouss, R; Nzaka Moukala, C; Ondongo Atipo, A M; Ondziel Opara, A S
Self-amputation of the penis treated immediately: case report and review of the literature. Self-amputation of the penis is rare in urological practice. It occurs more often in a context psychotic disease. It can also be secondary to alcohol or drugs abuse. Treatment and care vary according on the severity of the injury, the delay of consultation and the patient's mental state. The authors report a case of self-amputation of the penis in an alcoholic context. The authors analyze the etiological and urological aspects of this trauma.
Gentle, M J; Hunter, L N; Waddington, D
The number of pecks delivered by birds to an attractive visual stimulus was measured before and again 6, 26 and 32 h after partial beak amputation. There was a significant reduction in the number of pecks by birds 26 h after amputation but not at 6 h after. This reduction was considered to be a quantitative measure of pain related guarding behaviour. The results indicated the presence of a pain-free period immediately following amputation which may last in some birds for as long as 26 h.
Jekl, Vladimir; Hauptman, Karel; Knotek, Zdenek
Ophthalmic diseases are common in rabbits and rodents. Fast and definitive diagnosis is imperative for successful treatment of ocular diseases. Ophthalmic examination in rabbits and rodents can be challenging. Oculoscopy offers great magnification for the examination of the ocular structures in such animals, including the evaluation of cornea, anterior eye chamber, limbus, iris, lens, and retina. To date, oculoscopy has been described only sporadically and/or under experimental conditions. This article describes the oculoscopy technique, normal and abnormal ocular findings, and the most common eye disorders diagnosed with the aid of endoscopy in rabbits and rodents.
Llewellyn, L.M.; Handley, C.O.
Five races of cottontail rabbits belonging to three species occur in Virginia. One of them, the Mearns cottontail (Sylvilagus floridanus mearnsi), is reported here for the first time. It occurs in six southwestern counties of the state, while the eastern cottontail (S. f. mallurus) occurs in the remainder of the state with the exception of Smith and Fishermans islands off the eastern coast of Cape Charles, where it is replaced by Hitchens cottontail (S. f. hitchensi). The New England cottontail (S. transitionalis) is found on the higher mountain peaks, above 3000 feet, and the swamp rabbit (S. palustris) occurs in the Dismal Swamp region of southeastern Virginia.....The height of the breeding season for the eastern cottontail in Virginia is March and April, but breeding continues through the entire year except in December and January. The average litter size based on embryo counts was 4.7. The sex ratio of 234 specimens from all parts of the state, taken mostly in the December to February period, was 53 males to 47 females. That of a group of 145 rabbits live-trapped at Blacksburg during February and Marchwas 58 males to 42 females. The figures show that males are more active than females during the winter months, and therefore are more easily taken then....In transplanting cottontails from one section of the state to another, it is recommended that only cottontails of the same race as those originally present in the region being restocked be released there....Tularemia is not a common disease among rabbits in Virginia, but the rabbit ticks are often carriers of the disease and may transmit it to rabbits. Rabbit ticks are also found to be carriers of Rocky Mountain fever and American Q. fever. After the ticks drop off the rabbits to hibernate in the ground, which is likely to occur during mid-winter in Virginia, there is relatively little danger of humans contracting tularemia by contact with rabbits. Present laws in Virginia which prohibit rabbit hunting until the
Svensson, P; Ivarsson, M; Hesslow, G
To study the role of the mossy fiber afferents to the cerebellum in classical eye-blink conditioning, in particular the timing of the conditioned responses, we compared the effects of varying a peripheral conditioned stimulus with the effects of corresponding variations of direct stimulation of the mossy fibers. In one set of experiments, decerebrate ferrets were trained in a Pavlovian eye-blink conditioning paradigm with electrical forelimb train stimulation as conditioned stimulus and electrical periorbital stimulation as the unconditioned stimulus. When stable conditioning had been achieved, the effect of increasing the intensity or frequency of the forelimb stimulation was tested. By increasing the intensity from 1 to 2 mA, or the train frequency from 50 to 100 Hz, an immediate decrease was induced in both the onset latency and the latency to peak of the conditioned response. If the conditioned stimulus intensity/frequency was maintained at the higher level, the response latencies gradually returned to preshift values. In a second set of experiments, the forelimb stimulation was replaced by direct train stimulation of the middle cerebellar peduncle as conditioned stimulus. Varying the frequency of the stimulus train between 50 and 100 Hz had effects that were almost identical to those obtained when using a forelimb conditioned stimulus. The functional meaning of the latency effect is discussed. It is also suggested that the results support the view that the conditioned stimulus is transmitted through the mossy fibers and that the mechanism for timing the conditioned response is situated in the cerebellum.
Fergason, John; Keeling, John J; Bluman, Eric M
Blast-related extremity trauma represents a serious challenge because of the extent of bone and soft tissue damage. Fragmentation and blast injuries account for 56% of all injuries produced within the Iraqi and Afghan theaters where, as of July 2009, 723 combatants have sustained lower extremity limb loss. If limb salvage is not practical, or fails, then amputation should be considered. Amputation can be a reliable means toward pain relief and improvement of function. Optimizing functional outcome is paramount when deciding on definitive amputation level. Preservation of joint function improves limb biomechanics in many cases. Increased limb length also allows for the benefits associated with articular and distal limb proprioception. Amputees with improved lower extremity function also usually exhibit less energy consumption. Function and length are generally directly correlated, whereas energy consumption and length are inversely related. This article discusses the surgical principles of lower extremity amputation and postoperative management of amputees, and the various prosthetic options available.
Lantry, Jacob M; Perumal, Venkatachalapathy; Roberts, Craig S
The purpose of the study was to determine the risk of digital or distal segmental amputation and permanent unemployment in patients with these injury patterns. A retrospective chart review of 23 patients with multiple, ipsilateral injuries of the foot and ankle was performed. Amputations occurred in five patients (21.7%) and were most common in those with three-level injuries. Odds ratios showed that patients with an amputation were 9.75 times more likely to have a three-level injury than a two-level injury. At a mean follow-up of 12.9 months, 12 patients had not returned to work (60%), seven returned with restrictions, and only one patient returned to preinjury activities. It was concluded that patients with segmental foot and ankle injuries are at risk for amputation of the distal portion of the involved extremity and inability to return to their preinjury employment level (disability).
Pickwell, Kirsty; Siersma, Volkert; Kars, Marleen
OBJECTIVE Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation...... of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. RESEARCH DESIGN AND METHODS We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries...... the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively). CONCLUSIONS For individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score...
Raffin, Estelle E.; Pascal, Giraux,; Karen, Reilly,;
Amputation of a limb induces reorganization within the contralateral primary motor cortex (M1-c) (1-3). In the case of hand amputation, M1-c areas evoking movements in the face and the remaining part of the upper-limb expand toward the hand area. Despite this expansion, the amputated hand still...... retains a residual M1-c activity when amputees perform phantom limb movements (4-5). Except a correlation between phantom limb pain and M1-c expansion of the face (2-3), the relationship between the ability to voluntary move the phantom hand, the level of phantom limb pain, the degree of M1-c...... reorganization and the residual M1-c activity of the amputated hand is unknown. This fMRI study aimed to determine this relationship...
Full Text Available The article is exposition essence of problem of renewal of ability to work of a problem of restoration after amputation at the hip. The analysis of the standard program of the standard in traumatology programs of physical rehabilitation of patients after amputation and presents the results of the developed physical rehabilitation of patients with amputating the thigh stumps due to injury. The authors propose to use the means of physical rehabilitation in accordance with the flow dynamics of the reparative processes after amputation and clinical features of injury. All this contributes to the development of compensatory own human capabilities, resulting in remission. Since these funds most physiological, their correct application does not cause complications.
Otto, Iris A.; Kon, Moshe; Schuurman, AH; Van Minnen, L. Paul
Background: Traumatic arm amputations can be treated with replantation or surgical formalization of the stump with or without subsequent prosthetic fitting. In the literature, many authors suggest the superiority of replantation. This systematic review compared available literature to analyze whethe
Monteiro, Wuelton Marcelo; Oliveira, Sâmella Silva de; Sachett, Jacqueline de Almeida Gonçalves; Silva, Iran Mendonça da; Ferreira, Luiz Carlos de Lima; Lacerda, Marcus Vinícius Guimarães
Freshwater stingray injuries are a common problem in the Brazilian Amazon, affecting mostly riverine and indigenous populations. These injuries cause severe local and regional pain, swelling and erythema, as well as complications, such as local necrosis and bacterial infection. Herein, we report a case of bacterial infection and hallux necrosis, after a freshwater stingray injury in the Brazilian Amazon, which eventually required amputation. Different antimicrobial regimens were administered at different stages of the disease; however, avoiding amputation through effective treatment was not achieved.
Full Text Available A 60-year-old insulin dependent, diabetic male with severe atherosclerosis requiring multiple amputations in the extremities in the past, with normal renal function presented with gangrene of glans penis. He was initially treated with debridement but as the gangrene progressed, partial penile amputation was performed. He showed no further progress of the disease and had no voiding difficulties even after 4 years of follow up.
Colby Hansen, MD; Bradeigh Godfrey, DO; Jody Wixom, MD; Molly McFadden, MS
To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sw...
Moralle, Matthew R.; Stekas, Nicholas D.; Reilly, Mark C.; Sirkin, Michael S.; Adams, Mark R.
Introduction: Chronic osteomyelitis is a disease that requires fastidious treatment to eliminate. However, when eradication is unable to be achieved through exhaustive modalities of antibiotic therapy and multiple debridements, significant resection of the infected bone and soft tissue must be considered, including amputation. Here we report of a salvage procedure for chronic osteomyelitis of the left tibia by employing a rotationplasty to avoid an above knee amputation and instead provide th...
Background: Limb amputation has been a common injury occurring in the conflicts in Iraq and Afghanistan. Compared to other injuries, less attention has been given to this serious, disabling wound. Purpose: The article describes the Allied military experience of traumatic limb amputation in Iraq and Afghanistan. It intends to inform health care personnel involved in the care of serving military personnel and veterans about the scale of these casualties. Methods: A literature se...
Maria Teresa Verrone Quilici; Fernando de Sá Del Fiol; Alexandre Eduardo Franzin Vieira; Maria Inês de Toledo
The aim of this study was to identify and quantify risk factors for amputation in diabetic patients hospitalized for foot infections. This cross-sectional study comprised 100 patients with diabetic infectious complications in the lower limbs. The variables investigated were related to diabetes, infection, and treatment compliance. Multiple Cox regression analysis was performed to identify the variables independently associated with the outcome of amputation. The most prevalent chronic complic...
Fang Jun; Li Huazhuang; Dou Honglei; Chen Jingchun; Xu Aiping; Liu Wenguo; Ding Gang
Abstract Introduction Replantation of a limb to the contralateral stump after bilateral traumatic amputations is rare. To the best of our knowledge, there are only a few reports of crossover lower limb replantation in the literature. Case presentation We treated a 37-year-old Chinese woman with bilateral lower limb crush injuries sustained in a traffic accident. Her lower limb injuries were at different anatomic levels. We performed emergency bilateral amputations followed by crossover replan...
Rajendra Nehete; Anita Nehete; Sandeep Singla; Harshad Adhav
In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally s...
Full Text Available Bilateral upper limb amputations result in severe disability. High voltage electrical injury is a rare cause of such an outcome and injuries often occur as occupational hazards. We present three case reports of accidental high voltage injuries that occurred in a non-occupational setting. Victims were all initially managed at other centres before referral to our hospital and all subsequently had bilateral upper limb amputations. The high cost of treatment, importance of prevention, and need for rehabilitation are highlighted.
Morgenthal, S; Bayer, R; Doerre, A; Dreßler, J
Injuries of the tongue are generally self-inflicted lesions and occur during different diseases or external incidents. The amputation of the tongue is a rare event. In this article, we report about a woman presenting with a complete amputation of the anterior third of the tongue. The morphological findings, which are essential for the differentiation of self-inflicted injuries and injuries caused by a third party, are demonstrated.
Transfemoral amputations with more proximal amputation levels have the problem of secondary development into flexion and abduction contractures. This is induced by muscle imbalance, especially the loss of adductor muscle insertions when abductor muscle insertions are preserved. This causes considerable problems when fitting prosthetics. Myodesis with insertion of the distally detached adductor magnus muscle to the lateral femoral cortex, introduced here, results in a stronger stump with good muscle balance, and prosthetics fitting is significantly improved.
Boussakri, Hassan; Alassaf, Ihab; Hamoudi, Samir; Elibrahimi, Abdelhalim; Ntarataz, Philbert; ELMrini, Abdelmajid; Dumez, Jean Francois
Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations.
Full Text Available Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations.
Transfemoral amputations with more proximal amputation levels have the problem of secondary development into flexion and abduction contractures. This is induced by muscle imbalance, especially the loss of adductor muscle insertions when abductor muscle insertions are preserved. This causes considerable problems when fitting prosthetics. Myodesis with insertion of the distally detached adductor magnus muscle to the lateral femoral cortex, introduced here, results in a stronger stump with good muscle balance, and prosthetics fitting is significantly improved.
Vivas, Lilian L Y; Pauley, Tim; Dilkas, Steven; Devlin, Michael
Purpose This study investigated whether obesity impacted clinical outcomes of patients at discharge from inpatient amputation rehabilitation. Method This was a retrospective chart review examining admissions for lower extremity amputation rehabilitation at a Canadian Regional Amputee Rehabilitation Programme between December 2011 and June 2014. Discharge outcomes were predefined as the two-minute walk test (2MWT), the L-test of functional mobility and the SIGAM score. These were compared between each body mass index (BMI) group (underweight amputation groups. Results Of the 289 admissions meeting inclusion criteria, only underweight patients walked significantly less distance on the 2MWT than normal weight patients. There were group differences in the L-test, but post hoc testing was unable to qualify the differences. No significant difference was found in the SIGAM score. There were no significant differences found in the 2MWT, L-test or SIGAM when patients were grouped by amputation level. Conclusions Obesity does not appear to significantly impact inpatient amputation rehabilitation outcomes such as the 2MWT, L-test or SIGAM score. As such, obesity should not be a deciding factor as to whether a patient is offered rehabilitation. Implications for Rehabilitation Obesity is increasing in prevalence and is comorbid with peripheral vascular disease and diabetes, the leading causes of lower extremity amputation. Function is compromised in the obese general population when compared to non-obese individuals. Obesity does not seem to confer a disadvantage with regards to validated outcomes, such as the 2-min walk test, L-test or SIGAM score at discharge after inpatient amputation rehabilitation. Obesity should not be a barrier to offering inpatient rehabilitation to amputation patients.
Carly S. Eckard, MS, RD
Full Text Available Body composition and metabolism may change considerably after traumatic amputation because of muscle atrophy and an increase in adiposity. The purpose of this study was to quantify changes in weight, body composition, and metabolic rate during the first year following traumatic amputation in military servicemembers. Servicemembers without amputation were included for comparison. Participants were measured within the first 12 wk after amputation (baseline and at 6, 9, and 12 mo after amputation. Muscle mass, fat mass, weight, and metabolic rate were measured at each time point. There was a significant increase in weight and body mass index in the unilateral group between baseline and all follow-up visits (p < 0.01. Over the 12 mo period, total fat mass and trunk fat mass increased in both unilateral and bilateral groups; however, these changes were not statistically significant over time. Muscle mass increased in both the unilateral and bilateral groups despite percent of lean mass decreasing. No changes in resting metabolism or walking energy expenditure were observed in any group. The results of this study conclude that weight significantly increased because of an increase in both fat mass and muscle mass in the first year following unilateral and bilateral amputation.
Elizabeth Russell Esposito, PhD
Full Text Available Previous literature reports greater metabolic demand of walking following transtibial amputation. However, most research focuses on relatively older, less active, and often dysvascular amputees. Servicemembers with traumatic amputation are typically young, fit, and highly active before and often following surgical amputation of their lower limb. This study compared the metabolic demand of walking in young, active individuals with traumatic unilateral transtibial amputation (TTA and nondisabled controls. Heart rate (HR, rate of oxygen consumption, and rating of perceived exertion (RPE were calculated as subjects walked at a self-selected velocity and at five standardized velocities based on leg length. The TTA group completed a Prosthetics Evaluation Questionnaire. Oxygen consumption (p = 0.89, net oxygen consumption (p = 0.32, and RPE (p = 0.14 did not differ between groups. Compared with controls, HR was greater in the TTA group and increased to a greater extent with velocity (p < 0.001. Overall, the TTA group rated their walking abilities as high (mean: 93% out of 100%. This is the first study to report equivalent metabolic demand between persons with amputation and controls walking at the same velocity. These results may reflect the physical fitness of the young servicemembers with traumatic amputations and may serve to guide outcome expectations in the future.
Colby Hansen, MD
Full Text Available To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60 yr, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.
Taboga, Paolo; Kram, Rodger; Grabowski, Alena M
On curves, non-amputees' maximum running speed is slower on smaller radii and thought to be limited by the inside leg's mechanics. Similar speed decreases would be expected for non-amputees in both counterclockwise and clockwise directions because they have symmetric legs. However, sprinters with unilateral leg amputation have asymmetric legs, which may differentially affect curve-running performance and Paralympic competitions. To investigate this and understand the biomechanical basis of curve running, we compared maximum curve-running (radius 17.2 m) performance and stride kinematics of six non-amputee sprinters and 11 sprinters with a transtibial amputation. Subjects performed randomized, counterbalanced trials: two straight, two counterclockwise curves and two clockwise curves. Non-amputees and sprinters with an amputation all ran slower on curves compared with straight running, but with different kinematics. Non-amputees ran 1.9% slower clockwise compared with counterclockwise (Prunning. Sprinters with an amputation also reduced stride length in both curve-running directions, but reduced stride frequency only on curves with the affected leg on the inside. During curve running, non-amputees and athletes with an amputation had longer contact times with their inside compared with their outside leg, suggesting that the inside leg limits performance. For sprinters with an amputation, the prolonged contact times of the affected versus unaffected leg seem to limit maximum running speed during both straight running and running on curves with the affected leg on the inside.
Gary E Mason
Full Text Available PURPOSE: Although functional differences have been described between patients with lower extremity bone sarcoma with amputation and limb preservation surgery, differences have not clearly been shown between the two groups related to quality of life. The aim of the study was to determine if there is a difference in overall quality of life in lower extremity bone sarcoma survivors related to whether they had an amputation or a limb preservation procedure. PATIENTS AND METHODS: Eighty-two long-term survivors of lower extremity bone sarcoma were studied to make a comparison of the overall quality of life, pain assessment and psychological evaluations in limb preservation and amputation patients. Forty-eight patients with limb preservation and thirty-four patients with amputations were enrolled in the study. Validated psychometric measures including the Quality of Life Questionnaire, the Minnesota Multiphasic Personality Inventory and visual analog scales were utilized.RESULTS: The overall quality of life of patients with limb preservation was significantly higher than patients with amputation (p-value < 0.01. Significant differences were noted in the categories of material well being, job satisfiers and occupational relations. CONCLUSION: The overall quality of life of patients with limb preservation appears to be better than for those patients with amputation based on the quality of life questionnaire in patients surviving lower extremity bone sarcoma. Further analysis needs to verify the results and focus on the categories that significantly affect the overall quality of life.
Full Text Available Accumulating evidence has indicated that amputation induces functional reorganization in the sensory and motor cortices. However, the extent of structural changes after lower limb amputation in patients without phantom pain remains uncertain. We studied 17 adult patients with right lower limb amputation and 18 healthy control subjects using T1-weighted magnetic resonance imaging and diffusion tensor imaging. Cortical thickness and fractional anisotropy (FA of white matter (WM were investigated. In amputees, a thinning trend was seen in the left premotor cortex (PMC. Smaller clusters were also noted in the visual-to-motor regions. In addition, the amputees also exhibited a decreased FA in the right superior corona radiata and WM regions underlying the right temporal lobe and left PMC. Fiber tractography from these WM regions showed microstructural changes in the commissural fibers connecting the bilateral premotor cortices, compatible with the hypothesis that amputation can lead to a change in interhemispheric interactions. Finally, the lower limb amputees also displayed significant FA reduction in the right inferior frontooccipital fasciculus, which is negatively correlated with the time since amputation. In conclusion, our findings indicate that the amputation of lower limb could induce changes in the cortical representation of the missing limb and the underlying WM connections.
Hansen, Colby; Godfrey, Bradeigh; Wixom, Jody; McFadden, Molly
To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.
Hendershot, Brad D; Wolf, Erik J
Increases in spinal loading have been related to altered movements of the lower back during gait among persons with lower limb amputation, movements which are self-perceived by these individuals as contributing factors in the development of low back pain. However, the relationships between altered trunk kinematics and associated changes in lumbosacral kinetics during sit-to-stand and stand-to-sit movements in this population have not yet been assessed. Three-dimensional lumbosacral kinetics (joint moments and powers) were compared between 9 persons with unilateral transfemoral amputation (wearing both a powered and passive knee device), and 9 uninjured controls, performing five consecutive sit-to-stand and stand-to-sit movements. During sit-to-stand movements, lumbosacral joint moments and powers were significantly larger among persons with transfemoral amputation relative to uninjured controls. During stand-to-sit movements, lumbosacral joint moments and powers were also significantly larger among persons with transfemoral amputation relative to uninjured controls, with the exception of sagittal joint powers. Minimal differences in kinetic measures were noted between the powered and passive knee devices among persons with transfemoral amputation across all conditions. Altered lumbosacral kinetics during sitting and standing movements, important activities of daily living, may play a biomechanical role in the onset and/or recurrence of low back pain or injury among persons with lower-limb amputation.
Hyun, Seung-Hyun; Ryew, Che-Cheong
The aim of this study was to investigate the motor ability of forelimb according to on- or off-riding during cadences (walk and trot) of horse. Horses and rider selected as subject consisted of total 37 heads of Jeju native horse and 1 female rider. The variables analyzed composed of 1 stride length, 1 step length, elapsed time of stance, elapsed time of swing, elapsed time of 1 step, and forward velocity (x-axis). Two-way analysis of variance of variables was employed for the statistical analysis with the level of significance set at 5% (Phorse’s analysis meant that there was very close relation among variables of rider’s weight-velocity-stride length-stride elapsed time. Next study will be necessary to analyze cadence variables added both stride length and rider’s weight for riding activity and rehabilitation during horse riding using Jeju native horse. PMID:26933662
Téo Veiga De Oliveira
Full Text Available Non-mammalian cynodonts provide insights on several points about mammalian evolution, such as the postural change and locomotory advances within the group. Unfortunately, complete skeletons of Triassic cynodonts are rather uncommon and where more complete specimens are found they can offer a global vision on some traits not available from partial specimens. This is the case of the cynodont Trucidocynodon riograndensis, from the Triassic of Brazil, that has preserved its forelimbs providing some insights into locomotory properties. The movements between interclavicle and clavicle must have been limited, as such as those occurring between the latter and the scapulocoracoid although the long acromion process of this should have permitted a greater degree of freedom. Some of the more significant movements were those on the shoulder joint, in which the maximum adduction should have been ca. 35º relative to the parasagittal plane and the greater abduction ca. 55º. The maximum adduction occurred when the humerus was in the more retracted position during stride and the variation in the adduction/abduction should have been significant to the limb posture during its recovery stroke. The long olecranon and the distal overlapping between radius and ulna suggest the predominance of simple flexion/extension on the forearm without significant pronation/supination. The poorly preserved hand suggests that Trucidocynodon could have evolved a slight semidigitigrad condition in its forelimbs. All these features give to this cynodont an important role in the evolution of the mammalian locomotory properties indicating that some features, such as the possibility of greater humeral adduction, evolved early in cynodont lineage.
Swanstrom, Michael D; Zarucco, Laura; Stover, Susan M; Hubbard, Mont; Hawkins, David A; Driessen, Bernd; Steffey, Eugene P
The superficial (SDF) and deep digital flexor (DDF) muscles are critical for equine forelimb locomotion. Knowledge of their mechanical properties will enhance our understanding of limb biomechanics. Muscle contractile properties derived from architectural-based algorithms may overestimate real forces and underestimate shortening capacity because of simplistic assumptions regarding muscle architecture. Therefore, passive and active (=total - passive) force-length properties of the SDF and DDF muscles were measured directly in vivo. Muscles from the right forelimbs of four Thoroughbred horses were evaluated during general anesthesia. Limbs were fixed to an external frame with the muscle attached to a linear actuator and load cell. Each muscle was stretched from an unloaded state to a range of prefixed lengths, then stimulated while held at that length. The total force did not exceed 4000 N, the limit for the clamping device. The SDF and DDF muscles produced 716+/-192 and 1577+/-203 N maximum active isometric force (F(max)), had ascending force-length ranges (R(asc)) of 5.1+/-0.2 and 9.1+/-0.4 cm, and had passive stiffnesses of 1186+/-104 and 1132+/-51 N/cm, respectively. The values measured for F(max) were much smaller than predicted based on conservative estimates of muscle specific tension and muscle physiological cross-sectional area. R(asc) were much larger than predicted based on muscle fiber length estimates. These data suggest that accurate prediction of the active mechanical behavior of architecturally complex muscles such as the equine DDF and SDF requires more sophisticated algorithms.
Serrano, J; Cattin, M; Garcia Cota, E; Lewis, J; Moreira, P; Wlostowski, T; Gaderer, G; Loschmidt, P; Dedic, J; Bär, R; Fleck, T; Kreider, M; Prados, C; Rauch, S
Reliable, fast and deterministic transmission of control information in a network is a need formany distributed systems. One example is timing systems, where a reference frequency is used to accurately schedule time-critical messages. TheWhite Rabbit (WR) project is a multi-laboratory and multi-company effort to bring together the best of the data transfer and timing worlds in a completely open design. It takes advantage of the latest developments for improving timing over Ethernet, such as IEEE 1588 (Precision Time Protocol) and Synchronous Ethernet. The presented approach aims for a general purpose, fieldbus-like transmission system, which provides deterministic data and timing (sub-ns accuracy and ps jitter) to around 1000 stations. It automatically compensates for fiber lengths in the order of 10 km. This paper describes the WR design goals and the specification used for the project. It goes on to describe the central component of the WR system structure - the WR switch - with theoretical considerations a...
Macchi, Claudio; Cassigoli, Silvia; Lova, Raffaele Molino; Roccuzzo, Aurelio; Miniati, Benedetta; Ceppatelli, Simone; Conti, Andrea A; Gensini, Gian Franco
Videocapillaroscopy is a new technique allowing a noninvasive examination of the capillary framework of the skin by using a contact probe with magnifying lenses and a cold-light epiluminescence system. The aim of this article was to investigate, by videocapillaroscopy, the microcirculation of the skin of the stump in 70 consecutive patients with unilateral transfemoral amputation. Patients were divided into two subgroups according to their tolerance (A) or intolerance (B) to a prosthesis with an Icelandic-Swedish-New York socket. Subgroup A included 48 patients, 17 diabetic and 31 nondiabetic, and subgroup B included 22 patients, 16 diabetic and 6 nondiabetic. In subgroup B, the caliber of capillary loops was significantly larger (mean +/-standard deviation, 23.6 +/-2.04 vs. 16.2 +/-1.96 microm; P < 0.001), neoangiogenesis was significantly more frequent (82%vs. 25%, P < 0.001), and the presence of microaneurysms (64%vs. 15%, P < 0.001) and microhemorrhages (36%vs. 4%, P < 0.001) was also more frequent. Surprisingly, some such diabetes-like microvascular changes were also found in the six nondiabetic patients of subgroup B. By using multiple logistic regression analysis, intolerance to the prosthesis was significantly related to microvascular changes (P = 0.001) but not to diabetes (P = 0.601), although diabetes was unequally distributed in the two subgroups.
As chronic wounds, venous leg ulcers (VLUs) are costly and impact significantly on a patient's quality of life. This case study focuses on the key considerations for wound management of bilateral venous leg ulcers in a 45-year-old mother who had undergone multiple admissions with sepsis secondary to the ulcers and whose life was considered at risk. The primary concern was to stabilise the patient, and then to determine the aetiology of the leg ulcers and develop a treatment plan. Kerraboot (Crawford Healthcare) was chosen to dress the wound initially as it is relatively quick and easy to apply while being atraumatic, manages exudate and facilitates autolytic debridement (Harvey, 2006). After 12 days debridement was complete and granulation tissue was observed to the skin surface level. At this time, the patient's condition had stabilised and the wound aetiology could then be determined. The ulcers were confirmed as venous and were subsequently managed with compression bandaging. They continued to heal, reducing in size by 60% after a further 3 months. By agreeing a highly individualised wound treatment plan with the patient that was tailored to both her needs and those of the wound, and by continually reviewing and revising this plan, bilateral amputation was avoided in this previously non-concordant patient.
Swaminathan, Aparna; Vemulapalli, Sreekanth; Patel, Manesh R; Jones, W Schuyler
Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. PMID:25075192
Hedetoft, Christoffer; Rasmussen, Anne; Fabrin, Jesper
AIMS: We observed a large increase in type 2 diabetic subjects with foot ulcers in our diabetic outpatient foot clinic and wanted to identify the amputations rate and individuals at risk of amputations by comparing those who had had a regular control in the multidisciplinary foot clinic prior...... to the amputations and those who had not. METHODS: We examined all clinical records from the orthopaedic surgery department and the diabetic outpatient foot clinic of diabetic patients who underwent amputations for 6 years. RESULTS: Eighty-eight patients with type 2 diabetes underwent 142 amputations; 42 major...... and 100 minor amputations. There was no increase in the number of major amputations in this period. In the group not followed in the foot clinic prior to amputations we showed a greater major amputations rate (pdiabetes and less retinopathy...
河野, 一郎; 飛松, 好子; 前島, 洋; 森山, 英樹; 武本,秀徳; 坂, ゆかり; 大谷, 拓哉; 高杉, 紳一郎; 岩本, 幸英
The purpose of this study was to clarify the characteristics of postural control in persons with amputation and to examine the influence of two socket types. A group of six men with unilateral trans-femoral amputation (amputation group, AG) participated in this study. A group of twenty healthy men (control group, CG), matched for age, were also tested. The subjects performed two tests as follows: (1)quiet upright standing task (single-task, ST) and (2)upright standing and concurrent attention...
B. A. Kubheka
Full Text Available A survey was undertaken amongst twenty five black men living in the greater Durban area who had had amputations of the lower limbs. The type of amputation care and the rehabilitation programme they underwent post-operatively is described. The sample included men from 24 to 50 years of age, of whom the majority were from rural areas. The amputation care intra and post-operatively was marked by the lack of emotional preparation pre-operatively, and lack of rehabilitation information and teaching afterwards. Most respondents had to find information for themselves. This lack of information and teaching seemed to impede physical rehabilitation, with stump sores and limited use of prostheses being the main problems. Vocational rehabilitation was almost totally absent. In contrast to the twenty two respondents who worked before their amputations, only four worked afterwards. The majority had to support their families alone; sixteen of them were totally reliant on a Disability Grant. These problems lead to social isolation, depression, loneliness and other psycho-social problems.
Rubio, José Antonio; Aragón-Sánchez, Javier; Jiménez, Sara; Guadalix, Gregorio; Albarracín, Agustín; Salido, Carmen; Sanz-Moreno, José; Ruiz-Grande, Fernando; Gil-Fournier, Nuria; Álvarez, Julia
We analyzed the incidence of lower extremity amputations (LEAs) in the 3rd Health Care Area of Madrid before and after the March 2008 introduction of a multidisciplinary team for managing diabetic foot disease. We compared the amputation rates in people with and without diabetes during 2 periods: before (2001-2007) and after (2008-2011) the introduction of a Multidisciplinary Diabetic Foot Unit (MDFU). We also analyzed the trend of the amputation rates by joinpoint regression analysis and measured the annual percentage change (APC). During the study period, 514 nontraumatic LEAs were performed, 374 (73%) in people with diabetes and 140 (27%) in people without the disease. The incidence of LEAs showed a significant reduction in major amputations in people with diabetes, from 6.1 per 100 000 per year (95% confidence interval [CI] = 4.9 to 7.2), in the 2001 to 2007 period, to 4.0 per 100 000 per year (95% CI = 2.6 to 5.5) in the 2008 to 2011 period (P = .020). There were no changes in incidence of minor or total amputations in the diabetic population or in amputations in the nondiabetic population during the study period. Joinpoint regression analysis showed a significant reduction in the incidence of major LEAs in diabetic population with an APC of -6.6% (95% CI = -10.2 to -2.8; P = .003), but there were no other significant changes. This study demonstrates that the introduction of a multidisciplinary team, coordinated by an endocrinologist and a podiatrist, for managing diabetic foot disease is associated with a reduction in the incidence of major amputations in patients with diabetes.
Oliver, Noah G; Attinger, Christopher E; Steinberg, John S; Evans, Karen K; Vieweger, David; Kim, Paul J
Diabetic foot ulceration of the plantar hallux is a challenging condition and can require partial hallux amputation when complicated by infection. Lower extremity biomechanics play an important role in the development of hallux ulcers, and hallux rigidus (HR) could influence the outcomes after partial hallux amputation. We hypothesized that radiographic evidence of HR in patients with diabetes would be associated with greater ulcer recurrence and reamputation rates after partial hallux amputation. We performed a retrospective review of all patients with diabetes who had undergone a partial hallux amputation from January 2005 to December 2012. The subjects were divided into 2 cohorts according to the presence or absence of HR identified on preoperative radiographs. Baseline characteristics and outcomes were compared using a 2-sample Student's t test for continuous variables, and categorical variables were compared using the chi-square test for homogeneity and Fisher's exact test. A total of 52 patients were included, with 16 (31%) positive for radiographic evidence of HR at partial hallux amputation. Differences in the patient demographics and comorbidities were not significant between 2 cohorts with and without HR or reamputation. Reamputation was required in 5 subjects (31%) with HR and 2 (6%) without HR (p = .023). The average follow-up duration was 126 ± 89 weeks. Our results have demonstrated that the reamputation rate after partial hallux amputation is significantly greater in patients with than in those without radiographic evidence of HR. Surgeons should evaluate patients for HR when planning partial hallux amputation and use adjuvant methods of offloading when HR is evident to prevent recurrent ulceration and reamputation.
Yusof, Nazri Mohd; Rahman, Jamalludin Ab; Zulkifly, Ahmad Hafiz; Che-Ahmad, Aminudin; Khalid, Kamarul Ariffin; Sulong, Ahmad Fadzli; Vijayasingham, Naveen
INTRODUCTION Diabetes mellitus (DM) is the most common cause of amputations in Malaysia. This study aimed to identify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to a hospital, in order to reduce its likelihood. METHODS This cross-sectional study involved 218 patients with T2DM who were admitted to Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, for diabetic foot problems from June 2011 to July 2012. A form was developed to document the patients’ profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise logistic regression analysis. RESULTS A total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The following factors were found to be associated with the incidence of major lower limb amputations: T2DM duration ≥ 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C-reactive protein, urea and creatinine levels. However, only T2DM duration ≥ 10 years, positive bacterial culture and albumin levels were significant on stepwise logistic regression analysis. CONCLUSION T2DM duration ≥ 10 years, positive bacterial culture and low albumin levels were found to be significant predictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems. PMID:26668408
Fortington, Lauren V; Rommers, Gerardus M; Geertzen, Jan H B; Postema, Klaas; Dijkstra, Pieter U
Elderly people with a lower limb amputation impose a heavy burden on health resources, requiring extensive rehabilitation and long term care. Mobility is key to regaining independence; however, the impact of multiple comorbidities in this patient group can make regaining mobility a particularly challenging task. An evidence-based prognosis for mobility is needed for rehabilitation and long term care planning. This systematic review summarizes the prosthetic and nonprosthetic mobility outcomes achieved by elderly people with a lower limb amputation, to determine whether an accurate prognosis for mobility can be made. MEDLINE, EMBASE, and CINAHL were searched for studies published before May 2010 in English, German, Dutch, or French, using keywords and synonyms for elderly, mobility, rehabilitation, and amputation. Mobility focused on actual movement (moving from one place to another) and was limited to long-term measurements, 6 months after amputation or 3 months after discharge from rehabilitation. The 15 included studies featured a diversity of objective outcome measures and mobility grades that proved difficult to compare meaningfully. In general, studies that included selected populations of prosthetic walkers showed that advanced prosthetic mobility skills can be achieved by the elderly person with a lower limb amputation, including outdoor/community walking. Studies that included all subjects undergoing a lower limb amputation reported that less than half of the elderly population achieved a household level of prosthetic mobility. The predominant findings from the included studies were incomplete reporting of study populations and poor reporting of the reliability of the mobility measures used. The strength of conclusions from this review was therefore limited and the prognosis for mobility in elderly people after lower limb amputation remains unclear. Further research into mobility outcomes of this population is needed to provide evidence that enables more
Allais, Linda; Reynaud, Lucie
The rabbit is generally the non-rodent species or second species after the rat recommended by the regulatory authorities and is part of the package of regulatory reproductive studies for the detection of potential embryotoxic and/or teratogenic effects of pharmaceuticals, chemicals, food additives, and other compounds, including vaccines (see Chapters 1-7).Its availability, practicality in housing and in mating as well as its large size makes the rabbit the preferred choice as a non-rodent species. The study protocols are essentially similar to those established for the rat (Chapter 9), with some particularities. The study designs are well defined in guidelines and are relatively standardized between testing laboratories across the world.As for the rat, large litter sizes and extensive background data in the rabbit are valuable criteria for an optimal assessment of in utero development of the embryo or fetus and for the detection of potential external or internal fetal malformations.
Originally broadcast in April 2011 and aired again by BBC Radio 4 this November, Mary Toft’s Rabbit Tale is a radio drama retelling the story of its titular fraudster’s brief notoriety. With a high-profile cast – including singer Will Young as Toft’s husband and Rupert Graves as man-midwife, John Howard – the play explores a number of issues related to the alleged rabbit births of 1726 and their impact on public discourse of the time.
Holder, N; Weekes, C
The regeneration of surgically created mixed-handed limb stumps is examined in the axolotl. Operations were performed in the lower arm and upper arm regions and grafts were allowed to heal for approximately one month prior to amputation or were amputated immediately. In the lower arm group both anterior and posterior limb halves were inverted, whereas only posterior halves were inverted in the upper arm group. Almost all the limbs regenerated were normal in the anterior-posterior axis, whereas a range of limb types were found when the dorsal-ventral axis was analysed using the metacarpal muscle pattern and epidermal Leydig cell number as positional markers. The carpal and forearm muscle patterns were also analysed in order to assess whether the pattern determined from analysis at the metacarpal level reflected that seen at more proximal levels. The results are discussed in terms of the possible role of cell contribution from the stump to the blastema and the relevance of the study to models of pattern regulation.
Helfet, D L; Howey, T; Sanders, R; Johansen, K
Objective criteria can predict amputation after lower-extremity trauma. The authors examined the hypothesis that objective data, available early in the evaluation of patients with severe skeletal/soft-tissue injuries of the lower extremity with vascular compromise, might discriminate the salvageable from the unsalvageable limbs. The Mangled Extremity Severity Score (MESS) was developed by reviewing 25 trauma victims with 26 severe lower-extremity open fractures with vascular compromise. The four significant criteria (with increasing points for worsening prognosis) were skeletal/soft-tissue injury, limb ischemia, shock, and patient age. (There was a significant difference in the mean MESS scores; 4.88 in 17 limbs salvaged and 9.11 in nine limbs amputated; p less than 0.01). This scoring system was then prospectively evaluated in 26 lower-extremity open fractures with vascular injury over a 12-month period at two trauma centers. Again, there was a significant difference in the mean MESS scores; 4.00 for the 14 salvaged limbs and 8.83 for the 12 amputated limbs (p less than 0.01). In both the prospective and retrospective studies, a MESS score of greater than or equal to 7 had a 100% predictable value for amputation. This relatively simple, readily available scoring system of objective criteria was highly accurate in acutely discriminating between limbs that were salvageable and those that were unsalvageable and better managed by primary amputation.
During the French Revolution and Napoleon's campaigns, above-knee or below-knee amputations were performed either immediately or with a delay, which favoured septic problems. A rapidly operated amputation by a well-trained surgeon was the best way to save the life of a soldier who suffered from an open comminuted fracture of a limb. The conditions on military campaigns were indeed hard ones: doctors and surgeons had practically no resources and the transportation of severely injured persons was difficult. Such conditions favoured the pain and the danger caused by an injury, and it was rather impossible for the medical corps to lavish repeated treatments on the wounds. The amputated soldiers were then given prostheses: either a traditional peg-leg, with a flexed knee joint for trans-tibial amputations, or an "imitative" prosthesis, which tended to look like a real leg with eventually an articulated knee or foot. The author mentions famous or unrecognized amputated men, describing significant events.
Frölke, Jan Paul M; van de Meent, Henk
Following lower limb amputation, quality of life is highly related to the ability to use a prosthetic limb. The conventional way to attach a prosthetic limb to the body is with a socket. Many patients experience serious discomfort wearing a conventional prosthesis because of pain, instability during walking, pressure sores, bad smell or skin irritation. In addition, sitting is uncomfortable and pelvic and lower back pain due to unstable gait is often seen in these patients. The main disadvantage of the current prosthesis is the attachment of a rigid prosthesis socket to a soft and variable body. The socket must fit tightly for stability during walking but should also be comfortable for sitting. The implantation of an osseointegrated, intramedullary, transcutaneously conducted prosthesis is a new procedure for attaching a limb prosthesis to the human body without the disadvantages of the conventional prosthesis. The intramedullary prosthesis is designed with a rough surface resembling cancellous bone to enable a secure solid integration with the long bone. We treated two patients with this new prosthesis, a 44-year-old man after a transfemoral amputation, and a 32-year-old woman after a lower leg amputation; both amputations were necessary because of trauma. Those two patients are now, more than one year after the operation, showing excellent functional results without infectious complications. We assume that endo-exo prosthesis may be a promising option for selected patients unable to use a conventional prosthesis because of a problematic amputation stump.
ZAKARIA, Zamzuri; AFIFI, Mustaqim; SHARIFUDIN, Mohd Ariff
Background: Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. Methods: A cross-sectional study enrolling patients admitted to orthopaedic wards of a single tertiary hospital for diabetic foot disease was conducted. Patients who had undergone major amputation or with medical condition above the ankle joint were not included. Clinical data were collected by measurement of ankle brachial systolic index and Semmes-Weinstein 5.07 gauge monofilament test with foot clinical evaluation using King’s classification respectively. Results: The total number of patients included was 138, with mean age of 59.7 years (range 29 to 94 years old). Fifty patients (36.2%) had minor amputations. Poor compliance to diabetic treatment, King’s classification stage 5, low measures of ankle brachial systolic index, sensory neuropathy, high serum C-Reactive protein and high serum creatinine are significant predictive factors for minor amputation (P < 0.05). Conclusion: Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot. PMID:26023294
Mozumdar, Arupendra; Roy, Subrata K
Anthropometric somatotyping is one of the methods to describe the shape of the human body, which shows some associations with an individual's health and disease condition, especially with cardiovascular diseases (CVD). Individuals with lower extremity amputation (LEA) are known to be more vulnerable to the cardiovascular risk. The objectives of the present study are to report the somatotype of the individuals having lower extremity amputation, to study the possible variation in somatotype between two groups of amputated individuals, and to study the association between cardiovascular disease risk factor and somatotype components among individuals with locomotor disability. 102 adult male individuals with unilateral lower-extremity amputation residing in Calcutta and adjoining areas were investigated. The anthropometric data for somatotyping and data on cardiovascular risk traits (such as body mass index, blood pressure measurements, blood lipids) have been collected. The somatotyping technique of Carter & Heath (1990) has been followed. The result shows high mean values of endomorphy and mesomorphy components and a low mean value of the ectomorphy component among the amputated individuals having cardiovascular risks. The results of both discriminant analysis and logistic regression analysis show a significant relationship between somatotype components and CVD risk among the individuals with LEA. The findings of the present study support the findings of similar studies conducted on the normal population. Diagnosis of CVD risk condition through somatotyping can be utilized in prevention/treatment management for the individuals with LEA.
Ebrahimzadeh, Mohammad Hosein; Moradi, Ali; Khorasani, Mohammad Reza; Hallaj-Moghaddam, Mohammad; Kachooei, Amir Reza
In a cross-sectional study, 291 out of 500 veterans with war-related bilateral lower limb amputations from Iran-Iraq war (1980-1988) accepted to participate in our study. Information related to amputees and amputated limbs were gathered and a Persian version of the Medical Outcomes Study Short Form 36 (SF-36) was filled. To evaluate the effect of amputation level on health related quality of life, we classified patients to seven types according to the functional remainder of major joints (ankles, knees, hips). 97% of patients were male and the average age at the time of injury was 20 years. The major cause of war injury was shells in 50. 54% of amputees were involved in sport activities. The most common amputation level was transtibial (48%).The major stump complaint was muscle spasm. History of being hospitalized for a psychiatric disorder was reported in 5.6%. The average SF-36 score in type 2 to type 6 were 68, 60, 60, 56, and 62, respectively. Except Energy/Fatigue domain, all the other domains were different from normal population. There was not any significant statistical correlation between amputation type and any domain of the SF-36. Type 6 amputees showed an increase in physical health domains compared with former types.
Russell Esposito, Elizabeth; Wilken, Jason M
Low back pain (LBP) is common in individuals with transfemoral amputation and may result from altered gait mechanics associated with prosthetic use. Inter-segmental coordination, assessed through continuous relative phase (CRP), has been used to identify specific patterns as risk factors. The purpose of this study was to explore pelvis and trunk inter-segmental coordination across three walking speeds in individuals with transfemoral amputations with and without LBP. Nine individuals with transfemoral amputations with LBP and seven without pain were compared to twelve able-bodied subjects. Subjects underwent a gait analysis while walking at slow, moderate, and fast speeds. CRP and CRP variability were calculated from three-dimensional pelvis and trunk segment angles. A two-way ANOVA and post hoc tests assessed statistical significance. Individuals with transfemoral amputation demonstrated some coordination patterns that were different from able-bodied individuals, but consistent with previous reports on persons with LBP. The patient groups maintained transverse plane CRP consistent with able-bodied participants (p = 0.966), but not sagittal (p amputations and without LBP exhibited few differences. Only frontal and transverse CRP shifted toward out-of-phase as speed increased in the patient group with LBP. Although a cause and effect relationship between CRP and future development of back pain has yet to be determined, these results add to the literature characterizing biomechanical parameters of back pain in high-risk populations.
Joseph B. Webster, MD
Full Text Available Providing a satisfactory, functional prosthesis following lower-limb amputation is a primary goal of rehabilitation. The objectives of this study were to describe the rate of successful prosthetic fitting over a 12 mo period; describe prosthetic use after amputation; and determine factors associated with greater prosthetic fitting, function, and satisfaction. The study design was a multicenter prospective cohort study of individuals undergoing their first major lower-limb amputation because of vascular disease and/or diabetes. At 4 mo, unsuccessful prosthetic fitting was significantly associated with depression, prior arterial reconstruction, diabetes, and pain in the residual limb. At 12 mo, 92% of all subjects were fit with a prosthetic limb and individuals with transfemoral amputation were significantly less likely to have a prosthesis fit. Age older than 55 yr, diagnosis of a major depressive episode, and history of renal dialysis were associated with fewer hours of prosthetic walking. Subjects who were older, had experienced a major depressive episode, and/or were diagnosed with chronic obstructive pulmonary disease had greater functional restriction. Thus, while most individuals achieve successful prosthetic fitting by 1 yr following a first major nontraumatic lower-limb amputation, a number of medical variables and psychosocial factors are associated with prosthetic fitting, utilization, and function.
Hurley, Richard K; Rivera, Jessica C; Wenke, Joseph C; Krueger, Chad A
The capacity of servicemembers with amputation to return to duty after combat-related amputation and the associated disabilities remains largely unknown. The purpose of this study was to examine the disabling conditions and return to duty rates of servicemembers with amputation across all service branches following major limb amputations from September 2001 through July 2011. Pertinent medical information, military occupation status, return to duty designation, disabling conditions, and disability ratings for each servicemember were obtained from the Physical Evaluation Board Liaison Office (PEBLO). Across all service branches, 16 (2%) servicemembers were found fit for duty (Fit) and allowed to continue with their preinjury occupation. Another 103 (11%) were allowed to continue on Active Duty (COAD) in a less physically demanding role. More than half (554, 56%) were determined fully disabled (PEBLO rating > 75); the average disability rating was 73. COAD and Fit Army servicemembers had lower Injury Severity Scores than other servicemembers (17.4, p = 0.009 and 11.2, p rehabilitation, only 13% of all servicemembers with amputation are able to return to Active Duty and many have multiple disabling conditions that contribute to a very high level of disability.
Robbins, Christopher B; Vreeman, Daniel J; Sothmann, Mark S; Wilson, Stephen L; Oldridge, Neil B
The rate of war-related amputations in current U.S. military personnel is now twice that experienced by military personnel in previous wars. We reviewed the literature for health outcomes following war-related amputations and 17 studies were retrieved with evidence that (a) amputees are at a significant risk for developing cardiovascular disease; (b) insulin may play an important role in regulating blood pressure in maturity-onset obesity; (c) lower-extremity amputees are at risk for joint pain and osteoarthritis; (d) transfemoral amputees report a higher incidence of low back pain than transtibial amputees; and (e) 50 to 80% report phantom limb pain, with many amputees stating they were either told that their pain was imagined or their mental state was questioned. The consistency of the observations on health outcomes in these studies warrants careful examination for their implication in the contemporary treatment of war-related amputation.
Full Text Available Amputation of the penis is a rare condition reported from various parts of the world as isolated cases or small series of patients; the common etiology is self-mutilating sharp amputation or an avulsion or crush injury in an industrial accident. A complete reconstruction of all penile structures should be attempted in one stage which provides the best chance for full rehabilitation of the patient. We report here a single case of total amputation of the penis in an acute paranoid schizophrenic patient .The penis was successfully reattached using a microsurgical technique. After surgery, near-normal appearance and function including a good urine flow and absence of urethral stricture, capabilities of erection and near normal sensitivity were observed.
Hernández-Méndez, José Roberto; Rodríguez-Luna, María Rita; Guarneros-Zárate, Joaquín Eugenio; Vélez-Palafox, Mario
Introduction The traumatic injuries to the tongue can go form section to partial or complete amputation, the latter being a rare presentation in the setting of facial trauma or even in patients with mental illness. Case report We present 25-year-old patient with traumatic partial amputation of the tongue who presented to the emergency department with successful surgical repair with good functional and esthetic outcome. Discussion The tongue can suffer a broad type of traumatic injuries, in the setting of active bleeding, the muscular planes must be closed with absorbable sutures to stop the hemorrhage and prevent hematoma formation. Tongue surgical repair in the setting of a total section requires integrity of arterial and venous flow, so anastomosis must be executed. Conclusion Amputation of the tongue can put the patient's life at risk and its management needs to be mastered by the surgeons treating polytraumatized patients. PMID:26900463
Andre, A; Rongieres, M; Laffosse, J-M; Pailhe, R; Lauwers, F; Grolleau, J-L
Bilateral amputations of upper limbs are excessively rare clinical situations. We report an exceptional clinical case of bilateral amputation of upper limbs at different levels: destruction of the right hand and left transhumeral amputation in a patient after an attempted suicide on train lines. This special situation led us to perform a cross-hand replantation of the left hand to the right forearm. Only 4 other similar cases have been published in the literature. Once the surgical indication had been formulated collectively, and taking into account all the ethical issues surrounding such a decision, we had to solve the issue of inverting anatomical structures in emergency. We have provided a detailed description of our surgical technique. The aim was to save at least one organ used for grasping. The result obtained is presented and reviewed.
Nayak, Raj Kumar; Kirketerp-Møller, Klaus
INTRODUCTION: Previous work has shown that uncontrolled diabetes mellitus is associated with adverse surgical outcomes. The purpose of the present study was to establish if a high peri-operative random blood sugar (RBS) concentration among patients with diabetes with non-traumatic lower......: A total of 270 patients underwent non-traumatic LEA of whom 105 had diabetes, whereas 81 patients were included for this study. The mean age was 71 years (standard deviation: ± 11.8). Mortality was 27% and 16% were re-amputated within three months after their first amputation.The median pre-operative RBS.......50-7.22), with the Q1 tertile as the reference group. CONCLUSIONS: This study does not confirm that a high peri-operative RBS level can predict increased mortality or re-amputation among patients with diabetes who undergo non-traumatic LEA. Furthermore, based on our results, we cannot inform clinical decision...
Childers, W Lee; Kogler, Géza F
People with amputation move asymmetrically with regard to kinematics (joint angles) and kinetics (joint forces and moments). Clinicians have traditionally sought to minimize kinematic asymmetries, assuming kinetic asymmetries would also be minimized. A cycling model evaluated locomotor asymmetries. Eight individuals with unilateral transtibial amputation pedaled with 172 mm-length crank arms on both sides (control condition) and with the crank arm length shortened to 162 mm on the amputated side (CRANK condition). Pedaling kinetics and limb kinematics were recorded. Joint kinetics, joint angles (mean and range of motion [ROM]), and pedaling asymmetries were calculated from force pedals and with a motion capture system. A one-way analysis of variance with tukey post hoc compared kinetics and kinematics across limbs. Statistical significance was set to p kinetic asymmetries as clinically assumed. We propose that future research should concentrate on defining acceptable asymmetry.
de Oliveira Chini, Gislaine Cristina; Boemer, Magali Roseira
This study aimed to understand the implications and feelings associated with the experience of amputation. The literature review allowed the knowledge of this phenomenon under several perspectives, besides the appropriation of some ideas of the philosopher Merleau-Ponty about body and perception. After this initial knowledge, interviews were performed with people who underwent amputation, by living in their world and listening to their statements. By sharing these moments, it was possible to understand meanings from the perspective of those who experience it, which led to six thematic categories. In addition to understanding those who underwent amputation in their context and in their essence, some facets of this phenomenon were revealed through the phenomenological referential.
Amanda Lezanski Gujda
Full Text Available Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hyperhidrosis treatment after traumatic limb amputation. Articles discussing hyperhidrosis treatment for amputations secondary to chronic medical conditions were excluded. Seven case studies published over the last 12 years have demonstrated positive outcomes of this treatment strategy. Overall, there is little data examining this topic and current publications focus primarily on small case series. A larger, double-blind, placebo-controlled study would likely benefit veterans, service members, and civilians.
Yan Yang; Huan Wang; Zihui Zhang
Background:Flight is the central avian adaptation in evolution. Wing muscles form an important anatomical basis for avian flight, affecting wing performance and determine modes of flight. However, the roles of distal muscles in adjusting the wing, as well as their functional specializations, remain largely unknown. The importance of muscle fiber architecture has long been recognized. In this study, we provide quantitative anatomical data on the muscle architecture of the forelimb of the Golden Pheasant (Chrysolophus pictus), with an emphasis on brachial, antebrachial and manual segments. Methods:The forelimbs of five Golden Pheasants were dissected and detailed measurements of all muscles were made, including muscle mass, muscle belly length, fascicle length. From these values, muscle volume, physiological cross-sectional area (PCSA) and maximum isometric force were derived. Results:General trends such as the distribution of muscle mass, fascicle length and the ratio of tendon length/belly length are revealed. Comparing PCSAs between antebrachial depressors and elevators and between intrinsics of the alular digit and major digit yielded significant differences (p Conclusions:These observations illustrate the underlying structural basis for the functional capacities of the distal forelimb muscles and may provide additional information useful in further biomechanical and in vivo investigations.
Rodríguez-Calleja, Jose M; Santos, Jesús A; Otero, Andrés; García-López, María-Luisa
World rabbit meat production is estimated to be over 1 million tons, and Spain is the third largest producer. Although rabbit meat is marketed and consumed worldwide, information on microbiological quality is very scarce. Here, we report indicator organisms, spoilage flora, sensory quality, and some physicochemical traits of 24 h postmortem chilled rabbit carcasses and prepackaged rabbit meat stored chilled in air for 0 to 3 days at the retail level. The mean total bacterial count (4.01 +/- 0.48 log CFU/g) for carcasses dressed at a small abattoir by a manual process was significantly lower (P Pseudomonas, lactic acid bacteria, and yeasts. These microorganisms and Brochothrix thermosphacta were dominant on carcasses from the large abattoir. On prepacked hind legs (pH 6.26 +/- 0.18) stored at -1 to +1 degree C (supermarket 1), mean aerobic mesophilic count was 5.87 +/- 1.03 log CFU/g, and the major microbial groups were Pseudomonas, yeasts, lactic acid bacteria, and B. thermosphacta. On prepacked whole carcasses (pH 6.37 +/- 0.18) displayed at -1 to +5 degrees C (supermarket 2), mean aerobic mesophilic count was 6.60 +/- 1.18 and the same microbial groups were dominant. Relative Escherichia coli incidence was supermarket 2 > large abattoir > supermarket 1 > small abattoir. Overall, low numbers of coliforms, Enterobacteriaceae, psychrotrophic clostridia, coagulase-positive staphylococci, and molds were found. Sensory scores, pH values, and L-lactic acid content differentiated fresh carcasses from retail samples. Data obtained suggest that the microflora of chilled rabbit meat are different from those found on the meat of other animals.
Chu, Yue-Jie; Li, Xi-Wen; Wang, Peng-Hua; Xu, Jun; Sun, Hao-Jie; Ding, Min; Jiao, Jiao; Ji, Xiao-Yan; Feng, Shu-hong
The aim of this study is to determine the predictors for reulceration, reamputation and mortality in patients with diabetes following toe amputation, and the impact of activities of daily living on clinical outcomes. This prospective cohort study included 245 patients who had undergone toe amputation (202 healing and 43 non-healing) and was followed for a 5-year period. Data regarding new foot ulceration, reamputation and mortality were recorded, and the patients' activities of daily living were evaluated. The rate of wound healing was 82·4%. The rate of follow-up in the healed group was 91·6%. In years 1, 3 and 5, the cumulative incidence of patients who developed a new foot ulcer was 27·3%, 57·2% and 76·4%, respectively, leading to reamputation in 12·5%, 22·3% and 47·1%, respectively. The cumulative mortality was 5·8%, 15·1% and 32·7% at 1, 3 and 5 years, respectively. Multivariate analysis showed that GHbA1c > 9% (75 mmol/mol) was identified as an independent predictor of impaired wound healing, reulceration and reamputation. An age of >70 years was identified as an independent predictor of reamputation, mortality and impairment of activities of daily living. Despite a satisfactory initial healing rate after the first toe amputation, with the extension course after the toe amputation, the long-term outcomes are not optimistic. In developing countries like China, taking measures to prevent reulceration and reamputation is very important for patients with diabetic foot minor amputations, especially following toe amputation.
Full Text Available 【Abstract】Objective: Ectopic tissue transplanta- tion is not a new idea. Godina and his colleagues pioneered this method in the 1980s. This method is a last resort method of preserving an amputated body part, which consists of banking the amputated segment in an ectopic area and re- turning it to its native place at a later date. In this article we present our experience with this demanding procedure. Methods: Debridement was the mainstay of this procedure. The stump and amputated part are carefully de- brided and the stump was either closed primarily or covered by a flap. The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting. Results: Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study. The over- all success rate was about 70%, lower than expected but these are cases of severe crush injury. Although the func- tional recovery of these patients are very low, all of the successful cases except one could find a job as a janitor or light manual worker. No patient could return to his previous job. Conclusion: Ectopic transplantation of body parts is an accepted method of treatment of severely crushed ex- tremity or finger injuries. In our country an amputee has very little chance of finding a job instead a disabled person can. In addition in Iran cultures amputation is seen as pu- nishment of either the God or the society, so it is not well accepted and many patients persist on saving the limb even with no functional recovery. None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers. Key words: Replantation; Transplantation; Extremities; Amputation, traumatic
Lin, Suh-Jen; Winston, Katie D; Mitchell, Jill; Girlinghouse, Jacob; Crochet, Karleigh
Physical activity is important for general health. For an individual with amputation to sustain physical activity, certain functional capacity might be needed. Gait variability is related to the incidence of falls. This study explored the relationship between physical activity and a few common performance measures (six-minute walk test, step length variability, step width variability, and comfortable walking speed) in individuals with unilateral lower-limb amputation. Twenty individuals completed the study (age: 50±11yrs). Twelve of them had transtibial amputation, seven had transfemoral amputation, and one had through-knee amputation. Gait data was collected by the GaitRite instrumented walkway while participants performed a 3-min comfortable walking trial followed by a six-minute walk test. Physical activity was indicated by the mean of 7-day step counts via a pedometer. Gait variability was calculated by the coefficient of variation. Pearson correlation analysis was conducted between physical activity level and the 4 performance measures. Significance level was set at 0.05. Physical activity correlates strongly to comfortable walking speed (r=0.76), six-minute walk distance (r=0.67), and correlates fairly to step width variability (r=0.44). On the contrary, physical activity is inversely related to step length variability of the prosthetic leg (r=-0.46) and of the sound leg (r=-0.47). Having better functional capacity and lateral stability might enable an individual with lower-limb amputation to engage in a higher physical activity level, or vise versa. However, our conclusions are only preliminary as limited by the small sample size.
Bragaru, Mihai; van Wilgen, C. P.; Geertzen, Jan H. B.; Ruijs, Suzette G. J. B.; Dijkstra, Pieter U.; Dekker, Rienk
Introduction: Although individuals with lower limb amputation may benefit from participation in sports, less than 40% do so. Aim: To identify the barriers and facilitators that influence participation in sports for individuals with lower limb amputation. Design: Qualitative study. Participants: Twen
Ang Chuan Han
CONCLUSION: Microvascular spasm is a rare complication of inotrope use which may lead to extensive peripheral gangrene. Anecdotal reports of reversal agents have been discussed. Four limb amputations are a reasonable option especially if done in an elective setting after the gangrene has demarcated itself. Rehabilitation with prosthesis after 4 limb amputations can result in good functional outcome.
Desmond, Deirdre M.; MacLachlan, Malcolm
This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain after upper limb amputation. One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing residual and phantom limb pain experience. Prevalence…
Aaron R. Kampe
This study examined the effects of testosterone (T on the contractile properties of two sexually dimorphic forelimb muscles and one non-dimorphic muscle in male bullfrogs (Rana catesbeiana, Shaw 1802. The dimorphic muscles in castrated males with testosterone replacement (T+ achieved higher forces and lower fatigability than did castrated males without replaced testosterone (T0 males, but the magnitude of the differences was low and many of the pair-wise comparisons of each muscle property were not statistically significant. However, when taken as a whole, the means of seven contractile properties varied in the directions expected of masculine values in T+ animals in the sexually dimorphic muscles. Moreover, these data, compared with previous data on male and female bullfrogs, show that values for T+ males are similar to normal males and are significantly different from females. The T0 males tended to be intermediate in character between T+ males and females, generally retaining masculine values. This suggests that the exposure of young males to T in their first breeding season produces a masculinizing effect on the sexually dimorphic muscles that is not reversed between breeding seasons when T levels are low. The relatively minor differences in contractile properties between T+ and T0 males may indicate that as circulating T levels rise during breeding season in normal males, contractile properties can be enhanced rapidly to maximal functional levels for breeding success.
Saito, Kumiko; Tagawa, Masayo; Hasegawa, Atsuhiko
Since the RPR (rapid plasma regain) test was found to be useful for the diagnosis of rabbit syphilis, serological survey by this test has been carried out in Japanese companion rabbits. A hundred virgin household rabbits kept alone and without signs and history of syphilis were examined by RPR test from April 2001 to March 2002, in Tokyo, Japan. The test was positive in 35 cases and negative in 65 cases. RPR negative rabbits should be selected for breeding to prevent the spread of rabbit syphilis in companion rabbits in Japan.
Wuelton Marcelo Monteiro
Full Text Available Abstract: Freshwater stingray injuries are a common problem in the Brazilian Amazon, affecting mostly riverine and indigenous populations. These injuries cause severe local and regional pain, swelling and erythema, as well as complications, such as local necrosis and bacterial infection. Herein, we report a case of bacterial infection and hallux necrosis, after a freshwater stingray injury in the Brazilian Amazon, which eventually required amputation. Different antimicrobial regimens were administered at different stages of the disease; however, avoiding amputation through effective treatment was not achieved.
Nehete, Rajendra; Nehete, Anita; Singla, Sandeep; Adhav, Harshad
In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.
Full Text Available In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.
Ozçelik, Ismail Bülent; Mersa, Berkan; Kabakaş, Fatih; Saçak, Bülent; Kuvat, Samet Vasfi
Cross-over replantation is a salvage option for cases with bilateral extremity amputations where the wound conditions do not enable an orthotopic replantation. Here, we present a 24-year-old patient who applied to our center with bilateral transhumeral amputations. Due to the wound conditions, a cross-over replantation was performed. 24 months after the initial operation, the patient exhibits good protective sensation at the distal levels and function to some degree, whereas the active range of motion is not as promising as previously expected. In this article, we present this case together with its immediate and long-term outcomes and the consequences of the cross-over replantation.
Liang, Kailu; Zhong, Gang; Yin, Jiahui; Xiang, Zhou; Cen, Shiqiang; Huang, Fuguo
A 40-year-old woman had her right extremity avulsed at the proximal upper arm level and the wrist and hand of her left extremity irretrievably injured in a traffic accident. The right distal forearm was surgically amputated and replanted onto the stump of the left distal forearm. New strategy for nerve repair was applied and the function recovery of the cross-replanted hand was favorable. We thought that cross-extremity replantation was indicated when the patient suffered from bilateral total or subtotal amputation at different levels and orthotopic replantation was impossible.
Crystal L. Ramanujam
Full Text Available In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations.
Abdullah M Al-Wahbi
Full Text Available Abdullah M Al-WahbiDepartment of Surgery, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyahd, Kingdom of Saudi ArabiaBackground: Diabetic foot complications are a leading cause of lower extremity amputation. With the increasing incidence of diabetes mellitus in the Arab world, specifically in the Kingdom of Saudi Arabia, the rate of amputation will rise significantly. A diabetic foot care program was implemented at King Abdulaziz Medical City in Riyadh, Saudi Arabia, in 2002. The program was directed at health care staff and patients to increase their awareness about diabetic foot care and prevention of complications. The purpose of this study was to perform a primary evaluation of the program’s impact on the rate of lower extremity amputation due to diabetic foot complications.Method: This pilot study was the first analysis of the diabetic foot care program and examined two groups of participants for comparison, ie, a “before” group having had diabetic foot ulcers managed between 1983, when the hospital was first established, and 2002 when the program began and an “after group” having had foot ulcers managed between 2002 and 2004, in the program’s initial phase. A total of 41 charts were randomly chosen retrospectively. A data sheet containing age, gender, medical data, and the presentation, management, and outcome of diabetic foot cases was used for the analysis.Results: The before group contained 20 patients (17 males and the after group contained 21 patients (16 males. There was no difference between the two groups with regard to age and comorbidities. The rate of amputation was 70% in the before group and 61.9% in the after group. There was a decrease in the percentage of toe amputation in the after group and an increase in the percentage of below-knee amputation in the before group. However, these changes were not significant.Conclusion: The program, although evaluated at an early
Al Wahbi A
Full Text Available Abdullah Al Wahbi, Salman Aldakhil, Saud Al Turki, Abdulrahman El Kayali, Hussein Al Kohlani , Abdulaziz Al Showmer Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia Abstract: Amputation is most closely associated with blunt, lower limb injuries associated with vascular trauma. These vascular injuries require a special attention to prevent life and limb loss. Patient outcomes can also be improved by organizing vascular trauma data into appropriate systems to facilitate future studies. Keywords: vascular injuries, extremities trauma, amputation, ischemia
Penile amputation is a rare catastrophe and a serious complication of circumcision. Reconstruction of the glans penis may be indicated following amputation. Our report discusses a novel technique for reconfiguration of an amputated glans penis 1 year after a complicated circumcision. A 2-year-old male infant presented to us with glans penis amputation that had occurred during circumcision 1 year previously. The parents complained of severe meatal stenosis with disfigurement of the penis. Penis length was 3 cm. Complete penile degloving was performed. The distal part of the remaining penis was prepared by removing fibrous tissue. A buccal mucosal graft was applied to the distal part of the penis associated with meatotomy. The use of a buccal mucosal graft is a successful and simple procedure with acceptable cosmetic and functional results for late reconfiguration of the glans penis after amputation when penile size is suitable.
Kang, Norbert V; Pendegrass, Catherine; Marks, Linda; Blunn, Gordon
Exoprosthetic replacement with an artificial limb is the main option for reconstruction after traumatic amputation of an upper limb. Direct skeletal attachment using an osseointegrated implant improves the ease of fixation of the exoprosthesis to the amputation stump. We now report the use of an intraosseous transcutaneous amputation prosthesis that is designed to achieve osseocutaneous integration. Osseocutaneous integration differs from osseointegration because the aim is to create a stable interface among the implant, the bone, and the soft tissues. This reduces the risk of soft tissue infection and troublesome discharge, which are problems encountered with current osseointegrated implants that focus largely on the bone-implant interface. We describe our experience with an intraosseous transcutaneous amputation prosthesis in a case of transhumeral amputation with 2 years of follow-up.
Verschuren, Jesse E. A.; Zhdanova, Mariya A.; Geertzen, Jan H. B.; Enzlin, Paul; Dijkstra, Pieter U.; Dekker, Rienk
Aims and objectivesTo describe the impact of patients' lower limb amputations on their partners' sexual functioning and well-being. BackgroundAnnually, about 3300 major lower limb amputations are performed in the Netherlands. An amputation may induce limitations in performing marital activities, inc
Fortington, L.V.; Dijkstra, P.U.; Bosmans, J.C.; Post, W.J.; Geertzen, J.H.B.
Objective: To describe changes in health-related quality of life in people with lower limb amputation, from time of amputation to 18 months, taking into consideration the influence of age and walking distance. In addition, quality of life for people with amputation is compared with the Dutch populat
Prasanta K Maiti
Full Text Available It is popularly believed that eumycetoma cases should be dealt with using surgical amputation for a better chance of cure especially when chemotherapy has failed. However, amputation leads to disability on one hand and on the other it may also fail to be curative. We present two cases with contrasting treatment options and outcome. In the eumycetoma case reported here, a 40-year-old male presented with right foot swelling for 16 years, from which Scedosporium apiospermum was isolated. He responded poorly to antifungal therapy and refused below-knee amputation 12 years ago. With counseling and wound care his condition improved, and Foot and Ankle Ability Measure (FAAM score remained almost stable at 90% for 16 years, which is much better than the average functional outcome after amputation. Another 46-year-old female underwent below-knee amputation after receiving incomplete courses of antibiotics and antifungals for mycetoma of unknown etiology. She presented to us after recurrence of mycetoma on an amputated stump and was successfully treated by proper courses of antibiotics after detecting the causal agent, Actinomadura madurae. Her post-amputation disability and depression could have been avoided if the hasty decision of amputation had not been taken. In our opinion, living with drug-non-responsive mycetoma, supported by symptomatic management, may be a better option than amputation and its associated morbidities. So before taking the path of salvage amputation, we must consider many aspects, including patient′s livelihood, psychological aspects and chances of recurrence even after the procedure.
Marques, Raquel M; Teixeira, Luzia; Aguas, Artur P; Ribeiro, Joana C; Costa-e-Silva, António; Ferreira, Paula G
Rabbit Haemorrhagic Disease (RHD) is caused by a calicivirus (RHDV) that kills 90% of infected adult European rabbits within 3 days. Remarkably, young rabbits are resistant to RHD. We induced immunosuppression in young rabbits by treatment with methylprednisolone acetate (MPA) and challenged the animals with RHDV by intramuscular injection. All of these young rabbits died within 3 days of infection due to fulminant hepatitis, presenting a large number of RHDV-positive dead or apoptotic hepatocytes, and a significant seric increase in cytokines, features that are similar to those of naïve adult rabbits infected by RHDV. We conclude that MPA-induced immunosuppression abrogates the resistance of young rabbits to RHD, indicating that there are differences in the innate immune system between young and adult rabbits that contribute to their distinct resistance/susceptibility to RHDV infection.
Serrano, J; Cattin, M; van der Bij, E; Wlostowski, T; Daniluk, G; Lipinski, M; Beck, D; Hoffmann, J; Kreider, M; Prados, C; Rauch, S; Terpstra, W W; Zweig, M
The White Rabbit (WR) project started off to provide a sequencing and synchronisation solution for the needs of CERN and GSI. Since then, many other users have adopted it to solve problems in the domain of distributed hard realtime systems. The paper discusses the current performance of WR hardware, along with present and foreseen applications. It also describes current efforts to standardise WR under IEEE 1588 and recent developments on reliability of timely data distribution, finishing with an outline of future plans.
Tawfick, Wael A
Introduction: Patients with critical limb ischemia (CLI), who are unsuitable for intervention, face the consequence of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients. Objectives: To assess the outcome of SCBD in patients with severe CLI who are unsuitable for revascularization. Primary end points were limb salvage and 30-day mortality. Methods: From 2005 to 2012, 189 patients with severe CLI were not suitable for revascularization. In all, 171 joined the SCBD program. We match controlled 75 primary amputations. Results: All patients were Rutherford category 4 or higher. Sustained clinical improvement was 68% at 1 year. Mean toe pressure increased from 19.9 to 35.42 mm Hg, P < .0001. Mean popliteal flow increased from 35.44 to 55.91 cm\\/sec, P < .0001. The 30-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5%. All-cause survival was 69%. Median cost of managing a primary amputation patient is €29 815 compared to €3985 for SCBD. We treated 171 patients with artassist at a cost of €681 965. However, primary amputation for 75 patients cost €2 236 125. Conclusion: The SCBD therapy is a cost-effective and clinically effective solution in patients with CLI having no option of revascularization. It provides adequate limb salvage while providing relief of rest pain without any intervention.
Geertzen, Jan H. B.; Rommers, G. M.; Dekker, Rienk
Background and Aim: Education programmes of the International Society for Prosthetics and Orthotics (ISPO) are directed primarily at prosthetists and orthotists. In a multidisciplinary setting, greater attention should be given to other professionals working in the field of amputation, prosthetics a
Dorfman, David; George, Mary Catherine; Tamler, Ronald; Lushing, Julia; Nmashie, Alexandra; Simpson, David M
Pruritus is a risk factor for self-injury behavior (SIB) in sensory polyneuropathies. Although diabetes patients have elevated risk for pruritus, there are no reports of SIB in diabetic neuropathy. We present the case of a diabetes patient with neuropathy, whose pruritus induced SIB, resulted in partial amputation of a toe.
de Laat, Fred A.; Rommers, Gerardus M.; Dijkstra, Pieter U.; Geertzen, Jan H.; Roorda, Leo D.
Objective: To study the necessity and ability to climb stairs in persons after a lower-limb amputation (LLA) and the relation of this ability with personal and clinical variables. Design: Cross-sectional study. Setting: Outpatient department of a rehabilitation center. Participants: Persons with an
Needham, W. E.; And Others
A 39-year-old man who was blind, diabetic, and had a double amputation with chronic renal failure and peripheral vascular disease was treated with thermal biofeedback to reduce his depression through increased self-control, to minimize pain, and to facilitate healing of a pregangrenous hand. On treatment discharge, his mental and physical states…
Lee Childers, W; Prilutsky, Boris I; Gregor, Robert J
The neuromusculoskeletal system interacts with the external environment via end-segments, e.g. feet. A person with trans-tibial amputation (TTAmp) has lost a foot and ankle; hence the residuum with prosthesis becomes the new end-segment. We investigated changes in kinetics and muscle activity in TTAmps during cycling with this altered interface with the environment. Nine unilateral TTAmps and nine subjects without amputation (NoAmp) pedaled at a constant torque of 15 Nm and a constant cadence of 90 rpm (~150 watts). Pedal forces and limb kinematics were used to calculate resultant joint moments. Electromyographic activity was recorded to determine its magnitude and timing. Biomechanical and EMG variables of the amputated limb were compared to those of the TTAmp sound limb and to the dominant limb in the NoAmp group using a one-way ANOVA. Results showed maximum angular displacement between the residuum and prosthesis was 4.8±1.8 deg. The amputated limb compared to sound limb and NoAmp group produced lower extensor moments averaged over the cycle about the ankle (13±2.3, 20±5.7, and 19±5.3 Nm, respectfully) and knee (8.4±5.0, 15±4.5, and 12.7±5.9 Nm, respectfully) (pprosthetic socket control and highlight prosthetic control as an interaction between the residuum, prosthesis and external environment.
Cochrane, H; Orsi, K; Reilly, P
This paper is intended as a follow-up to the ISPO Consensus Conference on Amputation Surgery. It reviews all the literature on lower limb prosthetics published after 1990. The review was considered under six categories: feet, knees, hips, thermoplastics, liners/suspension and computers.
Boonstra, AM; Rijnders, LJM; Groothoff, J W; Eisma, W H
The aim of the study was to evaluate the use of prostheses, some secondary complications and functional aspects among children who had a congenital leg deficiency or an acquired leg amputation. Rehabilitation physicians were asked to refer children, aged 1-18 years, with a leg deficiency or amputati
Curtze, Carolin; Otten, Bert; Postema, Klaas
What happens to the mental representation of our body when the actual anatomy of our body changes? We asked 18 able-bodied controls, 18 patients with a lower limb amputation and a patient with rotationplasty to perform a laterality judgment task. They were shown illustrations of feet in different or
Fortington, Lauren V.; Rommers, Gerardus M.; Geertzen, Jan H. B.; Postema, Klaas; Dijkstra, Pieter U.
Elderly people with a lower limb amputation impose a heavy burden on health resources, requiring extensive rehabilitation and long term care. Mobility is key to regaining independence; however, the impact of multiple comorbidities in this patient group can make regaining mobility a particularly chal
The authors present the case of a young man with arthrogryphosis multiplex congenita and an above knee amputation who underwent an ipsilateral total hip replacement. The unique aspects of the case and technical difficulties are highlighted. Follow-up at five years revealed an excellent clinical and radiological outcome.
Gaffney, Brecca M; Murray, Amanda M; Christiansen, Cory L; Davidson, Bradley S
Patients with unilateral dysvascular transtibial amputation (TTA) have a higher risk of developing low back pain than their healthy counterparts, which may be related to movement compensations used in the absence of ankle function. Assessing components of segmental angular momentum provides a unique framework to identify and interpret these movement compensations alongside traditional observational analyses. Angular momentum separation indicates two components of total angular momentum: (1) transfer momentum and (2) rotational momentum. The objective of this investigation was to assess movement compensations in patients with dysvascular TTA, patients with diabetes mellitus (DM), and healthy controls (HC) by examining patterns of generating and arresting trunk and pelvis segmental angular momenta during gait. We hypothesized that all groups would demonstrate similar patterns of generating/arresting total momentum and transfer momentum in the trunk and pelvis in reference to the groups (patients with DM and HC). We also hypothesized that patients with amputation would demonstrate different (larger) patterns of generating/arresting rotational angular momentum in the trunk. Patients with amputation demonstrated differences in trunk and pelvis transfer angular momentum in the sagittal and transverse planes in comparison to the reference groups, which indicates postural compensations adopted during walking. However, patients with amputation demonstrated larger patterns of generating and arresting of trunk and pelvis rotational angular momentum in comparison to the reference groups. These segmental rotational angular momentum patterns correspond with high eccentric muscle demands needed to arrest the angular momentum, and may lead to consequential long-term effects such as low back pain.
Alan de Paula Mozella
Full Text Available OBJECTIVE: Identify the etiology and incidence, as well to assess functional outcomes of patients, undergoing lower limb amputation after failure or complication of total knee arthroplasty. These patients were treated at the Center for Knee Surgery at the National Institute of Traumatology and Orthopedics (INTO, during the period of January 2001 to December 2010. METHODS: The patients were interviewed and their charts were retrospectively analyzed to evaluate their functional outcome. RESULTS: The incidence of amputation due to failure or complication of total knee arthroplasty was 0.41% in 2409 cases. Recurrent deep infection was the cause of amputation in 81% of cases, being Staphylococcus aureus and Pseudomonas aeruginosa the most frequent germs. Vascular complications and periprosthetic fracture associated to metaphyseal bone loss were also causes of amputation. In our study, 44% of amputees patients were using orthesis and 62.5% have had the ability to walk. CONCLUSION: Incidence of 0.41%, being the main cause recurrent infection. The functional outcome is limited, and the fitting achieved in 44% of patients and only 62.5% are ambulatory.
This podcast provides health information on taking care of a new arm or leg after an amputation. Created: 2/18/2010 by National Center on Birth Defects and Developmental Disability, Disability and Health Program. Date Released: 2/18/2010.
Full Text Available Aim. In two German regions with 11.1 million inhabitants, 6 networks for specialized treatment of DFS were implemented until 2008. Data provided for accounting purposes was analysed in order to determine changes in the rate of diabetics requiring amputations in the years before and after the implementation. Method. Data covering 2.9 million people insured by the largest insurance company between 2007 and 2013 was analysed by the use of log-linear Poisson regression adjusted for age, gender and region. Results. The rate of diabetics needing major amputations fell significantly by 9.5% per year (p<0.0001 from 217 to 126 of 100,000 patients per year. The rate of diabetics needing amputations of any kind fell from 504 to 419 of 100,000 patients per year (p=0.0038. Discussion. The networks integrate health care providers in an organised system of shared care. They educate members of the medical community and the general public. At the same time, a more general disease management program for people with diabetes was implemented, which may also have contributed to this decrease. At the end of the observation period, the rate of diabetics requiring amputations was still high. For this reason, further expansion of organised specialized care is urgently needed.
Vrieling, Aline H.; van Keeken, Helco G.; Schoppen, Tanneke; Hof, At L.; Otten, Bert; Halbertsma, Jan P. K.; Postema, Klaas
Objective: To describe the adjustments in gait characteristics of obstacle crossing, gait initiation and gait termination that occur in subjects with a recent lower limb amputation during the rehabilitation process. Design: Prospective and descriptive study. Subjects: Fourteen subjects with a recent
Jayakaran, Prasath; Johnson, Gillian M.; Sullivan, S. John; Nitz, Jennifer C.
Measurement of balance and postural performance that underpins activities of daily living is important in the rehabilitation of individuals with a lower limb amputation (LLA), and there are a number of methods and strategies available for this purpose. To provide an evidence-based choice of approach, this review aims to critically review the tasks…
Jaegers, Sonja Maria Héléne José
This dissertation is concerned with the consequences of a transfemoral amputation for the morphology and functions of the muscles around the hip joint. Knowledge about and insight into the changes appearing in the morphology and functions of the hip muscles of transfemoral amputees are important to
Fortington, Lauren V.; Rommers, Gerardus M.; Postema, Klaas; van Netten, Jaap J.; Geertzen, Jan H. B.; Dijkstra, Pieter U.
Background: Investigating population changes gives insight into effectiveness and need for prevention and rehabilitation services. Incidence rates of amputation are highly varied, making it difficult to meaningfully compare rates between studies and regions or to compare changes over time. Study Des
Langlois, Karine; Villa, Coralie; Bonnet, Xavier; Lavaste, François; Fodé, Pascale; Martinet, Noel; Pillet, Hélène
The aim of the study was to investigate how kinematic and kinetic adjustments between level and slope locomotion of persons with transtibial amputation are related to their individual muscular and functional capacities. A quantified gait analysis was conducted on flat and slope surfaces for seven patients with transtibial amputation and a control group of eight subjects to obtain biomechanical parameters. In addition, maximal isometric muscular strength (knee and hip extensors) and functional scores were measured. The results of this study showed that most of the persons with transtibial amputation could adapt to ramp ascent either by increasing ankle, knee, and hip flexion angles of the residual limb and/or by recruiting their hip extensors to guarantee enough hip extension power during early stance. Besides, 6-minute walk test score was shown to be a good predictor of adaptation capacities to slope ascent. In ramp descent, the increase of knee flexion moment was correlated with knee extensor strength and residual-limb length. However, no correlation was observed with functional parameters. Results show that the walking strategy adopted by persons with transtibial amputation to negotiate ramp locomotion mainly depends on their muscular capacities. Therefore, muscular strengthening should be a priority during rehabilitation.
Bisseriex, H; Rogez, D; Thomas, M; Truffaut, S; Compere, S; Mercier, H; Dochez, F; Lapeyre, E; Thefenne, L
The epidemiological features and management practices associated with amputation in low-income countries, generally synonymous with the tropics, are different from those observed in Western countries. Unlike developed countries, amputation most frequently involves traumatic injury in young active people. However, Westernization of the lifestyle is leading to an increasing number of cases involving diabetes and atherosclerotic disease. In the developing world, leprosy and Buruli ulcer are still significant etiologic factors for amputation. In war-torn countries, use of antipersonnel landmines is another major cause of amputation with characteristic features. Management of amputees in the developing world is hindered by the lack of facilities for rehabilitation and prosthetic fitting. Many international organizations are supporting national programs to develop such facilities. In addition to being affordable, prosthetics and orthotics must be adapted to the living conditions of a mostly rural amputee population, i.e., heat, humidity, and farm work. The rehabilitation process must be part of a global handicap policy aimed at changing attitudes about disability and reintegrating amputees both socially and professionally.
... system” called the “K” level to quantify a patient’s outcome potential. The components considered medically appropriate are tied ... of bone density, back pain, amputation of another limb, and even some forms of cancer. ... and care of the prosthesis Care of the residual limb Care of the ...
This article reviews what is known about the diagnosis and management of cardiovascular diseases in the pet rabbit. Current knowledge is based on anecdotal reports, derived from research data using the rabbit as an animal model of human cardiovascular diseases, but most importantly canine and feline cardiology. It is likely that, as cardiovascular diseases are more often recognized, more specific information will soon become available for the treatment of the pet rabbit with cardiac disease.
Full Text Available Background: The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS in severely injured lower limbs. Materials and Methods: Retrospectively 25 and prospectively 36 lower limbs in 58 patients with high-energy injuries were evaluated with the use of MESS, to assist in the decision-making process for the care of patients with such injuries. Difference between the mean MESS scores for amputated and salvaged limbs was analyzed. Results: In the retrospective study 4.65 (4.65 ± 1.32 was the mean score for the salvaged limbs and 8.80 (8.8 ± 1.4 for the amputated limbs. In the prospective study 4.53 (4.53 ± 2.44 was the mean score for the salvaged limbs and 8.83 (8.83 ± 2.34 for the amputated limbs. There was a significant difference in the mean scores for salvaged and amputated limbs. Retrospective 21 (84% and prospective 29 (80.5% limbs remained in the salvage pathway six months after the injury. Conclusion: MESS could predict amputation of severely injured lower limbs, having score of equal or more than 7 with 91% sensitivity and 98% specificity. There was a significant difference in the mean MESS scores in the prospective study (n=36, 4.53 (4.53 ± 2.44 in thirty salvaged limbs (83.33% and 8.83 (8.83 ± 2.34 in six amputated limbs (16.66% with a P -value 0.002 ( P -value < 0.01. Similarly there was a significant difference in the mean MESS score in the retrospective study (n=25, 4.65 (4.65 ± 1.32 in twenty salvaged limbs (80% and 8.80 (8.8 ± 1.4 in five amputated limbs (20% with a P -value 0.00005 ( P -value < 0.01. MESS is a simple and relatively easy and readily available scoring system which can help the surgeon to decide the fate of the lower extremity with a high-energy injury.
Behr, James; Friedly, Janna; Molton, Ivan; Morgenroth, David; Jensen, Mark P; Smith, Douglas G
Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study was to determine whether individuals with knee-disarticulation amputations have worse pain and pain-related interference with physical function than do individuals with transtibial or transfemoral amputations. We analyzed cross-sectional survey data provided by 42 adults with lower-limb amputations. These individuals consisted of 14 adults reporting knee-disarticulation amputation in one limb and best-matched cases (14 reporting transfemoral amputation and 14 reporting transtibial amputation) from a larger cross-sectional sample of 472 individuals. Participants were rigorously matched based on time since amputation, reason for amputation, age, sex, diabetes diagnosis, and pain before amputation. Continuous outcome variables were analyzed by one-way analysis of variance. Categorical outcomes were analyzed by Pearson chi-square statistic. Given the relatively small sample size and power concerns, mean differences were also described by estimated effect size (Cohen's d). Of the 42 participants, 83% were male. They ranged in age from 36 to 85 (median = 55.1, standard deviation = 11.0). Most amputations were of traumatic origin (74%), and participants were on average 12.4 years from their amputations at the time of the survey. Individuals with transtibial amputation reported significantly more prosthesis use than did individuals with knee-disarticulation amputation. Amputation levels did not significantly differ in phantom limb pain, residual limb pain, back pain, and pain-related interference with physical function. Estimates of effect size, however, indicated that participants with knee-disarticulation amputation reported less phantom limb pain, phantom limb pain-related interference with physical function, residual limb pain, residual limb pain-related interference with physical
Full Text Available Several neural decoding algorithms have successfully converted brain signals into commands to control a computer cursor and prosthetic devices. A majority of decoding methods, such as population vector algorithms (PVA, optimal linear estimators (OLE, and neural networks (NN, are effective in predicting movement kinematics, including movement direction, speed and trajectory but usually require a large number of neurons to achieve desirable performance. This study proposed a novel decoding algorithm even with signals obtained from a smaller numbers of neurons. We adopted sliced inverse regression (SIR to predict forelimb movement from single-unit activities recorded in the rat primary motor (M1 cortex in a water-reward lever-pressing task. SIR performed weighted principal component analysis (PCA to achieve effective dimension reduction for nonlinear regression. To demonstrate the decoding performance, SIR was compared to PVA, OLE, and NN. Furthermore, PCA and sequential feature selection (SFS which are popular feature selection techniques were implemented for comparison of feature selection effectiveness. Among SIR, PVA, OLE, PCA, SFS, and NN decoding methods, the trajectories predicted by SIR (with a root mean square error, RMSE, of 8.47 ± 1.32 mm was closer to the actual trajectories compared with those predicted by PVA (30.41 ± 11.73 mm, OLE (20.17 ± 6.43 mm, PCA (19.13 ± 0.75 mm, SFS (22.75 ± 2.01 mm, and NN (16.75 ± 2.02 mm. The superiority of SIR was most obvious when the sample size of neurons was small. We concluded that SIR sorted the input data to obtain the effective transform matrices for movement prediction, making it a robust decoding method for conditions with sparse neuronal information.
Frigon, A; Thibaudier, Y; Hurteau, M-F
The modulation of the neural output to forelimb and hindlimb muscles when the left and right sides step at different speeds from one another in quadrupeds was assessed by obtaining electromyography (EMG) in seven intact adult cats during split-belt locomotion. To determine if changes in EMG during split-belt locomotion were modulated according to the speed of the belt the limb was stepping on, values were compared to those obtained during tied-belt locomotion (equal left-right speeds) at matched speeds. Cats were chronically implanted for EMG, which was obtained from six muscles: biceps brachii, triceps brachii, flexor carpi ulnaris, sartorius, vastus lateralis and medial gastrocnemius. During tied-belt locomotion, cats stepped from 0.4 to 1.0m/s in 0.1m/s increments whereas during split-belt locomotion, cats stepped with left-right speed differences of 0.1 to 0.4m/s in 0.1m/s increments. During tied-belt locomotion, EMG burst durations and mean EMG amplitudes of all muscles respectively decreased and increased with increasing speed. During split-belt locomotion, there was a clear differential modulation of the EMG patterns between flexors and extensors and between the slow and fast sides. Changes in the EMG pattern of some muscles could be explained by the speed of the belt the limb was stepping on, while in other muscles there were clear dissociations from tied-belt values at matched speeds. Therefore, results show that EMG patterns during split-belt locomotion are modulated to meet task requirements partly via signals related to the stepping speed of the homonymous limb and from the other limbs.
Shahram Nazerani; Hamed Vaseghi; Saied Hesami; Tina Nazerani
Objective:Ectopic tissue transplantation is not a new idea.Godina and his colleagues pioneered this method in the 1980s.This method is a last resort method of preserving an amputated body part,which consists of banking the amputated segment in an ectopic area and returning it to its native place at a later date.In this article we present our experience with this demanding procedure.Methods:Debridement was the mainstay of this procedure.The stump and amputated part are carefully debrided and the stump was either closed primarily or covered by a flap.The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting.Results:Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study.The overall success rate was about 70％,lower than expected but these are cases of severe crush injury.Although the functional recovery of these patients are very low,all of the successful cases except one could find a job as a janitor or light manual worker.No patient could return to his previous job.Conclusion:Ectopic transplantation of body parts is an accepted method of treatment of severely crushed extremity or finger injuries.In our country an amputee has very little chance of finding a job instead a disabled person can.In addition in Iran cultures amputation is seen as punishment of either the God or the society,so it is not well accepted and many patients persist on saving the limb even with no functional recovery.None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers.
João Paulo Tardivo
Full Text Available Diabetes is a chronic disease that affects almost 19% of the elderly population in Brazil and similar percentages around the world. Amputation of lower limbs in diabetic patients who present foot complications is a common occurrence with a significant reduction of life quality, and heavy costs on the health system. Unfortunately, there is no easy protocol to define the conditions that should be considered to proceed to amputation. The main objective of the present study is to create a simple prognostic score to evaluate the diabetic foot, which is called Tardivo Algorithm. Calculation of the score is based on three main factors: Wagner classification, signs of peripheral arterial disease (PAD, which is evaluated by using Peripheral Arterial Disease Classification, and the location of ulcers. The final score is obtained by multiplying the value of the individual factors. Patients with good peripheral vascularization received a value of 1, while clinical signs of ischemia received a value of 2 (PAD 2. Ulcer location was defined as forefoot, midfoot and hind foot. The conservative treatment used in patients with scores below 12 was based on a recently developed Photodynamic Therapy (PDT protocol. 85.5% of these patients presented a good outcome and avoided amputation. The results showed that scores 12 or higher represented a significantly higher probability of amputation (Odds ratio and logistic regression-IC 95%, 12.2-1886.5. The Tardivo algorithm is a simple prognostic score for the diabetic foot, easily accessible by physicians. It helps to determine the amputation risk and the best treatment, whether it is conservative or surgical management.
Marco Iosa, PhD
Full Text Available Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p < 0.001, harmony (p < 0.001, and symmetry (p < 0.001 of walking, with general trends following the noted order of subjects, but with the lowest laterolateral harmony in subjects with transtibial amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.
Lumeij, J.T.; Mikalová, L.; Smajs, D.
Abstract Cross infection of rabbits and hares with Treponema paraluiscuniculi from rabbits and the related microorganism from hares, which was provisionally named "Treponema paraluisleporis", revealed that T. paraluiscuniculi affects rabbits clinically, but only causes seroconversion in hares withou
Simmons, Jon D; Gunter, Joseph W; Schmieg, Robert E; Manley, Justin D; Rushton, Fred W; Porter, John M; Mitchell, Marc E
Extended length of time from injury to definitive vascular repair is considered to be a predictor of amputation in patients with popliteal artery injuries. In an urban trauma center with a rural catchment area, logistical issues frequently result in treatment delays, which may affect limb salvage after vascular trauma. We examined how known risk factors for amputation after popliteal trauma are affected in a more rural environment, where patients often experience delays in definitive surgical treatment. All adult patients admitted to the Level I trauma center, the University of Mississippi Medical Center, with a popliteal artery injury between January 2000 and December of 2007 were identified. Demographic information management and outcome data were collected. Body mass index, mangled extremity severity score (MESS), Guistilo open fracture score, injury severity score, and time from injury to vascular repair were examined. Fifty-one patients with popliteal artery injuries (53% blunt and 47% penetrating) were identified, all undergoing operative repair. There were nine amputations (17.6%) and one death. Patients requiring amputation had a higher MESS, 7.8 versus 5.3 (P score, Guistilo open fracture score, or time from injury to repair were not different between the two groups. Patients with a blunt mechanism of injury had a slightly higher amputation rate compared with those with penetrating trauma, 25.9 per cent versus 8.3 per cent (P = non significant). MESS, though not perfect, is the best predictor of amputation in patients with popliteal artery injuries. Morbid obesity is not a significant predictor for amputation in patients with popliteal artery injuries. Time from injury to repair of greater than 6 hours was not predictive of amputation. This study further demonstrates that a single scoring system should be used with caution when determining the need for lower extremity amputation.
Yan; Yang; Huan; Wang; Zihui; Zhang
Background: Flight is the central avian adaptation in evolution. Wing muscles form an important anatomical basis for avian flight, affecting wing performance and determine modes of flight. However, the roles of distal muscles in adjusting the wing, as well as their functional specializations, remain largely unknown. The importance of muscle fiber architecture has long been recognized. In this study, we provide quantitative anatomical data on the muscle architecture of the forelimb of the Golden Pheasant(Chrysolophus pictus), with an emphasis on brachial,antebrachial and manual segments.Methods: The forelimbs of five Golden Pheasants were dissected and detailed measurements of all muscles were made, including muscle mass, muscle belly length, fascicle length. From these values, muscle volume, physiological cross-sectional area(PCSA) and maximum isometric force were derived.Results: General trends such as the distribution of muscle mass, fascicle length and the ratio of tendon length/belly length are revealed. Comparing PCSAs between antebrachial depressors and elevators and between intrinsics of the alular digit and major digit yielded significant differences(p < 0.05). Pronounced development of the antebrachial depressors suggests that ventral rotation of the distal half of the wing is a pivotal factor in shape change and orientation modulation. Large PCSAs in tandem with the force generation capability of the major digit intrinsics may help stabilize the digits while enhancing support of the primary feathers. The architectural properties of the alular digit confirm that alular adjustment is essential to rapid adduction and abduction.Conclusions: These observations illustrate the underlying structural basis for the functional capacities of the distal forelimb muscles and may provide additional information useful in further biomechanical and in vivo investigations.
Full Text Available Abstract Background A complete spinal cord transection results in loss of all supraspinal motor control below the level of the injury. The neural circuitry in the lumbosacral spinal cord, however, can generate locomotor patterns in the hindlimbs of rats and cats with the aid of motor training, epidural stimulation and/or administration of monoaminergic agonists. We hypothesized that there are patterns of EMG signals from the forelimbs during quadrupedal locomotion that uniquely represent a signal for the “intent” to step with the hindlimbs. These observations led us to determine whether this type of “indirect” volitional control of stepping can be achieved after a complete spinal cord injury. The objective of this study was to develop an electronic bridge across the lesion of the spinal cord to facilitate hindlimb stepping after a complete mid-thoracic spinal cord injury in adult rats. Methods We developed an electronic spinal bridge that can detect specific patterns of EMG activity from the forelimb muscles to initiate electrical-enabling motor control (eEmc of the lumbosacral spinal cord to enable quadrupedal stepping after a complete spinal cord transection in rats. A moving window detection algorithm was implemented in a small microprocessor to detect biceps brachii EMG activity bilaterally that then was used to initiate and terminate epidural stimulation in the lumbosacral spinal cord. We found dominant frequencies of 180–220 Hz in the EMG of the forelimb muscles during active periods, whereas these frequencies were between 0–10 Hz when the muscles were inactive. Results and conclusions Once the algorithm was validated to represent kinematically appropriate quadrupedal stepping, we observed that the algorithm could reliably detect, initiate, and facilitate stepping under different pharmacological conditions and at various treadmill speeds.
Mohammad M. Al-Qattan
Full Text Available nAG (newt-Anterrior Gradient protein is the key mediator of regrowth of amputated limbs in salamanders. In a previous work in our lab, a new nAG gene (suitable for humans was designed and cloned. The cloned vector was transfected into primary human fibroblasts. The expression of nAG in human primary fibroblasts was found to suppress collagen expression. The current study shows that local injection of recombinant nAG reduces scar hypertrophy in the rabbit ear model. This is associated with lower scar elevation index (SEI, lower levels of collagen I & III, higher levels of MMP1, and a higher degree of scar maturation in experimental wounds compared to controls.
QianBao-zhen; H.O.Bogh; M.V.Johansen; WangPeng-peng
Fourteen pregnant rabbits were each infected with 300 cercariae of Schistosoma japonicum and divided into two groups.Group M (n =8)was infected during mid-gestation (the organogenetic stage)and group L (n=6)was infected during late-gestation (the post-organogenetic stage).Mother rabbits and rabbit kittens were killed 45-60 days after infection and perfused in order to obtain worm counts.Furthermore,faecal egg counts and tissue egg counts from livers were obtained from the mother rabbits as well as the rabbit kittens.All mother rabbits became infected harbouring 207.6+20.2 and 220.0+27.5 adult worms in group M and L,respectively.In groups M and L, 13.5%and 46.7% of the kittens were infected,respectively,In 12 of 14 litters at least one kitten was infected.Tne infected kittens harboured between one and three adult S.japonicum.The livers of the kittens infected with a worm pair displaced lesions,as a result of egg deposition.The results, therefore,show that congenital transmission of S.japonicum can occur in rabbits.The close anatomical resemblance between the rabbit and human placenta may be indicative of the presence of congenital transmssion of S.japomcum infection in humans.
Meent, H. van de; Hopman, M.T.E.; Frolke, J.P.M.
OBJECTIVE: To investigate walking ability and quality of life of osseointegrated leg prostheses compared with socket prostheses. DESIGN: Prospective case-control study. SETTING: University medical center. PARTICIPANTS: Subjects (N=22) with transfemoral amputation (1 bilateral) referred to our center
Fuoco, Michael; Cox, Leonard; Kinahan, Thomas
Traumatic self-amputation of the penis by a psychotic patient is rare. Microvascular replantation is the favored management approach. There are no known cases of self-amputation followed by ingestion of the stump and subsequent replantation. A 51-year-old patient with paranoid schizophrenia presented 2 hours following penile amputation. He had swallowed the excised portion, which was endoscopically retrieved from the stomach in the emergency department. Successful reattachment was achieved including microvascular repair of the dorsal penile arteries without cavernosal arterial anastamoses. A Winter's shunt was performed to improve venous circulation. The patient has been followed for 3 years from the date of repair. He has adequate erection for intercourse and good urinary function, but has experienced sensory loss over the dorsal aspect and glans and urethral stricture dilation. This is the first report of replantation following ingestion of an amputated penis.
A Stabilized Definitive Prosthesis (Procedure 1); Definitive Prosthesis With a Contact Socket (Procedure 1); Patients in the Initial Phase (Temporary Prosthesis, Rehabilitation) Following Unilateral Post- Transtibial Amputation (Procedure 2)
Jun Yao; Albert Chen; Todd Kuiken; Carolina Carmona; Julius Dewald
This case study demonstrates the change of sensory cortical representations of the residual parts of the arm in an individual who underwent a trans-humeral amputation and subsequent targeted reinnervation (TR). As a relatively new surgical technique, TR restores a direct neural connection from amputated sensorimotor nerves to specific target muscles. This method has been successfully applied to upper-limb and lower-limb amputees, and has shown effectiveness in regaining control signals via th...
Rethnam Ulfin; Yesupalan Rajam; Shoaib Amer; Ratnam Thanga K
Abstract Introduction Hip fracture fixation surgery in patients with below-knee amputations poses a challenging problem to the surgeon in terms of obtaining traction for reduction of the fracture. The absence of the foot and part of the leg in these patients makes positioning on the fracture table difficult. We highlight this difficult problem and suggest techniques to overcome it. Case presentation A 73-year-old man with bilateral below-knee amputations presented with a history of fall. Radi...
Livingstone, Wendy; Mortel, Thea F van de; Taylor, Beverly
Little research has been done on the experience of diabetes-related amputation. The aim of this study was to allow amputees to describe their experiences of amputation and to generate grounded theory that will lead health professionals towards a more comprehensive understanding of the realities of post-amputation life. Unstructured interviews were conducted with five participants with a diabetes-related amputation living in a rural setting, and their respective carers. The interviews were analysed using Grounded Theory methods. Data analysis revealed three categories: 'imposed powerlessness', 'adaptive functionality' and 'endurance'. The impact of participant's amputations were influenced by continuing limb problems post-amputation and co-existing complications affecting their physical function. Medical errors and lack of awareness of the risks for diabetic amputations resulted in uncertainty and fear. The participants' sense of grief, loss and shock post operatively continued later as they came to terms with their awkwardness of movement, yet they moved forward developing their own sense of hope through a coping process that revealed remarkable ability to endure and exert control over lives that seemed to be at the whim of an ongoing disease process. The substantive theory resulting from this grounded theory study was conceptualised as 'A Path of Perpetual Resilience'. It is important that psychosocial and not just physical adjustment is considered an indicator for determining outcomes for these people, and that future care involves strategies to promote this. A greater sample size is required to determine if these findings are transferable to the general diabetes-related amputation population.
Beurskens, Rainer; Wilken, Jason M.; Dingwell, Jonathan B.
Interestingly, young and highly active people with lower limb amputation appear to maintain a similar trunk and upper body stability during walking as able bodied individuals. Understanding the mechanisms underlying how this stability is achieved after lower leg amputation is important to improve training regimens for improving walking function in these patients. This study quantified how superior (i.e., head, trunk, and pelvis) and inferior (i.e., thigh, shank, and feet) segments of the body...
Made Bramantya Karna
Results: Patients who undergo amputation were 12 people and who successfully maintained limb were 46 people. The sensitivity ranged from 50% (MESI until 75% (HFS, a specificity ranging from 61% (HFS until 85% (NISSA. Positive predictive value ranged between 23% (PSI and 53% (NISSA and negative predictive value ranged from 81% (PSI until 91% (NISSA. Conclusions: This study failed to demonstrate the usefulness of the six counting system because it only shows the sensitivity and specificity in distinguishing limb amputation injuries that require immediate and that allows it to be maintained. Some have incorrectly predicted the counting system, where some patients were successfully maintained limb had been predicted for amputees and vice versa. [Int J Res Med Sci 2016; 4(8.000: 3521-3524
Holstein, P; Dovey, H; Lassen, N A
In 59 above-knee amputations healing of the stumps was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 1318-- or 125I--antipyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mm......Hg no less than nine (82 per cent) suffered severe wound complications. Out of the 48 cases with an SPP above 30 mmHg severe wound complications occurred in only four cases (8 per cent). The difference in wound complication rate is highly significant (P less than 0.01). The postoperative SPP measured...... on the stumps was on average only slightly and insignificantly higher than the preoperative values, explaining why the preoperative values related so closely to the postoperative clinical course. We conclude that the SPP can be used to predict ischaemic wound complications in above-knee amputations as has...
Shin, J C; Park, C; Kim, D Y; Choi, Y S; Kim, Y K; Seong, Y J
Great importance and caution should be placed on prosthetic fitting for a paraplegic patient with an anesthetic residual limb if functional ambulation is to be achieved. The combination of paraplegia with a transfemoral amputation and radial nerve palsy is a complex injury that makes the rehabilitation process difficult. This article describes a case of L2 paraplegia with a transfemoral amputation and radial nerve palsy on the right side. Following the rehabilitation course, the patient independently walked using a walker at indoor level with a transfemoral prosthesis with ischial containment socket, polycentric knee assembly, endoskeletal shank and multiaxis foot assembly and a knee ankle foot orthosis on the sound side. The difficulties of fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed.
Look, Nicole [Department of Applied Mathematics, University of Colorado Boulder, Boulder, Colorado 80309 (United States); Arellano, Christopher J.; Grabowski, Alena M.; Kram, Rodger [Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado 80309 (United States); McDermott, William J. [The Orthopedic Specialty Hospital, Murray, Utah 84107 (United States); Bradley, Elizabeth [Department of Computer Science, University of Colorado Boulder, Boulder, Colorado 80309, USA and Santa Fe Institute, Santa Fe, New Mexico 87501 (United States)
In this paper, we study dynamic stability during running, focusing on the effects of speed, and the use of a leg prosthesis. We compute and compare the maximal Lyapunov exponents of kinematic time-series data from subjects with and without unilateral transtibial amputations running at a wide range of speeds. We find that the dynamics of the affected leg with the running-specific prosthesis are less stable than the dynamics of the unaffected leg and also less stable than the biological legs of the non-amputee runners. Surprisingly, we find that the center-of-mass dynamics of runners with two intact biological legs are slightly less stable than those of runners with amputations. Our results suggest that while leg asymmetries may be associated with instability, runners may compensate for this effect by increased control of their center-of-mass dynamics.
ZHANG Gong-lin; CHEN Ke-ming; ZHANG Jun-hua; WANG Shi-yong
In cases of severe segmental injury across the hand and wrist, but one or other fingers are still in peak condition, the fingers can be selected for replantation at the forearm bones to restore pinch function. Here we reported an unusual case with a severe crush-avulsion amputated injury to the right hand caused by a machine accident. We conducted hand reconstruction using heterotopic replantation of the amputated index and little fingers.During 19 months follow-up, the bone union healed well with satisfactory outcome. The interphalangeal and metacarpophalangeal joint of the fingers after the heterotopic replantation had a good holding activity. This is a worthwhile procedure and the patient is satisfied with the result. The major disadvantage of this method is the poor appearance of the reconstructed fingers.
Full Text Available The aim of this study was to establish types of psychological reactions and conditions in patients with lower-extremity amputations. Apart from using psychological interviews, detection was performed using psychometric tests: Minnesota Multiphasic Personality Inventory and Beck Depression Inventory. Psychometric parameters were analyzed in a group of 20 examinees treated at the Medical Rehabilitation Clinic in Novi Sad. Out of the whole sample. 45% of patients presented with adaptive reactions to amputation and consequent disability, whereas 55% presented with maladaptive responses. The registered psychopathological symptoms included nosologic categories: reaction to stressful events and adjustment disorder (predominantly affecting other emotions: mixed disorder of conduct and emotions: prolonged depressive reaction and dysthymia. When working with lower-extremity amputees, apart from adaptive, nonpathological forms of behavior, one also encounters maladaptive responses with predomination of mood disorders due to severe somatic stress. .
Sehirlioglu, Ali; Ozturk, Cagatay; Yazicioglu, Kamil; Tugcu, Ilknur; Yilmaz, Bilge; Goktepe, Ahmet Salim
This article reports an analysis of 75 consecutive lower limb amputees who developed painful neuroma requiring surgical excision after lower limb amputation following landmine explosions. This retrospective study analyses the results of 75 patients who were treated for painful neuroma after lower limb amputation following landmine explosions between the years 2000 and 2006. The average time period from use of prosthesis to start of symptoms suggesting neuroma was 9.6 months. The average time period from start of pain symptoms to neuroma surgery was 7.8 months. All clinically proven neuromas were surgically resected. In the mean follow-up of 2.8 years, all patients were satisfied with the end results and all were free of any pain symptoms. Painful stump with clinical diagnostic findings of neuroma described above may be regarded as neuroma without requiring any further imaging modalities and is an indication for surgery if conservative measures fail.
van Zeeland, Y R A; Lennox, A; Quinton, J F; Schoemaker, N J
Preputial tumours in ferrets are frequently malignant and therefore warrant prompt investigation. As many cases do not respond favourably to surgery, even in combination with radiation therapy, wide surgical resection has been recommended. Such a procedure may necessitate partial or total penile resection but outcomes have thus far not been well described. The current case series describes two ferrets in which surgical resection, including penile amputation, was performed using 10 and 5 mm margins, respectively. In the first case, no recurrence of preputial gland adenocarcinoma was noted for 32 months postsurgery, whereas multiple attempts at surgery and radiation therapy were unsuccessful in the second. These cases suggest that margins of at least 1 cm may help achieve a better outcome. Penile amputation for the treatment of preputial tumours appears to be well tolerated by ferrets, as demonstrated by these cases.
Wosnitzka, M; Papenhoff, M; Reinersmann, A; Maier, C
This case study is the first to report successful treatment of bilateral phantom limb pain (PLP) in a patient with bilateral thigh amputation and inefficacious medical treatment using a protocol of graded interventions including mirror therapy (MT). MT is a common treatment for PLP but requires the induction of a visual illusion of an intact limb in the mirror, usually achieved by mirroring the healthy extremity. Here, we illustrate how application of a unilateral prosthesis sufficed to induce the necessary illusion. After sequential imagery, then lateralization training, which alleviated pain attacks, the patient received a further 3-week treatment of mirror treatment. Pain intensity was reduced by more than 85 %; the number of attacks were decreased by more than 90% per day. The analgesic efficacy lasted until the unexpected death of the patient several months later. This case illustrates the mechanisms of MT through overcoming the sensory incongruences underlying the distorted body schema and its efficacy in patients with bilateral amputation.
Full Text Available Abstract Introduction Replantation of a limb to the contralateral stump after bilateral traumatic amputations is rare. To the best of our knowledge, there are only a few reports of crossover lower limb replantation in the literature. Case presentation We treated a 37-year-old Chinese woman with bilateral lower limb crush injuries sustained in a traffic accident. Her lower limb injuries were at different anatomic levels. We performed emergency bilateral amputations followed by crossover replantation. Five years later, the woman had recovered well, and had perfect movement and stability in her replanted leg. After reviewing the literature, we thought that presentation of our patient’s case might provide useful information for clinicians. Conclusions Crossover replantation should be considered when evaluating a patient with bilateral lower limb injuries, thus allowing the patient to touch the ground and stand using their own foot.
Wong, Caroline Ngar-Chi; Yu, Joseph Man-Kit; Law, Sheung-Wai; Lau, Herman Mun-Cheung; Chan, Cavor Kai-Ming
The devastating earthquake in Sichuan, China on 12 May 2008 left thousands of survivors requiring medical care and intensive rehabilitation. In view of this great demand, the Chinese Speaking Orthopaedic Society established the "Stand Tall" project to provide voluntary services to aid amputee victims in achieving total rehabilitation and social integration. This case report highlights the multidisciplinary rehabilitation of a girl who suffered thoracolumbar vertebral collapse and underwent bilateral transtibial amputation. The rehabilitation team was involved in all stages of the care process from the pre-operative phase, through amputation, into prosthetic training, and during her life thereafter. Despite this catastrophic event, early rehabilitation and specially designed bilateral prostheses allowed her a high level of functional ability. The joint efforts of the multidisciplinary team and the advancement of new technology have revolutionized the care process for amputees.
Voos, James E; Heyworth, Benton E; Piasecki, Dana P; Henn, R Frank; MacGillivray, John D
Bilateral traumatic knee dislocations are a rarity. We report a case of bilateral traumatic knee dislocations with concomitant right hip dislocation and complete traumatic amputation of the left, nondominant upper extremity at the level of the proximal one-third of the humerus. Angiograms revealed no evidence of popliteal artery injury. Orthopedic treatment consisted of immediate reduction of the dislocations and urgent revision amputation of the upper extremity. Staged, bilateral knee ligamentous reconstructions were performed on hospital days 24 and 29, respectively. Despite this constellation of devastating injuries, the patient had a satisfactory outcome. In patients with high-energy hip or knee dislocations, the bilateral hips and knees should be carefully examined to check for associated fractures and/or dislocations.
Strøm, M; Konge, L; Lönn, L;
BACKGROUND AND AIM: To evaluate the amputation-free survival after below the knee percutaneous transluminal angioplasty in a consecutive group of patients with critical ischemia of the lower extremity. MATERIALS AND METHODS: A total of 70 consecutive patients with critical ischemia were treated...... with below the knee percutaneous transluminal angioplasty at the vascular center at Rigshospitalet with the purpose of limb salvage. All patients were deemed unfit for major surgery due to anatomical limitations or severe co-morbidity, and no prior attempts of revascularization were performed. Follow...... within the first year. Complications after percutaneous transluminal angioplasty were rare. Cumulative mortality after 1 and 2 years was 22% and 34%, respectively. Amputation-free survival at 1 and 2 years of follow-up was 68% and 58%, respectively. There were no association between known risk factors...
Crenshaw, Jeremy R; Kaufman, Kenton R; Grabiner, Mark D
The purpose of this report is to provide novel findings from the kinematics of five amputees following a laboratory-induced trip. Only amputees with a unilateral, transfemoral or knee disarticulation amputation were included in this study. When the prosthesis was obstructed, all subjects used a lowering strategy, resulting in three harness-assisted recoveries and one fall. When the non-prosthetic limb was obstructed, one subject fell using an elevating strategy, one subject fell using a lowering strategy, and one subject, who was harness-assisted, used a hopping strategy. These results can be used to guide further studies of how to limit prosthetic knee flexion due to weight-bearing during a lowering strategy, implement compensatory step training to reduce fall risk, and identify appropriate, context-specific recovery strategies for people with transfemoral or knee disarticulation amputations.
Casale, Roberto; Maini, Maurizio; Bettinardi, Ornella; Labeeb, Alaa; Rosati, Vanessa; Damiani, Carlo; Mallik, Maryam
The rehabilitation of the amputated patient is based on a coordinated sequence of diagnostic, prognostic and therapeutic procedures carried out by an interdisciplinary rehabilitation team, that works globally on all patient problems. The objectives of the different phases of the rehabilitation treatment were reviewed. Due to their relevance in conditioning the final outcome of the treatment, aspects requiring further studies and remarks, were also reviewed. Among these the psychological aspects, the alterations of all sensory inputs, the secondary alterations at the bone, articular and muscular level, pain of the residual limb and the phantom limb. Finally, the basic criteria to be used to choose the kind of prosthesis in relation to the characteristics and expectations of the amputated person, and the results of the recovery of the autonomy and walking ability, will be schematically described.
Full Text Available Abstract The devastating earthquake in Sichuan, China on 12 May 2008 left thousands of survivors requiring medical care and intensive rehabilitation. In view of this great demand, the Chinese Speaking Orthopaedic Society established the "Stand Tall" project to provide voluntary services to aid amputee victims in achieving total rehabilitation and social integration. This case report highlights the multidisciplinary rehabilitation of a girl who suffered thoracolumbar vertebral collapse and underwent bilateral transtibial amputation. The rehabilitation team was involved in all stages of the care process from the pre-operative phase, through amputation, into prosthetic training, and during her life thereafter. Despite this catastrophic event, early rehabilitation and specially designed bilateral prostheses allowed her a high level of functional ability. The joint efforts of the multidisciplinary team and the advancement of new technology have revolutionized the care process for amputees.
... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Quarantine of diseased rabbits. 354... INSPECTION AND CERTIFICATION VOLUNTARY INSPECTION OF RABBITS AND EDIBLE PRODUCTS THEREOF Inspection Procedures; Ante-Mortem Inspections § 354.124 Quarantine of diseased rabbits. If live rabbits, which...
Crossley, D A
The lagomorphs most commonly encountered as pets are rabbits. There are many breeds of domestic rabbit, varying from dwarf varieties with an adult weight of under one kilogram to giants weighing 10 kg. This article provides a working knowledge of the dental anatomy and physiology of rabbits so that veterinarians can interpret clinical and radiographic findings when investigating rabbits with suspected dental disease.
Schirò, Giuseppe Rosario; Sessa, Sergio; Piccioli, Andrea; MACCAURO, Giulio
Background In the last decades a lot of new reconstructive techniques were developed for the treatment of mangled lower extremity. However failed attempt to limb salvage is related to high risk of mortality for the patient. Several scores were developed to establish guidelines for the decision to amputate or not, however in literature there is no consensus about the reliability of this scores. Methods The authors focused their attention on the most used score system to provide guidance of the...
Kumar M; Badole C; Patond K
Background: The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS) in severely injured lower limbs. Materials and Methods: Retrospectively 25 and prospectively 36 lower limbs in 58 patients with high-energy injuries were evaluated with the use of MESS, to assist in the decision-making process for the care of patients with such injuries. Difference between the mean MESS scores for amputated and salvaged limbs was analyzed. Results: ...
Mathias, Zoë; Harcourt, D
This study investigates experiences of dating and intimate relationships amongst women who use a below-knee prosthesis. Method: Four women took part in semi-structured online interviews. Transcripts were subject to interpretative phenomenological analysis (IPA). Results: Five themes were identified: Revealing and Exposing: Disclosing the Amputation and Prosthesis; Judging and Judged: Internal Fears and Self-Doubt; Trusting and Accepting: Good Guy/Bad Guy Elimination; Taking it Further: The Ne...
Assessment of Neuropathic Symptoms and Signs pain scale. It aims to differentiate neuropathic pain from somatic or nociceptive pain . The S-LANSS...LANSS is in differentiating neuropathic pain from nociceptive pain , which makes this instrument ideal for the proposed study. Thomas Buchheit, MD...Award Number: W81XWH-12-2-0129 TITLE: Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post-Amputation Pain PRINCIPAL
Chung, Christine B.; Mohana-Borges, Aurea; Pathria, Mini [Department of Radiology, UCSD and VAHCS, 3350 La Village Drive, La Jolla, CA 92161 (United States)
Gout is a common rheumatologic disorder that can have an unusual clinical presentation. This case report describes the development of a gouty tophus at a site of remote traumatic forearm amputation in a patient with chronic myelogenous leukemia (CML). It further addresses the imaging characteristics of tophaceous gout as well as the differential diagnostic considerations as regards both the imaging findings and the clinical presentation. (orig.)
Herr, Hugh M.; Grabowski, Alena M.
Over time, leg prostheses have improved in design, but have been incapable of actively adapting to different walking velocities in a manner comparable to a biological limb. People with a leg amputation using such commercially available passive-elastic prostheses require significantly more metabolic energy to walk at the same velocities, prefer to walk slower and have abnormal biomechanics compared with non-amputees. A bionic prosthesis has been developed that emulates the function of a biolog...
Rommers, G. M.; Groothoff, J. W.; Eisma, W.H.
Objective and design: A systematic literature review to compare mobility scales used for lower limb amputees. A literature search was carried out by computerized search of biomedical literature including Medline and Embase. The studies included were published between 1978 and 1998 and including the following keywords: amputation, artificial limbs, prosthesis, lower limb, activities of daily living, mobility. Results: Thirty-five studies were identified; 19 had a measurement of separate levels...
Illes, Jennifer D.; Maola, Chad J.
Objective The purpose of this case report is to describe the chiropractic management of a patient with a unilateral transfemoral amputation and low back pain (LBP). Clinical Features A 20-year-old woman with right transfemoral amputation and a right upper extremity amputation due to amniotic band syndrome had approximately 40 different prosthetic lower extremities in the prior 20 years. She presented for chiropractic care for LBP (5/10 numeric pain scale) that she experienced after receiving a new right prosthetic leg. The pain increased with walking, attempts to exercise, and lying supine. Physical evaluation revealed asymmetrical leg length (long right limb); restricted left ankle dorsiflexion; restricted lumbopelvic motion; and hypertonicity of the left triceps surae muscle complex as well as the gluteus maximus, quadratus lumborum, and erector spinae bilaterally. Gait examination revealed a right Trendelenberg gait as well as a pattern of left vaulting. The working diagnosis was sacroiliac joint dysfunction, with lumbar facet syndrome secondary to a leg length inequality causing alteration in gait. Intervention and Outcome Chiropractic management included manipulative therapy to the lumbar spine and pelvis, trigger point therapy of hypertonic musculature, and strengthening of pelvic musculature. In addition, the patient's prosthetist shortened her new prosthetic device. After 18 treatments, LBP severity was resolved (0/10); and there was an overall improvement with gait biomechanics. Conclusion This case illustrates the importance of considering leg length inequality in patients with amputations as a possible cause of lower back pain, and that proper management may include adjusting the length of the prosthetic device and strengthening of the hip flexors and abductors, in addition to trigger point therapy and chiropractic manipulation. PMID:23450067
Full Text Available Neurofibromas are uncommon benign tumours and are still rarer in intramuscular locations. They are not detected until they cause a significant damage to the neighbouring tissues. We present a case of a giant intramuscular myxoid neurofibroma of the left forearm which eroded the radius and ulna, restricting the movements at the elbow and wrist joints and causing wrist drop resulting in an above elbow amputation. It was diagnosed by histopathology and was later confirmed by immunohistochemistry.
Chennakeshaviah, Gururajaparasad; Ravishankar, Sunila; Maggad, Rangaswamy; Manjunath, G. V.
Neurofibromas are uncommon benign tumours and are still rarer in intramuscular locations. They are not detected until they cause a significant damage to the neighbouring tissues. We present a case of a giant intramuscular myxoid neurofibroma of the left forearm which eroded the radius and ulna, restricting the movements at the elbow and wrist joints and causing wrist drop resulting in an above elbow amputation. It was diagnosed by histopathology and was later confirmed by immunohistochemistry. PMID:23198230
Reed, Amy B; Delvecchio, Cindy; Giglia, Joseph S
Lower extremity revascularization is often described as excessively lesion-centric, with insufficient focus on the patient. We investigated patients' perspectives of multiple procedures for limb salvage that culminated in major lower extremity amputation. A prospective vascular surgery database was queried from January 2000 to December 2005 for patients who had undergone below-knee (BKA) or above-knee (AKA) amputation after failed lower extremity revascularization. Patients were surveyed via telephone by a vascular nurse regarding thoughts on undergoing multiple procedures for limb salvage, involvement in decision making, functional status (work, meal preparation, shopping, driving), use of prosthesis, and independence. The Social Security Death Index was utilized to verify patient survival. Amputations for infection were excluded. Seventy-eight patients underwent AKA or BKA after failed revascularization. Forty-six patients (59%) were alive at 5 years. Thirteen patients were lost to follow-up, leaving 33 available for survey. A total of 142 lower extremity revascularizations (median = 4/patient) were performed on these patients including 94 surgical bypasses (median = 3/patient) and 48 percutaneous interventions (median = 1/patient). Eighty-five percent (28 of 33 patients) of amputees surveyed would do everything to save the leg if faced with a similar scenario, regardless of the number of procedures. Fifty-four percent (18/33) of patients actively used a prosthesis, and 91% (30/33) resided at home. In retrospect, patients are willing to undergo multiple revascularizations--percutaneous or open--to attempt limb salvage even if the eventual result is major amputation. Independence and functional status appear to be obtainable in a majority of patients. Patient-oriented outcomes are necessary to guide revascularization, whether it is by a percutaneous or open technique.
Won, Yougun; Yang, Kyu-Hyun; Kim, Kwang-Kyoun; Weaver, M J; Allen, Elizabeth M
An entrapment of the femoral artery by cerclage wiring is a rare complication after spiral diaphyseal femoral fractures. We report the case of an 82-year-old female treated by an antegrade intramedullary nailing and multiple cable augmentation, which was then complicated by injury to the femoral artery that resulted in ipsilateral leg necrosis and amputation. The entrapment was caused by direct belting by the cable and resulted in a total obstruction of the femoral artery.
Mathieu, L; Gaillard, C; Mottier, F; Bertani, A; Rongiéras, F; Chauvin, F
Double hand amputation leads to complete loss of prehensive function and touch sense. Patients become totally dependent on others for survival. In developing countries, where sophisticated myoelectric prosthesis are not available, the Krukenberg procedure gives to these patients elementary self-sufficiency for daily-life. This procedure can be performed in low-resources setting and requires minimal rehabilitation. However, patient selection and preparation are critical because of an unattractive aesthetic aspect which limits this operation use in occidental countries.
Jørgensen, Line Bisgaard; Skov, Ole; Yderstræde, Knud
Peripheral vascular thromboembolism is a rarely described complication of diabetic ketoacidosis. We report a 41-year-old otherwise healthy man admitted with ketoacidosis and ischaemia of the left foot. The patient was unsuccessfully treated with thromboendarterectomy, and the extremity was ultimately amputated. The patient had no family history of cardiovascular disease, and all blood sample analyses for hypercoagulability were negative. We recommend an increased focus on peripheral thromboembolism, when treating patients with severe ketoacidosis.
Marlene Schoeman, PhD; Ceri E. Diss, PhD; Siobhan C. Strike, PhD
Loading symmetry during vertical jump landings between a person with amputation’s intact and prosthetic limbs was assessed to determine the role of each limb in controlling the downward momentum of the center of mass during landing. Six participants with unilateral transtibial amputation (TTA) and ten nondisabled participants completed 10 maximal vertical jumps, of which the highest jump was analyzed. Contralateral symmetry was assessed through the Symmetry Index (SI), while symmetry at the g...
Plantar rotational flap technique for panmetatarsal head resection and transmetatarsal amputation: a revision approach for second metatarsal head transfer ulcers in patients with previous partial first ray amputation.
Boffeli, Troy J; Reinking, Ryan
Transfer ulcers beneath the second metatarsal head are common after diabetes-related partial first ray amputation. Subsequent osteomyelitis of the second ray can further complicate this difficult situation. We present 2 cases depicting our plantar rotational flap technique for revision surgery involving conversion to either panmetatarsal head resection or transmetatarsal amputation (TMA). These cases are presented to demonstrate our indications, procedure selection criteria, flap technique, operative pearls, and staging protocol. The goals of this surgical approach are to excise and close the plantar ulcer beneath the second metatarsal head, remove any infected bone, allow staged surgery if needed, remove all remaining metatarsal heads to decrease the likelihood of repeat transfer ulcers, preserve the toes when practical, avoid excessive shortening of the foot, avoid multiple longitudinal dorsal incisions, and create a functional and cosmetically appealing foot. The flap is equally suited for either panmetatarsal head resection or TMA. The decision to pursue panmetatarsal head resection versus TMA largely depends on the condition of the remaining toes. Involvement of osteomyelitis in the base of the second proximal phalanx, the soft tissue viability of the remaining toes, the presence of a preoperative digital deformity, and the likelihood that saving the lesser toes will be beneficial from a cosmetic or footwear standpoint are factors we consider when deciding between panmetatarsal head resection and TMA. Retrospective chart review identified prompt healing of the flap in both patients. Neither patient experienced recurrent ulcers or required subsequent surgery within the first 12 months postoperatively.
de Carvalho, Anna Paula Martins; Lima, Juliana Ywasaki; Azevedo, Carolina Torres; Botta, Silvina; de Queiroz, Fábio Ferreira; Campos, Adélia Sepúlveda; Barbosa, Lupércio de Araújo; da Silveira, Leonardo Serafim
The estuarine dolphin, Sotalia guianensis, is one of the most abundant cetacean species in Brazil. Determination of age and of aspects associated with the development of this species is significant new studies. Counts of growth layer groups in dentin are used to estimate age of these animals, though other ways to evaluate development are also adopted, like the measurement of total length (TL). This study presents a procedure to evaluate the development of the estuarine dolphin based on the ossification pattern of forelimbs. Thirty-seven estuarine dolphins found in the state of Espírito Santo, Brazil, were examined. Age was estimated, TL was measured and ossification of epiphyses was examined by radiography. We analyzed results using the Spearman correlation. Inspection of radiographs allowed evaluation of the significance of the correlation between age and development of the proximal (r = 0.9109) and distal (r = 0.9092) radial epiphyses, and of the distal ulnar epiphyses (r = 0.9055). Radiographic analysis of forelimbs proved to be an appropriate method to evaluate physical maturity, and may be a helpful tool to estimate age of these animals in ecological and population studies.
The decision to amputate or salvage a severely injured limb can be very challenging to the trauma surgeon. A misjudgment will result in either an unnecessary amputation of a valuable limb or a secondary amputation after failed salvage. Numerous scores have been proposed to provide guidelines to the treating surgeon, the notable of which are Mangled extremity severity score (MESS); the predictive salvage index (PSI); the Limb Salvage Index (LSI); the Nerve Injury, Ischemia, Soft tissue injury, Skeletal injury, Shock and Age of patient (NISSSA) score; and the Hannover fracture scale-97 (HFS-97). These scores have all been designed to evaluate limbs with combined orthopaedic and vascular injuries and have a poor sensitivity and specificity in evaluating IIIB injuries. Recently the Ganga Hospital Score (GHS) has been proposed which is specifically designed to evaluate a IIIB injury. Another notable feature of GHS is that it offers guidelines in the choice of the appropriate reconstruction protocol. The basis of the commonly used scores with their utility have been discussed in this paper.
Full Text Available The decision to amputate or salvage a severely injured limb can be very challenging to the trauma surgeon. A misjudgment will result in either an unnecessary amputation of a valuable limb or a secondary amputation after failed salvage. Numerous scores have been proposed to provide guidelines to the treating surgeon, the notable of which are Mangled extremity severity score (MESS; the predictive salvage index (PSI; the Limb Salvage Index (LSI; the Nerve Injury, Ischemia, Soft tissue injury, Skeletal injury, Shock and Age of patient (NISSSA score; and the Hannover fracture scale-97 (HFS-97. These scores have all been designed to evaluate limbs with combined orthopaedic and vascular injuries and have a poor sensitivity and specificity in evaluating IIIB injuries. Recently the Ganga Hospital Score (GHS has been proposed which is specifically designed to evaluate a IIIB injury. Another notable feature of GHS is that it offers guidelines in the choice of the appropriate reconstruction protocol.The basis of the commonly used scores with their utility have been discussed in this paper.
Shahriar, S H; Masumi, M; Edjtehadi, F; Soroush, M R; Soveid, M; Mousavi, B
This study was conducted to determine the cardiovascular risk factors among 327 Iranian males with bilateral lower limb amputation.The average age at the time of amputation and at the time of the study was 20.6 (SD = 5.4) and 42 years (SD = 6.3), respectively. Below both knees was the most common level of amputation (37.6%). About 95.4% had at least one modifiable risk factor. Prevalence of risk factors included: hyperglycemia 13.1%, systolic hypertension 18.9%, diastolic hypertension 25.6%, abdominal obesity 82.5%, high total cholesterol 36.7%, low HDL 25.9%, high LDL 24.7%, high triglycerides 32.1%, and smoking 31.8%. The most common risk factor was abdominal obesity. Prevalence of coronary artery disease was similar to the general Iranian population but prevalence of risk factors was higher significantly. The majority of the cases seem to be susceptible to cardiovascular disease in near future. Some strategies are needed as a primary prevention to reduce the risk of cardiovascular disease.
Herr, Hugh M.; Grabowski, Alena M.
Over time, leg prostheses have improved in design, but have been incapable of actively adapting to different walking velocities in a manner comparable to a biological limb. People with a leg amputation using such commercially available passive-elastic prostheses require significantly more metabolic energy to walk at the same velocities, prefer to walk slower and have abnormal biomechanics compared with non-amputees. A bionic prosthesis has been developed that emulates the function of a biological ankle during level-ground walking, specifically providing the net positive work required for a range of walking velocities. We compared metabolic energy costs, preferred velocities and biomechanical patterns of seven people with a unilateral transtibial amputation using the bionic prosthesis and using their own passive-elastic prosthesis to those of seven non-amputees during level-ground walking. Compared with using a passive-elastic prosthesis, using the bionic prosthesis decreased metabolic cost by 8 per cent, increased trailing prosthetic leg mechanical work by 57 per cent and decreased the leading biological leg mechanical work by 10 per cent, on average, across walking velocities of 0.75–1.75 m s−1 and increased preferred walking velocity by 23 per cent. Using the bionic prosthesis resulted in metabolic energy costs, preferred walking velocities and biomechanical patterns that were not significantly different from people without an amputation. PMID:21752817
Noah J. Rosenblatt, PhD
Full Text Available People with amputation are at increased risk of falling compared with age-matched, nondisabled individuals. This may partly reflect amputation-related changes to minimum toe clearance (MTC that could increase the incidence of trips and fall risk. This study determined the contribution of an active dorsiflexing prosthesis to MTC. We hypothesized that regardless of speed or incline the active dorsiflexion qualities of the ProprioFoot would significantly increase MTC and decrease the likelihood of tripping. Eight people with transtibial amputation walked on a treadmill with their current foot at two grades and three velocities, then repeated the protocol after 4 wk of accommodation with the ProprioFoot. A mixed-model, repeated-measures analysis of variance was used to compare MTC. Curves representing the likelihood of tripping were derived from the MTC distributions and a multiple regression was used to determine the relative contributions of hip, knee, and ankle angles to MTC. Regardless of condition, MTC was approximately 70% larger with the ProprioFoot (p < 0.001 and the likelihood of tripping was reduced. Regression analysis revealed that MTC with the ProprioFoot was sensitive to all three angles, with sensitivity of hip and ankle being greater. Overall, the ProprioFoot may increase user safety by decreasing the likelihood of tripping and thus the pursuant likelihood of a fall.
Dragu, A; Hohenberger, W; Lang, W; Schmidt, J; Horch, R E
Total forearm free flap procedures after forequarter amputations have been sparsely described in the literature. Using the amputated arm as a "free filet flap" remains a viable surgical option after radical forequarter amputations performed for the resection of large, invasive tumors of the shoulder or thoracic wall region. Using the forequarter specimen as a donor site seems favorable in that it eliminates the usual donor site morbidity. Nevertheless, in our patient with invasive ductal carcinoma of the breast and a fibrosarcoma suffering from severe pain and septic conditions - which failed to respond properly to conservative therapy - as well as rapidly progressive tumor ulceration despite repeated radiation therapy, we decided to attempt complete tumor removal by hemithoracectomy as a last resort. This decision was taken following multiple interdisciplinary consultations and thorough patient information. Although technically feasible with complete tumor removal and safe soft tissue free flap coverage, the postoperative course raises questions about the advisability of such ultra radical surgical procedures, as well as about the limitations of respiratory recovery after hemithoracectomy with removal of the sternum. Hence, based on our experience with such radical tumor surgery, we discuss the issues of diminished postoperative pulmonary function, intensive care possibilities and ethical issues. The English full-text version of this article is available at SpringerLink (under "Supplemental").
Rosenblatt, Noah J; Bauer, Angela; Rotter, David; Grabiner, Mark D
People with amputation are at increased risk of falling compared with age-matched, nondisabled individuals. This may partly reflect amputation-related changes to minimum toe clearance (MTC) that could increase the incidence of trips and fall risk. This study determined the contribution of an active dorsiflexing prosthesis to MTC. We hypothesized that regardless of speed or incline the active dorsiflexion qualities of the ProprioFoot would significantly increase MTC and decrease the likelihood of tripping. Eight people with transtibial amputation walked on a treadmill with their current foot at two grades and three velocities, then repeated the protocol after 4 wk of accommodation with the ProprioFoot. A mixed-model, repeated-measures analysis of variance was used to compare MTC. Curves representing the likelihood of tripping were derived from the MTC distributions and a multiple regression was used to determine the relative contributions of hip, knee, and ankle angles to MTC. Regardless of condition, MTC was approximately 70% larger with the ProprioFoot (p < 0.001) and the likelihood of tripping was reduced. Regression analysis revealed that MTC with the ProprioFoot was sensitive to all three angles, with sensitivity of hip and ankle being greater. Overall, the ProprioFoot may increase user safety by decreasing the likelihood of tripping and thus the pursuant likelihood of a fall.
Betz, A; Stock, W; Hierner, R; Sebisch, E; Schweiberer, L
A 66-year-old patient attempted suicide by jumping in front of a train. The lower extremities were amputated at different levels. On the right side, there was a complete amputation within the distal third of the lower leg. Proximal to the amputation site, there was an extensive soft-tissue and bone defect. On the left side, there was a crush injury of the tarsal and mid-tarsal bones. The left lower leg showed only few injuries. An ipsilateral (anatomical) replantation was not possible. In order to save one lower extremity, we decided to carry out a cross-over (contralateral) replantation of the right foot to the left lower leg. After a follow-up of six years, the patient is able to walk well with her prosthesis on the right side and the right foot hooked up to the left lower leg. Functionally, this treatment (cross-over replantation-one-side prosthesis of the lower leg) is much better than the prosthesis on both extremities, as the result has shown. Also from a psychological point of view, it seems to be better for the patient to preserve one extremity even with a cross-over replanted foot.
Moura Neto, Arnaldo; Zantut-Wittmann, Denise Engelbrecht; Fernandes, Tulio Diniz; Nery, Marcia; Parisi, Maria Candida Ribeiro
Treatment strategies for foot at risk and diabetic foot are mainly preventive. Studies describing demographic data, clinical and impacting factors continue to be, however, scarce. Our objective was to determine the epidemiological presentation of diabetic foot and understand whether there were easily assessable variables capable of predicting the development of diabetic foot. This was a retrospective study of 496 patients with established foot at risk or diabetic foot, who were evaluated based on age, gender, type and duration of diabetes, foot at risk classification, and the presence of deformities, ulceration, and amputation. The presence of deformities, ulceration, and amputation was recorded in 45.9, 25.3, and 12.9 % of patients, respectively. As for diabetic foot classification, the great majority of our cohort had diabetic neuropathy (92.9 %). Approximately 30 % had neuro-ischemic disease and only 7.1 % had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy. Foot classification was as a significant predictor for the presence of ulcer (p = 0.009; OR = 3.2; 95 % CI = 1.18-7.3). Only male gender was a significant predictor for ulceration (p diabetic foot (p diabetic foot were male gender and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease adds significantly to the risk for amputation among patients with the diabetic foot syndrome. Men, presenting combined risk factors, should be a group receiving special attention and in the foot clinic, due to their potentially worse evolution.
Mehmet Veli Karaaltin
Full Text Available Ischaemia period is the most important factor among those affecting success chance in replantation outcomes of major amputations. The excess amount of muscle tissue in amputation reduces critical ischaemia period and increases the risk for development of ischaemia-reperfusion damage. A significant increase is observed in tissue necrosis due to ischaemia-reperfusion damage even if cell death and circulation in tissue are provided after exceeding critical ischaemia period. There is a common consensus for especially protecting amputation materials in a hypothermic environment in order to prevent ischaemia-reperfusion damage. There are various methods to reduce ischaemia period which has a significant importance for increasing replantation success. We assert that the success is significantly increased when circulation is provided within the first hour by placing temporary feeding catheter on a reciprocal way as artery to artery and vein to vein before bone fixation as in our case presented in this report. [Hand Microsurg 2012; 1(1.000: 37-39
Barbara E. Bates, MD, MBA
Full Text Available This study’s objective was to determine how treatment-, environmental-, and facility-level characteristics contribute to postdischarge mortality prediction. The study included 4,153 Veterans who underwent lower-limb amputation in Department of Veterans Affairs facilities during fiscal years 2003 and 2004. Veterans were followed 1 yr postamputation. A Cox regression identified characteristics associated with mortality risk after hospital discharge following amputation. Older age, higher amputation level, and more comorbidities increased mortality likelihood. Patients who had inpatient procedures for pulmonary and renal problems had higher hazards of postdischarge death than those who did not (hazard ratio [HR] = 2.10, 95% confidence interval [CI] = 1.16–3.77, and HR = 2.22, 95% CI = 1.80–2.74, respectively. Patients who had central nervous system procedures had higher hazards of death early postdischarge (HR = 2.23, 95% CI = 1.60–3.11 at 0 d, but this association became insignificant by 180 d. Patients in a surgical intensive care unit (ICU, medical ICU, or medical bed section at the time of discharge were more likely to die than patients on a surgical bed section. Patients hospitalized in the Midwest were less likely to die early after discharge than patients in the Mountain Pacific region, but this regional effect became insignificant by 90 d. Adding treatment-, environmental-, and facility-level characteristics contributed additional information to a mortality risk model.
M. T. Karimi
Full Text Available Background. Hemipelvectomy amputation is a surgical procedure in which lower limb and a portion of pelvic are removed. There are a few studies in the literature regarding the performance of subjects with hip disarticulation during walking. However, there is no study on gait analysis of hemipelvectomy subject. Therefore, the aim of this paper was to evaluate the gait and stability of subject with hemipelvectomy amputation. Case Description and Methods. A subject with hemipelvectomy amputation at right side was involved in this study. He used a Canadian prosthesis with single axis ankle joint, 3R21 knee joint, and 7E7 hip joint for more than 10 years. The kinetic and kinematic parameters were collected by a motion analysis system and a Kistler force platform. Findings and Outcomes. There was a significant difference between knee, hip, and ankle range of motions and their moments in the sound and prosthesis sides. In the other side, the stability of the subject in the anteroposterior direction seems to be better than that in the mediolateral direction. Conclusions. There was a significant asymmetry between the kinetic and kinematic performance of the sound and prosthesis sides, which may be due to lack of muscular power and alignment of prosthesis components.
Herr, Hugh M; Grabowski, Alena M
Over time, leg prostheses have improved in design, but have been incapable of actively adapting to different walking velocities in a manner comparable to a biological limb. People with a leg amputation using such commercially available passive-elastic prostheses require significantly more metabolic energy to walk at the same velocities, prefer to walk slower and have abnormal biomechanics compared with non-amputees. A bionic prosthesis has been developed that emulates the function of a biological ankle during level-ground walking, specifically providing the net positive work required for a range of walking velocities. We compared metabolic energy costs, preferred velocities and biomechanical patterns of seven people with a unilateral transtibial amputation using the bionic prosthesis and using their own passive-elastic prosthesis to those of seven non-amputees during level-ground walking. Compared with using a passive-elastic prosthesis, using the bionic prosthesis decreased metabolic cost by 8 per cent, increased trailing prosthetic leg mechanical work by 57 per cent and decreased the leading biological leg mechanical work by 10 per cent, on average, across walking velocities of 0.75-1.75 m s(-1) and increased preferred walking velocity by 23 per cent. Using the bionic prosthesis resulted in metabolic energy costs, preferred walking velocities and biomechanical patterns that were not significantly different from people without an amputation.
Full Text Available The review starts with the description of the rabbits’ (Oryctolagus cuniculus main habits and the current situation concerning the rabbit husbandry and management systems, as well as their effects on the welfare of these animals. As far as the intensive rabbit husbandry systems are concerned, the main problems are related to the time since rabbits have been domesticated and their adaptive capacity and coping styles as respects the farming environment and management systems. Both these aspects have implications in the present and future of rabbit rearing for different purposes. Examples are given on the effects of different housing and management systems on rabbit welfare, as well as examples of the ethological, physiological and productive indicators used to evaluate these effects. Transportation and, more generally, preslaughter phases including catching, fasting and lairage at the abattoir are considered major stressors for farmed rabbits and might have deleterious effects on health, well-being, performance, and finally, product quality. A general statement of the recent scientific studies considering the effects of pre-slaughter factors on physiological and productive measurements are reported. Finally, some indications in order to improve rabbit welfare, already present at the European level, are also outlined, together with the European Food Safety Authority opinions.
Full Text Available The paper presents the most important parasitic infections of wild rabbits and hares, which harmful effect in this animal population is manifested as a gradual weakening of the immune system, reduction in fertility, weight loss and constant exhaustion. Order of Lagomorpha (hares or lagomorphs belongs to superorder of higher mammals which includes the family of rabbits (Leporidae which are represented in Europe as well as the family of whistleblowers (Ochotonidae which live only in North America and Northern regions of Asia. The most important representatives of Leporidae family are European hare (Lepus europeus and wild rabbit (Oryctolagus cuniculus. The most important endoparasitosis of hares and wild rabbits are: coccidiosis, encephalitozoonosis (nosemosis, toxoplasmosis, sarcocystosis, giardiasis, cryptosporidiosis, protostrongylosis, trichostrngylodosis, passalurosis, anoplocephalidosis, cysticercosis and fasciolosis. The most frequent ectoparasites of rabbits and wild hares are fleas, lice and ticks. Reduction in hare population, which is noticed in whole Europe including Serbia, is caused by changed living conditions, quantitatively and qualitatively insufficient nutrition, increased use of herbicides as well as various infectious diseases and the diseases of parasitic etiology. Since wild rabbits and hares pose a threat to health of domestic rabbits and people, knowledge of parasitic fauna of these wild animals is of extreme epizootiological and epidemiological importance.
Full Text Available Abstract Background Rabbit syndrome is a movement disorder that is associated with long-term exposure to neuroleptic medications. Of particular interest and importance is the risk of rabbit syndrome with exposure to the newer atypical antipsychotics. Our recent experience with such a case brought to light the importance of exploring this risk. Methods MEDLINE and PubMed (1972–2006 databases were searched for English language articles using the keywords rabbit syndrome, tardive dyskinesia, antipsychotic, extrapyramidal symptoms and side effects. A recent case study is used to expand upon the literature available on newer antipsychotics and rabbit syndrome. Results We reviewed papers that addressed the following aspects of rabbit syndrome 1 the clinical manifestations 2 prevalence and risk factors, 3 etiopathogenesis 4 older antipsychotics and rabbit syndrome 5 newer antipsychotics, 6 treatment options. Moreover, we report a case of RS in a 50 year old white female, diagnosed with bipolar I disorder, that, after the discontinuation of risperidone, developed involuntary movements of the mouth that were fine, rhythmic and rapid, along the vertical axis, and without involvement of the tongue. After the re-introduction of risperidone, the symptoms decreased in a few hours and disappeared after 3 days. Conclusion Eleven cases of rabbit syndrome have been documented since the implementation of newer antipsychotics. Future research is needed to better understand the etiopathogenesis of rabbit syndrome in psychiatric populations treated with the atypical antipsychotics. Understanding the differences and similarities of rabbit syndrome and tardive dyskinesia is crucial to the creation of a successful treatment paradigm.
Biggins, D.E.; Biggins, D.M.
We observed an attack by a bobcat (Lynx rufus) on a cottontail rabbit (Sylvilagus) that involved stealthy approach by the cat for >1 h, followed by a 12.3-s chase covering 116.0 m for the cat and 128.4 m for the rabbit. During the chase, the route of the cat from starting point to kill site was more direct than the semi-circular route of the rabbit. Stride lengths for the cat and total distance covered by the chase were longer than those previously reported for bobcats.
Chang, J; Jones, N F
From 1995 to 2000, five microvascular toe-to-hand transfers were performed in three children who were simultaneously undergoing lower extremity amputations. Their ages at time of transfer ranged from 4 to 10 years and the types of lower extremity amputation included toe amputation, foot amputation and through-knee amputation. The resulting toe-to-hand transfers included three great toe-to-thumb transfers and one combined great and second toe-to-hand transfer. The toe-to-hand transfers were all successful and all the lower extremity amputations healed without complications. In all cases, improved hand function and lower extremity function was noted by the families. These unique cases represent the ultimate use of spare parts in congenital hand surgery.
Hwang, Jae Ha; Kim, Kwang Seog; Lee, Sam Yong
Despite the frequent use of the fibular free flap, there have been no reports of severe compartment syndrome of the donor leg that necessitated limb amputation. A 66-yr-old man had a fibular osseous free flap transfer from the left leg to the mandible that was complicated by postoperative compartment syndrome. An extensive chronic leg wound resulted, which was treated with multiple debridements and finally with below-knee amputation. Successful coverage of the below-knee amputation stump was ...
张铭钧; 刘晓白; 徐建安; 储定慧; 闫娜
为探讨水翼法推进方式,进行了海龟柔性前肢仿生技术研究.基于水翼法运动解析,研究了海龟柔性水翼的弦向形变特征、反卡门涡街脱泻及斯特劳哈尔数等,推算出水翼尾涡脱泻的斯特劳哈尔数位于0.2～0.45之间,雷诺数位于3×102～3×104之间;根据海龟水翼粘弹本构特性,研制了半骼式仿生柔性水翼,并对其进行柔性形变和组织模态分析.通过水下仿生实验平台进行了半骼式柔性水翼和全骼式刚性水翼推进的直航、转艏性能对比实验,实验结果显示,虽然柔性水翼只有在较高ω1值拍动时的推进效率才高于刚性水翼,但其速度增长率却始终高于刚性水翼:并且随着ω1值的增长,柔性水翼对于样机速度减振方面的作用一直存在且越来越明显.实验研究结果为柔性水翼操纵与控制研究提供了技术基础.%In order to investigate the hydrofoil propulsion method, the bionic technology of the turtle's flexible forelimbs is studied. Based on the kinematical analysis of turtle hydrofoil, the chordwise deformation characteristics, the reverse Kurman vortex street shedding, and the Strouhal number of flexible hydrofoil are studied, and then it is calculated that the Strouhal number is between 0.2 and 0.45, the Reynolds number is from 3× 102 to 3× 104. According to the viscoelastic constitutive property of turtle hydrofoil, the half-iliac bionic flexible hydrofoil is developed, and its flexible deformation as well as tissue mode are analyzed. By use of the underwater bionic experimental sample, the direct navigation and yawing performance contrast tests of bionic sample with the half-iliac flexible hydrofoil and whole-iliac rigid hydrofoil are conducted respectively.The experiments' results show that, however the propulsion efficiency of flexible hydrofoil is higher than the rigid one only moving at the high value of ω1, the sample's acceleration when propelled by the flexible hydrofoil
Full Text Available OBJECTIVE: The clinical implication of the coronary artery calcium score (CS is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes. METHODS AND RESULTS: Eighty-two patients with symptomatic peripheral artery disease (age 61.0±12.4 years were followed for 21±11 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03. During the follow-up period (21±11 months, 29 (35% patients underwent amputation, and 24 (29% patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88-fold (95% confidence interval [CI] 1.18-12.72, p = 0.03 and a 5.16-fold (95% CI 1.13-21.61, p = 0.04 higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment. CONCLUSION: Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and all-cause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.
Ayaz, Saeed B; Mansoor, Sahibzada N; Qureshi, Ali R; Fahim, Muhammad
Introduction The Pakistan military has been actively engaged in the war against terror for more than a decade. Many officers and soldiers have lost their limbs in this war. But the data on traumatic lower limb amputations in Pakistan is sparse. The aim of this study is to prospectively document the epidemiological profile of lower limb military amputees presenting at the largest rehabilitation centre of Pakistan over a three-year period. Materials & methods A prospective three-year survey was conducted at the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Pakistan. One hundred twenty-three consecutive patients with lower limb amputations were enrolled in the survey. The demographic data, etiology, associated injuries, complications profile, and type of prosthesis provided were documented. The data analysis was done using the statistical analysis tool SPSS V 20 (IBM®,NY, USA). Results All patients were male. Most had traumatic amputation (119), were between 20–40 years (106), with unilateral amputation (115). Mine blast injury was the leading cause in 73 (59.3%) and most (58.5%) were fitted with modular prosthesis. Transtibial amputation was the commonest level (65), followed by transfemoral (30). The time of surgical amputation was not documented in 87% of the patients. Half of the patients (54%) had associated injuries. Seventy-nine patients had at least one complication with phantom pain being the commonest in 25% cases. Conclusions This is the largest prospective demographic survey of lower limb amputees in Pakistan military to date. Scores of soldiers and civilians in Pakistan have suffered lower limb amputation. The availability of demographic data can improve the trauma and rehabilitation services for better understanding and management of such cases. There is a need to conduct large scale community-based epidemiological surveys to direct future policies and develop amputee rehabilitation services in the public sector. PMID:27186448
Jones, W. Schuyler; Patel, Manesh R.; Dai, David; Subherwal, Sumeet; Stafford, Judith; Calhoun, Sarah; Peterson, Eric D.
Objectives We sought to characterize temporal trends, patient-specific factors and geographic variation associated with amputation in patients with lower extremity peripheral artery disease (LE PAD) during the study period. Background Amputation represents the end stage failure for those with LE PAD and little is known about the rates and geographic variation in use of LE amputation. Methods Using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000 to December 31, 2008, we examined national patterns of LE amputation among patients 65 years or older with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors. Results Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation declined from 7,258 per 100,000 PAD patients to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI, 0.95-0.95, p<0.001). Conclusions From 2000 to 2008, LE amputation rates decreased significantly among PAD patients. There however remains significant patient and geographic variation in amputation rates across the United States. PMID:23103040
Full Text Available The objective of the experiment was to evaluate the light colour preference of growing rabbits placed in a free-choice cage. The experiment was carried out on 128 Pannon White growing rabbits weaned at the age of 5 weeks and placed into blocks (2m2 of four cages. The rabbits could move freely among the four cages (0.5m2 each through swing doors. The cages differed only in the colour of the light applied (white, yellow, green or blue. The lighting schedule was 16L: 8D. From 6 until 10 weeks of age, infrared video recording was performed once a week (24 hours. The number of rabbits in each cage was counted every 15 minutes. Feed consumption was measured weekly. Between 6 and 10 weeks of age the rabbits significantly preferred white light (28.0%. The preference order was the following: yellow (26.3%, blue (23.4% and green (22.3% (P<0.001. No significant differences were recorded in the feed consumption among the cages. In conclusion, the cage preference of the rabbits was slightly affected by the light colour.
Seekamp, A; Regel, G; Ruffert, S; Ziegler, M; Tscherne, H
In IIIB and IIIC type open tibial fractures (according to Gustilo) the primary decision that has to be made regarding therapy is wether or not the limb can be salvaged. To standardize the criteria for amputation different salvage scores have been established in recent years. In this study the Hannover Fracture Scale (HFS), the Predictive Salvage Index (PSI), the Mangled Extremity Severity Score (MESS) and the NISSSA score were evaluated regarding their clinical relevance. When ROC Analysis was performed for all these scores in our patients the HFS revealed the highest sensitivity (0.91), but low specificity (0.71). The highest specificity was noted for the MESS (0.97), which in parallel showed the lowest sensitivity (0.59). In general it seems to be essential to make the right decision initially in order to avoid secondary amputation. All the scores mentioned here appear to be helpful in decision making. Salvaged limbs in IIIB and IIIC fractures presented a comparable good outcome, whereas salvaged IIIC injuries with a high score presented an outcome which was as bad as in secondary amputations. Secondary amputated patients required not only significant longer hospitalization but also resulted in poor outcome compared with the patients having received reconstruction or primary amputation.
Hagberg, K; Brånemark, R
Individuals with unilateral trans-femoral amputations due to non-vascular causes were studied in a mailed survey designed to investigate health-related quality of life (HRQL), prosthetic use and problems. The Swedish SF-36 Health Survey and a structured questionnaire designed for trans-femoral amputees were used. The series consisted of 97 subjects (60 men, 37 women), aged 20 to 69 years with a mean of 22 years since the amputation. Trauma was the cause of amputation in 55%, tumour in 35% and other causes in 10%. Ninety-two (92) subjects (95%) had a prosthesis and 80 (82%) used it daily. General HRQL was significantly lower than Swedish age- and gender-matched norms in all dimensions as measured by SF-36. Most frequently reported problems that had led to reduction in quality of life were heat/sweating in the prosthetic socket (72%), sores/skin irritation from the socket (62%), inability to walk in woods and fields (61%) and inability to walk quickly (59%). Close to half were troubled by stump pain (51%), phantom limb pain (48%), back pain (47%) and pain in the other leg (46%). One fourth considered themselves to have a poor or extremely poor overall situation. Transfemoral amputation, due to non-vascular causes, has an evident impact on quality of life and there are considerable problems related to the amputation and the prosthesis. Efforts to improve the physical and the psychological well-being for this group, with a long life expectancy, are needed.
Açikel, C; Peker, F; Akmaz, I; Ulkür, E
Thermal injury to the lower extremity sometimes necessitates amputation around the knee joint. Knee function is so critical to prosthetic rehabilitation that every attempt should be made to salvage the knee joint. This report presents an unusual case of bilateral lower extremity flame burn requiring amputations. While the distal two-thirds of the legs and both feet were totally necrotic, the thermal damage was limited to skin and subcutaneous tissue sparing muscle and bone in the proximal one-third of the legs and posterior thighs. The below-knee amputation level was salvaged by muscle transposition over the anterior tibia and resurfacing of muscle cuffs with thick split-thickness skin grafts. The post-operative period was uneventful. Amputation stumps tolerated the below-knee prosthesis well and the patient attained independent functional prosthetic ambulation at the post-operative fourth month. It is known from the reconstruction of the plantar foot that skin-grafted muscle tissue tolerates weight bearing and shearing forces well. This principle can also be used for salvage aspects of the below-knee amputation level.
Dillon, Michael P; Barker, Timothy M
Our understanding of the gait mechanics of persons with partial foot amputation and the influence of prosthetic intervention has been limited by the reporting of isolated gait parameters in specific amputation levels and limited interpretation and discussion of results. This observational study aimed to more completely describe the gait patterns of persons with partial foot amputation wearing their existing prosthesis and footwear in comparison with a nonamputee control group. Major adaptations occurred once the metatarsal heads were compromised. Persons with transmetatarsal and Lisfranc amputation who were wearing insoles and slipper sockets maintained the center of pressure behind the end of the residuum until after contralateral heel contact. This gait pattern may be a useful adaptation to protect the residuum, moderate the requirement of the calf musculature, or compensate for the compliance of the forefoot. Power generation across the affected ankle was virtually negligible, necessitating increased power generation across the hip joints. The clamshell devices fitted to the persons with Chopart amputation restored their effective foot length and normalized many aspects of gait. These persons' ability to adopt this gait pattern may be the result of the broad anterior shell of the socket, a relatively stiff forefoot, and immobilization of the ankle. The hip joints still contributed significantly to the power generation required to walk.
Gotman, Irena; Zaretzky, Asaph; Psakhie, Sergey G.; Gutmanas, Elazar Y.
The research aim was to evaluate the bone regeneration capability of novel load-bearing NiTi alloy (Nitinol) scaffolds in a critical-size defect (CSD) model. High strength "trabecular Nitinol" scaffolds were prepared by PIRAC (Powder Immersion Reaction Assisted Coating) annealing of the highly porous Ni foam in Ti powder at 900°C. This was followed by PIRAC nitriding to mitigate the release of potentially toxic Ni ions. Scaffolds phase composition and microstructure were characterized by X-ray diffraction and scanning electron microscopy (SEM/EDS), and their mechanical properties were tested in compression. New Zealand white rabbits received bone defect in right radius and were divided in four groups randomly. In the control group, nothing was placed in the defect. In other groups, NiTi scaffolds were implanted in the defect: (i) as produced, (ii) loaded with bone marrow aspirate (BMA), and (iii) biomimetically CaP-coated. The animals were sacrificed after 12 weeks. The forelimbs with scaffolds were resected, fixed, sectioned and examined in SEM. New bone formation inside the scaffold was studied by EDS analysis and by the processing of backscattered electron images. Bone ingrowth into the scaffold was observed in all implant groups, mostly next to the ulna. New bone formation was strongly enhanced by BMA loading and biomimeatic CaP coating, the bone penetrating as much as 1-1.5 mm into the scaffold. The results of this preliminary study demonstrate that the newly developed high strength trabecular Nitinol scaffolds can be successfully used for bone regeneration in critical size defects.
Gotman, Irena, E-mail: firstname.lastname@example.org; Gutmanas, Elazar Y., E-mail: email@example.com [Department of Materials Science and Engineering, Techion-Israel Institute of Technology, Haifa, 32000 Israel (Israel); National Research Tomsk Polytechnic University, Tomsk, 634050 (Russian Federation); Zaretzky, Asaph [The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, 31096 Israel (Israel); Psakhie, Sergey G. [National Research Tomsk Polytechnic University, Tomsk, 634050 (Russian Federation); Institute of Strength Physics and Materials Science SB RAS, Tomsk, 634055 (Russian Federation)
The research aim was to evaluate the bone regeneration capability of novel load-bearing NiTi alloy (Nitinol) scaffolds in a critical-size defect (CSD) model. High strength “trabecular Nitinol” scaffolds were prepared by PIRAC (Powder Immersion Reaction Assisted Coating) annealing of the highly porous Ni foam in Ti powder at 900°C. This was followed by PIRAC nitriding to mitigate the release of potentially toxic Ni ions. Scaffolds phase composition and microstructure were characterized by X-ray diffraction and scanning electron microscopy (SEM/EDS), and their mechanical properties were tested in compression. New Zealand white rabbits received bone defect in right radius and were divided in four groups randomly. In the control group, nothing was placed in the defect. In other groups, NiTi scaffolds were implanted in the defect: (i) as produced, (ii) loaded with bone marrow aspirate (BMA), and (iii) biomimetically CaP-coated. The animals were sacrificed after 12 weeks. The forelimbs with scaffolds were resected, fixed, sectioned and examined in SEM. New bone formation inside the scaffold was studied by EDS analysis and by the processing of backscattered electron images. Bone ingrowth into the scaffold was observed in all implant groups, mostly next to the ulna. New bone formation was strongly enhanced by BMA loading and biomimeatic CaP coating, the bone penetrating as much as 1–1.5 mm into the scaffold. The results of this preliminary study demonstrate that the newly developed high strength trabecular Nitinol scaffolds can be successfully used for bone regeneration in critical size defects.
Cheng, Lijia; Lu, Xiaofeng; Shi, Yujun; Li, Li; Xue, Jing; Zhang, Li; Xia, Jie; Wang, Yujia; Zhang, Xingdong; Bu, Hong
Bone tissue engineering (BTE) is approached via implantation of autogenous mesenchymal stem cells (MSCs), marrow cells, or platelet-rich plasma, etc. To the contrary, gene therapy combining with the bone marrow (BM) has not been often reported. This study was performed to investigate whether a modified BTE method, that is, the BM and a recombinant human bone morphogenetic protein-2 adenovirus (Ad.hBMP-2) gene administering in hydroxyapatite/β-tricalcium phosphate (HA/β-TCP) ceramics could accelerate the healing of segmental defects in the rabbit radius. In our study, ceramics were immersed in the adenovirus overnight, and half an hour before surgery, autologous BM aspirates were thoroughly mixed with the ceramics; at the same time, a 15-mm radius defect was introduced in the bilateral forelimbs of all animals, after that, this defect was filled with the following: (1) Ad.hBMP-2 + HA/β-TCP + autologous BM (group 1); (2) HA/β-TCP + Ad.hBMP-2 (group 2); (3) HA/β-TCP alone (group 3); (4) an empty defect as a control (group 4). Histological observation and μ-CT analyses were performed on the specimens at weeks 2, 4, 8, and 12, respectively. In group 1, new bone was observed at week 4 and BM appeared at week 12, in groups 2 and 3, new bone was observed at week 8 and it was more mature at week 12, in contrast, the defect was not bridged in group 4 at week 12. The new bone area percentage in group 1 was significantly higher than that in groups 2 and 3. Our study indicated that BM combined with hBMP-2 adenovirus and porous ceramics could significantly increase the amount of newly formed bone. And this modified BTE method thus might have potentials in future clinical application.
Zheng, Tao; Parkes, John P
Rabbit haemorrhagic disease (RHD) is an acute fatal disease of domestic and wild European rabbits (Oryctolagus cuniculus) caused by RHD virus (RHDV). Accurate assessment of immunity is of great importance for the conservation and control of wild rabbits. We evaluated a competitive ELISA (cELISA) against isotype ELISAs for assessing the protective immunity against the disease by challenging 50 wild-caught rabbits with a lethal dose of RHDV. Death or survival to the challenge was used as a criterion to determine the performance characteristics of the assay for the assessment of immunity in rabbits. At 1:10 dilution, a serum exhibiting ≥ 25% inhibition (1:10(25)) was regarded as the presence of RHDV-specific antibodies. Eleven of 16 (68.8%) rabbits with antibodies at 1:10(25) (rabbit calicivirus, which interfered with isotype ELISAs, had little impact on the specificity of the cELISA for the diagnosis of RHDV infection. The presence of RHDV-specific antibody at 1:10(50) by the cELISA is a reliable indicator for the protective immunity. In contrast to isotype ELISAs, the cELISA is a valuable specific tool for monitoring the herd immunity to RHD for the conservation and management of wild rabbits in the field.
Kawamura, Yoshinori; Shirotsuka, Yasuki; Awatsuji, Hirofumi; Matsumoto, Kiyoshi; Sato, Keiichiro
The effects of thalidomide on the embryo-fetal development (EFD) of rabbit fetuses and the sensitive periods (SP) for the various malformations were compared between Kbl:JW and Kbl:NZW rabbits to investigate possible strain differences. The post-implantation loss rate and number of placental remnants were increased and the number of live fetuses was decreased in both of the strains in the EFD study and in Kbl:NZW at 300 mg/kg dosed on GD 7-8 in the SP study. In the external and skeletal examinations, head, limb and tail malformations were observed in both the strains in the EFD and SP studies at the same dose levels in the same dosing period. In the visceral examination, hydrocephaly, cardiovascular malformations, absent pulmonary intermedial lobe, diaphragmatic hernia and/or abnormal liver lobation were also observed in both of the strains in the EFD and SP studies at the same dose levels and in the same dosing period. Plasma concentrations of thalidomide were equivalent between the two strains in the SP study. There were strain differences in some parameters, such as the post-implantation loss rate and the frequencies of malformations in forelimb and hindlimb and pulmonary intermedial lobe, but similar types of malformations or variations were induced at the same dose levels on the same dosing period in both strains. Therefore, it is concluded that there were no essential differences in sensitivity of the fetuses to thalidomide between Kbl:JW and NZW rabbits and both of the strains are useful to evaluate the teratogenic effects of thalidomide.
David M Kietrys
Full Text Available We sought to determine if tendon inflammatory and histopathological responses increase in aged rats compared to young rats performing a voluntary upper extremity repetitive task, and if these changes are associated with motor declines. Ninety-six female Sprague-Dawley rats were used in the rat model of upper extremity overuse: 67 aged and 29 young adult rats. After a training period of 4 weeks, task rats performed a voluntary high repetition low force (HRLF handle-pulling task for 2 hrs/day, 3 days/wk for up to 12 weeks. Upper extremity motor function was assessed, as were inflammatory and histomorphological changes in flexor digitorum and supraspinatus tendons. The percentage of successful reaches improved in young adult HRLF rats, but not in aged HRLF rats. Forelimb agility decreased transiently in young adult HRLF rats, but persistently in aged HRLF rats. HRLF task performance for 12 weeks lead to increased IL-1beta and IL-6 in flexor digitorum tendons of aged HRLF rats, compared to aged normal control (NC as well as young adult HRLF rats. In contrast, TNF-alpha increased more in flexor digitorum tendons of young adult 12-week HRLF rats than in aged HRLF rats. Vascularity and collagen fibril organization were not affected by task performance in flexor digitorum tendons of either age group, although cellularity increased in both. By week 12 of HRLF task performance, vascularity and cellularity increased in the supraspinatus tendons of only aged rats. The increased cellularity was due to increased macrophages and connective tissue growth factor (CTGF-immunoreactive fibroblasts in the peritendon. In conclusion, aged rat tendons were overall more affected by the HRLF task than young adult tendons, particularly supraspinatus tendons. Greater inflammatory changes in aged HRLF rat tendons were observed, increases associated temporally with decreased forelimb agility and lack of improvement in task success.
Kietrys, David M; Barr-Gillespie, Ann E; Amin, Mamta; Wade, Christine K; Popoff, Steve N; Barbe, Mary F
We sought to determine if tendon inflammatory and histopathological responses increase in aged rats compared to young rats performing a voluntary upper extremity repetitive task, and if these changes are associated with motor declines. Ninety-six female Sprague-Dawley rats were used in the rat model of upper extremity overuse: 67 aged and 29 young adult rats. After a training period of 4 weeks, task rats performed a voluntary high repetition low force (HRLF) handle-pulling task for 2 hrs/day, 3 days/wk for up to 12 weeks. Upper extremity motor function was assessed, as were inflammatory and histomorphological changes in flexor digitorum and supraspinatus tendons. The percentage of successful reaches improved in young adult HRLF rats, but not in aged HRLF rats. Forelimb agility decreased transiently in young adult HRLF rats, but persistently in aged HRLF rats. HRLF task performance for 12 weeks lead to increased IL-1beta and IL-6 in flexor digitorum tendons of aged HRLF rats, compared to aged normal control (NC) as well as young adult HRLF rats. In contrast, TNF-alpha increased more in flexor digitorum tendons of young adult 12-week HRLF rats than in aged HRLF rats. Vascularity and collagen fibril organization were not affected by task performance in flexor digitorum tendons of either age group, although cellularity increased in both. By week 12 of HRLF task performance, vascularity and cellularity increased in the supraspinatus tendons of only aged rats. The increased cellularity was due to increased macrophages and connective tissue growth factor (CTGF)-immunoreactive fibroblasts in the peritendon. In conclusion, aged rat tendons were overall more affected by the HRLF task than young adult tendons, particularly supraspinatus tendons. Greater inflammatory changes in aged HRLF rat tendons were observed, increases associated temporally with decreased forelimb agility and lack of improvement in task success.
Hirsch, G; McBride, M E; Murray, D D; Sanderson, D J; Dukes, I; Menard, M R
Gait was analyzed in seven otherwise healthy males at least 11 mo after they had recovered from a traumatic unilateral transmetatarsal amputation incurred during the course of their usual occupation. All seven were fitted with a semirigid foot orthosis. Four were also fitted with a Chopart prosthesis. Gait was evaluated with forceplate measurements of ground reaction force during free walking, by clinical observation of such ambulation on videotape, and by the subjective impression of the men as obtained by a questionnaire. In all men, with unmodified footwear, with the orthosis, and with the prosthesis, the forceplate data showed an abnormal pattern characterized by reduced stance duration and deficient forward propulsion on the amputated side. The abnormality and asymmetry of ground-reaction forces were less with greater preserved stump length and for a given stump length were with the above-ankle concept (Chopart) prosthesis than with the below-ankle concept. These features were recognized during the clinical analysis of all footwear, but there was an extra irregularity of weight progression noted with the fixed ankle of the Chopart prosthesis. The questionnaire reported stump problems to be the principal difficulty, and the follow-up revealed persistent attempts at surgical management including consideration of amputation at a higher level. It was concluded that the patient and the surgeons are likely to choose preservation of limb length over considerations of function during acute care and that the prosthetic concept best suited to deal with the resulting stump should emphasize unloading the distal part of the stump and smoothing out the impulsive force peak on the stump in late stance to minimize pain and to enhance ambulation capacity.