WorldWideScience

Sample records for amputations

  1. Amputation - traumatic

    Science.gov (United States)

    ... sharing features on this page, please enable JavaScript. Traumatic amputation is the loss of a body part, usually ... fitting and functional prosthesis can speed rehabilitation. Causes Traumatic amputations usually result from factory, farm, power tool accidents, ...

  2. Foot amputation - discharge

    Science.gov (United States)

    Amputation - foot - discharge; Trans-metatarsal amputation - discharge ... You have had a foot amputation. You may have had an accident, or your foot may have had an infection or disease and doctors could ...

  3. Leg or foot amputation

    Science.gov (United States)

    ... to function after the amputation depend on many things. Some of these are the reason for the amputation, whether you have diabetes or poor blood flow, and your age. Most people can still be active following amputation.

  4. A prophylactic amputation

    Directory of Open Access Journals (Sweden)

    Faria Afsana

    2010-10-01

    Full Text Available A case of amputation of the fourth toe is described in a diabetic patient. The patient had overlapping of third and fourth toes since her childhood and later she developed soft lipomas over the fourth toe and lateral aspect of the dorsum of the foot. The lipomas were excised without relief of pain. Subsequently, the fourth toe was disarticulated with relief of pain and healing of ulcers. The role of prophylactic amputations in such cases is described. Ibrahim Med. Coll. J. 2010; 4(2: 87-89

  5. Preventable amputations in Ethiopia

    African Journals Online (AJOL)

    Sew. Mi. 6. Discussion. Gas gangre. Total. This study thus confirms that at the present time about a half of the limbs being amputated at our. Hospital (and probably throughout Ethiopia) could have been saved, or prevented by relatively simple means. These include reducing the number of road traffic accident casualties by ...

  6. Epidemiology of leg amputation

    DEFF Research Database (Denmark)

    Ebskov, L B; Schroeder, T V; Holstein, P E

    1994-01-01

    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 ...

  7. Forequarter amputation for malignancy

    NARCIS (Netherlands)

    Rickelt, J.; Hoekstra, H.; van Coevorden, F.; de Vreeze, R.; Verhoef, C.; van Geel, A. N.

    Background: Forequarter amputation (FQA) is an important treatment for malignant disease of the shoulder girdle. The aim of this study was to elucidate its role in surgical oncology. Methods: This retrospective study analysed 40 patients who had an FQA. In nine, the chest wall was resected. The most

  8. Total middle ray amputation.

    Science.gov (United States)

    Lyall, H; Elliot, D

    1996-10-01

    Eight patients underwent middle ray amputation with excision of the whole of the middle metacarpal and careful soft tissue repair. Excision of the base of the middle metacarpal allowed easier approximation of the index and ring rays without the tendency of these fingers to either scissor on finger flexion or to remain slightly apart. Complete removal of the middle metacarpal appears to allow the bases of the index and ring metacarpals to migrate together. The removal of the metacarpal base caused no functional problems and the technique created a good three-finger hand from both a functional and cosmetic point of view.

  9. Management of fingertip amputations.

    Science.gov (United States)

    Peterson, Steven L; Peterson, Emma L; Wheatley, Michael J

    2014-10-01

    Injuries to the fingertips are among the most common injuries to the hand and result in approximately 4.8 million emergency department visits per year. Most injuries are lacerations or crushes; amputations represent a small but complex spectrum of injury. Treatments available cover a broad range of techniques with no single recommended reference standard for treatment. Although there is no consensus on how these injuries should be treated, the goals of treatment should include minimization of pain, optimization of healing time, preservation of sensibility and length, prevention of painful neuromas, avoidance or limiting of nail deformity, minimization of time lost from work, and provision of an acceptable cosmetic appearance. In this review we present a variety of options in caring for these injuries to help achieve these goals, and the available data that support the various treatment plans. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  10. Elective amputation of a "healthy limb".

    Science.gov (United States)

    Blom, Rianne M; Guglielmi, Valeria; Denys, Damiaan

    2016-10-01

    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. BIID patients are not psychotic and are mentally competent to oversee the consequences of an elective amputation. The authors offer arguments in favor of elective amputation.

  11. Traumatic hand amputation while wakeboarding

    OpenAIRE

    Woodacre, Timothy; Marshall, Morwena

    2011-01-01

    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 civili...

  12. Return to sport following amputation.

    Science.gov (United States)

    Matthews, D; Sukeik, M; Haddad, F

    2014-08-01

    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.

  13. Phantom pain after eye amputation

    DEFF Research Database (Denmark)

    Rasmussen, Marie L R; Prause, Jan U; Toft, Peter B

    2011-01-01

    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...... 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...... scale, ranging from 0 to 100, was 36 (range: 1–89). One-third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress/fatigue were the most commonly reported triggers for pain. Conclusions: Phantom pain after eye amputation is relatively common. The pain...

  14. Symptomatic Neuroma Following Initial Amputation for Traumatic Digital Amputation.

    Science.gov (United States)

    Vlot, Margot A; Wilkens, Suzanne C; Chen, Neal C; Eberlin, Kyle R

    2018-01-01

    We tested the null hypothesis that no factors are independently associated with the development of symptomatic neuroma after traumatic digital amputation. We performed a retrospective review of 1,083 patients who underwent revision amputation for traumatic digital amputation; we excluded those undergoing replantation or revascularization. Patients who developed a painful neuroma during follow-up were identified with a minimum follow-up of 1 week and a median of 3.3 months. We calculated the rate of developing a painful neuroma as a proportion of the total number of patients and performed multivariable logistic regression analysis to identify factors independently associated with its development. Of 1,083 patients, 71 (6.6%) developed a symptomatic neuroma. Mean time to diagnosis was 6.4 months. A total of 47 patients (66%) underwent surgery for painful neuroma. Mean time to surgical intervention was 11 months. Index finger injury and avulsion injury mechanism were significantly associated with a higher risk for symptomatic neuroma. Approximately 1 in 15 patients will develop a symptomatic neuroma after traumatic digital amputation and more than half of these patients will undergo revision surgery for neuroma, with a mean time to operative intervention of 11 months. Prognostic II. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. AMPUTATION AND REFLEX SYMPATHETIC DYSTROPHY

    NARCIS (Netherlands)

    GEERTZEN, JHB; EISMA, WH

    Reflex sympathetic dystrophy is a chronic pain syndrome characterized by chronic burning pain, restricted range of motion, oedema and vasolability. Patients are difficult to treat and the prognosis is very often poor. This report emphasizes that an amputation in case of a reflex sympathetic

  16. INCIDENCE OF AMPUTATION IN EMERGENCY

    Directory of Open Access Journals (Sweden)

    K. Rojaramani Kumbha

    2016-08-01

    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

  17. Transfemoral Amputation After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Schrøder, Henrik M; Odgaard, Anders

    2016-01-01

    complications in 9 (8%). In 92 (80%) of the cases, there were ≥2 indications for amputation. CONCLUSIONS: The cumulative incidence of amputation within 15 years after primary knee arthroplasty was 0.32%, with a tendency toward a decreasing incidence in the last part of the study period. LEVEL OF EVIDENCE......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...... were followed by amputation. Hospital records of all identified cases were reviewed. A competing-risk model was used to estimate the cumulative incidence of amputation. Differences in cumulative incidences were analyzed with use of the Gray test. RESULTS: A total of 115 amputations were performed...

  18. INCORRECT PRESERVATION OF AMPUTATED DIGITS

    Directory of Open Access Journals (Sweden)

    Uroš Ahčan

    2004-09-01

    Full Text Available Background. A decision to replant is critically dependent on the condition of the amputated digit and the way it was preserved during transport. The most common error is exposing the amputated digit to very low temperatures. Preservation directly on ice, on cooling devices in portable refrigerators, or on top of packets of frozen meat often result in a frozen and therefore unusable body digit.Methods. An inquiry questionnaire on correct methods of preservation of amputated digits was conducted on a sample of 30 lay persons, 30 medical students, and 15 physicians.Three simulations of most frequently used methods of preservation of amputated digit were conducted (the correct method; directly on ice; on cooling devices of portable refrigerators. Environment temperature of the (simulated amputated digits stored was measured.In a retrospective study, hospital records of patients treated at the Clinical department of plastic surgery and burns in Ljubljana between 1998 and 2002 were examined. We determined the number of replantations performed, gender of the patients, their age, the mechanism of the injury, the success rate of the replantation, and the duration of hospitalisation. In five case described in detail, we present an inadequate treatment of the amputated digits.Results. The results of the questionnaire survey show that no less than 86.7% of lay person respondents would have treated the injuries in an incorrect way; same holds for 43.4% students of medicine, and 33.3% of practicing physicians.The temperature of the simulated amputated digit remained above 5°C throughout the simulated correct treatment. When preserved directly on ice on or coolant bodies, the temperature dropped below the freezing point and never climbed above 0°C throughout the duration of the simulation (150 minutes.Between years 1998 and 2002, Clinical department of plastic surgery and burns at the University clinical centre Ljubljana admitted 124 injured persons with

  19. [Lower extremity amputation rates in diabetic patients].

    Science.gov (United States)

    Cisneros-González, Nelly; Ascencio-Montiel, Iván Jesús; Libreros-Bango, Vita Norma; Rodríguez-Vázquez, Héctor; Campos-Hernández, Ángel; Dávila-Torres, Javier; Kumate-Rodríguez, Jesús; Borja-Aburto, Víctor Hugo

    2016-01-01

    The lower extremity amputations diminish the quality of life of patients with Diabetes Mellitus (DM). The aim of this study was to describe the lower extremity amputation rates in subjects with DM in the Mexican Social Security Institute (IMSS), comparing 2004 and 2013. A comparative cross-sectional study was done. Amputations were identified from the hospital records of System of Medical Statistics (DataMart). The DM patient census was obtained from the System of Integral Attention to Health. Major and minor amputations rates were expressed per 100,000 DM patients. We observed 2 334 340 and 3 416 643 DM patients during 2004 and 2013, respectively. The average age at the time of the amputation was similar in 2004 and 2013 (61.7 and 65.6 years old for minor and major amputations respectively). The major amputations rates were 100.9 and 111.1 per 100 000 subjects with DM in during 2004 and 2013 (p = 0.001); while minor amputations rates were 168.8 and 162.5 per 100 000 subjects with DM in during 2004 and 2013 respectively (p = 0.069). The lower extremity amputations rates at IMSS are very high compared with that reported in developed countries. The major amputations rate increased in 2013 compared with 2004.

  20. Pathophysiology of Post Amputation Pain

    Science.gov (United States)

    2014-12-01

    in regions of the somatosensory cortex in the vicinity of the somatotopic mapping of upper or lower limb regions (yellow and blue circles, resp...human somatosensory cortex following amputation. Neuroreport 1998;9:1013-7. 38. Karl A, Birbaumer N, Lutzenberger W, Cohen LG, Flor H. Reorganization...of motor and somatosensory cortex in upper extremity amputees with phantom limb pain. J Neurosci 2001;21:3609-18. 39. Sica RE, Sanz OP, Cohen LG

  1. Replantation of ring avulsion amputations

    Directory of Open Access Journals (Sweden)

    Sabapathy R

    2003-01-01

    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.

  2. Pattern Of Lower Limb Amputations In Eku | Akhator | Ebonyi ...

    African Journals Online (AJOL)

    Below knee amputation constituted 57.4% of the cases and above knee amputation constituted 35.2%, with diabetic foot gangrene being the most common indication for amputation. The pattern of lower limb amputation in Eku is ... facilities for lower limb prosthesis is recommended. Keywords: Lower limb; amputation; ...

  3. Prosthetic rehabilitation of an amputated finger

    Directory of Open Access Journals (Sweden)

    Meenu Garg

    2016-01-01

    Full Text Available Amputation of finger causes devastating physical, psychosocial, and economic damage to an individual. The concealment of an amputated part with the help of prosthesis can shield an amputee from social stigma. Prosthesis for such patient must be comfortable to wear lightweight, durable, cosmetically pleasing easy to put on and remove. The restoration of finger amputations depends on the amount of tissue involved, the involvement of bone, the angles and levels of amputation, and the involvement of other fingers. The microsurgical reimplantation helps to save many severely injured and traumatically amputed finger. The prosthetic rehabilitation of an amputated finger is considered when microvascular reconstruction is not possible, unavailable, unsuccessful, or unaffordable. Most accepted material is silicones because of their better esthetics, ease of manipulation, and availability. This paper presents prosthetic rehabilitation of index finger of the right hand with custom made silicon prosthesis.

  4. [May physicians amputate a healthy limb?].

    Science.gov (United States)

    Denys, Damiaan

    2014-01-01

    A recent article in the Dutch Journal of Medicine describes two cases of patients with body integrity identity disorder (BIID), a disorder in which patients might resort to self-amputation in order to create the body they wish for. The authors wonder if medical professionals should provide elective amputations in BIID patients in order to prevent them from harm and death. The amputation of a healthy limb in BIID in a medical context is currently under discussion. Doctors struggle to proceed to elective amputation of a healthy body part in BIID. An analogy with gender dysphoria or euthanasia might shed a different light on this dilemma.

  5. Upper extremity amputations after motor vehicle rollovers.

    Science.gov (United States)

    Ball, Chad G; Rozycki, Grace S; Feliciano, David V

    2009-08-01

    The upper extremity is vulnerable to injury during a rollover motor vehicle crash (MVC). There is some concern that positioning one's arm on a vehicle door/window eliminates the benefit of maintaining containment within a protective structure. Mangled extremities with associated vascular injuries have an amputation rate exceeding 40%. The primary goal was to describe the care process and outcome of patients requiring an emergent upper extremity amputation after a rollover MVC. All patients requiring an upper extremity amputation after a rollover MVC (2000-2008) were included. Patient demographics, injuries, and outcomes were analyzed. Seventeen patients required an upper extremity amputation after a rollover MVC (mean injury severity score = 23; hemodynamic instability at presentation = 29%). Injuries occurred on the side ipsilateral to the occupant vehicle position in 88% of cases. Most (76%) amputations occurred between May 1 and August 1 of their respective years, with 11 (65%) in the past 24 months. All amputations except one (replantation attempt) were completed within 24 hours. Concurrent operative procedures were performed in six (35%) patients, including three diagnostic peritoneal lavages, two laparotomies (splenectomies), one craniotomy, and one thoracotomy (atrial rupture). Mortality (12%) was a direct result of traumatic brain injuries. Temporary intravascular shunts were used before amputation in four (24%) patients. The majority (65%) of amputations were above the elbow joint. Blunt mangled upper extremities requiring completion amputations are most often caused by MVC rollovers. The risk of this injury is strongly associated with summer days and seems to be increasing in frequency.

  6. Quality of life of eye amputated patients

    DEFF Research Database (Denmark)

    Rasmussen, Marie L R; Ekholm, Ola; Prause, Jan U

    2011-01-01

    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...... were eye amputation, i.e. evisceration, enucleation, orbital exenteration or secondary implantation of an orbital implant during the period 1996–2003, and participation in a previous investigation (2005). In total, 159 eye-amputated patients were included, and completed a self......: The eye-amputated patients had significantly (p

  7. Return to work after lower limb amputation.

    Science.gov (United States)

    Burger, Helena; Marincek, Crt

    2007-09-15

    To review the literature on return to work after lower limb amputation. A comprehensive review of literature on return to work after lower limb amputation was carried out, searching MEDLINE and PubMED. Most authors found return-to-work rate to be about 66%. Between 22 and 67% of the subjects retained the same occupation, while the remainder had to change occupation. Post-amputation jobs were generally more complex with a requirement for a higher level of general educational development and were physically less demanding. The return to work depends on: general factors, such as age, gender and educational level; factors related to impairments and disabilities due to amputation (amputation level, multiple amputations, comorbidity, reason for amputation, persistent stump problems, the time from the injury to obtaining a permanent prosthesis, wearing comfort of the prosthesis, walking distance and restrictions in mobility); and factors related to work and policies (salary, higher job involvement, good support from the implementing body and the employer and social support network). Subjects have problems returning to work after lower limb amputation. Many have to change their work and/or work only part-time. Vocational rehabilitation and counselling should become a part of rehabilitation programme for all subjects who are of working age after lower limb amputation. Better cooperation between professionals, such as rehabilitation team members, implementing bodies, company doctors and the employers, is necessary.

  8. [Minor foot amputations in diabetic foot syndrome].

    Science.gov (United States)

    Biehl, C; Eckhard, M; Szalay, G; Heiss, C

    2016-10-01

    The treatment strategy for diabetic foot syndrome must take into account protective sensibility of the foot, open wounds, infection status, and the rules of septic bone surgery. Interventions are classified as elective, prophylactic, curative, or emergency. Amputations in the forefoot and midfoot region are performed as ray amputations (including metatarsal), which can often be carried out as "inner" amputations. Gentle tissue treatment mandatory because of greater risk of revision with re-amputation compared to classical amputation. Good demarcation of infection, acute osteomyelitis, osteolytic lesions, neurotropic ulcer, arterial and venous blood flow to the other toes, gangrene of other toes with metatarsal affection. Arterial occlusive disease, infection of neighboring areas, avoidable amputations, poorly healing ulcers on the lower leg. Primary dorsal approach; minimal incisional distance (5 cm) to minimize skin necrosis risk. Atraumatic preparation, minimize hemostasis to not compromise the borderline perfusion situation. In amputations, plantar skin preparation and longer seams placed as dorsal as possible, either disarticulated and maintain cartilage, or round the cortical metatarsal bone after resection. Diabetes control. Braun splint, mobilization in a shoe with forefoot decompression and hindfoot support, physiotherapy. Antibiotics based on resistance testing. If no complications, dressing change on postoperative day 1. Optimal wound drainage by lowering foot several times a day; drainage removal after 12-24 h. Insoles and footwear optimization. Amputations require continued attention and if necessary treatment to avoid sequelae. Insufficient treatment associated with recurrent ulceration and altered anatomy.

  9. [WHICH IN SURGERY OF LOWER LIMB AMPUTATION].

    Science.gov (United States)

    Mezzetti, Roberto

    2015-01-01

    Lower limb amputation is in effect decisive surgery in the treatment of ischemic gangrene whether nature of post-traumatic or secondary to arterial disease of the lower limbs. The amputation is not however to be considered debulking surgery. The demolition regards the limb behind which we do not have the presence scotomize amputee who requires to be accompanied in dealing with a new life that has as its main objective the autonomy scope family and society. The search for a good level of amputation surgery then makes reconstructive surgery. The level of amputation will allow in fact the use ofprincipals able to guarantee the total autonomy. After an analysis of surgical techniques the author will then analyze the latest devices available in the permit to pursue the best possible level of amputation even in cases where the disease is starting to discourage the doctor.

  10. Amputations

    Science.gov (United States)

    ... when using forklifts and doors as well as trash compactors and powered and non-powered hand tools. ... the workplace? Yes. The Occupational Safety and Health Administration (OSHA) has the following standards in Title 29 ...

  11. Primary and Revision Amputation Surgery in a Tertiary Institution in ...

    African Journals Online (AJOL)

    We set out to study the cases undergoing amputation surgery with special interest of determining the prevalence rate of revision amputation surgery; its indication ... The commonest indication found for amputation surgery was trauma while it was ascending gangrene for revision amputation. Among those who had revision ...

  12. Major upper limb amputation after Snake Bite Gangrene | Ajibade ...

    African Journals Online (AJOL)

    Major lower limb amputations following snake bite gangrene have been reported from the savannah belt of Nigeria. In bites delivered to the upper limb, amputations are often of the digits (minor amputations). We report the case of a male farmer who had an above elbow amputation after a snake bite to the hand. Explanation ...

  13. Diabetes: foot ulcers and amputations.

    Science.gov (United States)

    Hunt, Dereck L

    2011-08-26

    Diabetic foot ulceration is full-thickness penetration of the dermis of the foot in a person with diabetes. Severity is classified using the Wagner system, which grades it from 1 to 5. The annual incidence of ulcers among people with diabetes is 2.5% to 10.7% in resource-rich countries, and the annual incidence of amputation for any reason is 0.25% to 1.8%. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent foot ulcers and amputations in people with diabetes? What are the effects of treatments in people with diabetes with foot ulceration? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 50 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review, we present information relating to the effectiveness and safety of the following interventions: debridement, human cultured dermis, human skin equivalent, patient education, pressure off-loading with felted foam or pressure-relief half-shoe, pressure off-loading with total-contact or non-removable casts, screening and referral to foot-care clinics, systemic hyperbaric oxygen for non-infected ulcers, systemic hyperbaric oxygen in infected ulcers, therapeutic footwear, topical growth factors, and wound dressings.

  14. [Body integrity identity disorder, relief after amputation].

    Science.gov (United States)

    Blom, R M; Braam, A W; de Boer-Kreeft, N; Sonnen, M P A M

    2014-01-01

    Body integrity identity disorder (BIID) is a rare condition in which a person, for no apparent physical reason, is tormented by the experience that a body-part, such as a limb, does not really belong to the body. Patients experience an intense desire for the limb to be amputated (a 'desire' formerly referred to as 'apotemnophilia'). We report on a 58-year-old male patient with BIID who froze one of his legs so that he could amputate it himself. A surgeon ultimately intervened and amputated the leg professionally. The patient was extremely relieved and was still experiencing relief at a follow-up three years later.

  15. Ideal functional outcomes for amputation levels.

    Science.gov (United States)

    Meier, Robert H; Melton, Danielle

    2014-02-01

    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. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. A Systematic Review of Outcomes after Revision Amputation for Treatment of Traumatic Finger Amputation.

    Science.gov (United States)

    Yuan, Frank; McGlinn, Evan P; Giladi, Aviram M; Chung, Kevin C

    2015-07-01

    Revision amputation is often the treatment for traumatic finger amputation injuries. However, patient outcomes are inadequately reported, and their impact is poorly understood. The authors performed a systematic review to evaluate outcomes of revision amputation and amputation wound coverage techniques. The authors searched all available English literature in the PubMed and Embase databases for articles reporting outcomes of nonreplantation treatments for traumatic finger amputation injuries, including revision amputation, local digital flaps, skin grafting, and conservative treatment. Data extracted were study characteristics, patient demographic data, sensory and functional outcomes, patient-reported outcomes, and complications. A total of 1659 articles were screened, yielding 43 studies for review. Mean static two-point discrimination was 5.0 ± 1.5 mm (n = 23 studies) overall, 6.1 ± 2.4 mm after local flap procedures, and 3.8 ± 0.4 mm after revision amputation. Mean total active motion was 93 ± 8 percent of normal (n = 6 studies) overall. It was 90 ± 9 percent of normal after local flap procedures and 95 percent of normal after revision amputation. Seventy-seven percent of patients reported cold intolerance after revision amputation. Ninety-one percent of patients (217 of 238) reported "satisfactory" or "good/excellent" ratings regardless of treatment. Revision amputation and conservative treatments result in better static two-point discrimination outcomes compared with local flaps. All techniques preserve total active motion, although arc of motion is slightly better with revision amputation. Revision amputation procedures are frequently associated with cold intolerance. Patients report "satisfactory," "good," or "excellent" ratings in appearance and quality of life with all nonreplantation techniques.

  17. Leg or foot amputation - dressing change

    Science.gov (United States)

    ... patientinstructions/000018.htm Leg or foot amputation - dressing change To use the sharing features on this page, please enable JavaScript. You will need to change the dressing on your limb. This will help ...

  18. Lower extremity amputation: a contemporary series.

    Science.gov (United States)

    Stone, Patrick A; Flaherty, Sarah K; Hayes, J David; AbuRahma, Ali F

    2007-01-01

    We sought to identify the results achieved with lower extremity amputations performed by both community and university-based surgeons as well as from multiple disciplines (orthopedic/general/vascular surgeons) serving a predominantly nonurban population. A review of 411 consecutive patients undergoing 508 non-traumatic lower extremity amputations at Charleston Area Medical Center from January 1999 to December 2003 was conducted. Amputations were performed most frequently at the below knee level (50.9%). Perioperative mortality (30-day) for the cohort was 11%. Mortality increased with more proximal level of initial amputations: 1.6% for transmetatarsal, 3.6% for below knee, 17.6% for above knee and 100% of those requiring hip disarticulation. Stump failure requiring conversion to a more proximal level was seen in 34.5% of TMA's, 12% of BKA, 6% of AKA during the follow-up period. Twenty-one percent of patients required bilateral amputations by the end of the follow-up period. Non-wound related morbidity for all procedures (i.e. pneumonia, stroke, renal failure) was 29%. Rehabilitation documentation was available for 55% of the cohort, of whom only 27% (N=61) were fitted for, and ambulating with a prosthesis during the follow-up period. Survival at 6 months, 1 year and 2 years was 59%, 47% and 23% respectively. Patients requiring major lower extremity amputation represent the peak of high-risk patients undergoing vascular surgery. Significant perioperative morbidity and limited survival is seen in this cohort. Early vascular surgery referral may reduce more proximal amputations and improve functional outcome in a group with poor longevity and limited functional capacity with amputation at the transtibial level and proximal.

  19. Factors affecting outcome after traumatic limb amputation.

    Science.gov (United States)

    Perkins, Z B; De'Ath, H D; Sharp, G; Tai, N R M

    2012-01-01

    Traumatic leg amputation commonly affects young, active people and leads to poor long-term outcomes. The aim of this review was to describe common causes of disability and highlight therapeutic interventions that may optimize outcome after traumatic leg amputation. A comprehensive search of MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature databases was performed, using the terms 'leg injury', 'amputation' and 'outcome'. Articles reporting outcomes following traumatic leg amputation were included. Studies demonstrated that pain, psychological illness, decreased physical and vocational function, and increased cardiovascular morbidity and mortality were common causes of disability after traumatic leg amputation. The evidence highlights that appropriate preoperative management and operative techniques, in conjunction with suitable rehabilitation and postoperative follow-up, can lead to improved treatment outcome and patient satisfaction. Patients who undergo leg amputation after trauma are at risk of poor long-term physical and mental health. Clinicians involved in their care have many opportunities to improve their outcome using a variety of therapeutic variables. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  20. Dermatological changes of amputation stump

    Directory of Open Access Journals (Sweden)

    Arora P

    1993-01-01

    Full Text Available Dermatological changes of stumps of 174 amputees are presented. The commonest dermatological change recorded at the site of amputation stump was hyperpigmentation in 46 (26.4% followed by callosities in 32 (18.3%, scaling in 29 (16.7%, cutaneous atrophy in 20 (11.5%, lichenification in 19(10.9%, traumatic ulcer and bacterial infections in 18 (10.3% each, hypertrophic scar in 14 (8.1%, hypopigmentation and corns in 13 (7.4% each, verrucous hypertrophy of stump in 12 (6.9%, dermatophytic infection in 5(2.9%, stump oedema and phantom limb in 4 (2.3% each, intertriginous dermatitis in 3( 1.7%, allergic contact dermatitis (resin and frictional eczema in 2(1.1% each. Epidermoid cyst, keloid formation, anaesthesia, gangrene and cutaneous horn were recorded in 1 (0.6% each. Atrophy (epidermal and derma, anaesthesia, alopecia and elephantiasis of the stump have not been documented in the literature earlier.

  1. Tourniquets do not increase the total blood loss or re-amputation risk in transtibial amputations

    DEFF Research Database (Denmark)

    Wied, Christian; Tengberg, Peter T; Holm, Gitte

    2017-01-01

    AIM: To investigate the total blood loss (TBL) and the safety with respect to the re-amputation rate after transtibial amputation (TTA) conducted with and without a tourniquet. METHODS: The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between Januar...

  2. Fingertip Amputation Treatment: A Survey Study.

    Science.gov (United States)

    Miller, Andrew J; Rivlin, Michael; Kirkpatrick, William; Abboudi, Jack; Jones, Christopher

    2015-09-01

    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.

  3. Traumatic penile amputation: a case report.

    Science.gov (United States)

    Patial, Tushar; Sharma, Girish; Raina, Pamposh

    2017-10-10

    Traumatic amputation of the penis is a rare surgical emergency. Although repair techniques have been well described in literature, failure of replantation and its causes are poorly understood and reported. Herein, we report the case of a 9 year old boy who underwent replantation of his amputated penis with delayed failure of the surgery, along with a discussion of recent advances in the management of this condition. CASE  PRESENTATION: A 9-year-old boy was referred to our hospital for traumatic amputation of the penis. Papaverine aided microsurgical replantation of the severed part was performed, but by 48 h, the glans became discoloured and necrosis set in by 4 days. Unfortunately, by day 12 two thirds of the re-implanted penis was lost along with overlying skin. Replantation of an amputated penis in a pediatric patient is a daunting task even for experienced surgeons. The vasodilatory effect of papaverine for vascular anastomosis is well described, but the use of a paediatric cannula for identification and instillation of papaverine into penile vasculature, has not been described for the repair of penile amputation. Despite its apparent failure, we believe this technique may be valuable to surgeons who might encounter this rare event in their surgical practice, especially in resource limited settings like ours.

  4. Life after lower extremity amputation in diabetics.

    Science.gov (United States)

    Cox, P St L; Williams, S K P; Weaver, S R

    2011-10-01

    Lower limb amputees typically have reduced mobility which affects their ability to perform daily tasks and to successfully reintegrate into community life. A major goal of rehabilitation for amputees is to improve quality of life (QOL). This study therefore focussed on QOL and functional independence for persons with lower limb amputations secondary to diabetes. To determine the QOL and functional independence of lower limb diabetic amputees one to three years post amputation, using variables such as age, gender and amputation level. A total of 87 participants were selected from the 2006-2009 physiotherapy records at the St Ann's Bay Hospital. These participants completed the World Health Organization Quality of Life Scale (WHO QOL-BREF) and the Functional Independence Measure (FIM). Data were analysed using SPSS (version 12) and the mean values for QOL and functional independence were calculated. Relationships between the variables: age, gender and level of amputation with QOL and functional independence were analysed using descriptive and inferential statistical techniques. Among the 35 males and 52 females participating in the study, below knee amputees recorded higher scores for QOL (p quality of life of all participants. The results showed that below knee amputees functioned better than those with above knee amputations and that females were more likely to cope and function with the disability than males.

  5. A retrospective study of functional outcomes after successful replantation versus amputation closure for single fingertip amputations.

    Science.gov (United States)

    Hattori, Yasunori; Doi, Kazuteru; Ikeda, Keisuke; Estrella, Emmanuel P

    2006-01-01

    To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations. Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed. Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer. Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump. Therapeutic, Level III.

  6. Characterisation and outcomes of upper extremity amputations.

    Science.gov (United States)

    Tennent, David J; Wenke, Joseph C; Rivera, Jessica C; Krueger, Chad A

    2014-06-01

    The purpose of this study is to characterise the injuries, outcomes, and disabling conditions of the isolated, combat-related upper extremity amputees in comparison to the isolated lower extremity amputees and the general amputee population. A retrospective study of all major extremity amputations sustained by the US military service members from 1 October 2001 to 30 July 2011 was conducted. Data from the Department of Defense Trauma Registry, the Armed Forces Health Longitudinal Technology Application, and the Physical Evaluation Board Liaison Offices were queried in order to obtain injury characteristics, demographic information, treatment characteristics, and disability outcome data. A total of 1315 service members who sustained 1631 amputations were identified; of these, 173 service members were identified as sustaining an isolated upper extremity amputation. Isolated upper extremity and isolated lower extremity amputees had similar Injury Severity Scores (21 vs. 20). There were significantly more non-battle-related upper extremity amputees than the analysed general amputation population (39% vs. 14%). Isolated upper extremity amputees had significantly greater combined disability rating (82.9% vs. 62.3%) and were more likely to receive a disability rating >80% (69% vs. 53%). No upper extremity amputees were found fit for duty; only 12 (8.3%) were allowed continuation on active duty; and significantly more upper extremity amputees were permanently retired than lower extremity amputees (82% vs. 74%). The most common non-upper extremity amputation-related disabling condition was post-traumatic stress disorder (PTSD) (17%). Upper extremity amputees were significantly more likely to have disability from PTSD, 13% vs. 8%, and loss of nerve function, 11% vs. 6%, than the general amputee population. Upper extremity amputees account for 14% of all amputees during the Operation Enduring Freedom and Operation Iraqi Freedom conflicts. These amputees have significant

  7. Successful microsurgical replantation of an amputated penis

    Directory of Open Access Journals (Sweden)

    Sanchit Garg

    2016-01-01

    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.

  8. Amputation Surgery in a Secondary Healthcare Facility in Nigeria ...

    African Journals Online (AJOL)

    ... our experience in amputation surgery over a ten – year period in a secondary healthcare facility in sub- Saharan Africa. A retrospective study of 117 patients that underwent amputation in the facility between January 1998 and December 2007. Trauma remains the commonest indication for amputation in our environment.

  9. Lower limb amputation for ischaemia with special reference to the ...

    African Journals Online (AJOL)

    The patient must be left with an amputation stump that can bear weight and, when necessary, to which a prosthesis can be fitted. The scope of what follows is not intended to be a detailed text on amputation, but to provide some insight for the clinician, based on general experience with amputation over a number of years.

  10. Successful Replantation of Amputated Penile Shaft following Industrial Injury

    Directory of Open Access Journals (Sweden)

    M Salehipour

    2010-09-01

    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.

  11. Indications Level and Outcome of Lower Extremity Amputations in ...

    African Journals Online (AJOL)

    Wound dehiscence occurred in 8 patients and flap necrosis in 4. A reamputation rate of 16.7% was recorded for below knee amputations. The mortality rate was 15.2%. None of the patients acquired any prosthesis during convalescence. The below knee amputation is the commonest amputation level here and it reflects the ...

  12. Congenital Amputation Involving the Hands and Feet: A Case Report

    African Journals Online (AJOL)

    There were forefoot amputations on both lower limbs. Scars were noticed over the amputation stumps with no associated congenital anomaly. Conclusion: Congenital amputation involving all limbs as an isolated entity is a rare condition; the cause of which is probably as a result of congenital amniotic bands. Keywords: ...

  13. CHANGES IN HIP MUSCLES AFTER ABOVE-KNEE AMPUTATION

    NARCIS (Netherlands)

    JAEGERS, SMHJ; ARENDZEN, JH; DEJONGH, HJ

    1995-01-01

    To learn about the changes appearing in hip muscles after an above-knee amputation, 3-dimensional reconstructions of the hip and thigh region of 12 patients with above-knee amputations were made based on transverse magnetic resonance images, In all patients, the amputations were done at least 2

  14. Adjustment to finger amputation and silicone finger prosthesis use.

    Science.gov (United States)

    Kuret, Zala; Burger, Helena; Vidmar, Gaj; Maver, Tomaz

    2018-01-11

    Finger amputations are the most common amputations of upper limbs. They influence hand function, general functioning and quality of life. One of the possibilities for rehabilitation after finger amputation is fitting a silicone finger prosthesis. We wanted to evaluate the adjustment to amputation and prosthesis use in patients after finger amputation. We included 42 patients with partial or complete single or multiple finger amputation of one hand who visited the outpatient clinic for prosthetics and orthotics at our institute and received a silicone prosthesis. We assessed their adjustment to amputation and prosthesis with the Trinity Amputation and Prosthesis Experience Scales (TAPES). Most of the patients (28, 67%) had a single finger amputated. The average scores on all TAPES subscales (except adjustment to limitation) were above 50% of the maximum possible score. On average, the scores were the highest on the general adjustment and satisfaction with the prosthesis subscales. Silicone prostheses for finger amputation of upper limb play an important role in the process of adaptation to amputation. They offer aesthetically satisfying results and alleviate social interactions, which influences overall quality of life. Implications for Rehabilitation Silicone prostheses for finger amputation of upper limb offer an aesthetically satisfying result and alleviate problems with social interactions. Their influence on hand function is not optimal, but the prosthesis improves the amputee's quality of life.

  15. State of the Art: Amputation and Prosthetics.

    Science.gov (United States)

    Westberry, David E

    2017-09-01

    Amputation is not a defeat or failure of treatment, but an effective management strategy for certain conditions in the pediatric population. The principles of management, especially in the pediatric population, have not changed. Current surgical strategies focus on providing an optimal residual limb for prosthetic fitting. New technology provides improvement in the design and fabrication of prosthetic devices.

  16. A case of dorsal oblique fingertip amputation.

    Science.gov (United States)

    Takeda, Shinsuke; Tatebe, Masahiro; Morita, Akimasa; Yoneda, Hidemasa; Iwatsuki, Katsuyuki; Hirata, Hitoshi

    2017-01-01

    This study reports successful finger replantation in a patient with a dorsal oblique fingertip amputation. When repairing this unique type of injury, an evaluation of the remaining vessels is more useful for successful replantation than the anatomical zone classification. We propose that Kasai's classification is appropriate for guiding treatment.

  17. A case of dorsal oblique fingertip amputation

    OpenAIRE

    Takeda, Shinsuke; Tatebe, Masahiro; Morita, Akimasa; Yoneda, Hidemasa; Iwatsuki, Katsuyuki; Hirata, Hitoshi

    2017-01-01

    Abstract This study reports successful finger replantation in a patient with a dorsal oblique fingertip amputation. When repairing this unique type of injury, an evaluation of the remaining vessels is more useful for successful replantation than the anatomical zone classification. We propose that Kasai?s classification is appropriate for guiding treatment.

  18. Calcanectomy, an alternative amputation? Two case reports

    NARCIS (Netherlands)

    Geertzen, Jan H. B.; Jutte, Paul; Rompen, Christiaan; Salvans, Merse

    2009-01-01

    A limb amputation is a traumatic experience for the amputee but it is also a challenge for the recipient to get used to a new situation and reach her/his greatest level of independence. Two patients are presented who had undergone a total calcanectomy. In the first case, a woman with spina bifida

  19. Amputations De Membres Inferieurs : Aspects Epidemiologiques ...

    African Journals Online (AJOL)

    Le respect de bons principes chirurgicaux et de techniques éprouvées est un gage de meilleures suites opératoires. Mots clés : Amputation, membre inférieur, ... Results: We had noted an annual frequency of 2.1% of the operational activities in the chirurgical department. There was a male prevalence of the patients ...

  20. The Functions of an Amputation Clinic*

    African Journals Online (AJOL)

    1971-08-28

    Aug 28, 1971 ... Left through knee. Left hindquarter ... Right hip disarticulation. Left hip disarticulation. Right Symes amputation. Total. CONCLUSION. Rehabilitation. Returned to previous employment. New employment. Grants arranged. Pensions and a decision is then made as to when a prosthesis should be ordered, or if ...

  1. Amniotic amputation | Ayadi | Pan African Medical Journal

    African Journals Online (AJOL)

    Amniotic band syndrome (ABS) is an uncommon, congenital fetal abnormality. Lower extremity limb defects are the common manifestations of ABS. The most common features include congenital distal ring constrictions, intrauterine amputations, and acrosyndactyly. Rare cases of craniofacial and visceral defects were ...

  2. The mangled limb: salvage versus amputation.

    Science.gov (United States)

    Wolinsky, Philip R; Webb, Lawrence X; Harvey, Edward J; Tejwani, Nirmal C

    2011-01-01

    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.

  3. Contralateral Total Hip Arthroplasty After Hindquarter Amputation

    Directory of Open Access Journals (Sweden)

    Scott M. M. Sommerville

    2006-01-01

    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.

  4. [Knee disarticulation and through-knee amputation].

    Science.gov (United States)

    Baumgartner, R

    2011-10-01

    A knee disarticulation or a through-knee stump is superior compared to a transfemoral stump. The thigh muscles are all preserved, and the muscle balance remains undisturbed. The range of motion of the hip joint is not limited. The bulbous shape of the stump allows full weight bearing at the stump end and can easily be fitted with a prosthesis. An amputee with a bilateral knee disarticulation is able to walk "barefoot". A more distal amputation level, e.g., an ultra-short transtibial amputation, is not possible. Important alternative to transfemoral amputations. Possible for any etiology except for Buerger-Winiwarter's disease. New indications are infected and loosened total knee replacements. Preservation of the knee joint is possible. Knee disarticulation is a very atraumatic procedure, compared to transfemoral amputations. Neither bones nor muscles have to be severed, just skin, ligaments, vessels, and nerves. Even the meniscal cartilages may be left in place to act as axial shock absorbers. The cartilage of the femur is not resected, but only bevelled in case of osteoarthritis. There are no tendon attachments or myoplastic procedures necessary. The patella remains in place and is held in position only by the retinacula. Skin closure must be performed without the slightest tension, and if possible not in the weight-bearing area. Transcondylar amputations across the femoral condyles only are indicated when there are not sufficient soft tissues for wound closure of a knee disarticulation. Alternatives as the techniques of Gritti, Klaes, and Eigler, the shortening of the femur and the Sauerbruch's rotation plasty [14] are presented and discussed. The risk of decubital ulcers is rather high. Correct bandaging of the stump is, therefore, particularly important. Prosthetic fitting is possible 3-6 weeks after surgery. The type of prosthesis depends on the amputee's activity level. The superior performance of amputees with knee disarticulations in sports prove the

  5. Management of complications relating to finger amputation and replantation.

    Science.gov (United States)

    Woo, Sang-Hyun; Kim, Young-Woo; Cheon, Ho-Jun; Nam, Hyun-Je; Kang, Dong-Ho; Kim, Jong-Min; Ahn, Hee-Chan

    2015-05-01

    There are many options in the management of fingertip or finger amputations. Injudicious revision amputation may cause complications. These complications can be prevented by tension-free closure of the amputation stump or primary coverage with appropriate flap. Replantation is the best way to keep the original length and maintain digital function. Patent vein repair or venous drainage with bleeding until neovascularization to the replanted part is the key to successful replantation. Prevention and management of complications in replantation and revision amputation increase patients' satisfaction and decrease costs. Research is needed to define new indications of replantation for digital amputation. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. [Desire for amputation in body integrity identity disorder].

    Science.gov (United States)

    Blom, Rianne M; Hennekam, Raoul C M

    2014-01-01

    Body integrity identity disorder (BIID) is a rare neuropsychiatric disorder in which patients experience a mismatch between the real and experienced body from childhood. BIID results in a strong desire to amputate or paralyse one or more limbs. We describe two BIID patients. A 40-year-old healthy male suffered daily from his desire for amputation, and therefore made a request for amputation at our academic medical centre. A 61-year-old male proceeded to self-amputation to create the body he had wished for, thereby curing himself from BIID. To date, no treatment has been found for BIID. Therefore patients often proceed to self-amputation, which could lead to serious and even dangerous complications. These case histories suggest that elective amputation may be a treatment for BIID. Many doctors, however, will question the admissibility of amputation of a healthy limb.

  7. [Factors associated with amputation in diabetic patients with foot ulcer].

    Science.gov (United States)

    Real Collado, J T; Valls, M; Basanta Alario, M L; Ampudia Blasco, F J; Ascaso Gimilio, J F; Carmena Rodríguez, R

    2001-02-01

    To analyse risk factors for amputation in diabetic foot ulcers. We have studied 152 diabetic patients (in 14 food ulcers treatment was amputation) who were attendance between January 1996 and June 1998 in the diabetic foot Unit. Subjects with gangrene were excluded. Risk factors for amputation were: previous history of amputation (odds ratio 3.7; 1.0113.7), proliferative retinopathy, osteomielitis, and independently clinical signs of peripheral vasculopathy (7.1; 1.88-27.2) and severe infection (14.4; 2.92-71.2). Diabetic subjects with foot ulcers and previous history of amputation, proliferative retinopathy, osteomielitis, clinical signs of peripheral vasculopathy and/or severe infection were a high risk group for amputation and in this group aggressive therapeutical and preventive approaches should be done in order to prevent amputation.

  8. Amputation Totale de La Verge: A Propos de Trois Observations ...

    African Journals Online (AJOL)

    Conclusion: qu'elle soit d'origine criminelle ou psychogène, l'amputation totale du pénis est rarissime. Les conséquences sont urinaires, sexuelles et psychogènes. La prise en charge doit être multidisciplinaire. Mots Clés: Verge; amputation; méat; sténose. English Title: Total penile amputation: a report on three cases.

  9. Amputation of extremity in patients with atherosclerotic gangrene

    Directory of Open Access Journals (Sweden)

    Tsareva Yu.O.

    2011-12-01

    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

  10. Predicting prosthetic prescription after major lower-limb amputation.

    Science.gov (United States)

    Resnik, Linda; Borgia, Matthew

    2015-01-01

    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 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.

  11. Changes in hip muscles after above-knee amputation.

    Science.gov (United States)

    Jaegers, S M; Arendzen, J H; de Jongh, H J

    1995-10-01

    To learn about the changes appearing in hip muscles after an above-knee amputation, 3-dimensional reconstructions of the hip and thigh region of 12 patients with above-knee amputations were made based on transverse magnetic resonance images. In all patients, the amputations were done at least 2 years before the study and were necessitated by trauma or osteosarcoma. The results show that, at higher amputation levels, the geometry of the once-biarticular muscles was changed. The cleaved muscles (40%-60%) and the intact muscles (0-30%) at the amputated side were atrophied. The amount of atrophy of the intact muscles at the amputated side was related to stump length. To avoid an abduction contracture in 8 patients with amputations, the iliotibial tract was not fixed. In 4 of these 8 patients, a flexion contracture was visible. If the tract was not fixed, the hip extension torque of the gluteus maximus, which inserts into the tract, decreased. As a result, the risk of appearance of a flexion contracture increased because the strongest hip flexor (iliopsoas muscle) was not involved in the amputation. Abduction contracture could be avoided only if the hip adductors were fixed accurately, especially at higher amputation levels.

  12. Physical and social factors determining quality of life for veterans with lower-limb amputation(s)

    DEFF Research Database (Denmark)

    Christensen, Jan; Ipsen, Thomas; Doherty, Patrick

    2016-01-01

    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......-limb amputation(s), HRQoL outcome and veterans. Physical and social factors that influence HRQoL were extracted. Results The literature search identified 2073 citations, leading to the inclusion of 10 studies in the systematic review. Physical activity level, sport participation, level of amputation, back pain......, 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...

  13. Successful replantation in ten-digit amputation.

    Science.gov (United States)

    Kantarci, Umit; Cepel, Selim; Buldu, Halil

    2010-01-01

    Amputations involving ten digits are very rare because of different lengths of the digits. A 34-year-old man working in a printing house presented one hour after guillotine amputation involving all ten digits. Surgery was initiated 80 minutes after admission and took seven hours. Under axillary anesthesia, the operation was performed by two teams each consisting of two microsurgeons and two assistants. Replantation was completed without the use of any skin graft or flap. Fingertip examination showed poor arterial circulation in the second, third, and fourth digits of the left hand after 24 hours of replantation and surgical exploration was performed, during which anastomosis of the ulnar digital artery of the second digit was re-established and a Y-shaped vein graft was placed at the level of the third web to restore revascularization of the third and fourth digits. However, these interventions did not prevent the development of necrosis in the distal segment of the fourth digit which resulted in dry gangrene that required amputation. After 38 months of replantation, radiographic examination showed complete union in all fingers without malunion or damage to the joint surface and about 8 degrees of medial angulation in the proximal phalanx of the fourth digit of the right hand. The patient did not have difficulty in performing daily activities and had a considerably good pinching. Losses of active range of motion of the metacarpophalangeal and interphalangeal joints were within the rage of 10 to 30 degrees in both hands. In the assessment of sensation, static and dynamic two-point discrimination test results were 6.1 mm and 4.0 mm, respectively.

  14. Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation

    DEFF Research Database (Denmark)

    van Battum, P; Schaper, N; Prompers, L

    2011-01-01

    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....

  15. The potential benefit of pre-operative assessment of amputation ...

    African Journals Online (AJOL)

    The potential benefit of pre-operative assessment of amputation wound healing potential in peripheral vascular disease. M. Mars, R. P. Mills, J. V. Robbs. Abstract. Choosing the most distal amputation level that will heal is difficult in patients with peripheral vascular disease. From 1984 to 1988,965 patients underwent 1 563 ...

  16. Causal conditions for major limb amputation at a specialist hospital ...

    African Journals Online (AJOL)

    The causes of major limb amputation included trauma (n=122, 61.6%), diabetic foot disease (n=36, 18.2%), musculoskeletal tumours (n=26, 13.1%) and peripheral vascular disease (unrelated to diabetes) (n=10, 5.1%). Traditional bone setters' gangrene was the predominant cause (n=65, 53.3%) of traumatic amputation.

  17. Prevalence, Indications, Levels and Outcome Limb amputations at ...

    African Journals Online (AJOL)

    Prevalence, Indications, Levels and Outcome Limb amputations at University Teaching Hospital-Butare in Rwanda. ... Results: Out of 3466 operated cases in Surgery Department, there were 107 limb amputations accounting for 3.08% of all operations performed during the study period. Females accounted for 29.9% cases.

  18. A Review of Amputation of 106 Hand Digits | Olaitan | Nigerian ...

    African Journals Online (AJOL)

    Industrial accidents constitute the highest reason for amputation in 42.4% of all the digits amputated. Conclusion: With improved facilities and awareness of the people and therefore early presentation to the hospital, many of the hand digits would be salvaged. We also suggest education of the people and training on the use ...

  19. Lower limb amputation for ischaemia with special reference to the ...

    African Journals Online (AJOL)

    Mars M, Elson KI, Salisbury RT, Robbs JV. Do pre-operative antibiotics reach the operative field in amputation surgery for peripheral vascular disease? A pilot study. S Afr J Surg. 1990; 28: 58-61. 7. Huizinga WKJ, Robbs JV, Bhamjee A. Wound infection after major lower limb amputation – the role of antibiotic prophylaxis.

  20. Replantation and revascularization vs. amputation in injured digits

    NARCIS (Netherlands)

    Mulders, Marjolein A. M.; Neuhaus, Valentin; Becker, Stéphanie J. E.; Lee, Sang-Gil; Ring, David C.

    2013-01-01

    The purpose of this study was to analyze factors associated with the decision to replant or revascularize rather than amputate an injured digit as well as factors associated with successful replantation or revascularization. We reviewed 315 complete and subtotal amputations at or proximal to the

  1. Surgical Limb Amputation: A Five-Year Experience At Hilltop ...

    African Journals Online (AJOL)

    BACKGROUND: Limb amputation is one of the oldest and commonest surgical procedures known to man. It is performed by the orthopedic, general, vascular and trauma surgeons. At Hilltop Orthopedic Hospital, Enugu, limb amputation is found prevalent, yet most times it is objectionable to the patient. METHOD: A ...

  2. Amputation des quatre members | Feruzi | Pan African Medical Journal

    African Journals Online (AJOL)

    , Mireille Kakinga Zabibu, Jules Panda Mulefu, Francois Tshilombo Katombe. Abstract. Les auteurs présentent les cas d'amputation des quatre membres réalisée chez trois patients différents. Ce sont des amputations réalisées pour chaque ...

  3. Major limb amputations in El Obeid Hospital, Western Sudan ...

    African Journals Online (AJOL)

    Objectives: To study the causes and pattern of major limb amputations in El Obeid Hospital, Western Sudan. Patients and methods: The records of 50 major limb amputations performed in patients admitted to the University Surgical Unit at El Obeid Teaching Hospital, Western Sudan in two years were retrospectively studied.

  4. Beak Amputation Effects on Performance and Egg Quality ...

    African Journals Online (AJOL)

    An experiment was conducted to determine the effect of beak amputation on performance and egg quality characteristics of egg-type chickens. A total of 132 native layers (Yacon) chickens were obtained from a commercial hatchery for the study. There were four treatments in which upper and lower beaks were amputated at ...

  5. Progression of disease preceding lower extremity amputation in Denmark

    DEFF Research Database (Denmark)

    Jensen, Pia Søe; Petersen, Janne; Kirketerp-Møller, Klaus

    2017-01-01

    OBJECTIVES: Patients with non-traumatic lower extremity amputation are characterised by high age, multi-morbidity and polypharmacy and long-term complications of atherosclerosis and diabetes. To ensure early identification of patients at risk of amputation, we need to gain knowledge about....... Data were retrieved from 14 years before until 1 year after the amputation. Descriptive statistics were used to describe the progression of diseases and use of medication and healthcare services. PARTICIPANTS: An unselected cohort of patients (≥50 years; n=2883) subjected to a primary non-traumatic......, 64% had been in contact with the hospital or outpatient clinics within the last 3 years, and 29% received a prescription of opioids 3 years prior to the amputation. CONCLUSION: Among patients with non-traumatic lower extremity amputation, one-third live with undiagnosed and untreated atherosclerosis...

  6. Racial odds for amputation ratio in traumatic lower extremity fractures.

    Science.gov (United States)

    Weber, Daniel J; Shoham, David A; Luke, Amy; Reed, R Lawrence; Luchette, Fred A

    2011-12-01

    Recent studies have demonstrated that black patients receive substandard care compared with white patients across healthcare settings. The purpose of this study was to evaluate the association of race on the management (salvage vs. amputation) of traumatic lower extremity open fractures. Data analysis was conducted using the American College of Surgeon's National Trauma Data Bank. Open tibial and fibular (OTFF) and open femoral (OFF) fractures among adults above the age of 18 were identified by International Classification of Diseases, 9th Revision codes. Injuries were identified as amputated based on the presence of one of three types of knee amputations. Statistical analysis included logistic regression stratified for sex, age, race, mechanism of injury, severity, and insurance type. From the National Trauma Data Bank, 10,082 OFF and 22,479 OTFF were identified. Amputation rates were 3.1% for OFF and 4.2% for OTFF. With age stratification, the ratio of amputation odds for blacks to amputation odds for whites (i.e., the Racial Odds for Amputation Ratio [ROAR]) demonstrated a significant interaction between black and age in both the OFF (p = 0.028) and OTFF (p = 0.008) groups. In younger patients, a lower ROAR (p = 0.016) favored salvage in blacks, while the ROAR in older patients favored amputation in blacks (p = 0.013). The higher prevalence of penetrating injuries in blacks only accounted for 12.7% of the lower ROAR among younger adults. There exists a racial disparity in the management of lower extremity open fractures. Older blacks have greater odds of amputation that is not explained by mechanism. In contrast, younger blacks have lower odds for amputation that is only partially explained by mechanism of injury.

  7. Rehabilitation Trends After Lower Extremity Amputations in Canada.

    Science.gov (United States)

    Kayssi, Ahmed; Dilkas, Steven; Dance, Derry L; de Mestral, Charles; Forbes, Thomas L; Roche-Nagle, Graham

    2017-05-01

    The heterogeneity of medical complications that lead to amputation has resulted in a diverse patient population with differing rehabilitation needs; however, the rehabilitation trends for patients with lower extremity amputations across Canada have not been studied previously. To describe trends in rehabilitation after lower extremity amputations and the factors affecting rehabilitation length of stay in Canada. Retrospective cohort analysis. Canadian inpatient rehabilitation facilities that received persons with lower extremity amputations discharged from academic or community hospitals. Patients underwent lower extremity amputations between 2006 and 2009 for nontraumatic indications and were then discharged to a rehabilitation facility. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database that includes hospital admissions across Canada except Quebec. Inpatient rehabilitation after lower extremity amputations. Length of stay, discharge destination, and change in total and motor function scores. The analysis included 5342 persons who underwent lower extremity amputations, 1904 of whom were transferred to a rehabilitation facility (36%). Patients most commonly underwent single below-knee (74%) and above-knee (17%) amputations. The duration of rehabilitation varied by whether the amputation was performed by a vascular (median = 36 days), orthopedic (median = 38 days), or general surgeon (median = 35 days). The overall median length of stay was 36 days. Most patients (72%) subsequently were discharged home and 9% were readmitted to hospital. Predictors of longer rehabilitation included amputation by an orthopedic surgeon (beta = 5.0, P ≤ .01), older age (beta = 0.2, P ≤ .01), and a history of ischemic heart disease (beta = 3.8, P = .03) or congestive heart failure (beta = 5, P = .04). Patients who spent Canada after lower extremity amputation varies by the type of surgeon performing the amputation. Advanced age

  8. Reorganization of the primary motor cortex following lower-limb amputation for vascular disease: a pre-post-amputation comparison.

    Science.gov (United States)

    Hordacre, Brenton; Bradnam, Lynley V; Crotty, Maria

    2017-08-01

    This study compared bilateral corticomotor and intracortical excitability of the primary motor cortex (M1), pre- and post-unilateral transtibial amputation. Three males aged 45, 55, and 48 years respectively who were scheduled for elective amputation and thirteen (10 male, 3 female) healthy control participants aged 58.9 (SD 9.8) were recruited. Transcranial magnetic stimulation assessed corticomotor and intracortical excitability of M1 bilaterally. Neurophysiological assessments were performed 10 (SD 7) days prior to surgery and again at 10 (SD 3) days following surgery. Data were analyzed descriptively and objectively compared to 95% confidence intervals from control data. Prior to amputation, all three patients demonstrated stronger short-latency intracortical inhibition evoked from M1 ipsilateral to the affected limb and reduced long-latency intracortical inhibition evoked from M1 contralateral to the affected limb compared to control subjects. Following amputation, short-latency intracortical inhibition was reduced in both M1s and long-latency intracortical inhibition was reduced for the ipsilateral M1. Single-pulse motor evoked potential amplitude and motor thresholds were similar pre-to-post amputation. Modulation of intracortical excitability shortly following amputation indicates that the cortical environment may be optimized for reorganization in the acute post-amputation period which might be significant for learning to support prosthetic mobility. Implications for Rehabilitation Amputation of a lower-limb is associated with extensive reorganization at the level of the cortex. Reorganization occurs in the acute post-amputation period implying a favorable cortical environment for recovery. Rehabilitation or brain interventions may target the acute pre-prosthetic post-amputation period to optimize recovery.

  9. Limb amputations from the ancient times to the present.

    Science.gov (United States)

    Stryła, Wanda; Pogorzała, Adam M; Kasior, Iwona; Nowakowski, Andrzej

    2013-07-26

    Amputations, or the removal of limbs at different levels, have been performed since the ancient times. The first reports of amputations originate from the ancient ruins in Egypt, where primitive prosthetic toes were found in the tombs of the Pharaohs. In Europe, during the period of ancient Greece and Rome, various examples of amputations were described on amphoras and mosaics. During the middle ages, the body was marginalized and replaced by the worship of human spirituality. As a result reports of amputations from that time period are scarce. True development of amputation and prosthetic techniques took place during the Renaissance and centuries that followed. Present-day indications for amputation are similar to those utilized in the ancient times. The greatest development of limb amputation techniques and prosthetic methods began in the 20th century and continues to this day. Despite the development of new techniques in prosthetics, many solutions have their roots in designs originating in the ancient times and differ only in their structural design.

  10. Level selection in leg amputation for arterial occlusive disease

    DEFF Research Database (Denmark)

    Holstein, P

    1982-01-01

    measurements of the skin perfusion pressure (SPP). Out of 62 BK amputations with an SPP above 30 mmHg wound healing failed in only 2 cases (3 per cent). Out of 13 BK amputations with an SPP between 20 and 30 mmHg 7 cases (54 per cent) failed and out of 9 BK amputations with an SPP below 20 mmHg no less than 8......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...... cases (89 per cent) failed to heal. The difference in failure rate is significant (P less than 0.0001). Out of the 15 failed BK amputations at low pressures (below 30 mmHg) only one case had local signs of ischaemia, which might have warned the surgeons. On the other hand, in 13 out of the 18 cases...

  11. Modified scintigrafic technique for amputation level selection in diabetics

    Energy Technology Data Exchange (ETDEWEB)

    Dwars, B.J.; Rauwerda, J.A.; Broek, T.A.A. van den; Rij, G.L. van; Hollander, W. den; Heidendal, G.A.K.

    1989-01-01

    A modified /sup 123/I-antipyrine cutaneous washout technique for the selection of amputation levels is described. The modifications imply a reduction of time needed for the examination by simultaneous recordings on different levels, and a better patient acceptance by reducing inconvenience. Furthermore, both skin perfusion pressure (SPP) and skin blood flow (SBF) are determined from each clearance curve. In a prospective study among 26 diabetic patients presenting with ulcers or gangrene of the foot, both SPP and SBF were determined preoperatively on the selected level of surgery and on adjacent amputation sites. These 26 patients underwent 12 minor foot amputations and 17 major lower limb amputations. Two of these amputations failed to heal. SBF values appeared indicative for the degree of peripheral vascular disease, as low SBF values were found with low SPP values. SPP determinations revealed good predictive values: All surgical procedures healed when SPP>20 mmHg, but 2 out of 3 failed when SPP<2 mmHg. If SPP values would have been decisive, the amputation would have been converted to a lower level in 6 out of 17 cases. This modified scintigrafic technique provides accurate objective information for amputation level selection.

  12. Level selection in leg amputation for arterial occlusive disease

    DEFF Research Database (Denmark)

    Holstein, P

    1982-01-01

    cases (89 per cent) failed to heal. The difference in failure rate is significant (P less than 0.0001). Out of the 15 failed BK amputations at low pressures (below 30 mmHg) only one case had local signs of ischaemia, which might have warned the surgeons. On the other hand, in 13 out of the 18 cases......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...... measurements of the skin perfusion pressure (SPP). Out of 62 BK amputations with an SPP above 30 mmHg wound healing failed in only 2 cases (3 per cent). Out of 13 BK amputations with an SPP between 20 and 30 mmHg 7 cases (54 per cent) failed and out of 9 BK amputations with an SPP below 20 mmHg no less than 8...

  13. Treatment of fingertip amputation in adults by palmar pocketing of the amputated part.

    Science.gov (United States)

    Jung, Mi Sun; Lim, Young Kook; Hong, Yong Taek; Kim, Hoon Nam

    2012-07-01

    First suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults. Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm. Of a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results. A composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.

  14. Treatment of Fingertip Amputation in Adults by Palmar Pocketing of the Amputated Part

    Directory of Open Access Journals (Sweden)

    Mi Sun Jung

    2012-07-01

    Full Text Available BackgroundFirst suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults.MethodsBetween 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm.ResultsOf a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results.ConclusionsA composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.

  15. FROM CULTURAL IMPOTENCE TO CULTURAL AMPUTATION

    Directory of Open Access Journals (Sweden)

    Вячеслав Владимирович Суханов

    2013-04-01

    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

  16. Complete Brachial Plexus Injury - An Amputation Dilemma. A Case Report

    Directory of Open Access Journals (Sweden)

    Choong CYL

    2015-11-01

    Full Text Available Brachial plexus injuries with intact yet flail limb presents with problems of persistent neuropathic pain and recurrent shoulder dislocations, that render the flail limb a damn nuisance. As treating surgeons, we are faced with the dilemma of offering treatment options, bearing in mind the patient’s functional status and expectations. We present a case of a 55-year old housewife with complete brachial plexus injury begging for surgical amputation of her flail limb, 6 years post-injury. Here we discuss the outcome of transhumeral amputation and the possibility of offering early rather than delayed amputations in this group of patients.

  17. Lower Limb Amputation in Patients with Vascular Disease

    OpenAIRE

    Johannesson, Anton

    2009-01-01

    The current prevalence of persons amputated at transmetatarsal level or higher in Sweden can be estimated to be between 5000 and 5500 persons (approx. 0.06 % of the population). The majority of these are patients with vascular disease (≈ 80%). In Sweden between 1000 and1100 new amputees can be expect every year. Less than 5% of all amputations will be related to causes other than vascular disease. Lower limb amputation (LEA) in patients with vascular disease may not only be highly disablin...

  18. Coping and posttraumatic growth in women with limb amputations.

    Science.gov (United States)

    Stutts, Lauren A; Bills, Sarah E; Erwin, Savannah R; Good, Jessica J

    2015-01-01

    While ample research has examined the psychological experiences of men with limb amputations, minimal research has examined the psychological experiences of women with limb amputations. The present study utilizes a qualitative design to examine coping and posttraumatic growth in women with limb amputations. Thirty women completed the posttraumatic growth inventory (PTGI) and provided open-ended responses about coping, social support, discrimination, support groups, and acceptance. Interpretative phenomenological analysis was used to discern emergent and superordinate themes in qualitative responses. Superordinate themes included social support (friendships/family and community), self-beliefs, resources, physical complications, spirituality, specific strategies, and acceptance. Concerns related specifically to participants' gender identity included appearance and motherhood. Overall, women reported moderate-to-high PTGI scores. The current findings address a void in the literature by illuminating the unique perspective of women with amputations. Future research should use quantitative methodology to expand on our research findings, as well as assess interventions to assist women adjusting to limb loss.

  19. Lower Limb Amputation at the 34 Military Hospital in Freetown ...

    African Journals Online (AJOL)

    Lower Limb Amputation at the 34 Military Hospital in Freetown, Sierra Leone: Causes and Indications. Paul F. Nabieu, Thomas A. Massaquoi, S. D. Massaquoi, G Luseni, B. Idris, T. B. Kamara, M. L. Baryoh ...

  20. Discussion: Reconstruction of Fingertip Amputation: Necrosis Is Expected

    OpenAIRE

    Jung, Mi Sun; Lim, Young Kook; Hong, Yong Taek; Kim, Hoon Nam; Ki, Sae Hwi

    2012-01-01

    Background First suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults. Methods Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation ...

  1. Self-Amputation in Two Non-Psychotic Patients.

    Science.gov (United States)

    Rahmanian, Hamid; Petrou, Nikoletta A; Sarfraz, M Aamer

    2015-09-01

    Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are associated with psychosis, with a small number being assigned the controversial diagnosis of body identity integrity disorder. In this article, we report two cases of non-psychotic self-amputation and their similarities with a view to highlighting the risk factors and formulating an appropriate management plan.

  2. Self-Amputation in Two Non-Psychotic Patients

    OpenAIRE

    Rahmanian, Hamid; Petrou, Nikoletta A.; Sarfraz, M. Aamer

    2015-01-01

    Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are associated with psychosis, with a small number being assigned the controversial diagnosis of body identity integrity disorder. In this article, we report two cases of non-psychotic self-amputation and their similarities with a view to highlighting the risk factors and formulating an appropriate management plan.

  3. ORIGINAL ARTICLE Patterns and Causes of Amputation in Ayder ...

    African Journals Online (AJOL)

    2018-01-01

    Jan 1, 2018 ... 8. Table 2: Causes of amputation in Ayder referral hospital. Causes of Amputation. Number %. Tumor. 21. 24.1. Peripheral arterial disease(PAD) 18. 20.7. Trauma. Fall down accident (FDA). 9. 10.3. Electrical burn. 9. 10.3. Machine injury. 5. 5.7. Road trafic accident (RTA). 5. 5.7. Others(bullet, other burns) 5.

  4. [Repair of fingertip amputations using composite grafts: nine clinical cases].

    Science.gov (United States)

    Al Saflan, A; May, P; Revol, M; Servant, J-M

    2010-08-01

    Even if a digital replantation is not possible, we present a series of nine cases of fingertip amputations treated with clinical efficacy by using a composite graft from the amputated finger part. All of our eight patients (four children and four adults) were traumatically amputated. The level of amputation passed by the bunch of P3 and carried partially or completely the ungula. The reposition was always performed under local anaesthesia. Our evaluation related on the survival of the composite grafts, the functional and the aesthetic result. The composite grafts were revascularised in eight amputations out of nine, with a satisfactory remote result on the function as well as aesthetic level. After a short recall of the alternative surgical methods of the treatment of the fingertip amputations, we will insist on the simplicity and the reliability of the repositioning of a composite graft, recommended for us from the start and depending on the traumatic level. In the event of a failure, surgeons still have the possibility of realising the other alternative surgical methods. 2009. Published by Elsevier SAS.

  5. Treatment Failure and Leg Amputation Among Patients With Foot Osteomyelitis.

    Science.gov (United States)

    Barshes, Neal R; Mindru, Cezarina; Ashong, Chester; Rodriguez-Barradas, Maria; Trautner, Barbara W

    2016-12-01

    We sought to identify factors associated with treatment failure and leg amputations among those patients who presented with foot osteomyelitis. Characteristics, treatments, and outcomes for all patients treated for probable or definite foot osteomyelitis (per consensus definition) between January 2011 and March 2015 were reviewed. Multivariate Cox regression models were used to identify risk factors for treatment failure (unanticipated resection of additional bone or leg amputation) and of leg amputation alone. A total of 184 episodes of foot osteomyelitis met inclusion criteria. Treatment failure occurred in 53 (28.8%) and leg amputation in 21 (11.4%). Risk factors for treatment failure included severe/unaddressed peripheral artery disease, homelessness, Pseudomonas aeruginosa or Escherichia coli bone isolates, serum albumin <2.8 mg/dL, hallux involvement, insulin therapy, 60 or more pack-years smoking, and <7 days of directed antibiotic therapy for a positive bone margin. Delayed primary wound closure (ie, staged operations) had significantly lower treatment failure risk. Unanticipated resection of bone was not associated with leg amputation. Foot osteomyelitis treatment failure is common. Various factors can help identify those at risk for treatment failure and/or leg amputation, and further studies should focused whether initial management or follow-up should change when these factors are present.

  6. Rehabilitation for patients with paraplegia and lower extremity amputation.

    Science.gov (United States)

    Wang, Fangyong; Hong, Yi

    2015-10-01

    [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.

  7. Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity : Amputation surgery and postoperative management. Part 1

    NARCIS (Netherlands)

    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

    2015-01-01

    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

  8. Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity: Amputation surgery and postoperative management. Part 1.

    Science.gov (United States)

    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; Smit Duijzentkunst, Rob; Spruit-van Eijk, Monica; Versteegen, Gerbrig; Voesten, Harrie

    2015-10-01

    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. To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 1 focuses on amputation surgery and postoperative management. Systematic literature design. Literature search in five databases. Quality assessment on the basis of evidence-based guideline development. An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity. The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for diagnosis, referral, assessment, and undergoing amputation of a lower extremity and can be used to provide patient information. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. © The International Society for Prosthetics and Orthotics 2014.

  9. Racial Variation in Treatment of Traumatic Finger/Thumb Amputation: A National Comparative Study of Replantation and Revision Amputation.

    Science.gov (United States)

    Mahmoudi, Elham; Swiatek, Peter R; Chung, Kevin C; Ayanian, John Z

    2016-03-01

    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 declining steadily 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. Using a two-level hierarchical model, the authors retrospectively compared replantation rates for African American patients with those of whites, adjusting for patient and hospital characteristics. Patients younger than 65 years 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. The authors analyzed 13,129 patients younger than 65 years with traumatic finger/thumb amputation. Replantation rates declined over time from 19 percent to 14 percent (p = 0.004). Adjusting for patient and hospital characteristics, African Americans (OR, 0.81; 95 percent CI, 0.66 to 0.99; p = 0.049) were less likely to undergo replantation procedures than whites, and uninsured patients (OR, 0.73; 95 percent CI, 0.62 to 0.84; p amputation injuries. Regionalization of care for these injuries may not only provide a higher quality care but also reduce variations in treatment. Risk, III.

  10. Female American Kestrel survives double amputation

    Science.gov (United States)

    Skipper, Ben R.; Boal, Clint W.

    2011-01-01

    Free-ranging raptors are susceptible to a variety of injuries, many of which are sustained while pursuing and/or capturing live prey. Injuries hindering an individual’s ability to capture prey, such as partial blindness, damage to the bill, and foot or leg injuries, are debilitating and potentially life-threatening. However, there are ample observations in the literature of free-ranging raptors with eye (Bedrosian and St.Pierre 2007), bill (Strobel and Haralson-Strobel 2009) and foot and leg injuries (Blodget et al. 1990, Murza et al. 2000, Dwyer 2006, Bedrosian and St.Pierre 2007), suggesting that some individuals are able to compensate for their injuries if only partial functionality is lost (e.g., loss of only one eye). Reports of injuries resulting in the complete loss of functionality (e.g., loss of both eyes) are rare as individuals suffering such severe trauma presumably do not survive long. Here we report the capture on a bal-chatri trap of an American Kestrel (Falco sparverius; hereafter kestrel) with previous amputation of both legs

  11. Spina bifida and lower limb amputation in Northern Ireland: A retrospective study of demographics and outcome.

    Science.gov (United States)

    Graham, Lorraine

    2017-10-01

    Spina bifida is an uncommon cause for lower limb amputation. The causes and level of amputation and mobility outcome for these patients have not been reported previously. To identify the causes and level of amputation and the mobility outcome for amputee patients with spina bifida. Retrospective case series. Chart review of patients identified by computer as having an amputation secondary to neurological or congenital cause. Additional patients identified from the Regional Spina Bifida Medical Clinic. Demographics, cause and level of mobility pre- and post-amputation recorded from the prosthetic notes. In total, 16 patients were identified who had a diagnosis of spina bifida and a lower limb amputation. Mean age at the time of amputation was 28.5 years. In total, 15 patients had a transtibial amputation. In total, 14 patients post-amputation were able to maintain their mobility, wheelchair or walking, without any change in type of aid needed. Patients with spina bifida appear to require lower limb amputation at a younger age than patients with peripheral vascular disease. Almost all patients had prior chronic skin infection/osteomyelitis as precursors for amputation. The most common level for amputation was transtibial. Mobility was maintained for all patients, albeit for two in a more supported way. Clinical relevance Spina bifida is an uncommon reason for amputation. Patients, are often younger and medically complicated. Chronic skin ulceration, was the most common indication for amputation. Wheelchair or walking ambulance was maintained at the same level for most patients.

  12. Treatment of Fingertip Amputation in Adults by Palmar Pocketing of the Amputated Part

    Directory of Open Access Journals (Sweden)

    Mi Sun Jung

    2012-07-01

    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.

  13. Metabolic and body composition changes in first year following traumatic amputation.

    Science.gov (United States)

    Eckard, Carly S; Pruziner, Alison L; Sanchez, Allison D; Andrews, Anne M

    2015-01-01

    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 amputation.

  14. Major limb amputations: A tertiary hospital experience in northwestern Tanzania

    Directory of Open Access Journals (Sweden)

    Chalya Phillipo L

    2012-05-01

    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

  15. Primary suture of amputation wound: pro et contra.

    Science.gov (United States)

    Muminagic, Sahib N

    2011-01-01

    During the First World War and the Second World War more than 80 % of wounded persons had injuries of upper or lower limbs. In the recent war in the Former Yugoslavia the percentage of persons with these injuries was above 80%. Each war is also characterized by the high percentage of wounded persons with amputations of upper or lower extremities. These amputations occurred mostly in the cases of polytrauma. In other cases we faced with severely wounded extremities with an extensive destruction of soft tissues, bones, blood vessels and joints, where the amputation is the only possible intervention to save the patient. In the previous World Wars, the surgeons have tried to shorten the time of treatment and to accept the surgical technique, by the application of primary suture of the wound. During the aggression on Bosnia and Herzegovina we were faced with a large number of wounded persons with amputations i.e. cases where we applied the primary suture. The results were still surprising and in many cases the wounds had primarily healed. The results were better when they were using primary suture on the upper extremities, measured at 61.9 % while the percentage of using the same suture on the lower limbs was of 48.8 %. The results of the war year 1995 were improved in comparison to the percentages listed above. The statistical analysis indicated that early application of the primary suture to the amputation wound was possible and largely successful, but, only when performed under certain conditions.

  16. Always Contact a Vascular Interventional Specialist Before Amputating a Patient with Critical Limb Ischemia

    International Nuclear Information System (INIS)

    Met, Rosemarie; Koelemay, Mark J. W.; Bipat, Shandra; Legemate, Dink A.; Lienden, Krijn P. van; Reekers, Jim A.

    2010-01-01

    Patients with severe critical limb ischemia (CLI) due to long tibial artery occlusions are often poor candidates for surgical revascularization and frequently end up with a lower limb amputation. Subintimal angioplasty (SA) offers a minimally invasive alternative for limb salvage in this severely compromised patient population. The objective of this study was to evaluate the results of SA in patients with CLI caused by long tibial occlusions who have no surgical options for revascularization and are facing amputation. We retrospectively reviewed all consecutive patients with CLI due to long tibial occlusions who were scheduled for amputation because they had no surgical options for revascularization and who were treated by SA. A total of 26 procedures in 25 patients (14 males; mean age, 70 ± 15 [SD] years) were evaluated. Technical success rate was 88% (23/26). There were four complications, which were treated conservatively. Finally, in 10 of 26 limbs, no amputation was needed. A major amputation was needed in 10 limbs (7 below-knee amputations and 3 above-knee amputations). Half of the major amputations took place within 3 months after the procedure. Cumulative freedom of major amputation after 12 months was 59% (SE = 11%). In six limbs, amputation was limited to a minor amputation. Seven patients (28%) died during follow-up. In conclusion, SA of the tibial arteries seem to be a valuable treatment option to prevent major amputation in patients with CLI who are facing amputation due to lack of surgical options.

  17. [Fingertip replantation after amputation: report of 32 fingers].

    Science.gov (United States)

    Ren, Gao-hong; Pei, Guo-xian; Gu, Li-qiang; Guo, Gang

    2004-08-01

    To describe the surgical techniques and our experiences in fingertip replantation after amputation. On the basis of examination of the anatomic features and the degree of fingertip vascular injury, 32 amputated fingertips in 26 cases were replanted, and flexible revascularization procedures of both artery and vein anastomoses, artery-only anastomosis, arterialized vein and arteriovenous anastomosis were adopted. All the replanted fingertips were trained with comprehensive rehabilitation program. Twenty-nine replanted fingertips survived but 3 failed, and the overall survival rate was 90.06%. During the follow-up lasting from 4 months to 5 years, the 29 replanted fingertips survived with excellent blood supply, good sensory functions, satisfactory shape and functions according to the criteria by Society of Hand Surgery of Chinese Medical Association. Fingertip replantation after amputation can achieve not only high survival rate but also satisfactory appearance and functions as long as appropriate operative procedures are adopted with comprehensive rehabilitation therapy.

  18. Amputation and prosthesis implantation shape body and peripersonal space representations.

    Science.gov (United States)

    Canzoneri, Elisa; Marzolla, Marilena; Amoresano, Amedeo; Verni, Gennaro; Serino, Andrea

    2013-10-03

    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.

  19. Factors related to successful job reintegration of people with a lower limb amputation

    NARCIS (Netherlands)

    Schoppen, Tanneke; Boonstra, Antje; Groothoff, JW; van Sonderen, E; Goeken, LN; Eisma, Willem

    2001-01-01

    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

  20. Gait biomechanics following lower extremity trauma: Amputation vs. reconstruction.

    Science.gov (United States)

    Russell Esposito, Elizabeth; Stinner, Daniel J; Fergason, John R; Wilken, Jason M

    2017-05-01

    Surgical advances have substantially improved outcomes for individuals sustaining traumatic lower extremity injury. Injuries once requiring lower limb amputation are now routinely managed with limb reconstruction surgery. However, comparisons of functional outcomes between the procedures are inconclusive. To compare gait biomechanics after lower limb reconstruction and transtibial amputation. Twenty-four individuals with unilateral lower limb reconstruction wearing a custom ankle-foot orthosis (Intrepid Dynamic Exoskeletal Orthosis), 24 with unilateral, transtibial amputation, and 24 able-bodied control subjects underwent gait analysis at a standardized Froude speed based on leg length. Lower extremity joint angles, moments, and powers, and ground reaction forces were analyzed on the affected limb of patients and right limb of able-bodied individuals. ANOVA with Tukeys post-hoc tests determined differences among groups and post-hoc paired t-tests with Bonferroni-Holm corrections determined differences between limbs. The ankle, knee, and hip exhibited significant kinematic differences between amputated, reconstructed and able-bodied limbs. The reconstruction group exhibited less ankle power and range of motion while the amputee group exhibited lower knee flexor and extensor moments and power generation. Gait deficiencies were more pronounced at the ankle following limb reconstruction with orthosis use and at the knee following transtibial amputation with prosthesis use. Although both groups in the cohorts tested can replicate many key aspects of normative gait mechanics, some deficiencies still persist. These results add to the growing body of literature comparing amputation and limb reconstruction and provide information to inform the patient on functional expectations should either procedure be considered. Copyright © 2017. Published by Elsevier B.V.

  1. Factors Associated with Amputation after Popliteal Vascular Injuries.

    Science.gov (United States)

    Keeley, Jessica; Koopmann, Matthew; Yan, Huan; DeVirgilio, Christian; Putnam, Brant; Y Kim, Dennis; Plurad, David

    2016-05-01

    Popliteal artery trauma has the highest rate of limb loss of all peripheral vascular injuries. The objectives of this study were to evaluate outcomes after popliteal vascular injury and to identify predictors of amputation. Retrospective data over a 14-year period were collected for patients with popliteal artery with or without vein injuries. Patient demographics, mechanism of injury, Injury Severity Score (ISS), Mangled Extremity Severity Score (MESS), and physiologic parameters were extracted. Time to operative intervention, operative time, type of vascular repair, need for concomitant orthopedic procedures, and outcomes including amputation rate, and in-hospital mortality were recorded. Fifty-one patients were found to have popliteal artery injuries, with a median age of 25 (range 10-70 years). The median ISS was 9, and the mean extremity Abbreviated Injury Severity score was 3. The mechanism of injury was blunt for 43% and penetrating for 57%. Fasciotomies were performed in 74% of patients and 64% of patients underwent combined orthopedic and vascular procedures. Overall, 66% of these patients had their vascular procedure performed first. Ten patients required amputation: 1 immediate and 9 after attempted limb salvage (20%). We found that those patients requiring amputation had a higher incidence of blunt trauma (80% vs. 35%, P = 0.014) and higher MESS score (7.1 vs. 4.7, P = 0.02). There was no difference in the incidence of amputation for those who underwent orthopedic fixation before vascular repair (P = 0.68). Popliteal vascular injuries continue to be associated with a high risk of amputation. Those patients undergoing attempted limb salvage should be revascularized expediently, but selected patients may undergo orthopedic stabilization before vascular repair without increased risk of limb loss. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Through Knee Amputation: Technique Modifications and Surgical Outcomes

    Directory of Open Access Journals (Sweden)

    Frank P Albino

    2014-09-01

    Full Text Available BackgroundKnee disarticulations (KD are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center.MethodsA retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A. between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified.ResultsBetween 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%, arterial thrombosis (35%, and trauma (9%. Postoperative complications included superficial cellulitis (13%, soft tissue infection (4%, and flap ischemia (4% necessitating one case of surgical debridement (4% and four trans-femoral amputations (9%. 9 (22% patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P<0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P<0.01.ConclusionsKnee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown.

  3. Traumatic amputation of the left lower renal pole in children

    Energy Technology Data Exchange (ETDEWEB)

    Waxman, J.; Belman, A.B.; Kass, E.J.

    1985-07-01

    Four children between 5 and 10 years old suffered traumatic amputation of the left lower renal pole following flank trauma. All patients were evaluated with excretory urography and isotope renography. The renal scan clearly demonstrated failure of perfusion of the lower renal pole and urinary extravasation, and was believed to be more valuable than the standard excretory urogram as a diagnostic tool. All children were managed similarly: delayed (72 to 96 hours) exploration, simple removal of the amputated segment and insertion of a Penrose drain. They all have done well. The patients were normotensive at followup and had excellent function of the remaining portion of the kidney.

  4. Amputation and prosthesis implantation shape body and peripersonal space representations

    OpenAIRE

    Canzoneri, Elisa; Marzolla, Marilena; Amoresano, Amedeo; Verni, Gennaro; Serino, Andrea

    2013-01-01

    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...

  5. Outcomes of dogs undergoing limb amputation, owner satisfaction with limb amputation procedures, and owner perceptions regarding postsurgical adaptation: 64 cases (2005-2012).

    Science.gov (United States)

    Dickerson, Vanna M; Coleman, Kevin D; Ogawa, Morika; Saba, Corey F; Cornell, Karen K; Radlinsky, MaryAnn G; Schmiedt, Chad W

    2015-10-01

    To evaluate outcomes of dogs and owner satisfaction and perception of their dogs' adaptation following amputation of a thoracic or pelvic limb. Retrospective case series. 64 client-owned dogs. Procedures-Medical records of dogs that underwent limb amputation at a veterinary teaching hospital between 2005 and 2012 were reviewed. Signalment, body weight, and body condition scores at the time of amputation, dates of amputation and discharge from the hospital, whether a thoracic or pelvic limb was amputated, and reason for amputation were recorded. Histologic diagnosis and date of death were recorded if applicable. Owners were interviewed by telephone about their experience and interpretation of the dog's adaptation after surgery. Associations between perioperative variables and postoperative quality of life scores were investigated. 58 of 64 (91%) owners perceived no change in their dog's attitude after amputation; 56 (88%) reported complete or nearly complete return to preamputation quality of life, 50 (78%) indicated the dog's recovery and adaptation were better than expected, and 47 (73%) reported no change in the dog's recreational activities. Body condition scores and body weight at the time of amputation were negatively correlated with quality of life scores after surgery. Taking all factors into account, most (55/64 [86%]) respondents reported they would make the same decision regarding amputation again, and 4 (6%) indicated they would not; 5 (8%) were unsure. This information may aid veterinarians in educating clients about adaptation potential of dogs following limb amputation and the need for postoperative weight control in such patients.

  6. THE FEASIBILITY OF HIND FOOT AMPUTATION IN SELECTED SARCOMAS OF THE FOOT

    NARCIS (Netherlands)

    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

  7. Motor cortex changes after amputation are modulated by phantom limb motor control rather than pain

    DEFF Research Database (Denmark)

    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...

  8. Incidence of re-amputation following partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy: a systematic review.

    Directory of Open Access Journals (Sweden)

    Sara L. Borkosky

    2012-01-01

    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

  9. Early versus delayed amputation in the setting of severe lower extremity trauma.

    Science.gov (United States)

    Williams, Zachary F; Bools, Lindsay M; Adams, Ashley; Clancy, Thomas V; Hope, William W

    2015-06-01

    Leg-threatening injuries present patients and clinicians with the difficult decision to pursue primary amputation or attempt limb salvage. The effects of delayed amputation after failed limb salvage on outcomes, such as prosthetic use and hospital deposition, are unclear. We evaluated the timing of amputations and its effects on outcomes. We retrospectively reviewed all trauma patients undergoing lower extremity amputation from January 1, 2000 through December 31, 2010 at a Level 2 trauma center. Patients undergoing early amputation (amputation within 48 hours of admission) were compared with patients undergoing late amputation (amputations >48 hours after admission). Patient demographics, injury specifics, operative characteristics, and outcomes were documented. During the 11-year study period, 43 patients had a lower extremity amputation and 21 had early amputations. The two groups were similar except for a slightly higher Mangled Extremity Severity Score in the early amputation group. Total hospital length of stay significantly differed between groups, with the late amputation group length of stay being nearly twice as long. The late amputation group had significantly more ipsilateral leg complications than the early group (77% vs 15%). There was a trend toward more prosthetic use in the early group (93%vs 57%, P = 0.07). Traumatic lower extremity injuries requiring amputation are rare at our institution (0.3% incidence). Regardless of the amputation timing, most patients were able to obtain a prosthetic. Although the late group had a longer length of hospital stay and more local limb complications, attempted limb salvage still appears to be a viable option for appropriately selected trauma patients.

  10. Natural control capabilities of robotic hands by hand amputated subjects.

    Science.gov (United States)

    Atzori, Manfredo; Gijsberts, Arjan; Caputo, Barbara; Muller, Henning

    2014-01-01

    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.

  11. Body extract of tail amputated zebrafish promotes culturing of ...

    African Journals Online (AJOL)

    HJE

    After Broussonet (1786) reported that an adult fish could completely regenerate its fins after amputation, many studies focusing on fish fin regeneration have been conducted to examine the regeneration mechanism. (Akimenko et al., 1995; Poss et al., 2000). In particular, small teleost fish such as the zebra fish (Danio rerio).

  12. Safer Amputations: A review o f 158 cases | Unegbu | Nigerian ...

    African Journals Online (AJOL)

    A total of 253 amputations were carried out but only 158 case records were available for review. The age range of study population was 9days-78years.; 46.83% of study population fell within the age bracket of 21-40 years. Trauma related causes were the commonest indications, accounting for 77.58% of cases. Only 2 ...

  13. Prevention of wound sepsis in amputations by peri-operative ...

    African Journals Online (AJOL)

    as regards development of sepsis in wounds closed primarily or left open while under A-CA cover. In a series of 44 patients with lower limb ischaemia requiring amputation for major limb sepsis, the per- formance of a new antibiotic combination with B- lactamase-inhibiting properties, amoxycillin plus . c1avulanic acid ...

  14. Psychological effects of amputation: A review of studies from India

    Directory of Open Access Journals (Sweden)

    Anamika Sahu

    2016-01-01

    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.

  15. External Auditory Canal Stenosis After Traumatic Auricular Amputation

    NARCIS (Netherlands)

    Wong Chung, J.E.; Chussi, D.C; Heerbeek, N. van

    2017-01-01

    BACKGROUND: The auricles are easily injured or amputated in case of head trauma. Inadequate treatment of the external auditory canal (EAC) after auricular injury is often seen and can lead to significant complications of the EAC. CASE REPORT: The authors report 4 cases of auricular injury or

  16. Notes to Parents - When Your Child Has Undergone Amputation.

    Science.gov (United States)

    Pierson, Margaret Hauser

    Designed to provide parents with basic information about the physical and emotional aspects of amputation, the booklet gives information about the grief response, body image, phantom limb sensation, stump care, and the prosthesis. The section on the grief process describes normal reactions to loss: denial, anger, bargaining, depression, and…

  17. Amputation of the limbs: 10 years' experience at Enugu State ...

    African Journals Online (AJOL)

    Male to female ratio was 1.2 to 1; age range was 5 to 88years with mean age 45.4years. Peak age incidence was in the 6th decade. Below knee amputation was the most common operation, and delayed wound healing, the commonest postoperative complication. Thirty amputees procured prosthesis within three months of ...

  18. Pains of amputation amongst diabetic foot ulcer patients in north ...

    African Journals Online (AJOL)

    The diabetic patient has a foot at risk of developing infections when not properly cared for. Ulcer prevalence of over 40% T2DM accounts for over 50% of major amputations with high morbidities and mortalities. The pathophysiology of DFU is multi factorial consisting of peripheral polyneuropathy, arterial disease, and ...

  19. The Functions of an Amputation Clinic | Birkenstock | South African ...

    African Journals Online (AJOL)

    In an effort towards a more positive approach to the treatment and rehabilitation of the amputee, an Amputation Clinic was commenced at Groote Schuur Hospital in 1968. During this period 301 new amputees were seen and assisted in rehabilitation. The importance of psychological trauma and readjustment is emphasized ...

  20. Amputation Totale de La Verge: A Propos de Trois Observations

    Directory of Open Access Journals (Sweden)

    Kimassoum Rimtebaye

    2015-03-01

    Conclusion: qu’elle soit d’origine criminelle ou psychogène, l’amputation totale du pénis est rarissime. Les conséquences sont urinaires, sexuelles et psychogènes. La prise en charge doit être multidisciplinaire.

  1. Satisfaction and adherence of patients with amputations to ...

    African Journals Online (AJOL)

    Abstract. Background: Individuals who have undergone a lower limb amputation require comprehensive rehabilitation from the multidisciplinary team to ensure optimal treatment outcomes and social integration. Physiotherapists play a pivotal role within the multidisciplinary team and offer patients physical and psychosocial ...

  2. Early outcome of vascular lower limb amputations at a National ...

    African Journals Online (AJOL)

    OUTCOME MEASURES: These included the wound healing time, number of stump revisions, number of conversions to a higher amputation level, the ... CONCLUSION: While the findings of this study compare with other series, the prolonged hospital stay is of concern considering the younger average age of the patients.

  3. Wavefront aberrometry and refractive outcomes of flap amputation after LASIK

    NARCIS (Netherlands)

    Al Saady, Rana L.; van der Meulen, Ivanka J.; Nieuwendaal, Carla P.; Engelbrecht, Leonore A.; Mourits, Maarten P.; Lapid-Gortzak, Ruth

    2014-01-01

    Laser in situ keratomileusis flap amputation was performed in 3 eyes of 2 patients because of flap melt and surface irregularity. In the first patient, a 34-year-old man, flaps were excised after a photorefractive keratectomy retreatment procedure on a previous LASIK flap had been done, secondary to

  4. Carpal myxosarcoma and forelimb amputation in a ferret

    NARCIS (Netherlands)

    van Zeeland, Y.R.A.; Hernandez-Divers, S.J.; Blasier, M.W.; Vila-Garcia, G.; Delong, D.; Stedman, N.L.

    2006-01-01

    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,

  5. The eventual outcome of patients who had lower limb amputations ...

    African Journals Online (AJOL)

    C De Klerk

    Background: Peripheral vascular disease (PVD) presenting with irreversible lower limb pathology has a high morbidity and mortality rate. This study aimed to determine the outcome of patients who underwent lower limb amputations (LLAs) because of PVD at Pelonomi Hospital, Bloemfontein, 2008–2011. Methods: ...

  6. Take Care of Yourself After an Amputation or Other Surgery

    Centers for Disease Control (CDC) Podcasts

    2010-02-18

    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.

  7. Satisfaction and adherence of patients with amputations to ...

    African Journals Online (AJOL)

    Background: Individuals who have undergone a lower limb amputation require comprehensive rehabilitation from the multidisciplinary team to ensure optimal treatment outcomes and social integration. Physiotherapists play a pivotal role within the multidisciplinary team and offer patients physical and psychosocial ...

  8. Features of surgical tactics in traumatic amputations of limbs

    Directory of Open Access Journals (Sweden)

    E. V. Ponomarenko

    2016-12-01

    Full Text Available The frequency of traumatic amputations is constantly growing, which is associated with the development of transport and modern technology, military conflicts. Aim: To improve the results of treatment of patients with wound and functional defects after injury by developing a comprehensive program of surgical treatment to restore the shape and function of the trunk and limbs. Materials and methods. From 2010 to 2016 52 patients were observed in the clinic. Traumatic amputations at the hip level were observed in 14 patients, at the level of the upper third of the tibia – in 7 patients, at the level of the lower third of the tibia – 3, foot – 6. Simultaneous amputation of two lower limbs was observed in 2 patients. Amputation of upper limbs at shoulder level was observed in 3 patients, hand – 2, fingers – 15 patients. Among the reasons of limb amputations road traffic injuries occupied the leading position – 77.8 %. Combined injury (mechanical and thermal was observed in 1 case – there was a burn of amputated limb. In 31 cases (59.6 % there was complete amputation of a limb, incomplete – in 21 cases (40.4 %. Results. As a result of these tactics, only in 3 cases we had to do limb reamputation due to the inconsistency of the stump. In 22 patients for the conservation of sufficient length and the optimum shape of the stump the imposition of primary sutures was not made. At the stage of recovery of tissue covering the stump in 16 cases the closure of wound defects with simple split skin graft was fulfilled, 3 – with plastic by local tissues, 4 – islet flap on the peripheral stalk, 1 – plastic flat bridging flap, 20 operations were performed with tubular migratory classic flap. There were no complications in the postoperative period. Conclusions. The main principles in establishing the indications for reconstruction of large limb segments should be both critical attitude to the operation and strict individual approach to each

  9. Risk factors for major amputation in hospitalised diabetic foot patients.

    Science.gov (United States)

    Namgoong, Sik; Jung, Suyoung; Han, Seung-Kyu; Jeong, Seong-Ho; Dhong, Eun-Sang; Kim, Woo-Kyung

    2016-03-01

    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. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  10. Midfoot amputations expand limb salvage rates for diabetic foot infections.

    Science.gov (United States)

    Stone, Patrick A; Back, Martin R; Armstrong, Paul A; Flaherty, Sarah K; Keeling, W Brent; Johnson, Brad L; Shames, Murray L; Bandyk, Dennis F

    2005-11-01

    The persistent high incidence of limb loss resulting from advanced forefoot tissue loss and infection in diabetic patients prompted an evaluation of transmetatarsal (TMA) and transtarsal/midfoot amputations in achieving foot salvage at our tertiary vascular practice. Over the last 8 years, 74 diabetic patients required 77 TMAs for tissue loss and/or infection. Twelve (16%) of the patients had a contralateral below-knee amputation (BKA) and 26% (n = 20) had dialysis-dependent renal failure. Thirty-five (45%) limbs had concomitant revascularization (bypass grafting or percutaneous transluminal angioplasty), 32 (42%) had arterial occlusive disease by noninvasive testing and/or arteriography but were not or could not be revascularized, and seven (13%) had normal hemodynamics. Patient factors, arterial testing, operative complications, operative mortality (foot salvage was possible in 61% (25/41) of nonhealing TMAs. Overall limb salvage for TMA/midfoot procedures was estimated from Kaplain-Meier life tables to be 73%, 68%, and 62% at 1, 3, and 5 years, respectively, with only 50% of dialysis patients avoiding major amputation. Ankle pressure >100 mm Hg and a biphasic pedal waveform had a positive predictive value (PPV) of 79%, and toe pressure >50 mm Hg had a PPV of 91% for determining healing of TMA/midfoot amputations. One- and 3-year survival rates were only 72% and 69% for the entire cohort from life table estimates. Aggressive attempts at foot salvage are justified in diabetic patients with advanced forefoot tissue loss/infection after assuring adequate arterial perfusion. Transtarsal amputations salvaged over half of nonhealing TMAs with excellent functional results.

  11. Measuring outcomes and determining long-term disability after revision amputation for treatment of traumatic finger and thumb amputation injuries.

    Science.gov (United States)

    Giladi, Aviram M; McGlinn, Evan P; Shauver, Melissa J; Voice, Taylor P; Chung, Kevin C

    2014-11-01

    Disability ratings after finger amputations are based on anatomical injury according to the American Medical Association's Guides to the Evaluation of Permanent Impairment. These ratings determine disability and compensation, without considering validated outcomes measures. The authors hypothesize that patient-reported outcomes reflect function and health-related quality of life after traumatic finger amputations, and that Guides scoring does not accurately rate postamputation disability. Patients were classified by amputation: single finger, thumb, multifinger, or multifinger plus thumb. Eighty-four patients completed functional tests, the Jebsen-Taylor Hand Function Test, and patient-reported outcomes [Brief Michigan Hand Questionnaire (MHQ), Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Short Form-36 health-related quality-of-life questionnaire). Patients were given disability scores according to the Guides. Pearson correlations between outcomes metrics were calculated, and linear regression evaluated associations between amputation group, Guides score, and outcomes measures. The Brief MHQ and Quick DASH questionnaires had significant correlation with functional tests, the Jebsen-Taylor test, and the physical component summary of Short Form-36. Only the Brief MHQ correlated with the mental component summary of the Short Form-36 (r=0.29, p=0.02). The Guides score only correlated with the Jebsen-Taylor test (r=0.47, pamputation group and Guides score do not predict patient-reported outcomes. The American Medical Association Guides score represents anatomical and functional outcomes without addressing mental health and other components of disability. As a result, Guides scoring is inadequate for determining postamputation disability. In evaluating composite amputation outcomes, Brief Michigan Hand Questionnaire outperformed other metrics. Risk, II.

  12. Epidemiology of post-traumatic limb amputation: a National Trauma Databank analysis.

    Science.gov (United States)

    Barmparas, Galinos; Inaba, Kenji; Teixeira, Pedro G R; Dubose, Joseph J; Criscuoli, Michele; Talving, Peep; Plurad, David; Green, Donald; Demetriades, Demetrios

    2010-11-01

    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 Traumatic limb 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.

  13. Use of vacuum-assisted closure therapy following foot amputation.

    Science.gov (United States)

    Ballard, K; McGregor, F

    2001-08-01

    This case study highlights the use of vacuum-assisted closure (VAC) in a diabetic man following a partial transverse amputation of his foot. In this situation infection-free healing is imperative in order to salvage the limb and prevent further trauma. VAC therapy facilitates rapid granulation of wounds and reduces bacterial colonization rates. This method was adopted as a suitable therapy for treatment of a patient who suffered from a complex wound at high-risk of reinfection.

  14. Amputation Totale de La Verge: A Propos de Trois Observations

    African Journals Online (AJOL)

    Kimassoum Rimtebaye

    Introduction. Lavergeestunorganemasculindotéd'unedoublefonction(urinaire et copulation). L'amputation totale de la verge est rare [1–4]. Elle s'observe soit dans un contexte criminel ou dans le cadre d'une auto- mutilation chez un patient psychogène souffrant de schizophrénie. [5,6]. Elle pose quatre problèmes: sexuel, ...

  15. Tetanus following replantation of an amputated finger: a case report.

    Science.gov (United States)

    Hayashida, Kenji; Murakami, Chikako; Fujioka, Masaki

    2012-10-08

    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. 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. 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.

  16. Tetanus following replantation of an amputated finger: a case report

    Directory of Open Access Journals (Sweden)

    Hayashida Kenji

    2012-10-01

    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.

  17. Anxiety and depression following traumatic limb amputation: a systematic review.

    Science.gov (United States)

    Mckechnie, P S; John, A

    2014-12-01

    Traumatic amputation can result in multiple physical, psychological and socio-economic sequalae. While there has been a significant increase in investment and public profile of the rehabilitation of patients who have experienced traumatic limb amputation, little is known about the prevalence of anxiety and depression, especially in the long term. To determine the association between traumatic limb amputation and anxiety and depression. A literature search of available databases including Cochrane, Medline, Embase, and PsycINFO was performed for relevant studies since 2002. Secondary outcomes included the effect on employment, substance misuse, relationships and quality of life. Randomised control trials, observational studies or reviews which met the inclusion, exclusion and quality criteria. Levels of anxiety and depression are significantly higher than in the general population. Significant heterogeneity exists between studies making meta-analyses inappropriate. Improved rehabilitation is having a positive effect on employment rates. There appears to be no significant effect on substance abuse and relationships. All studies demonstrated high prevalence of anxiety and depression in post-traumatic amputees. No good prospective data exists for levels of anxiety and depression beyond two years of follow up and this should be an area of future study. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  18. Provision of Prosthetic Services Following Lower Limb Amputation in Malaysia

    Science.gov (United States)

    Arifin, Nooranida; Hasbollah, Hasif Rafidee; Hanafi, Muhammad Hafiz; Ibrahim, Al Hafiz; Rahman, Wan Afezah Wan Abdul; Aziz, Roslizawati Che

    2017-01-01

    The incidence of lower limb amputation is high across the globe and continues to be a major threat to morbidity and mortality. Consequently, the provision of high quality and effective prosthetics services have been known as an essential component for a successful rehabilitation outcome. In Malaysia, amputation prevalence has been increasing in which several main components of service delivering aspects (such as service intervention, prosthetic personnel) should be anticipated to accommodate for the increasing demand. This article highlights the hurdles experienced in providing prosthetic services in Malaysia from multiple aspects such as financial burden to acquire the prosthesis and lack of expertise to produce quality prosthesis. This paramount issues consequently justify for the urgency to carry out national level survey on the current statistics of lower limb amputation and to ascertain the available workforce to provide a quality prosthetics services. Only with accurate and current information from the national survey, strategies and policies aimed at enhancing the outcome from prosthetics services can be achieved. PMID:29386978

  19. Exploring ethical justification for self-demand amputation.

    Science.gov (United States)

    Tomasini, Floris

    2006-01-01

    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.

  20. Provision of Prosthetic Services Following Lower Limb Amputation in Malaysia.

    Science.gov (United States)

    Arifin, Nooranida; Hasbollah, Hasif Rafidee; Hanafi, Muhammad Hafiz; Ibrahim, Al Hafiz; Rahman, Wan Afezah Wan Abdul; Aziz, Roslizawati Che

    2017-10-01

    The incidence of lower limb amputation is high across the globe and continues to be a major threat to morbidity and mortality. Consequently, the provision of high quality and effective prosthetics services have been known as an essential component for a successful rehabilitation outcome. In Malaysia, amputation prevalence has been increasing in which several main components of service delivering aspects (such as service intervention, prosthetic personnel) should be anticipated to accommodate for the increasing demand. This article highlights the hurdles experienced in providing prosthetic services in Malaysia from multiple aspects such as financial burden to acquire the prosthesis and lack of expertise to produce quality prosthesis. This paramount issues consequently justify for the urgency to carry out national level survey on the current statistics of lower limb amputation and to ascertain the available workforce to provide a quality prosthetics services. Only with accurate and current information from the national survey, strategies and policies aimed at enhancing the outcome from prosthetics services can be achieved.

  1. What are the key conditions associated with lower limb amputations in a major Australian teaching hospital?

    Directory of Open Access Journals (Sweden)

    Lazzarini Peter A

    2012-05-01

    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

  2. The eye amputated - consequences of eye amputation with emphasis on clinical aspects, phantom eye syndrome and quality of life

    DEFF Research Database (Denmark)

    Rasmussen, Marie Louise Roed

    2010-01-01

    In this thesis the term eye amputation (EA) covers the removing of an eye by: evisceration, enucleation and exenteration. Amputation of an eye is most frequently the end-stage in a complicated disease, or the primary treatment in trauma and neoplasm. In 2010 the literature is extensive due...... to knowledge about types of surgery, implants and surgical technique. However, not much is known about the time past surgery. THE PURPOSE OF THE PHD THESIS WAS: To identify the number of EA, the causative diagnosis and the indication for surgical removal of the eye, the chosen surgical technique...... and to evaluate a possible change in surgical technique in Denmark from 1996 until 2003 (paper I); To describe the phantom eye syndrome and its prevalence of visual hallucinations, phantom pain and phantom sensations (paper II); To characterise the quality of phantom eye pain, including its intensity...

  3. Pirogoff amputation for a bilateral traumatic lower-extremity amputee: indication and technique.

    Science.gov (United States)

    Ipaktchi, Kyros; Seidl, Adam; Banegas, Rodrigo; Hak, David; Mauffrey, Cyril

    2014-06-01

    Although only a small portion of all lower-extremity amputations in the United States are of traumatic origin, almost half of all living amputees have sustained traumatic amputations. This particular epidemiology is explained by the younger age, and thus longer life expectancy, of traumatic amputees. In this group especially, restoration and lifelong maintenance of ambulation and mobility is essential. The authors present the case of a bilateral traumatic lower-leg amputee whose management included a Pirogoff amputation. Although this amputation technique is not widely used, the authors believe it greatly facilitated stump and soft tissue management in this case and allowed for improved mobility. The indication for and technique of Pirogoff amputation are described, and a brief overview of amputation techniques in the foot is provided. Copyright 2014, SLACK Incorporated.

  4. Ectopic banking of amputated great toe for delayed thumb reconstruction: case report.

    Science.gov (United States)

    Valerio, Ian L; Hui-Chou, Helen G; Zelken, Jonathan; Basile, Patrick L; Ipsen, Derek; Higgins, James P

    2014-07-01

    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. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. The role of elective amputation in patients with traumatic brachial plexus injury.

    Science.gov (United States)

    Maldonado, Andrés A; Kircher, Michelle F; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

    2016-03-01

    Despite undergoing complex brachial plexus, surgical reconstructions, and rehabilitation, some patients request an elective amputation. This study evaluates the role of elective amputation after brachial plexus injury. A retrospective chart review was performed for all the 2140 patients with brachial plexus injuries treated with elective amputation between 1999 and 2012 at a single institution. Analysis was conducted on the potential predisposing factors for amputation, amputation level, and postamputation complications. Patients were evaluated using pre- and postamputation Disabilities of the Shoulder, Arm, and hand scores in addition to visual analog pain scores. The following three conditions were observed in all nine patients who requested an elective amputation: (1) Pan-plexus injury; (2) non-recovery (mid-humeral amputation) or elbow flexion recovery only (forearm amputation) 1 year after all other surgical options were performed; and (3) at least one chronic complication (chronic infection, nonunion fractures, full-thickness burns, chronic neck pain with arm weight, etc.). Pain improvement was found in five patients. Subjective patient assessments and visual analog pain scores before and after amputation did not show a statistically significant improvement in Disabilities of the Shoulder, Arm, and Hand Scores. However, four patients reported that their shoulder pain felt "better" than it did before the amputation, and two patients indicated they were completely cured of chronic pain after surgery. Elective amputation after brachial plexus injury should be considered as an option in the above circumstances. When the informed and educated decision is made, patients can have satisfactory outcomes regarding amputation. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Clinical characteristics and survival of patients with diabetes mellitus following non-traumatic lower extremity amputation.

    Science.gov (United States)

    Wiessman, Maya Paryente; Liberty, Idit F; Segev, Renana Wilkof; Katz, Tiberiu; Abu Tailakh, Muhammad; Novack, Victor

    2015-03-01

    Diabetes mellitus-related lower extremity amputation is a major complication severely affecting patient survival and quality of life. To analyze epidemiological and clinical trends in the incidence and survival of lower extremity amputations among diabetes patients. We conducted a retrospective observational cohort study of 565 consecutive diabetes patients who underwent their first non-traumatic lower extremity amputation between January 2002 and December 2009. Major amputations were performed in 316 (55.9%) patients: 142 above the knee (25.1%) and 174 below (30.8%); 249 (44.1%) had a minor amputation. The incidence rates of amputations decreased from 2.9 to 2.1 per 1000 diabetes patients. Kaplan-Meier survival analysis showed that first year mortality rates were lower among patients with minor amputations (31.7% vs. 39.6%, P = 0.569). First year mortality rates following below-knee amputation were somewhat lower than above-knee amputation (33.1 vs. 45.1%, respectively). Cox regression model of survival at 1 year after the procedure found that age (HR 1.06 per year, 95% CI 1.04-1.07, P amputation (HR 1.36, 95% CI 1.01-1.83, P = 0.045) and ischemic heart disease (HR 1.68, 95% CI 1.26-2.24, P traumatic amputations in diabetes patients between January 2002 and December 2009 decreased slightly. However, one year mortality rates after the surgery did not decline and remained high, stressing the need for a multidisciplinary effort to prevent amputations in diabetes patients.

  7. Management of Complex Extremity Injuries: Tourniquets, Compartment Syndrome Detection, Fasciotomy, and Amputation Care

    Science.gov (United States)

    2012-01-01

    and knee joints. As with energy-transferring orthotics, lower extremity amputees can attain good function with energy transfer prosthesis . In general...E mail address: robert.rush1@us.army.mil KEYWORDS Extremity injury Mangled extremity Amputation Compartment syndrome Fasciotomy Prosthesis ...the soft tissue coverage of the bone for a below-the- knee amputation. 3. The definitive amputation procedure and stump closure do not have to be done at

  8. Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

    Directory of Open Access Journals (Sweden)

    Ramkumar Nirupama

    2005-03-01

    Full Text Available Abstract Background Surgical treatment of peripheral vascular disease (PVD in dialysis patients is controversial. Methods We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation. Results Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896 or amputation (n = 2,046 in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR 19.0, 95% CI (confidence interval 13.86–25.95]. The odds of dying within 30 days and within1 year were higher (30 day OR: 1.85, 95% CI: 1.45–2.36; 1 yr OR: 1.46, 95% CI: 1.25–1.71 in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (rd percentile of propensity score and moderate likelihood of amputation (33rd to 66th percentile but not in high likelihood group (>66th percentile. The number of hospital days in the amputation and revascularization groups was not different. Conclusion Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.

  9. Treating Intractable Post-Amputation Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks

    Science.gov (United States)

    2016-01-01

    AD_________________ Award Number: W81XWH-13-2-0009 TITLE: Treating Intractable Post-Amputation Phantom Limb Pain with Ambulatory Continuous...Annual 3. DATES COVERED 26 Dec 2014- 25 Dec 2015 4. TITLE AND SUBTITLE Treating Intractable Post-Amputation Phantom Limb Pain with Ambulatory...effective treatment for intractable phantom limb pain following a traumatic limb amputation. There is currently no reliable treatment for phantom limb pain

  10. Patients amputated by work accidents: characteristics and years accumulated of potential productive life lost

    OpenAIRE

    Camacho-Conchucos, Herminio Teófilo

    2011-01-01

    Objectives: To determine the accumulated years of potential productive life lost in amputated patients by work accidents. Design: Descriptive, retrospective, cross-sectional study. Setting: Instituto Nacional de Rehabilitacion, Callao, Peru. Participants: Amputated patients by work accidents. Interventions: Review of 1 290 medical records of amputated patients attended from January 1, 2003, to December 31, 2007, 108 due to work accidents. The accumulated years of potential productive life los...

  11. Distal phalanx amputation with delayed presentation and successful reconstruction with reposition and flap after 2 weeks

    Directory of Open Access Journals (Sweden)

    Jefferson Braga-Silva

    2016-01-01

    Full Text Available Traumatic finger amputations are common, causing significant functional and cosmetic deficits. Microsurgical replantation techniques are the mainstay of treatment for most such injuries although they require adequate conservation of the amputated segment for a successful result. In distal finger amputations, replantation is the procedure of choice, as long as the amputated fragment is viable. If replantation is not an option, reposition + flap using a neurovascular flap can be an efficient option, as this offers improved skin coverage. To the best of our knowledge, this case illustrates the longest cold ischaemic time with a successful outcome.

  12. Acute phase reactants predict the risk of amputation in diabetic foot infection.

    Science.gov (United States)

    Akinci, Baris; Yener, Serkan; Yesil, Sena; Yapar, Nur; Kucukyavas, Yasin; Bayraktar, Firat

    2011-01-01

    prediction of amputation would aid clinicians in the management of diabetic foot infections. We aimed to assess the predictive value of baseline and post-treatment levels of acute phase reactants in the outcome of patients with diabetic foot infections. we collected data prospectively during minimum follow-up of 6 months in patients with infected diabetic foot ulcers hospitalized in Dokuz Eylul University Hospital between January 1, 2003, and January 1, 2008. After excluding patients who did not attend the hospital for follow-up visits regularly (n = 36), we analyzed data from 165 foot ulcer episodes. limb ischemia and osteomyelitis were much more frequent in patients who underwent amputation. Wagner grade, which assesses ulcer depth and the presence of osteomyelitis or gangrene, was higher in patients who needed amputation. Ulcer size was slightly larger in the amputation group. Baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, white blood cell counts, and platelet counts were significantly elevated in patients who underwent amputation. Albumin levels were significantly suppressed in the amputation group. Univariate analysis showed that a 1-SD increase in baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, and white blood cell counts and a 1-SD decrease in post-treatment albumin levels were significantly associated with increased risk of amputation. Post-treatment C-reactive protein level was strongly associated with amputation risk. circulating levels of acute phase reactants were associated with amputation risk in diabetic foot infections.

  13. Peak oxygen consumption in older adults with a lower limb amputation.

    Science.gov (United States)

    Wezenberg, Daphne; de Haan, Arnold; Faber, Willemijn X; Slootman, Hans J; van der Woude, Lucas H; Houdijk, Han

    2012-11-01

    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). Cross-sectional descriptive. Human motion laboratory at a rehabilitation center. Older subjects (n=36) who underwent lower limb amputation and age-matched, able-bodied controls (n=21). All subjects were able to walk for a minimum of 4 minutes. Not applicable. Peak oxygen consumption (Vo(2)(peak)) was measured using open-circuit respirometry while performing a discontinuous, graded, 1-legged, peak cycle exercise test. After correcting for age, body mass index, and sex, the multiple linear regression analysis revealed that subjects who underwent amputation had a 13.1% lower aerobic capacity compared with able-bodied controls (P=.021). Differentiation among etiologies revealed that subjects with a vascular amputation had a lower Vo(2)(peak) of 29.1% compared with able-bodied controls (Ptraumatic amputees did not differ from able-bodied controls (P=.127). After correcting for etiology, no association between level of amputation and Vo(2)(peak) was found (P=.534). Older adults who underwent an amputation because of vascular deficiency had a lower aerobic capacity compared with able-bodied controls and people with a traumatic amputation. The level of amputation was not associated with Vo(2)(peak). Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  14. The effect of amputation level and age on outcome: an analysis of 135 amputees.

    Science.gov (United States)

    Yilmaz, Murat; Gulabi, Deniz; Kaya, Ibrahim; Bayram, Erhan; Cecen, Gultekin Sitki

    2016-01-01

    In this retrospective study, the impact of age, amputation level and the cause of amputation were examined using the Hospital Anxiety and Depression Scale (HADS) and Medicare K scores of amputees with unilateral lower-limb amputation. In total, 135 patients with unilateral transfemoral (TF) or (TT) transtibial amputations were examined. All data were collected using questionnaires that were either self-administered or administered during an interview. The HADS was developed as a self-reporting questionnaire to detect adverse anxiety and depressive status. K code is used to describe the functional abilities of amputees. The mean age at the time of surgery was 52.79 ± 13.08 years. The mean time since amputation was 59.20 ± 24.41 months for TT, and 60.89 ± 22.09 months for TF amputation. The HADS-A scores of the transfemoral amputation group were determined as significantly high compared to those of the transtibial group (p traumatic transfemoral amputation. Therefore, adequate psychiatric evaluation and rehabilitation should be applied to all amputees, especially in cases of young, traumatic, transfemoral amputations. Level 3, retrospective comparative cohort study.

  15. Difficult to predict early failure after major lower-extremity amputations

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Holm, Gitte; Gebuhr, Peter

    2015-01-01

    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...

  16. Effect of primary and secondary wartime below-knee amputation on length of hospitalization and rehabilitation

    Directory of Open Access Journals (Sweden)

    Jandrić Slavica

    2002-01-01

    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.

  17. Sex after amputation: the relationships between sexual functioning, body image, mood and anxiety in persons with a lower limb amputation.

    Science.gov (United States)

    Woods, Lorraine; Hevey, David; Ryall, Nicola; O'Keeffe, Fiadhnait

    2018-07-01

    The study examined the relationships between psychological variables and sexual functioning in persons with lower limb amputations. Sixty-five participants (n = 49 males, n = 16 females) with lower limb amputations completed a battery of self-report questionnaires regarding their current psychological well-being and their current sexual activity. Measures included the anxiety items on the Hospital Anxiety and Depression Scale, the Beck Depression Inventory - Second Edition, Body Image Quality of Life Inventory, Body Exposure Self-Consciousness during Intimate Situations and the Golombok-Rust Inventory of Sexual Satisfaction. Half of all participants with lower limb amputations were not currently sexually active. Approximately 60% of those who were sexually active scored within the clinical range for overall sexual dysfunction. Overall levels of sexual dysfunction were associated with significantly higher levels of anxiety (r = 0.40, p < 0.005), depression (r = 0.41, p < 0.015) and body exposure self-consciousness during sexual activities (r = 0.56, p < 0.005). Body image self-consciousness during sexual activities was the strongest predictor of sexual dysfunction. Psychological challenges following limb loss are strongly associated with levels of sexual dysfunction. The study highlights the need for psychological and psychosexual assessment and intervention following limb loss to enhance sexual functioning and overall quality of life. Implications for Rehabilitation Only half of the participants with a lower limb amputation were sexually active. Over 60% of those who were sexually active reported clinical levels of sexual dysfunction. One third of the entire sample scored within the clinical range for depression and for anxiety. Depression, anxiety and body image issues were significantly associated with sexual dysfunction in the current sample of individuals with lower limb amputation. There is a need for psychosexual assessment

  18. Acute bone changes after lower limb amputation resulting from traumatic injury.

    Science.gov (United States)

    Bemben, D A; Sherk, V D; Ertl, W J J; Bemben, M G

    2017-07-01

    Bone health is critical for lower limb amputees, affecting their ability to use a prosthesis and their risk of osteoporosis. We found large losses in hip bone mineral density (BMD) and in amputated bone strength in the first year of prosthesis use, suggesting a need for load bearing interventions early post-amputation. Large deficits in hip areal BMD (aBMD) and residual limb volumetric BMD (vBMD) occur after lower limb amputation; however, the time course of these bone quality changes is unknown. The purpose of this study was to quantify changes in the amputated bone that occur during the early stages post-amputation. Eight traumatic unilateral amputees (23-53 years) were enrolled prior to surgery. Changes in total body, hip, and spine aBMD (dual-energy X-ray absorptiometry); in vBMD, stress-strain index (SSI), and muscle cross-sectional area (MCSA) (peripheral QCT); and in bone turnover markers were assessed after amputation prior to prosthesis fitting (pre-ambulatory) and at 6 and 12 months walking with prosthesis. Hip aBMD of the amputated limb decreased 11-15%, which persisted through 12 months. The amputated bone had decreases (p 650 mg/cm 3 (58 to 43% of total area) or >480 mg/cm 3 (65% to 53%), suggesting an increase in cortical porosity after amputation. Bone alkaline phosphatase and sclerostin were elevated (p amputation and are not regained by 12 months of becoming ambulatory. Early post-amputation may be the most critical window for preventing bone loss.

  19. Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer.

    Science.gov (United States)

    Pickwell, Kristy; Siersma, Volkert; Kars, Marleen; Apelqvist, Jan; Bakker, Karel; Edmonds, Michael; Holstein, Per; Jirkovská, Alexandra; Jude, Edward; Mauricio, Didac; Piaggesi, Alberto; Ragnarson Tennvall, Gunnel; Reike, Heinrich; Spraul, Maximilian; Uccioli, Luigi; Urbancic, Vilma; van Acker, Kristien; van Baal, Jeff; Schaper, Nicolaas

    2015-05-01

    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. We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries. Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively). 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 for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  20. Standing balance in people with trans-tibial amputation due to vascular causes: A literature review.

    Science.gov (United States)

    Seth, Mayank; Lamberg, Eric

    2017-08-01

    Balance is an important variable to consider during the rehabilitation process of individuals with trans-tibial amputation. Limited evidence exists on the balance abilities of people with trans-tibial amputation due to vascular causes. The purpose of this article is to review literature and determine if standing balance is diminished in people with trans-tibial amputation due to vascular causes. Literature review. Data were obtained from PubMed, Google Scholar, OandP.org , CINHAL, and Science Direct. Studies were selected only if they included standing balance assessment of people with unilateral trans-tibial amputation due to vascular causes. The review yielded seven articles that met the inclusion criteria. The general test methodology required participants to stand still on force platforms, with feet together, while center of pressure or postural sway was recorded. According to the findings of this review, individuals with trans-tibial amputees due to vascular causes have diminished balance abilities. Limited evidence suggests their balance might be further diminished as compared to individuals with trans-tibial amputation due to trauma. Although the evidence is limited, because of the underlying pathology and presence of comorbidities in individuals with trans-tibial amputation due to vascular causes, one cannot ignore these findings, as even a minor injury from a fall may develop into a non-healing ulcer and affect their health and well-being more severely than individuals with trans-tibial amputation due to trauma. Clinical relevance Individuals with trans-tibial amputation due to vascular causes have diminished balance abilities compared to healthy individuals and individuals with trans-tibial amputation due to trauma. This difference should be considered when designing and fabricating prostheses. Prosthetists and rehabilitation clinicians should consider designing amputation cause-specific rehabilitation interventions, focussing on balance and other

  1. Phalangeal regrowth in rodents: postamputational bone regrowth depends upon the level of amputation.

    Science.gov (United States)

    Neufeld, D A; Zhao, W

    1993-01-01

    Conflicting reports of distal phalangeal regrowth prompted a reexamination of bone growth following phalangeal amputation in mammals. Digits of neonatal and adult mice and rats were amputated at various levels. The short-term response was examined on histological sections, and long-term growth was documented by alizarin red-staining of KOH-digested digits. Three patterns of response were seen to correspond to three general levels of amputation. Complete bone regeneration occurred frequently by five weeks following amputation through the distal one-quarter of the distal phalanx. Amputation through the central region of the distal phalanx yielded substantial bone growth, but the form of the regrowth was imperfect even three months after amputation. Amputation through more proximal levels of the digit yielded no significant elongation. To investigate why the response varies in relation to the level of amputation, we are conducting both in vivo and in vitro experiments. We have learned that simple avulsion of the nail plate provokes substantial remodeling of the distal phalanx. We are further exploring the trophic influence of nail organ on bone structure and growth in vivo. We have also recently determined that entire digits may be kept alive in vitro when cultured in DMEM:F-12:BGJb medium supplemented with insulin, EGF and FGF. This system sufficiently replicates in vivo conditions such that osteogenesis occurs both endosteally and distal to the amputation plane in vitro. The effects of growth factors, retinoic acid, and the presence or absence of nail organ components on amputational bone growth at all three levels are currently being studied in vitro. The goal of these studies is to determine why bone fails to grow, undergoes hyperplasia, or regenerates following amputation at different levels in mammals.

  2. Predictive factors for lower extremity amputations in diabetic foot infections

    Directory of Open Access Journals (Sweden)

    Zameer Aziz

    2011-09-01

    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.

  3. Rehabilitation outcome following war-related transtibial amputation in Kosovo.

    Science.gov (United States)

    Osmani-Vllasolli, Teuta; Hundozi, Hajrije; Orovcanec, Nikola; Krasniqi, Blerim; Murtezani, Ardiana

    2014-06-01

    Previous literature has suggested that age, level of amputation, residual limb length, comorbidities, mental disorders, and cause of amputation can affect the ability to successfully ambulate with prosthesis. The objective of this study was to analyze the predictors that affect the rehabilitation outcome of war-related transtibial amputees and the relationship of these factors with ambulation ability after prosthetic fitting. Retrospective observational study. We reviewed the records of 69 war-related transtibial amputees. The rehabilitation outcome was analyzed according to the grade of rehabilitation summarized in three grades. Multiple logistic regression analysis was used to determine the odds of achieving the first rehabilitation grade. The majority of patients with transtibial amputations achieved the first grade of rehabilitation (59.4%). The factors that significantly influenced the achievement of the first grade of rehabilitation were age and absence of posttraumatic stress disorder. For every 1-year increase in patient age, the odds of achieving first grade of rehabilitation decreased by a factor of 0.9. Patients without posttraumatic stress disorder had 12.9 greater odds of achieving the first rehabilitation grade compared to patients with posttraumatic stress disorder. Achievement of the first grade of rehabilitation among war-related transtibial amputees is dependent on patient age and the absence of posttraumatic stress disorder. Understanding the factors that may affect the rehabilitation outcome of war-related amputees could lead to a more specific organization of the rehabilitation, especially in a country that has recently been involved in war. This is the first study to focus on determinants of prosthetic rehabilitation in these patients. © The International Society for Prosthetics and Orthotics 2013.

  4. Intrauterine Idiopathic Amputation of the Head of a Porcine Foetus

    DEFF Research Database (Denmark)

    Agerholm, J. S.; Garoussi, M. T.

    2013-01-01

    Contents An anencephalic full-term porcine foetus accompanied by a mummified head was submitted for examination. The neck almost entirely lacked skin and was covered by granulation tissue as were the exposed parts of the spine and spinal cord. The case represents a rare case of intrauterine...... amputation. A definitive cause could not be established because the placenta was not available. The most likely cause is strangulation of the neck. Such strangulation could be due to a defect of the allantoamnion with herniation of the foetal head or entanglement by amniotic constriction bands....

  5. Reconstructive operations at the amputations of the penis of children

    Directory of Open Access Journals (Sweden)

    A. K. Fayzulin

    2014-12-01

    Full Text Available In the article the versions of rendering to surgical aid to children with the iatrogenic and traumatic amputations of penis are represented. Are described the surgical methods, with make it possible to attain lengthening the state of sexual term with the simultaneous elimination of the meatal stenosis. The application of a free skin flap for the imitation of head and closing of the trunk of penis is the method of selection with the deficiency of skin coating and considerably improves cosmetic result of operation.

  6. Amputations for extremity soft tissue sarcoma in an era of limb salvage treatment : Local control and survival

    NARCIS (Netherlands)

    Stevenson, Marc G; Musters, Annelie H; Geertzen, Jan H B; van Leeuwen, Barbara L; Hoekstra, Harald J; Been, Lukas B

    2018-01-01

    BACKGROUND: Despite multimodality limb salvage treatment (LST) for locally advanced extremity soft tissue sarcoma (ESTS), some patients still need an amputation. Indications for amputation and oncological outcome for these patients are described. METHODS: Between 1996 and 2016, all patients who

  7. Substantial reduction in the number of amputations among patients with diabetes

    DEFF Research Database (Denmark)

    Rasmussen, Benjamin S B; Yderstraede, Knud B; Carstensen, Bendix

    2016-01-01

    the hospital administrative system, diabetes status by linkage with the Danish National Diabetes Register, and mortality and population data by extraction from Statistics Denmark. Amputation rates were analysed using proportional hazard models. We analysed the incidence of the first amputation at each level...... 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......, patients with diabetes had an HR for below-ankle amputations (BAAs) of 14.7 for men and 7.5 for women, and for from-ankle-to-knee amputations (BKAs) of 7.6 and 8.4 for men and women, respectively. For above-knee amputations (AKAs) the numbers were 4.0 for men and 3.7 for women. We found an annual reduction...

  8. Direct medical costs of accidental falls for adults with transfemoral amputations.

    Science.gov (United States)

    Mundell, Benjamin; Maradit Kremers, Hilal; Visscher, Sue; Hoppe, Kurtis; Kaufman, Kenton

    2017-12-01

    Active individuals with transfemoral amputations are provided a microprocessor-controlled knee with the belief that the prosthesis reduces their risk of falling. However, these prostheses are expensive and the cost-effectiveness is unknown with regard to falls in the transfemoral amputation population. The direct medical costs of falls in adults with transfemoral amputations need to be determined in order to assess the incremental costs and benefits of microprocessor-controlled prosthetic knees. We describe the direct medical costs of falls in adults with a transfemoral amputation. This is a retrospective, population-based, cohort study of adults who underwent transfemoral amputations between 2000 and 2014. A Bayesian structural time series approach was used to estimate cost differences between fallers and non-fallers. The mean 6-month direct medical costs of falls for six hospitalized adults with transfemoral amputations was US$25,652 (US$10,468, US$38,872). The mean costs for the 10 adults admitted to the emergency department was US$18,091 (US$-7,820, US$57,368). Falls are expensive in adults with transfemoral amputations. The 6-month costs of falls resulting in hospitalization are similar to those reported in the elderly population who are also at an increased risk of falling. Clinical relevance Estimates of fall costs in adults with transfemoral amputations can provide policy makers with additional insight when determining whether or not to cover a prescription for microprocessor-controlled prosthetic knees.

  9. Peak oxygen consumption in older adults with a lower limb amputation.

    NARCIS (Netherlands)

    Wezenberg, D.; de Haan, A.; Faber, W.X; Slootman, H.J.; van der Woude, L.H.V.; Houdijk, J.H.P.

    2012-01-01

    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

  10. Surgical management of traumatic penile amputation: a case report and review of the world literature.

    Science.gov (United States)

    Raheem, Omer A; Mirheydar, Hossein S; Patel, Nishant D; Patel, Sunil H; Suliman, Ahmed; Buckley, Jill C

    2015-03-01

    There is paucity of case reports that describe the successful reimplantation of a penis after amputation. We sought to report on self-inflicted penile amputation and comment on its surgical management and review current literature. To report on self-inflicted penile amputation and comment on its surgical management and review current literature. A 19-year-old male with no prior medical history presented to our university-affiliated trauma center following sustaining a self-inflicted amputation of shaft penis secondary to severe methamphetamine-induced psychosis. He immediately underwent extensive reconstructive reimplantation of the penis performed jointly by plastics and urology teams reattaching all visible neurovascular bundles, urethra, and corporal and fascial layers. The patient was discharged with a suprapubic tube in place and a Foley catheter in place with well-healing tissue. To review the current published literature and case reports on the management of penile amputation with particular emphasis its etiology, surgical repairs, potential complications and functional outcomes. We report herein a case of a traumatic penile amputation and successful outcome of microscopic reimplantation and review of the published literature with particular comments on surgical managements. We review the literature and case reports on penile amputation and its etiology, surgical management, variables effecting outcomes, and its complications. Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, and Buckley JC. Surgical management of traumatic penile amputation: A case report and review of the world literature. Sex Med 2015;3:49-53.

  11. Peak Oxygen Consumption in Older Adults With a Lower Limb Amputation

    NARCIS (Netherlands)

    Wezenberg, Daphne; de Haan, Arnold; Faber, Willemijn X.; Slootman, Hans J.; van der Woude, Lucas H.; Houdijk, Han

    2012-01-01

    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

  12. Therapy-Resistant Complex Regional Pain Syndrome Type I : To Amputate or Not?

    NARCIS (Netherlands)

    Bodde, M.I.; Dijkstra, P.U.; den Dunnen, W.F.A.; Geertzen, J.H.B.

    2011-01-01

    Background: Amputation for the treatment of long-standing, therapy-resistant complex regional pain syndrome type I (CRPS-I) is controversial. An evidence-based decision regarding whether or not to amputate is not possible on the basis of current guidelines. The aim of the current study was to

  13. Evaluation of upper extremity traumatic amputations by means of etiology, demographics and therapy

    Directory of Open Access Journals (Sweden)

    Daghan Dagdelen

    2012-12-01

    Conclusion: Distal finger amputations (Tamai zones I and II form the most controversial amputation level. The decision of stump, local flap or replantation at this level will not only affect the patients' functional and body integrity but also the daily activity and dexterity of manual labor. [Hand Microsurg 2012; 1(3.000: 95-98

  14. Pattern of limb amputations in male patients in a sub-urban teaching ...

    African Journals Online (AJOL)

    Background: Extremity amputations represent a major disability and it is compounded by the difficulty in obtaining prosthesis in developing nations. The consequences of loss of ... The most frequent level of amputation was below knee level in 53.1% of cases, followed by above knee in 31.2% of cases. The lower limb was ...

  15. The effect of limb amputation on standing weight distribution in the remaining three limbs in dogs.

    Science.gov (United States)

    Cole, Grayson Lee; Millis, Darryl

    2017-01-16

    Despite the fact that limb amputation is a commonly performed procedure in veterinary medicine, quantitative data regarding outcomes are lacking. The intention of this study was to evaluate the effect of limb amputation on weight distribution to the remaining three limbs at a stance in dogs. Ten dogs with a prior forelimb amputation and ten dogs with a prior hindlimb amputation; all of which had no history of orthopaedic or neural disease in the remaining three limbs were included in the study. Standing weight bearing was evaluated with a commercial stance analyzer in all dogs. Five valid trials were obtained and a mean percentage of weight bearing was calculated for each remaining limb. The dogs with a previous forelimb amputation, and also those with a previous hindlimb amputation, had the largest mean increase in weight bearing in the contralateral forelimb. In conclusion, proactive monitoring of orthopaedic disease in the contralateral forelimb may be advisable in dogs with a previous limb amputation. In addition, when determining candidacy for a limb amputation, disease of the contralateral forelimb should be thoroughly evaluated.

  16. Replantation versus Prosthetic Fitting in Traumatic Arm Amputations: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    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.

  17. Predicting prosthetic use in elderly patients after major lower limb amputation.

    NARCIS (Netherlands)

    Eijk, M.S. van; Linde, H. van der; Buijck, B.I.; Geurts, A.C.H.; Zuidema, S.U.; Koopmans, R.T.

    2012-01-01

    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

  18. Sexuality in people with a lower limb amputation : a topic too hot to handle?

    NARCIS (Netherlands)

    Verschuren, J. E. A.; Enzlin, P.; Geertzen, J. H. B.; Dijkstra, P. U.; Dekker, R.

    2013-01-01

    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

  19. An Epidemiological and Etiological Report on Lower Extremity Amputation in Northwest of Iran

    Directory of Open Access Journals (Sweden)

    Alireza Rouhani

    2013-12-01

    Full Text Available Background: Lower extremity amputation has different etiologies and the purpose of the study was to describe the demographics and etiologies of amputations. This study was designed to evaluate amputations performed in the province of Eastern Azerbaijan (north-west of Iran and to       determine specific causes of amputations associated with geographical and cultural characteristics of the region.   Methods: We have done this retrospective and descriptive study from June 1st, 2005 to June 1st, 2010 in Tabriz Shohada Hospital (Tabriz, Iran. The patients were evaluated with respect to age, sex, etiology, side and level of amputations, prevalence of amputations among the sexes at different ages and surgical interventions performed. Results: One-hundred-sixty files were identified with a diagnosis of lower limb amputation. Trauma was the most frequent cause in 67 cases (46%, followed by vascular disease in 61 cases (42%, and then infection in 18 cases (12%. Eighty percent of patients were male and 20% were female. Conclusion: This investigation shows that trauma (especially due to car accidents is the most common cause of amputations in our region, followed by vascular problems.

  20. Replantation versus Prosthetic Fitting in Traumatic Arm Amputations: A Systematic Review.

    Science.gov (United States)

    Otto, Iris A; Kon, Moshe; Schuurman, Arnold H; van Minnen, L Paul

    2015-01-01

    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.

  1. Replantation versus Prosthetic Fitting in Traumatic Arm Amputations: A Systematic Review

    OpenAIRE

    Otto, Iris A.; Kon, Moshe; Schuurman, Arnold H.; van Minnen, L. Paul

    2015-01-01

    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 whether replantation is functionally and psychologically more profitable than formalization and prosthetic fitting in patients with traumatic arm amputation. Methods: Functional outcome and satisfaction ...

  2. Diabetes-related amputations create considerable public health burden in the UK.

    Science.gov (United States)

    Graz, Heather; D'Souza, Vijay K; Alderson, David E C; Graz, Michael

    2018-01-01

    The main aim of this study was to assess the cost of diabetic amputation (both direct and indirect) to the National Health Service from the point of amputation onwards. This systematic review involved searches of published literature between January 2007 and March 2017 mainly using the bibliographic databases, the Cochrane Library, EMBASE via Ovid®, MEDLINE via Ovid®, as well as grey literature, both in print and in electronic formats published through non-commercial publications, which reported the cost of amputation due to diabetic foot ulcers. The studies included in this review varied considerably in estimating the cost including cost elements and how those costs were categorised. The cost estimates for inpatient care associated with amputation involving admissions or procedures on amputation stumps in people with diabetes was £43.8 million. The annual expenditure for post-amputation care involving prosthetic care, physiotherapy, transport and wheelchair use was £20.8 million. There is a considerable public health and economic burden caused by diabetes-related amputations in England. More focussed research is needed with improved methods of estimating costs that would account for direct and indirect costs associated with diabetic amputation. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Epidemiology and pattern of limb amputations at a private hospital in ...

    African Journals Online (AJOL)

    Background: Amputation of either the upper or lower extremities in man presents a special public health challenge due to the problems associated with patients' rehabilitation. Objective: To determine the epidemiology and pattern of limb amputations in a private medical setting in Owerri, Imo State. Methodology: This was a ...

  4. Shoe adaptation after amputation of the II-V phalangeal bones of the foot

    NARCIS (Netherlands)

    Rommers, G. M.; Diepstraten, H. J. M.; Bakker, E.; Lindeman, E.

    2006-01-01

    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

  5. Major limb amputations in a tertiary hospital in North Western Nigeria.

    African Journals Online (AJOL)

    This is usually due to the high rate of road traffic accidents and consequent mismanagement by traditional bone setters. Keywords: Limb amputations, tertiary hospital, North Western Nigeria. ... mors, diabetic gangrene, peripheral artery disease, limb infections and burns.4. While the indications for amputation in Europe and.

  6. Treatment of fingertip amputation: comparison of results between microsurgical replantation and pocket principle.

    Science.gov (United States)

    Yabe, Tetsuji; Tsuda, Tomoyuki; Hirose, Shunsuke; Ozawa, Toshiyuki

    2012-05-01

    In this article, a comparison of replantation using microsurgical replantation (replantation) and the Brent method and its modification (pocket principle) in the treatment of fingertip amputation is reported. As a classification of amputation level, we used Ishikawa's subzone classification of fingertip amputation, and the cases of amputations only in subzone 2 were included in this study. Between these two groups, there was no statistical difference in survival rate, postoperative atrophy, or postoperative range of motion. In terms of sensory recovery, some records were lost and exact study was difficult. But there was no obvious difference between these cases. In our comparison of microsurgical replantation versus the pocket principle in treatment of subzone 2 fingertip amputation, there was no difference in postoperative results. Each method has pros and cons, and the surgeon should choose which technique to use based on his or her understanding of the characteristics of both methods. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  7. Limb amputations in fixed dystonia: a form of body integrity identity disorder?

    Science.gov (United States)

    Edwards, Mark J; Alonso-Canovas, Araceli; Schrag, Arnette; Bloem, Bastiaan R; Thompson, Philip D; Bhatia, Kailash

    2011-07-01

    Fixed dystonia is a disabling disorder mainly affecting young women who develop fixed abnormal limb postures and pain after apparently minor peripheral injury. There is continued debate regarding its pathophysiology and management. We report 5 cases of fixed dystonia in patients who sought amputation of the affected limb. We place these cases in the context of previous reports of patients with healthy limbs and patients with chronic regional pain syndrome who have sought amputation. Our cases, combined with recent data regarding disorders of mental rotation in patients with fixed dystonia, as well as previous data regarding body integrity identity disorder and amputations sought by patients with chronic regional pain syndrome, raise the possibility that patients with fixed dystonia might have a deficit in body schema that predisposes them to developing fixed dystonia and drives some to seek amputation. The outcome of amputation in fixed dystonia is invariably unfavorable. Copyright © 2011 Movement Disorder Society.

  8. Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer

    DEFF Research Database (Denmark)

    Pickwell, Kirsty; Siersma, Volkert; Kars, Marleen

    2015-01-01

    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......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....... RESULTS Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity...

  9. Assistive technologies for pain management in people with amputation: a literature review.

    Science.gov (United States)

    Ghoseiri, Kamiar; Allami, Mostafa; Soroush, Mohammad Reza; Rastkhadiv, Mohammad Yusuf

    2018-01-23

    The prevalence of limb amputation is increasing globally as a devastating experience that can physically and psychologically affect the lifestyle of a person. The residual limb pain and phantom limb pain are common disabling sequelae after amputation surgery. Assistive devices/technologies can be used to relieve pain in people with amputation. The existing assistive devices/technologies for pain management in people with amputation include electrical nerve block devices/technologies, TENS units, elastomeric pumps and catheters, residual limb covers, laser systems, myoelectric prostheses and virtual reality systems, etc. There is a great potential to design, fabricate, and manufacture some portable, wireless, smart, and thin devices/technologies to stimulate the spinal cord or peripheral nerves by electrical, thermal, mechanical, and pharmaceutical stimulus. Although some preliminary efforts have been done, more attention must be paid by researchers, clinicians, designers, engineers, and manufacturers to the post amputation pain and its treatment methods.

  10. A Salvage Operation for Total Penis Amputation Due to Circumcision

    Directory of Open Access Journals (Sweden)

    Bilsev Ince

    2013-05-01

    Full Text Available Circumcision is one of the most common rituals in Jewish and Islamic cultures. It may also be performed for phimosis correction or the treatment of recurrent balanitis. Although circumcision is considered to be a technically easy and safe surgical procedure with no significant risk, it may lead to severe complications such as necrotizing fasciitis or total penis amputation. In this report, we present a case of penis amputation at two levels occurring with third-degree burns due to electrocautery during circumcision. Although penile replantation was attempted, it was unsuccessful due to burn damage to the veins. After restoration of the functional structures, the penis was buried in the inguinal area by reepithelization to maintain blood circulation. The recovery of the penis was successful. This case is presented as a novel example of groin flap surgery to achieve a functionally and aesthetically acceptable outcome in a salvage operation for a penis with significant traumatic injury, which has not been previously reported in the literature.

  11. Surgical reimplantation of penile glans amputation in children during circumcision

    Directory of Open Access Journals (Sweden)

    Bouassida Khaireddine

    2014-01-01

    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.

  12. Early interfaced neural activity from chronic amputated nerves

    Directory of Open Access Journals (Sweden)

    Kshitija Garde

    2009-05-01

    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. .

  13. Rehabilitation after Amputation: Psychotherapeutic Intervention Module in Indian Scenario

    Directory of Open Access Journals (Sweden)

    Kalpana Srivastava

    2014-01-01

    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.

  14. Functional improvement with digital prosthesis use after multiple digit amputations.

    Science.gov (United States)

    Lifchez, Scott D; Marchant-Hanson, Judith; Matloub, Hani S; Sanger, James R; Dzwierzynski, William W; Nguyen, Hanh H

    2005-07-01

    Patients who sustain traumatic amputation of multiple fingers suffer both a functional and psychologic loss. Previous studies of prosthesis use for finger amputees have focused primarily on the psychologic benefits. Clinically our group noticed a functional improvement on hand function tests when patients with multiple digit amputations used a prosthesis. Given the expense of multiple finger prostheses we sought to determine if they led to a consistent functional improvement in these patients. Ten consecutive patients performed a battery of hand function tests and rated their ability to perform a variety of activities of daily living both with and without their prosthesis using the Disabilities of the Arm, Shoulder, and Hand questionnaire. Our results show a significant improvement in 3-finger-pinch strength and grip strength and a trend of improvement of tip-pinch, lateral-pinch, and grip strength in dynamometer positions 1, 2, 3, and 4 in these patients when tested with and without their prostheses. Function in activities of daily living, as assessed by the Disabilities of the Arm, Shoulder, and Hand questionnaire, was improved globally with prosthesis use. In addition, significant improvement was noted in several specific activities including opening a jar, writing, and turning a key, among others. These results show that prosthesis use provides a functional benefit to these patients in multiple activities.

  15. [Costs in hand amputations derived from labor injuries].

    Science.gov (United States)

    Castañeda-Borrayo, Yaocihuatl; Mireles-Pérez, Ana Bárbara Isabel; González-Ramos, Ana Margarita; Pérez-García, Cindy; Navarro-Trujillo, Luz Rocío

    2010-01-01

    Hand injuries by labor accidents are first rank. It is necessary to have a multidisciplinary medical approach to frequently generated temporary and permanent disabilities that affect costs to an institution and to enterprise. To determine the direct cost (DC) and the indirect cost (IC) of complete and partial amputations in hand caused by labor injuries. An observational study was performed. The data was obtained from labor injuries with amputation of a finger or hand that received multidisciplinary management. The costs were calculated according to the list of Institutional Unit Costs. The IC were obtained with the "safety pays" program. We included 48 cases. The average age was 32.17 years; the cost of surgical operations was $767,470; and the payment of a partial disability permanent was $1,032,670; the DC of the sample of 48 workers was $2,955,007 with an IC of $3,250,507 and a total cost of $6,205,515, the average cost per worker of $51,741 for DC, $56,915 for IC and $108,657 for the total cost. Costs of hand injures requires the creation of prevention programs.

  16. The auto-amputated adnexa: a review of findings in a pediatric population.

    Science.gov (United States)

    Focseneanu, Mariel A; Omurtag, Kenan; Ratts, Valerie S; Merritt, Diane F

    2013-12-01

    To quantify our experience and that of the literature with diagnosis and management of the auto-amputated adnexa in a pediatric population. Case series and literature review. Tertiary care medical center. Case series of pediatric patients (auto-amputation collected from our medical center and the literature. None. Auto-amputated adnexa. In addition to the 3 cases discussed from our institution, 91 cases of auto-amputated adnexa were identified in the literature dating back to 1943, for a total of 94 cases. Forty-nine percent (46/94) of the cases involved girls in a pediatric population (auto-amputated adnexa. 34 out of 46 cases were analyzed in detail. The right adnexa were involved in 56% of the cases. The most common presenting complaint verbalized by the older girls was pain; however, 8 cases were identified in asymptomatic girls undergoing unrelated diagnostic testing. The auto-amputated adnexa is a rare finding in the pediatric population, but it must be considered as a possible explanation for the incidental finding of absence of the fallopian tube or ovary in the subgroup of patients who undergo surgery for any reason. Patients with an antecedent history of pelvic pain either chronic or intermittent in nature may be diagnosed with torsion or less frequently auto-amputation of the adnexa. A fetal "pelvic mass" or "ovarian cyst" may predispose the adnexa to torsion and subsequent auto-amputation either in-utero or post-delivery. Many of these antenatally diagnosed cysts and even subsequent auto-amputations are completely asymptomatic, however, and do not compromise fertility assuming the contralateral adnexa are normal. Thus expectant management is appropriate for small (less than 4 cm), asymptomatic simple cysts and even suspected auto-amputated adnexa in an asymptomatic patient. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Check list of symptoms SCL-90-R at persons with extremities amputations.

    Science.gov (United States)

    Kapidzić-Duraković, Suada; Karabegović, Azra; Halilbegović, Emir; Cićkusić, Amela; Osmanović, Nusret; Kudumović, Zijada

    2006-02-01

    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

  18. Check List of Symptoms SCL - 90 - R at Persons with Extremities Amputations

    Directory of Open Access Journals (Sweden)

    Suada Kapidžić-Duraković

    2006-02-01

    Full Text Available 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

  19. The importance of orthoses on activities of daily living in patients with unilateral lower limb amputations.

    Science.gov (United States)

    Onat, Sule Sahin; Ünsal-Delialioğlu, Sibel; Özel, Sumru

    2017-01-01

    The role of the selected prothesis on activities of daily living (ADL). To evaluate the impact of prothesis on ADL in patients with lower-limb amputations. The data of 500 patients with unilateral lower limb amputation were recorded. The activity level was defined based on the Medicare Functional Classification Level. Old and new prescribed prosthesis were recorded. Nottingham Extended Activities of daily living activities Daily Living Scale was used to evaluate ADL. Amputation levels were transfemoral (TF) in 268 (53.6%), transtibial (TT) in 178 (35.6%), knee disarticulation (KD) in 54 (10.8%). In patients with TF and KD amputation active vacuum system, pin modular system, hydraulic system and mechanical modular prosthesis were replaced with the swing stance phase microprocessor-controlled prostheses. In patients with TT amputation pin modular system, hydraulic system and mechanical modular prosthesis were converted to active vacuum system prostheses. Prescribed new prosthesis has caused a statistically significant increase in all amputation levels in ADL of patients (p≤ 0.05). We observed that there was significant improvement in ADL when conventional prostheses replaced with advanced technology prostheses in unilateral lower extremity amputation patients.

  20. Incidence of Overuse Musculoskeletal Injuries in Military Service Members With Traumatic Lower Limb Amputation.

    Science.gov (United States)

    Farrokhi, Shawn; Mazzone, Brittney; Eskridge, Susan; Shannon, Kaeley; Hill, Owen T

    2018-02-01

    To describe the incidence of overuse musculoskeletal injuries in service members with combat-related lower limb amputation. Retrospective cohort study. Military treatment facilities. Service members with deployment-related lower limb injury (N=791): 496 with a major lower limb amputation and 295 with a mild lower limb injury. Not applicable. The outcomes of interest were clinical diagnosis codes (International Classification of Diseases-9th Revision) associated with musculoskeletal overuse injuries of the lumbar spine, upper limb, and lower limb regions 1 year before and 1 year after injury. The overall incidence of developing at least 1 musculoskeletal overuse injury within the first year after lower limb amputation was between 59% and 68%. Service members with unilateral lower limb amputation were almost twice as likely to develop an overuse lower or upper limb injury than those with mild combat-related injury. Additionally, service members with bilateral lower limb amputation were more than twice as likely to develop a lumbar spine injury and 4 times more likely to develop an upper limb overuse injury within the first year after amputation than those with mild combat-related injury. Incidence of secondary overuse musculoskeletal injury is elevated in service members with lower limb amputation and warrants focused research efforts toward developing preventive interventions. Published by Elsevier Inc.

  1. Comparison of patient-reported outcomes after traumatic upper extremity amputation: Replantation versus prosthetic rehabilitation.

    Science.gov (United States)

    Pet, Mitchell A; Morrison, Shane D; Mack, Jacob S; Sears, Erika D; Wright, Thomas; Lussiez, Alisha D; Means, Kenneth R; Higgins, James P; Ko, Jason H; Cederna, Paul S; Kung, Theodore A

    2016-12-01

    After major upper extremity traumatic amputation, replantation is attempted based upon the assumption that outcomes for a replanted limb exceed those for revision amputation with prosthetic rehabilitation. While some reports have examined functional differences between these patients, it is increasingly apparent that patient perceptions are also critical determinants of success. Currently, little patient-reported outcomes data exists to support surgical decision-making in the setting of major upper extremity traumatic amputation. Therefore, the purpose of this study is to directly compare patient-reported outcomes after replantation versus prosthetic rehabilitation. At three tertiary care centers, patients with a history of traumatic unilateral upper extremity amputation at or between the radiocarpal and elbow joints were identified. Patients who underwent either successful replantation or revision amputation with prosthetic rehabilitation were contacted. Patient-reported health status was evaluated with both DASH and MHQ instruments. Intergroup comparisons were performed for aggregate DASH score, aggregate MHQ score on the injured side, and each MHQ domain. Nine patients with successful replantation and 22 amputees who underwent prosthetic rehabilitation were enrolled. Aggregate MHQ score for the affected extremity was significantly higher for the Replantation group compared to the Prosthetic Rehabilitation group (47.2 vs. 35.1, ptraumatic amputation reported more favorable patient-reported outcomes after successful replantation compared to revision amputation with prosthetic rehabilitation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Comparison of Intact Knee Cartilage Thickness in Patients with Traumatic Lower Extremity Amputation and Nonimpaired Individuals.

    Science.gov (United States)

    Kesikburun, Serdar; Köroğlu, Özlem; Yaşar, Evren; Güzelküçük, Ümüt; Yazcoğlu, Kamil; Tan, Arif Kenan

    2015-08-01

    The aim of this study was to assess the femoral articular cartilage thickness of the intact knee in patients with traumatic lower extremity amputation compared with nonimpaired individuals. A total of 30 male patients with traumatic lower extremity amputation (mean [SD] age, 31.2 [6.3] yrs) and a random sample of 53 age-matched and body mass index-matched male nonimpaired individuals (mean [SD] age, 29.8 [6.3] yrs) participated in the study. Exclusion criteria were age younger than 18 yrs, history of significant knee injury, previous knee surgery, or rheumatic disease. The femoral articular cartilage thickness was measured using ultrasound at the midpoints of the medial condyle, the intercondylar notch, and the lateral condyle. Ultrasonographic cartilage measurement was performed on the intact side of the patients with amputation and on both sides of the nonimpaired individuals. The femoral articular cartilage thickness of the intact knees of the patients with amputation was significantly decreased at the lateral and medial condyles compared with the nonimpaired individuals (P amputation and the nonimpaired individuals (P > 0.05). There was a premature cartilage loss in the intact limb knee of the patients with traumatic amputation. This result supports the view that patients with traumatic lower extremity amputation are at increased risk for developing knee osteoarthritis in the intact limb.

  3. Cooling Composite Graft for Distal Finger Amputation: A Reliable Alternative to Microsurgery Implantation.

    Science.gov (United States)

    Idone, Francesco; Sisti, Andrea; Tassinari, Juri; Nisi, Giuseppe

    2016-01-01

    Finger amputations are the most common injuries to the upper limb. There are many options in the management of fingertip or finger amputations. We report our experience using cooling composite graft (Hirase technique) for distal finger amputation, as alternative to microsurgery implantation. We collected a case series of eight patients and report on the clinical outcomes after a 10-month follow-up period. The amputated part survived almost completely in six patients; in these cases, the fingertip amputations were classified, according to the Allen classification, as level I in two cases, level II in three cases and level III in one case. Re-implantation of an amputated finger with the Hirase technique is possible and can provide good distal soft-tissue coverage and recovery of sensory and motor functions. We believe that re-attachment of the amputated portion as a composite graft represents an important alternative to microsurgery. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  4. Adjustments to amputation and an artificial limb in lower limb amputees.

    Science.gov (United States)

    Sinha, Richa; van den Heuvel, Wim J A; Arokiasamy, Perianayagam

    2014-04-01

    Positive adjustments to amputation and an artificial limb play important roles in the rehabilitation process. 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 amputation-related factors that could potentially influence these adjustments. Cross-sectional. Adult unilateral and non-congenital lower limb amputees (n = 368) met the inclusion/exclusion criteria. Face-to-face interviews were conducted using structured questionnaires including patient's background, amputation and the Trinity Amputation and Prosthesis Experience Scales. Amputees were on average satisfied with the functioning of the prosthesis, moderately psychosocially adjusted and not restricted in performing functional and social activities, except for athletic activities. Age, employment, daily use of prosthesis and assistive device use were the most important factors associated with adjustments to amputation and prosthesis, followed by gender, co-morbidity and amputation level. Evaluation of employment status and measures to curb unemployment through vocational rehabilitation and providing assistance for placement should be intrinsic to the rehabilitation programme. Future studies are envisaged to understand the underlying factors determining the extent of daily use of prosthesis and the reasons for the use of assistive devices by the amputees. Clinical relevance Proper appraisal and measures to alleviate employment and co-morbidity, related issues, routine evaluation of daily use of prosthesis and providing appropriate gait training might facilitate immediate and long-term adjustment.

  5. Amputation of finger by horse bite with complete avulsion of both flexor tendons.

    Science.gov (United States)

    Koren, Lior; Stahl, Shalom; Rovitsky, Alexey; Peled, Eli

    2011-08-08

    Amputation of fingers with tendon avulsion occurs through a traction injury, and most occur through a ring avulsion mechanism. Usually the flexor digitorum profundus is torn out with the amputated finger. Replantation usually is recommended only when the amputation is distal to the flexor digitorum superficialis insertion. Animal bites are relatively common, with a decreasing order of frequency of dogs, cats, and humans. Horse bites are relatively infrequent but are associated with crush injuries and tissue loss when they occur. This article describes a 23-year-old man with amputation of his middle finger at the level of the proximal phalanx after being bitten by a horse. The amputated stump was avulsed with the middle finger flexor digitorum profundus and flexor digitorum superficialis torn from the muscle-tendon junction from approximately the middle of the forearm. The patient had no other injuries, and he was able to move his other 4 fingers with only mild pain. As the amputated digit was not suitable for replantation, the wound was irrigated and debrided. The edges of the phalanx were trimmed, and the edges of the wound were sutured. Tetanus toxoid and rabies vaccine were administered, along with intravenous amoxicillin and clavulanic acid. The patient was discharged from the hospital 2 days later, with no sign of infection of the wound or compartment syndrome of the forearm. This case demonstrates the weakest point in the myotendinous junction and emphasizes the importance of a careful physical examination in patients with a traumatic amputation. Copyright 2011, SLACK Incorporated.

  6. Predicting prosthetic use in elderly patients after major lower limb amputation.

    Science.gov (United States)

    van Eijk, Monica Spruit-; van der Linde, Harmen; Buijck, Bianca; Geurts, Alexander; Zuidema, Sytse; Koopmans, Raymond

    2012-03-01

    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 (SNFs) are scarce. To predict prosthetic use and physical mobility in geriatric patients admitted to SNFs for rehabilitation after lower limb amputation and the impact of multimorbidity. Prospective design. Univariate and multivariate logistic and linear regression analyses were used to identify determinants that were independently related to prosthetic use and the timed-up-and-go test (TUG test). Of 55 eligible patients, 38 had complete assessments on admission and at discharge. Fifty per cent was provided with a prosthesis. Multimorbidity was present in 53% of the patients. Being able to ambulate independently, and having a transtibial amputation (rather than a higher level of amputation), without phantom pain determined prosthetic use (R(2)=56%), while cognitive abilities, low amputation level, and pre-operative functional abilities were independently associated with the TUG test (R(2)=82%). Elderly patients referred to an SNF for prosthetic training have a high probability of using a prosthesis when having an independent ambulation after transtibial amputation, without phantom pain. These patients should be considered for prosthetic training.

  7. [Tests of hand functionality in upper limb amputation with prosthesis].

    Science.gov (United States)

    Bazzini, G; Orlandini, D; Moscato, T A; Nicita, D; Panigazzi, M

    2007-01-01

    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.

  8. Acute ischemia after revision hallux valgus surgery leading to amputation.

    Science.gov (United States)

    Goforth, W David; Kruse, Dustin; Brantigan, Charles O; Stone, Paul A

    2013-01-01

    Acute arterial insufficiency after revision hallux valgus surgery is a rare complication. The identification of surgical candidates who are at risk of vascular complications is of utmost importance. The patient-reported symptoms and physical findings combined with noninvasive vascular studies are generally reliable to assess the vascular status but can fail to identify patients with atypical disease patterns. We present the case of a patient with normal pulses who underwent revision hallux valgus surgery, leading to gangrene of the hallux that required transmetatarsal amputation. We reviewed the vascular evaluation methods and causes of acute ischemia after surgery, including vasculitis. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Prosthetic Rehabilitation of Amputated Thumb: A Simplified Approach.

    Science.gov (United States)

    Agrawal, Kaushal Kishor; Aggarawal, Himanshi; Singh, Kamleshwar

    2014-12-01

    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 aesthetically by a non-invasive and cost effective prosthetic procedure by using heat temperature vulcanizing silicone material. The prosthesis (the thumb) was attached using medical adhesives. On 3 months recall appointment, no complications were observed. The prosthesis was in good shape and required no further intervention. The prosthetic thumb lacks the sensation of a normal or reconstructed thumb, although it does not require the multiple procedures of surgical reconstruction and the accompanying loss of time for rehabilitation and healing.

  10. An analysis of risk factors associated with traumatic extremity amputation stump wound infection in a Nigerian setting.

    Science.gov (United States)

    Omoke, Njoku Isaac; Nwigwe, Chinedu Gregory

    2012-11-01

    We aimed to determine the risk factors associated with traumatic extremity amputation stump wound infection in our environment. This was a retrospective analysis of databases that included the entire patient population with traumatic extremity amputation seen in Ebonyi State University Teaching Hospital and Federal Medical Centre Abakaliki from January 2001 to December 2011. There were 63 patients studied and stump wound infection was a complication in 38 (60 %) of them. Stump wound infection rate significantly correlated with the form of amputation, i.e., a higher rate in crushing than guillotine (sharp clear-cut) amputation (80.5 vs. 22.7 % p amputation (80.6 vs. 33.3 % p amputation (71.1 vs. 60.7 % p amputation interval (p amputation as an independent risk factor (p traumatic amputation stump wound infection. The only independent predictor of traumatic extremity amputation stump wound infection is a crushing form of amputation; it should be accorded a high priority in interventions aimed at reducing infection rate.

  11. A developing world experience with distal foot amputations for diabetic limb salvage

    Directory of Open Access Journals (Sweden)

    Omer Salahuddin

    2013-10-01

    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

  12. The influence of traumatic transfemoral amputation on metabolic cost across walking speeds.

    Science.gov (United States)

    Russell Esposito, Elizabeth; Rábago, Christopher A; Wilken, Jason

    2017-06-01

    Recent literature indicates equivalent costs of walking can be achieved after a transtibial amputation when the individual is young, active, and/or has extensive access to rehabilitative care. It is unknown if a similar cohort with transfemoral amputation can also achieve lower metabolic costs of walking than previously reported. Compare metabolic cost in individuals with a transfemoral amputation to controls and to the literature across a range of walking speeds. Cross-sectional. A total of 14 individuals with a unilateral transfemoral amputation (27 ± 5 years, N = 4 mechanical knee, N = 10 microprocessor knee) and 14 able-bodied controls (26 ± 6 years) walked at self-selected and four standardized speeds. Heart rate, metabolic rate (mL O 2 /kg/min), metabolic cost (mL O 2 /kg/m), and rating of perceived exertion were calculated. Self-selected speed was 8.6% slower in the transfemoral amputation group ( p = 0.031). Across standardized speeds, both metabolic rate and metabolic cost ranged from 44%-47% greater in the transfemoral amputation group ( p amputation group was relatively young, physically fit, and had extensive access to rehabilitative care, the metabolic cost of walking fell within the ranges of the literature on older or presumably less fit individuals with transfemoral amputation. Clinical relevance Developments in prosthetic technology and/or rehabilitative care may be warranted and may reduce the metabolic cost of walking in individuals with a transfemoral amputation.

  13. Assessment of anxiety and depression after lower limb amputation in Jordanian patients

    Directory of Open Access Journals (Sweden)

    Ziad M Hawamdeh

    2008-06-01

    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

  14. Traumatic near amputation secondary to hippopotamus attack: lessons for surgeons.

    Science.gov (United States)

    Drake, Frederick Thurston; Quiroga, Elina; Kariuki, Hazel W; Shisanya, Kizito A; Hotchkiss, Matthew P; Monroe-Wise, Aliza; Drake, John K; Mburu, Joseph; Farquhar, Carey; Flum, David R

    2014-05-01

    A 34-y-old man presented to Naivasha District Hospital (NDH) in Naivasha Town, Kenya, with near-complete below-knee amputation and hemorrhage after a hippopotamus attack. Residents from the University of Washington (UW), Departments of Surgery, Anesthesia, and Medicine, were rotating at NDH with the Clinical Education Partnership Initiative, a joint venture of UW and University of Nairobi. These providers met the patient in the operating theater. The leg was mangled with severely traumatized soft tissues and tibia-fibula fractures. The visiting UW Surgery resident (R3) and an NDH medical officer (second-year house officer) performed emergency below-knee completion amputation--the first time either had performed this operation. The three major vessel groups were identified and ligated. Sufficient gastrocnemius and soleus were preserved for future stump construction. The wound was washed out, packed with betadine-soaked gauze, and wrapped in an elasticized bandage. Broad-spectrum antibiotics were initiated. Unfortunately, the patient suffered infection and was revised above the knee. After a prolonged course, the patient recovered well and was discharged home. NDH house officers and UW trainees collaborated successfully in an emergency and conducted the postoperative care of a patient with a serious and challenging injury. Their experience highlights the importance of preparedness, command of surgical basics, humility, learning from mistakes, the expertise of others, a digitally connected surgical community, and the role of surgery in global health. These lessons will be increasingly pertinent as surgical training programs create opportunities for their residents to work in developing countries; many of these lessons are equally applicable to surgical practice in the developed world. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Flexor hallucis longus and extensor digitorum longus tendon transfers for balancing the foot following transmetatarsal amputation.

    Science.gov (United States)

    Roukis, Thomas S

    2009-01-01

    Transmetatarsal amputation is a useful surgical procedure that is applicable to the treatment of the dysvascular, neuropathic, and/or traumatized forefoot. Because of the loss of the insertions of some of the extrinsic pedal musculature, transmetatarsal amputation is known to be associated with imbalance of the residual foot, and this can lead to complications related to cutaneous compromise, as well as difficulties with bracing and shoe fit. In this techniques report, we describe a combination of tendon transfers that use flexor hallucis longus and extensor digitorum longus, which can be useful in preventing pedal imbalance following transmetatarsal amputation.

  16. Therapy-Resistant Complex Regional Pain Syndrome Type I: To Amputate or Not?

    OpenAIRE

    Bodde, M.I.; Dijkstra, P.U.; den Dunnen, W.F.A.; Geertzen, J.H.B.

    2011-01-01

    Background: Amputation for the treatment of long-standing, therapy-resistant complex regional pain syndrome type I (CRPS-I) is controversial. An evidence-based decision regarding whether or not to amputate is not possible on the basis of current guidelines. The aim of the current study was to systematically review the literature and summarize the beneficial and adverse effects of an amputation for the treatment of long-standing, therapy-resistant CRPS-I. Methods: A literature search, using Me...

  17. [Self-amputation of the penis treated immediately: Case report and review of the literature].

    Science.gov (United States)

    Odzébé, A W S; Bouya, P A; Otiobanda, G F; Banga Mouss, R; Nzaka Moukala, C; Ondongo Atipo, A M; Ondziel Opara, A S

    2015-12-01

    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. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. An ICF-based education programme in amputation rehabilitation for medical residents in the Netherlands

    NARCIS (Netherlands)

    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

  19. Flexor Digitorum Superficialis Tenodesis for Traumatic Digit Amputation at the Level of the Proximal Phalanx.

    Science.gov (United States)

    O'Shaughnessy, Maureen A; Kakar, Sanjeev

    2017-09-01

    Traumatic amputation of the digit requiring revision amputation at the level of the proximal phalanx provides the opportunity to improve flexor function via tenodesis of the remaining flexor digitorum superficialis (FDS) tendon. Salvage of the remaining FDS and performing flexor tenodesis to the proximal phalanx allows increased flexion at the metacarpophalangeal (MCP) joint. This series reviews FDS tenodesis, outlining its surgical technique with clinical and functional outcomes. Institutional review board-approved retrospective study was performed. Twelve digits in 8 patients were included. Average flexion-extension arc of affected MCP joint was 82°, and average grip strength was 70% of unaffected extremity. No patients required revision surgery or revision amputation. One patient had a minor wound infection treated successfully with oral antibiotics. FDS tenodesis is a reliable motion-preserving procedure for patients with amputations at the level of the proximal phalanx to maintain flexion at the MCP joint.

  20. Replantation versus prosthetic fitting in traumatic arm amputations : A systematic review

    NARCIS (Netherlands)

    Otto, Iris A.; Kon, Moshe; Schuurman, AH; Van Minnen, L. Paul

    2015-01-01

    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

  1. Motor cortex changes after amputation are modulated by phantom limb motor control rather than pain

    DEFF Research Database (Denmark)

    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...

  2. Association between Caveolin-1 expression and pathophysiological progression of femoral nerves in diabetic foot amputation patients

    Directory of Open Access Journals (Sweden)

    Ding Min

    2017-10-01

    Full Text Available To evaluate the pathological changes of femoral nerves and the levels of caveolin-1 in diabetic foot amputation patients with neuropathy, and evaluate the association between caveolin-1 and neuropathy development.

  3. Replantation of fingertip amputation by using the pocket principle in adults.

    Science.gov (United States)

    Lee, P K; Ahn, S T; Lim, P

    1999-04-01

    There are several treatment modalities for zone 1 or zone 2 fingertip amputations that cannot be replanted by using microsurgical techniques, such as delayed secondary healing, stump revision, skin graft, local flaps, distant flaps, and composite graft. Among these, composite graft of the amputated digit tip is the only possible means of achieving a full-length digit with a normal nail complex. The pocket principle can provide an extra blood supply for survival of the composite graft of the amputated finger by enlarging the area of vascular contact. The surgery was performed in two stages. The amputated digit was debrided, deepithelialized, and reattached to the proximal stump. The reattached finger was inserted into the abdominal pocket. About 3 weeks later, the finger was removed from the pocket and covered with a skin graft. We have consecutively replanted 29 fingers in 25 adult patients with fingertip amputations by using the pocket principle. All were complete amputations with crushing or avulsion injuries. Average age was 33.64 years, and men were predominant. The right hand, the dominant one, was more frequently injured, with the middle finger being the most commonly injured. Of the 29 fingers, 16 (55.2 percent) survived completely and 10 (34.5 percent) had partial necrosis less than one-quarter of the length of the amputated part. The results of the above 26 fingers were satisfactory from both functional and cosmetic aspects. Twenty of the 29 fingers, which had been followed up for more than 6 months (an average of 16 months), were included in a sensory evaluation. Fifteen of these 20 fingers (75 percent) were classified as "good" (static two-point discrimination of less than 8 mm and normal use). From the overall results and our experience, we suggest that the pocket principle is a safe and valuable method in replantation of zone 1 or zone 2 fingertip amputation, an alternative to microvascular replantation, even in adults.

  4. Classification of Distal Fingertip Amputation Based on the Arterial System for Replantation

    OpenAIRE

    Park, Hyun Chul; Bahar-Moni, Ahmed Suparno; Cho, Sang Hyun; Kim, Sang Soo; Park, Hyun Sik; Ahn, Sang Cheon

    2012-01-01

    During replantation of distal fingertip amputation, identification of the artery is the most important but time consuming procedure. Depending on the damaged arterial structure, we classified distal fingertip amputations into 4 zones, on the basis of three dimensional concept. Zone 1 injury was defined as damage to the proximal central pulp artery; zone 2 injury, damage to the branch of the central pulp artery; zone 3 injury, damage to the distal central pulp artery; and zone 4 injury, no inj...

  5. Emergency Department Wait Time and Treatment of Traumatic Digit Amputation: Do Race and Insurance Matter?

    Science.gov (United States)

    Mahmoudi, Elham; Swiatek, Peter R; Chung, Kevin C

    2017-02-01

    Little is known about the association between the quality of trauma care and management of nonfatal injuries. The authors used emergency department wait times as a proxy for hospital structure, process, and availability of on-call surgeons with microsurgical skills. They evaluated the association between average hospital emergency department wait times and likelihood of undergoing digit replantation for patients with traumatic amputation digit injuries. The authors hypothesized that hospitals with shorter emergency department wait times were associated with higher odds of replantation. Using the 2007 to 2012 National Trauma Data Bank, the authors' final sample included 12,126 patients. Regression modeling was used to first determine factors that were associated with longer emergency department wait times among patients with digit amputation injuries. Second, the authors examined the association between emergency department wait times for this population at a hospital level and replantation after all types of digit amputation and after complicated thumb amputation injuries only. For patients with simple and complicated thumb amputation injuries, and patients with complicated thumb amputation injuries only, longer emergency department wait times were associated with lower odds of replantation. In addition, being minority and having no insurance were associated with longer emergency department wait times; teaching hospitals were associated with shorter emergency department wait times; and finally, for patients with complicated thumb amputation injuries only, there was no association between patients' minority or insurance status and replantation. Variation in emergency department wait time and its effects on treatment of traumatic digit amputation may reflect maldistribution of hand or plastic surgeons with the required microsurgical skills among trauma centers across the United States. Therapeutic, III.

  6. Trends in traumatic limb amputation in Allied Forces in Iraq and Afghanistan

    OpenAIRE

    Duncan Wallace

    2012-01-01

    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...

  7. Limb Amputations in Fixed Dystonia: A Form of Body Integrity Identity Disorder?

    OpenAIRE

    Edwards, Mark J; Alonso-Canovas, Araceli; Schrag, Arnette; Bloem, Bastiaan R; Thompson, Philip D; Bhatia, Kailash

    2011-01-01

    Fixed dystonia is a disabling disorder mainly affecting young women who develop fixed abnormal limb postures and pain after apparently minor peripheral injury. There is continued debate regarding its pathophysiology and management. We report 5 cases of fixed dystonia in patients who sought amputation of the affected limb. We place these cases in the context of previous reports of patients with healthy limbs and patients with chronic regional pain syndrome who have sought amputation. Our cases...

  8. Treating Intractable Post Amputation Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks

    Science.gov (United States)

    2018-01-01

    Award Number: W81XWH-13-2-0009 TITLE: Treating Intractable Post-Amputation Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks...26 Dec 2016 – 25 Dec 2017 4. TITLE AND SUBTITLE Treating Intractable Post-Amputation Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve...trial to determine if ambulatory continuous peripheral nerve block (CPNB) is an effective treatment for intractable phantom limb pain following a

  9. Physiological responses to multiple speed treadmill walking for Syme vs. transtibial amputation--a case report.

    Science.gov (United States)

    Lin-Chan, S; Nielsen, D H; Shurr, D G; Saltzman, C L

    2003-12-02

    To date, there have been no longitudinal studies comparing walking at different levels of amputation. The objective of this study was to compare the self-selected walking velocity (SSWV) and selected physiologic variables during walking between a Syme and a later transtibial level of amputation for a single subject. Additional comparison was made between the SACH foot prosthesis and a dynamic response foot prosthesis. A 35-year-old male with a traumatic Syme amputation later underwent elective transtibial amputation. SSWV and multiple speed treadmill walking tests (53.64, 67.05, 80.46, 93.87 and 107.28 m/min) were evaluated under three conditions (Syme prosthesis with SACH foot, transtibial prosthesis with SACH foot, and transtibial prosthesis with Flex-Foot). Walking with transtibial prosthesis showed minimal differences in oxygen consumption (0 - 5% reduction), heart rate response (0 - 1% reduction), or gait efficiency (0 - 5% improvement) across all speeds when compared with Syme prosthesis (both with SACH foot). However, the SSWV was 6 - 8% faster for the transtibial SACH foot. Walking with transtibial Flex-Foot required less cardiovascular demand than with transtibial SACH foot at higher speeds. In this case report, it seemed that transtibial amputation did not have adverse effects on selected physiological responses at a variety of walking speeds when compared to Syme amputation, and that the use of a dynamic response foot enhanced his gait performance. Further experimental studies involving more subjects with traumatic Syme and transtibial amputations are required to better understand the effect of these two levels of amputation on energy cost of walking.

  10. Kinetic, kinematic, magnetic resonance and owner evaluation of dogs before and after the amputation of a hind limb.

    Science.gov (United States)

    Galindo-Zamora, Vladimir; von Babo, Verena; Eberle, Nina; Betz, Daniela; Nolte, Ingo; Wefstaedt, Patrick

    2016-01-25

    The amputation of a limb is a surgical procedure that is regularly performed in small animal practice. In spite of several clinical reports indicating high owner satisfaction after limb amputation in dogs, an amputation is still very critically seen by the owners, and even by some veterinarians, due to the lack of accurate information about the recovery of amputee patients. Thus, the objective of this study was to prospectively evaluate, both objectively and subjectively, the recovery outcome of dogs undergoing a hind limb amputation. Twelve patients in which a hind limb amputation was scheduled were studied. Kinetic and kinematic gait analyses were performed before the amputation, and 10, 30, 90 and 120 days after surgery. Magnetic resonance (MR) examination of the contralateral stifle joint was performed before and 120 days after amputation. The subjective impressions of the owners were gathered at the same examination times of the gait analyses. Kinetic data showed a redistribution of the load to all remaining limbs after the amputation; ten days after the procedure patients had already established their new locomotory pattern. Kinematic data showed significant differences between sessions in the mean angle progression curves of almost all analyzed joints; however, the ranges of motion were very similar before and after the amputation, and remained constant in the subsequent sessions after the amputation. No changes in the signal intensity of the soft tissues evaluated, and no evidence of cartilage damage or osteoarthritis was seen on the MR examination of the contralateral stifle. Owners evaluated the results of the amputation very positively, both during and at the end of the study. Dogs had a quick adaptation after a hind limb amputation, and the adaptation process began before the amputation was performed. This happened without evidence of morphologic changes in the contralateral stifle joint, and with a very positive evaluation from the owner.

  11. Effects of Traumatic Amputation on β-Trace Protein and β2-Microglobulin Concentrations in Male Soldiers.

    Science.gov (United States)

    Little, Dustin J; Yuan, Christina M; Thurlow, John S; Gounden, Verena; Doi, Sonia Q; Pruziner, Alison; Abbott, Kevin C; Theeler, Brett J; Olson, Stephen W

    2015-01-01

    Serum creatinine (SCr) levels are decreased following traumatic amputation, leading to the overestimation of glomerular filtration rate (GFR). β-Trace protein (BTP) and β2-microglobulin (B2M) strongly correlate with measured GFR and have not been studied following amputation. We hypothesized that BTP and B2M would be unaffected by traumatic amputation. We used the Department of Defense Serum Repository to compare pre- and post-traumatic amputation serum BTP and B2M levels in 33 male soldiers, via the N Latex BTP and B2M nephelometric assays (Siemens Diagnostics, Tarrytown, N.Y., USA). Osterkamp estimation using DEXA scan measurements was used to establish percent estimated body weight loss (%EBWL). Results were analyzed for small (3-5.9% EBWL), medium (6-13.5%), and large (>13.5%) amputation subgroups; and for a control group matched 1:1 to the 12 large amputation subjects. Paired Student's t test was used for comparisons. Mean serum BTP levels were unchanged in controls, all amputees, and the small and medium amputation subgroups. BTP appeared to decrease following large %EBWL amputation (p = 0.05). Mean serum B2M levels were unchanged in controls, all amputees, and the small and medium amputation subgroups. B2M appeared to increase following large %EBWL amputation (p = 0.05). BTP and B2M levels are less affected than SCr by amputation, and should be considered for future study of GFR estimation. BTP and B2M changes following large %EBWL amputation require validation and may offer insight into non-GFR BTP and B2M determinants as well as increased cardiovascular disease and mortality following amputation. © S. Karger AG, Basel.

  12. Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation

    Science.gov (United States)

    Rink, Cameron L.; Wernke, Matthew M.; Powell, Heather M.; Tornero, Mark; Gnyawali, Surya C.; Schroeder, Ryan M.; Kim, Jayne Y.; Denune, Jeffrey A.; Albury, Alexander W.; Gordillo, Gayle M.; Colvin, James M.; Sen, Chandan K.

    2017-01-01

    Objective: (1) Develop a standardized approach to quantitatively measure residual limb skin health. (2) Report reference residual limb skin health values in people with transtibial and transfemoral amputation. Approach: Residual limb health outcomes in individuals with transtibial (n = 5) and transfemoral (n = 5) amputation were compared to able-limb controls (n = 4) using noninvasive imaging (hyperspectral imaging and laser speckle flowmetry) and probe-based approaches (laser doppler flowmetry, transcutaneous oxygen, transepidermal water loss, surface electrical capacitance). Results: A standardized methodology that employs noninvasive imaging and probe-based approaches to measure residual limb skin health are described. Compared to able-limb controls, individuals with transtibial and transfemoral amputation have significantly lower transcutaneous oxygen tension, higher transepidermal water loss, and higher surface electrical capacitance in the residual limb. Innovation: Residual limb health as a critical component of prosthesis rehabilitation for individuals with lower limb amputation is understudied in part due to a lack of clinical measures. Here, we present a standardized approach to measure residual limb health in people with transtibial and transfemoral amputation. Conclusion: Technology advances in noninvasive imaging and probe-based measures are leveraged to develop a standardized approach to quantitatively measure residual limb health in individuals with lower limb loss. Compared to able-limb controls, resting residual limb physiology in people that have had transfemoral or transtibial amputation is characterized by lower transcutaneous oxygen tension and poorer skin barrier function. PMID:28736682

  13. Fingertip reconstruction with simultaneous flaps and nail bed grafts following amputation.

    Science.gov (United States)

    Hwang, Euna; Park, Byung Ho; Song, Seung Yong; Jung, Ho Sung; Kim, Chung Hun

    2013-07-01

    To report our technique and results with treating fingertip amputations with flaps and simultaneous nailbed grafts. We reconstructed 20 fingertip amputations with loss of bone and nail with flaps combined with nailbed grafts. We reconstructed the volar side of the fingertip with a flap, and the dorsal side of the fingertip with a nailbed grafted to the raw inner surface of the flap. We employed volar V-Y advancement flaps for transverse or dorsal oblique fingertip injuries and generally used abdominal flaps for volar oblique fingertip injuries. We harvested nailbeds from the amputated finger or from the patient's first toe. The length of the amputated fingertips was restored with the flaps, and the lost nailbeds were restored to their natural appearance with the nailbed grafts. We classified the results according to the length of the reconstructed fingertip and the appearance of the nail. Excellent or good results were achieved in 16 cases. Three cases had fair results and 1 had a poor result. We observed favorable results for distal fingertip amputations (Allen type II or III). In particular, most cases that were reconstructed with volar V-Y advancement flaps combined with nailbed grafts demonstrated favorable results. This method is useful for the restoration of dorsal oblique or transverse type fingertip amputations and is a good alternative when replantation is not an option. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. Traumatic Finger Amputation Treatment Preference among Hand Surgeons in the United States and Japan.

    Science.gov (United States)

    Shauver, Melissa J; Nishizuka, Takanobu; Hirata, Hitoshi; Chung, Kevin C

    2016-04-01

    Large geographic differences in procedure utilization draw into question its appropriate use. In Japan, replantation is frequent for even very distal finger amputations. In the United States, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences. The authors created a survey to assess experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter Study and to hand surgeons making podium presentations at the Thirty-Second Annual Meeting of the Central Japanese Society for Surgery of the Hand. One hundred percent of both groups responded. There were no significant differences in surgeon experience. Japanese surgeons were significantly more likely to recommend replantation in all scenarios, despite 62 percent ranking function 6 months after replantation as "poor." Japanese surgeons also rated the appearance of a hand with an amputated finger significantly poorer. Finally, Japanese surgeons were significantly more likely to report stigmatization against finger amputees. There is no study with a high level of evidence comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, such as that planned by the Finger Replantation and Amputation Multicenter Study, can provide evidence toward the appropriate use of replantation.

  15. Daily physical activity and heart rate response in people with a unilateral traumatic transtibial amputation.

    Science.gov (United States)

    Bussmann, Johannes B; Schrauwen, Hannelore J; Stam, Henk J

    2008-03-01

    To test the hypothesis that people with a unilateral traumatic transtibial amputation are less active than people without an amputation, and to explore whether both groups have a similar heart rate response while walking. A case-comparison study. General community. Nine subjects with a unilateral traumatic transtibial amputation and 9 matched subjects without known impairments. Not applicable. Percentage of dynamic activities in 48 hours (expressing activity level). Additionally, we examined heart rate and percentage heart rate reserve during walking (expressing heart rate response) and body motility during walking (expressing walking speed). These parameters were objectively measured at participants' homes on 2 consecutive days. Subjects with an amputation showed a lower percentage of dynamic activities (6.0% vs 11.7% in a 48-h period, P=.02). No significant differences were found between the 2 groups in heart rate (91.1 bpm vs 89.5 bpm, P=.86) and percentage heart rate reserve during walking (28.2% vs 27.5%, P=1.0). Body motility during walking was lower in the amputation group (.14 g vs .18 g, Ptraumatic transtibial amputation are considerably less active than persons without known impairments. The results indicate that heart rate response during walking is similar in both groups, and is probably regulated by adapting one's walking speed.

  16. Does unilateral transtibial amputation lead to greater metabolic demand during walking?

    Science.gov (United States)

    Esposito, Elizabeth Russell; Rodriguez, Kelly M; Ràbago, Christopher A; Wilken, Jason M

    2014-01-01

    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 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.

  17. Hospital Quality and Performance of a Complex Surgical Procedure after Traumatic Digit Amputation.

    Science.gov (United States)

    Swiatek, Peter R; Pandit, Anita; Chung, Kevin C; Mahmoudi, Elham

    2016-07-01

    Traumatic digit amputations are prevalent injuries that have long-term disabling consequences. Although replantation after traumatic digit amputation is a complex procedure, the aesthetic, functional, and long-term economic benefits of replantation render it preferable to revision amputation when clinically indicated. The authors adapted the Donabedian quality-of-care conceptual framework to examine the association between hospital outcome quality measured by observed-to-expected mortality ratio and the treatment received after traumatic digit amputation. The authors hypothesized that the probability of undergoing replantation is higher in hospitals with lower observed-to-expected mortality ratios. Data from 106 qualified Level I and II trauma centers included in the 2007 to 2012 National Trauma Data Bank were used to estimate hospital-specific observed-to-expected mortality ratio. The authors then used a two-level logistic hierarchical model, adjusting for patient, clinical, and hospital characteristics, to examine whether observed-to-expected mortality ratio, as one of the commonly used hospital quality measures, is a predictor of the treatment received for 4169 patients with traumatic digit amputation. Compared with trauma centers with high observed-to-expected mortality ratios, the probability of undergoing replantation was substantially higher in trauma centers with low observed-to-expected mortality ratios (OR, 5.09; 95 percent CI, 2.51 to 10.30; p amputation injury. The observed-to-expected mortality ratio, as an outcome measure of hospital quality, is an important predictor of the treatment received.

  18. The Plasticity of Brain Gray Matter and White Matter following Lower Limb Amputation

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    Guangyao Jiang

    2015-01-01

    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.

  19. Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation.

    Science.gov (United States)

    Rink, Cameron L; Wernke, Matthew M; Powell, Heather M; Tornero, Mark; Gnyawali, Surya C; Schroeder, Ryan M; Kim, Jayne Y; Denune, Jeffrey A; Albury, Alexander W; Gordillo, Gayle M; Colvin, James M; Sen, Chandan K

    2017-07-01

    Objective: (1) Develop a standardized approach to quantitatively measure residual limb skin health. (2) Report reference residual limb skin health values in people with transtibial and transfemoral amputation. Approach: Residual limb health outcomes in individuals with transtibial ( n  = 5) and transfemoral ( n  = 5) amputation were compared to able-limb controls ( n  = 4) using noninvasive imaging (hyperspectral imaging and laser speckle flowmetry) and probe-based approaches (laser doppler flowmetry, transcutaneous oxygen, transepidermal water loss, surface electrical capacitance). Results: A standardized methodology that employs noninvasive imaging and probe-based approaches to measure residual limb skin health are described. Compared to able-limb controls, individuals with transtibial and transfemoral amputation have significantly lower transcutaneous oxygen tension, higher transepidermal water loss, and higher surface electrical capacitance in the residual limb. Innovation: Residual limb health as a critical component of prosthesis rehabilitation for individuals with lower limb amputation is understudied in part due to a lack of clinical measures. Here, we present a standardized approach to measure residual limb health in people with transtibial and transfemoral amputation. Conclusion: Technology advances in noninvasive imaging and probe-based measures are leveraged to develop a standardized approach to quantitatively measure residual limb health in individuals with lower limb loss. Compared to able-limb controls, resting residual limb physiology in people that have had transfemoral or transtibial amputation is characterized by lower transcutaneous oxygen tension and poorer skin barrier function.

  20. Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation.

    Science.gov (United States)

    Hansen, Colby; Godfrey, Bradeigh; Wixom, Jody; McFadden, Molly

    2015-01-01

    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.

  1. Effective local anesthesia for onabotulinumtoxin A injections to treat hyperhidrosis associated with traumatic amputation.

    Science.gov (United States)

    Shi, Lucy L; Sargen, Michael R; Chen, Suephy C; Arbiser, Jack L; Pollack, Brian P

    2016-06-15

    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. To present a novel method for improving local anesthesia with BTX-A injections. Methods & A 29-year-old military veteran with a below-the-knee amputation of his right leg was suffering from amputation site hyperhidrosis, which was impeding his ability to comfortably wear a prosthesis. Prior to presenting to our clinic, the patient received one treatment of BTX-A injections to his amputation stump while under general anesthesia for surgical repair of trauma-related injuries. In our dermatology clinic, we repeated the procedure using topical lidocaine-prilocaine (30 gm total) for local anesthesia. This provided effective relief of hyperhidrosis for 6 months, but the procedure was very painful (9/10 intensity). We repeated the same procedure 6 months later, using ice in addition to topical lidocaine-prilocaine (30 gm) for local anesthesia; this resulted in reduced pain (3/10 intensity) for the patient. We suggest using ice in combination with a topical anesthetic as an effective method for pain control that avoids general anesthesia in treating amputation-associated hyperhidrosis.

  2. Quality of Life Following Amputation or Limb Preservation in Patients with Lower Extremity Bone Sarcoma

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    Gary E Mason

    2013-08-01

    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.

  3. Computed tomographic appearances of the pelvis following hindquarter amputation.

    Science.gov (United States)

    Fowler, J; Davies, A M; Carter, S R; Grimer, R J; Sneath, R S

    1992-12-01

    Bilateral and midline symmetry of the normal pelvic anatomy is an aid to the interpretation of computed tomographic (CT) examinations. Following hindquarter amputation (HQA) or partial hemipelvectomy (PHP) the normal anatomical relationships are disturbed. The CT examinations of 15 patients who had undergone either an HQA or a PHP for an advanced musculoskeletal malignancy are reviewed. The new "normal" anatomy revealed displacement of the bladder and small bowel to the side of surgery in one third of patients, more commonly in the PHP cases. There were varying degrees of wasting of the ipsilateral musculature, gluteus maximus muscle flap, erector spinae and psoas muscles, etc., because of partial denervation and disruption of their origin or insertion. Recurrent tumour was identified in eight of 10 cases in which it was clinically suspected prior to the CT examination. Invariably the recurrence arose within the muscle flap at the resection margin. Bone involvement by direct tumour spread was present in three cases. Pitfalls in differentiating recurrent tumour from scar tissue are discussed.

  4. Mount Everest and Makalu cold injury amputation: 40 years on.

    Science.gov (United States)

    Morrison, Shawnda A; Gorjanc, Jurij; Mekjavic, Igor B

    2014-04-01

    Freezing cold injuries (frostbite) of the extremities are a common injury among alpinists participating in high altitude expeditions, particularly during inclement weather conditions. Anecdotally, a digit that has suffered frostbite may be at greater risk to future cold injuries. In this case study, we profile a 62-year-old elite alpinist who suffered multiple digit amputations on both his hands and foot after historic summit attempts on Makalu (8481 m) and Mt. Everest (8848 m) in 1974-1979. We describe the clinical treatment he received at that time, and follow up his case 40 years after the first incidence of frostbite utilizing a noninvasive evaluation of hand and foot function to a cold stress test, including rates of re-warming to both injured and non-injured digits. Finger rates of recovery to the cold stress test were not different (0.8 vs. 1.0°C·min(-1)) except one (injured, left middle finger, distal phalanx; 0.4°C·min(-1)). Toe recovery rates after cold-water immersion were identical between previously injured and non-injured toes (0.2°C·min(-1)). Thermocouple data indicate that this alpinist's previous frostbite injuries may not have significantly altered his digit rates of re-warming during passive recovery compared to his non-injured digits.

  5. [New technologies in the prosthetic management after amputations].

    Science.gov (United States)

    Schäfer, M; Gawron, O

    2015-06-01

    In Germany around 70,000 amputations are carried out on extremities each year. Modern prosthetic functional components have become more and more sophisticated and must be understood and applied by their users to be of beneficial use in everyday life. The prosthetic socket is the most important component of modern extremity prosthetics. Which demands have to be met by a modern prosthetic socket so that innovative function-improving components in prosthetics can be successfully applied? Complex prosthetic technologies are rarely compatible with a lower overall weight of the prosthesis. The increase in functionality also produces differentiated force effects on the human body. Modern socket technologies, therefore, have to compensate for the increased strain and counteract the increasing dynamics between the stump and the prosthesis. This can be achieved through the application of adhesive socket materials and through new adhesive mechanisms. Form variants can also improve the connection between stump and prosthetic socket. The improvements in prosthetic socket technology presented here have a lasting positive effect on the daily routine of many amputees. Not only do they improve the control and application of modern prosthetic components, but also clearly enhance the wearing comfort. The prosthetic socket is crucial for the success of exoskeletal prosthetic management. The better we succeed in making the human body and the prosthetic socket an entity, the more usefully and comfortably innovative prosthetic methods can be applied.

  6. Prosthesis intolerance in patients with transfemoral amputation: a videocapillaroscopic study.

    Science.gov (United States)

    Macchi, Claudio; Cassigoli, Silvia; Lova, Raffaele Molino; Roccuzzo, Aurelio; Miniati, Benedetta; Ceppatelli, Simone; Conti, Andrea A; Gensini, Gian Franco

    2004-06-01

    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 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.

  7. Lower-Limb Amputation and Effect of Posttraumatic Stress Disorder on Department of Veterans Affairs Outpatient Cost Trends

    Science.gov (United States)

    2015-07-01

    SD = standard deviation, TBI = traumatic brain injury. 831 BHATNAGAR et al. Lower-limb amputation , PTSD, and VA costsFigure 1. Among Veterans with...PTSD = posttraumatic stress disorder, TBI = traumatic brain injury. 835 BHATNAGAR et al. Lower-limb amputation , PTSD, and VA costsModel Covariates...JRRD Volume 52, Number 7, 2015Pages 827–838Lower-limb amputation and effect of posttraumatic stress disorder on Department of Veterans Affairs

  8. Amputation history and rehabilitation of black men living in the greater Durban area who have had traumatic amputations of the lower limb

    Directory of Open Access Journals (Sweden)

    B. A. Kubheka

    1995-05-01

    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.

  9. Amputation history and rehabilitation of black men living in the greater Durban area who have had traumatic amputations of the lower limb

    Directory of Open Access Journals (Sweden)

    B. A. Kubheka

    1995-03-01

    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.

  10. Toe Pressures are Superior to Duplex Parameters in Predicting Wound Healing following Toe and Foot Amputations.

    Science.gov (United States)

    Stone, Patrick A; Glomski, Alexis; Thompson, Stephanie N; Adams, Elliott

    2018-01-01

    No criteria, including preamputation vascular diagnostic thresholds, have been established to reliably predict healing versus nonhealing following minor lower extremity amputations. Thus, the goal of our study was to identify clinical factors, including noninvasive vascular laboratory measures, associated with wound healing following toe, forefoot, and midfoot amputations. We retrospectively examined records of patients receiving elective toe, forefoot, or midfoot amputation at our institution over a 5-year span (2010-2015). A total of 333 amputations received noninvasive vascular assessment of the lower extremity preamputation and follow-up at 90 days postamputation. Multivariate binomial logistic regression was used to identify variables predicting wound healing as defined as the absence of reamputation due to wound breakdown. Wound healing occurred in 81% of amputations. A total of 23 (7%) patients required revisions of the foot while 39 (12%) patients required major amputations by 90 days. Chi-squared analysis found that toe pressure at or above the value of 47 mm Hg (P = 0.04), bi/triphasic anterior tibial (P = 0.01), and posterior tibial artery (P = 0.01) waveforms were associated with wound healing. When these diagnostic parameters were examined in the presence of confounders (increasing age, chronic kidney disease, and concomitant revascularization), only toe pressure ≥ 47 mm Hg predicted amputation site healing (odds ratio: 3.1 [95% CI: 1.0-9.4], P = 0.04). Preamputation toe pressures of 47 mm Hg and above are associated with wound healing. No other noninvasive vascular studies predicted wound healing in the presence of confounders. Thus, toe pressures may assist in clinical decision-making and should be routinely obtained preamputation. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot.

    Science.gov (United States)

    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

    2014-03-01

    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.

  12. Lower extremity amputations in persons with and without diabetes in Italy: 2001-2010.

    Directory of Open Access Journals (Sweden)

    Flavia L Lombardo

    Full Text Available OBJECTIVE: To analyze hospitalization for lower extremity amputations (LEAs and amputee rates in persons with and without diabetes in Italy. RESEARCH DESIGN AND METHODS: All patients with LEAs in the period 2001-2010 were identified analyzing the National Hospital Discharge Record database. For each year, amputee and hospitalization rates for LEAs were calculated either for persons with diabetes or without. Time trend for major and minor amputations were analysed. RESULTS: From 2001 to 2010 a mean annual number of 11,639 individuals underwent a lower extremity amputation: 58.6% had diabetes accounting for 60.7% of total hospitalizations. In 2010, the crude amputee rate for LEAs was 20.4 per 100,000 inhabitants: 247.2 for 100.000 persons with diabetes, and 8.6 for those without diabetes. Having diabetes was associated to an increased risk of amputation (Poisson estimated RR 10.9, 95%CI 9.4-12.8. Over the whole period, a progressive reduction of amputee rates was observed for major amputations either among persons with diabetes (-30.7% or without diabetes (-12.5%, while the rates of minor amputations increased progressively (+22.4% among people without diabetes and were nearly stable in people with diabetes (-4.6%. A greater number of minor amputations were performed among persons with than without diabetes: in 2010, the minor-to-major ratio among persons with diabetes (2.5 was more than twice than in those without diabetes (1.0. CONCLUSIONS: The nationwide analyses confirm a progressive reduction of hospitalization and amputee rates for major LEAs, suggesting an earlier and more diffuse approach aimed at limb salvage.

  13. Reducing major lower extremity amputations after the introduction of a multidisciplinary team in patient with diabetes foot ulcer.

    Science.gov (United States)

    Wang, Chuan; Mai, Lifang; Yang, Chuan; Liu, Dan; Sun, Kan; Song, Weidong; Luo, Baoming; Li, Yan; Xu, Mingtong; Zhang, Shaoling; Li, Fangping; Ren, Meng; Yan, Li

    2016-07-07

    Diabetic foot ulceration is receiving more attention because of its high amputation and mortality rate. It is essential to establish the frequency of amputations in people with diabetes after any change to the management of diabetic foot care. The present study aim to compare the frequency of lower-extremity amputations in patients with diabetes foot ulcer over a ten-year period. Six hundred forty eight patients with diabetes foot ulcer were retrospectively studied from 2004 to 2013. The clinical features, laboratory results and the lower-extremity amputations were recorded. Major amputation was defined as amputations above the ankle while minor amputation was amputations below the ankle in the present study. Patients with diabetic foot ulcer were old (age 66.96 ± 11.96 years), with a long duration of diabetes (10.30 ± 6.94 years), high HbA1c (9.19 ± 2.62 %), SBP (144.05 ± 24.18 mmHg), DBP (79.53 ± 11.88 mmHg), LDL-C (2.71 ± 0.93 mmol/L) and had great frequency of neuropathy (62.7 %), retinopathy (45.0 %), nephropathy (39.5 %) and PAD (33.2 %). From 2004 to 2013, the frequency of all lower-extremity amputations is 12.0 % (5.2 % major amputation, 6.8 % minor amputation). The frequency of major amputations decreased from 9.5 % in 2004 and 14.5 % in 2005 to less than 5.0 % after 2006. In particular, there was a significant decline in major amputations of diabetic foot patient with Wagner 3 to 4 wounds. The frequency rate of major amputations in diabetic foot patient with Wagner 3 to 4 wounds fell from 35.7 % in 2004 to 4.4 % after 2007. The change in frequency of minor amputations was fluctuation. 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 frequency of major amputations in patients with diabetes.

  14. [Applications of myo-periosteal fibular bone bridging for traumatic transtibial amputation].

    Science.gov (United States)

    Song, Dengxin; Zhang, Qianfa; Zhu, Cheng; He, Xiaowen; Liao, Xiaohui; Yi, Chengla

    2013-11-01

    To compare the effectiveness between the myo-periosteal fibular bone bridging and traditional transtibial amputation in the treatment of amputation below knee so as to provide theoretical basis for choosing transtibial amputation in clinical application. Between November 2001 and November 2011, 38 patients with mangled lower extremity were treated by transtibial amputation. Among 38 patients, 17 (group A) underwent myo-periosteal fibular bone bridging (the operation techniques of an attached peroneal muscle myo-periosteal fibular strut bridge between the end of the tibia and fibula below knee amputation), and other 21 (group B) underwent traditional transtibial amputation. There was no significant difference in age, gender, injury cause, amputation cause, side, and disease duration between 2 groups (P > 0.05). The quality of life (QOL) was analyzed using 36-item short form health survey (SF-36), and prosthesis satisfaction by Trinity amputation and prosthesis experience scale (TAPES). Healing of incision by first intention was obtained in all patients of 2 groups; no necrosis, infection, or poor stumps was observed. The mean follow-up time was 22 months (range, 14-30 months) in group A, and 26 months (range, 15-30 months) in group B. The patients achieved good healing of bone bridging, no bone nonunion occurred. The healing time was (5.1 +/- 1.1) months in group A and (3.3 +/- 0.6) months in group B, showing significant difference between 2 groups (t=9.82, P=-0.00). Spur occurred at the distal fibula in an 11-year-old boy of group B after 2 years of operation, which blocked use of prosthesis; prosthesis was well used in the other patients. After 12 months of operation, SF-36 score was 55.84 +/- 14.01 in group A and 49.93 +/- 12.78 in group B, showing significant difference (P 0.05). TAPES score was 12.12 +/- 2.23 in group A and 10.10 +/- 2.00 in group B, showing significant difference (t=2.891, P=0.006). It is a very effective method to treat traumatic amputation

  15. Bacterial genus is a risk factor for major amputation in patients with diabetic foot

    Directory of Open Access Journals (Sweden)

    NATÁLIA ANÍCIO CARDOSO

    Full Text Available ABSTRACT Objective: to evaluate whether bacterial genus is a risk factor for major amputation in patients with diabetic foot and infected ulcer. Methods: we conducted a case-control, observational study of 189 patients with infected ulcers in diabetic feet admitted to the Vascular Surgery Service of the Risoleta Tolentino Neves Hospital, from January 2007 to December 2012. The bacteriological evaluation was performed in deep tissue cultures from the lesions and amputation was considered major when performed above the foot'smiddle tarsus. Results: the patients'mean age was 61.9±12.7 years; 122 (64.6% were men. The cultures were positive in 86.8%, being monomicrobial in 72% of the cases. In patients with major amputation, Acinetobacter spp. (24.4%, Morganella spp. (24.4%, Proteus spp. (23.1% and Enterococcus spp. (19.2% were the most frequent types of bacteria. The most commonly isolated species were Acinetobacter baumannii, Morganella morganii, Pseudomonas aeruginosa and Proteus mirabilis. As predictors of major amputation, we identified the isolation of the generaAcinetobacter spp. and Klebsiella spp., serum creatinine ≥1.3mg/dl and hemoglobin <11g/dl. Conclusion: the bacterial genera Acinetobacter spp. and Klebsiella spp. identified in infected ulcers of patients with diabetic foot were associated with a higher incidence of major amputation.

  16. [Replantation of fingertip amputation in lack of availability of intravenous anastomosis].

    Science.gov (United States)

    Wei, Jian-Min; Sun, Jun-Suo; Jiao, Xiao-Hu; Jing, Dou-Xing; He, Wei; Jin, Wen-Kuo; Chen, Shi-Gao

    2012-08-01

    To discuss the replantation of fingertip amputation in lack of availability of intravenous anastomosis. From November 2009 to November 2010, 86 patients (104 fingers) with fingertip amputation were treated with replantatioin, including 64 males and 22 females, with an average age of 26 years ranging from 2 to 64 years. The time from injury to therapy was from 30 min to 12 h, time of broken finger ischemia was from 2.5 to 12 h. Preoperative examination showed no obvious abnormalities. Four different replantation methods were selectively applied to these 104 amputated fingertips of 86 cases: (1) replantation with anastomosis of single or bilateral proper digital artery in 37 fingers; (2) replantation with arteriovenous bypass in 27 fingers; (3) replantation with exclusive anastomosis of digital artery in 24 fingers; (4) replantation with removing the palmar pocket method in 16 fingers. One hundred and two of 104 amputated fingertips were survived. Among these survived fingers,75 cases (92 fingers) were followed-up for 6 to 24 months. According to the assessment standard of Chinese Medical Association of Hand Surgery, the results were excellent in 52 cases, good in 19, poor in 4. It benefits to expand the indications and improve the survival rate of replantation of fingertip amputation with the correct choice of different replantation methods according to the injury situation of the broken fingertip artery after debridement under the microscope.

  17. Very low survival rates after non-traumatic lower limb amputation in a consecutive series

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Holm, Gitte; Kirketerp-Møller, Klaus

    2012-01-01

    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......% trans-femoral) were studied. Their mean age was 75.8 years; 21 (23%) were admitted from a nursing home and 87 (92%) were amputated due to a vascular disease and/or diabetes. Thirty days and 1-year mortality were 30 and 54%, respectively. Cox regression analysis demonstrated that the 30-day mortality...... was associated with older age (P = 0.01), and the number of co-morbidities (P = 0.04), when adjusted for gender, previous amputations, cause of and amputation level, and residential status. Thus, a patient with 4 or 5 co-morbidities (n = 20) was seven times more likely to die within 30 days, compared...

  18. Podiatry impact on high-low amputation ratio characteristics: A 16-year retrospective study.

    Science.gov (United States)

    Schmidt, Brian M; Wrobel, James S; Munson, Michael; Rothenberg, Gary; Holmes, Crystal M

    2017-04-01

    Complications from diabetes mellitus including major lower extremity amputation may have significant impact on a patient's mortality. This study determined what impact the addition of a limb salvage and diabetic foot program involving podiatry had at an academic institution over 16years by analyzing high-low amputation ratio data. The high-low amputation ratio in the diabetic population who underwent non-traumatic amputation of the lower extremity was retrospectively evaluated at an academic institution via cohort discovery of the electronic medical record and analysis of billing over 16years. We directly compared two eras, one without podiatry and one with a podiatry presence. It was found that with the addition of a podiatry program, limb salvage rates significantly increased (R 2 (without podiatry)=0.45, R 2 (with podiatry)=0.26), with a significant change in both the rate of limb salvage per year (-0.11% per year versus -0.36% per year; pamputation ratio (0.89 without podiatry to 0.60 with podiatry). Of note, approximately 40 major lower extremity amputations were avoided per year with the addition of a podiatry program (pamputations can be avoided and more limbs can be salvaged, thus preventing some of the moribund complications from this condition. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Retrograde intramedullary fixation of long bone fractures through ipsilateral traumatic amputation sites.

    Science.gov (United States)

    Wagner, Scott C; Chi, Benjamin B; Gordon, Wade T; Potter, Benjamin K

    2015-06-01

    The technique of retrograde intramedullary fixation of fractures through open traumatic amputations has not been previously described. We performed a retrospective case series at a tertiary-care military hospital setting. Ten patients met inclusion criteria. All were male, and all were injured through improvised explosive device. Outcome measures included the incidence of fracture nonunion, osteomyelitis or acute infection, heterotopic ossification (HO), as well as successful prosthesis fitting and ambulation. Average time to fixation after injury and amputation closure was 11.7 and 12.2 days, respectively. Follow-up averaged 20.2 months. The radiographic union rate was 100%, and time to osseous union averaged 7.5 months. One patient had an amputation site infection requiring revision, but none of the nails was removed for infectious reasons. HO occurred in 7 patients, and 2 patients required revision for symptomatic HO. All patients were successfully fitted with prostheses and able to ambulate. To our knowledge, this is the only series in the literature to specifically describe retrograde intramedullary fixation of long bone fractures through the zone of traumatic amputation sites. The infectious risk is relatively low, whereas the union rate (100%) and successful prosthesis fitting are high. For patients with similar injuries, retrograde intramedullary fixation through the zone of amputation is a viable treatment option.

  20. [Amputation and equipment of the lower limb during the Revolution and the Empire].

    Science.gov (United States)

    Vesselle, Benoît

    2014-01-01

    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.

  1. Body integrity identity disorder (BIID)--is the amputation of healthy limbs ethically justified?

    Science.gov (United States)

    Müller, Sabine

    2009-01-01

    The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image.

  2. Maximum-speed curve-running biomechanics of sprinters with and without unilateral leg amputations.

    Science.gov (United States)

    Taboga, Paolo; Kram, Rodger; Grabowski, Alena M

    2016-03-01

    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 (Pleg on the inside compared with the outside of the curve (Pleg 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. © 2016. Published by The Company of Biologists Ltd.

  3. [The endo-exo prosthesis for patients with a problematic amputation stump].

    Science.gov (United States)

    Frölke, Jan Paul M; van de Meent, Henk

    2010-01-01

    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.

  4. Prosthetic fitting, use, and satisfaction following lower-limb amputation: a prospective study.

    Science.gov (United States)

    Webster, Joseph B; Hakimi, Kevin N; Williams, Rhonda M; Turner, Aaron P; Norvell, Daniel C; Czerniecki, Joseph M

    2012-01-01

    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.

  5. Effects of prosthetic limb prescription on 3-year mortality among Veterans with lower-limb amputation.

    Science.gov (United States)

    Kurichi, Jibby E; Kwong, Pui; Vogel, W Bruce; Xie, Dawei; Cowper Ripley, Diane; Bates, Barbara E

    2015-01-01

    Our objective was to determine the relationship between receipt of a prescription for a prosthetic limb and 3 yr mortality postsurgery among Veterans with lower-limb amputation (LLA). We conducted a retrospective observational study that included 4,578 Veterans hospitalized for LLA and discharged in fiscal years 2003 and 2004. The outcome was time to all-cause mortality from the amputation surgical date up to the 3 yr anniversary of the surgical date. Of the Veterans with LLA, 1,300 (28.4%) received a prescription for a prosthetic limb within 1 yr after the surgical amputation. About 46% (n = 2,086) died within 3 yr of the surgical anniversary. Among those who received a prescription for a prosthetic limb, only 25.2% died within 3 yr of the surgical anniversary. After adjustment, Veterans who received a prescription for a prosthetic limb were less likely to die after the surgery than Veterans without a prescription, with a hazard ratio of 0.68 (95% confidence interval: 0.60-0.77). Findings demonstrated that Veterans with LLA who received a prescription for a prosthetic limb within 1 yr after the surgical amputation were less likely to die within 3 yr of the surgical amputation after controlling for patient-, treatment-, and facility-level characteristics.

  6. Shoe adaptation after amputation of the II - V phalangeal bones of the foot.

    Science.gov (United States)

    Rommers, G M; Diepstraten, H J M; Bakker, E; Lindeman, E

    2006-12-01

    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 insole solution for the solitary first phalangeal bone after amputation of the phalangeal bones II - V. The normal adaptation for forefoot amputations is stiffening of the sole of the shoe and a rocker bar to improve the toe off phase with load reduction of the forefoot. Because the patient had to do excessive stair climbing during work another solution was chosen. As a foot orthosis, a metal soleplate was made in order to have free movement during loading and toe-off during walking. The soleplate gives safety and provides self-adjusting properties after toe off. This enables the shoe technician to make a shoe without a rocker bar or an extra stiff insole. The 0.5 mm custom-made spring-steel plate is also used as a protective in industrial safety shoes. To improve shoe adaptation more research and case reports have to be published in order to inform doctors and shoe technicians about everyday solutions to partial foot amputations.

  7. Prosthesis evaluation questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life.

    Science.gov (United States)

    Legro, M W; Reiber, G D; Smith, D G; del Aguila, M; Larsen, J; Boone, D

    1998-08-01

    To develop a self-report questionnaire for persons with lower limb amputations who use a prosthesis. The resulting scales were intended to be suitable to evaluate the prosthesis and life with the prosthesis. The conceptual framework was health-related quality of life. Multiple steps of scale development, terminating with test-retest of the Prosthesis Evaluation Questionnaire (PEQ) by mail. SOURCE OF SAMPLE: Records from two Seattle hospitals. Ninety-two patients with lower limb amputations who varied by age, reason for amputation, years since amputation, and amputation level. The 10 scales used were 4 prosthesis function scales (Usefulness, Residual Limb Health, Appearance, and Sounds), 2 mobility scales (Ambulation and Transfers), 3 psychosocial scales (Perceived Responses, Frustration, and Social Burden), and 1 Well-being scale. Validation measures were the Medical Outcomes Study Short Form-36, the Social Interaction subscale from the Sickness Impact Profile, and the Profile of Mood States-short form. Nine PEQ scales demonstrated high internal consistency. All met test-retest criteria for comparing group results. Validity was described based on methods used to gather original items, distribution of scores, and comparison of scores with criterion variables. The PEQ scales displayed good psychometric properties. Future work will assess responsiveness of PEQ scales to changes in prosthetic components. We conclude that they will be useful in evaluation of prosthetic care.

  8. A systematic review describing incidence rate and prevalence of dysvascular partial foot amputation; how both have changed over time and compare to transtibial amputation

    Directory of Open Access Journals (Sweden)

    Michael P Dillon

    2017-11-01

    Full Text Available Abstract Background Partial foot amputation (PFA is a common consequence of advanced peripheral vascular disease. Given the different ways incidence rate and prevalence data have been measured and reported, it is difficult to synthesize data and reconcile variation between studies. As such, there is uncertainty in whether the incidence rates and prevalence of PFA have increased over time compared to the decline in transtibial amputation (TTA. The aims of this systematic review were to describe the incidence rate and prevalence of dysvascular PFA over time, and how these compare to TTA. Method Databases (i.e., MEDLINE, EMBASE, psychINFO, AMED, CINAHL, ProQuest Nursing and Allied Health were searched using MeSH terms and keywords related to amputation level and incidence rate or prevalence. Original research published in English from 1 January 2000 to 31 December 2015 were independently appraised, and data extracted, by two reviewers. The McMaster Critical Review Forms were used to assess methodological quality and bias. Results were reported as narrative summaries given heterogeneity of the literature and included the weighted mean annual incidence rate and 95% confidence interval. Results Twenty two cohort studies met the inclusion criteria. Twenty one reported incidence rate data for some level of PFA; four also included a TTA cohort. One study reported prevalence data for a cohort with toe(s amputation. Samples were typically older, male and included people with diabetes among other comorbidities. Incidence rates were reported using a myriad of denominators and strata such as diabetes type or initial/recurrent amputation. Conclusion When appropriately grouped by denominator and strata, incidence rates were more homogenous than might be expected. Variation between studies did not necessarily reduce confidence in the conclusion; for example, incidence rate of PFA were many times larger in cohorts with diabetes (94.24 per 100,000 people with

  9. Symmetrical kinematics does not imply symmetrical kinetics in people with transtibial amputation using cycling model.

    Science.gov (United States)

    Childers, W Lee; Kogler, Géza F

    2014-01-01

    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.

  10. Classification of distal fingertip amputation based on the arterial system for replantation.

    Science.gov (United States)

    Park, Hyun Chul; Bahar-Moni, Ahmed Suparno; Cho, Sang Hyun; Kim, Sang Soo; Park, Hyun Sik; Ahn, Sang Cheon

    2013-06-01

    During replantation of distal fingertip amputation, identification of the artery is the most important but time consuming procedure. Depending on the damaged arterial structure, we classified distal fingertip amputations into 4 zones, on the basis of three dimensional concept. Zone 1 injury was defined as damage to the proximal central pulp artery; zone 2 injury, damage to the branch of the central pulp artery; zone 3 injury, damage to the distal central pulp artery; and zone 4 injury, no injury to the central pulp artery, injury only to the lateral pulp artery. From April 2010 to June 2011, 27 patients were evaluated. Successful replantation was observed in 21 patients. Skin necrosis occurred in six patients. For distal fingertip amputation classification based on the damaged arterial system is an easy method to find out the appropriate artery which should be anastomosed during replantation.

  11. Margins of stability in young adults with traumatic transtibial amputation walking in destabilizing environments.

    Science.gov (United States)

    Beltran, Eduardo J; Dingwell, Jonathan B; Wilken, Jason M

    2014-03-21

    Understanding how lower-limb amputation affects walking stability, specifically in destabilizing environments, is essential for developing effective interventions to prevent falls. This study quantified mediolateral margins of stability (MOS) and MOS sub-components in young individuals with traumatic unilateral transtibial amputation (TTA) and young able-bodied individuals (AB). Thirteen AB and nine TTA completed five 3-min walking trials in a Computer Assisted Rehabilitation ENvironment (CAREN) system under each of three test conditions: no perturbations, pseudo-random mediolateral translations of the platform, and pseudo-random mediolateral translations of the visual field. Compared to the unperturbed trials, TTA exhibited increased mean MOS and MOS variability during platform and visual field perturbations (pamputation achieved lateral stability similar to that of their able-bodied counterparts during unperturbed and visually-perturbed walking. However, based on mean and variability of MOS, unilateral transtibial amputation was shown to have affected lateral walking stability during platform perturbations. Published by Elsevier Ltd.

  12. Traumatic partial amputation of the tongue. Case report and literature review.

    Science.gov (United States)

    Hernández-Méndez, José Roberto; Rodríguez-Luna, María Rita; Guarneros-Zárate, Joaquín Eugenio; Vélez-Palafox, Mario

    2016-02-01

    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. 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. 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. 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.

  13. Hand reconstruction using heterotopic replantation of amputated index and little fingers

    Directory of Open Access Journals (Sweden)

    ZHANG Gong-lin

    2012-02-01

    Full Text Available 【Abstract】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. Key words: Amputation traumatic; Hand injuries; Replantation; Transplantation heterotopic

  14. Ischaemic wound complications in above-knee amputations in relation to the skin perfusion pressure

    DEFF Research Database (Denmark)

    Holstein, P

    1980-01-01

    Healing of the stumps in 59 above-knee amputations was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 131I-(-) or 125I-(-) antipyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mm......Hg no fewer than 9 (82 per cent) suffered wound complications. Out of the 48 cases with an SPP above 30 mmHg severe wound complications occurred in only 4 cases (8 per cent). The difference in wound complication rate is highly significant (P ... ischaemic wound complications in above-knee amputations as has previously been shown to be the case in below-knee amputations....

  15. [Cross-hand replantation in bilateral upper limb amputation: An anatomical emergency].

    Science.gov (United States)

    Andre, A; Rongieres, M; Laffosse, J-M; Pailhe, R; Lauwers, F; Grolleau, J-L

    2015-08-01

    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. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Fingertip amputation salvage on arterial anastomosis alone: an investigation of its limitations.

    Science.gov (United States)

    Ito, Hiroshi; Sasaki, Kenji; Morioka, Kousuke; Nozaki, Motohiro

    2010-09-01

    We have previously reported the importance of adequate and precise arterial anastomosis and the hypothesis that, up to subzone III, fingertip amputation salvage can be achieved on arterial anastomosis alone. These findings were reported during the meeting of the Japanese Society of Reconstructive Microsurgery. This is our follow-up report with insight and opinion on the limitations of complete fingertip amputation salvage on arterial anastomosis alone. We examined 67 fingers (59 patients) with fingertip amputations presenting to our hospital between January 2005 and December 2008. Amputation levels and whether these injuries received only arterial or both arterial and venous anastomoses were noted. Fisher exact test was used to examine statistical differences between the groups. Amputation levels were 11 in subzone I, 20 in subzone II, 17 in subzone III, and 19 in subzone IV. Successful replantation was achieved in 87% (58 of 67) of fingers. There was no statistically significant difference between fingers receiving arterial alone versus both anastomoses in amputations of subzones I, II, and III. We found that with proper postoperative congestion care, no statistically significant difference in replantation success of fingers receiving arterial anastomosis alone versus both arterial and venous were noted up to subzone III. However, in subzone IV, regardless of the postoperative congestion, compete necrosis rates are high; thus, it is speculated that a venous anastomosis is necessary for successful replantation. It is preferable to perform as many anastomoses as possible, but we believe that it is also desirable for the procedure to be fast and less invasive. In cases that have no adequate vein, fingertip replantation can be achieved on arterial anastomosis alone up to subzone III.

  17. Sound limb loading in individuals with unilateral transfemoral amputation across a range of walking velocities.

    Science.gov (United States)

    Russell Esposito, Elizabeth; Aldridge Whitehead, Jennifer M; Wilken, Jason M

    2015-12-01

    Individuals with unilateral transfemoral amputation demonstrate significantly increased rates of osteoarthritis in their sound knee. This increased risk is likely the result of altered knee mechanical loading and gait compensations resulting from limited function in the prosthetic limb. Altered knee loading as calculated using loading rates and peak external knee adduction moments and impulses have been associated with both the development and progression of knee osteoarthritis in other populations. The purpose of this study was to determine if young individuals with transfemoral amputation demonstrate biomechanical indicators of increased knee osteoarthritis risk. Fourteen young male Service Members with unilateral transfemoral amputation and 14 able-bodied service members underwent biomechanical gait analysis at three standardized walking velocities. A two-way ANOVA (group × speed) with unpaired comparisons with Bonferroni-Holm post-hoc corrections assessed statistical significance and effect sizes (d) were calculated. Normalized peak external knee adduction moments and impulses were 25.7% (P 0.994) and 27.1% (P 1.019) lower, respectively, in individuals with trans-femoral amputation than controls when averaged across speeds, and effect sizes were large. External knee flexor moments were not, however, different between groups and effect sizes were generally small (P > 0.380, d amputation and effect sizes were large (P 1.644). Individuals with transfemoral amputation did not demonstrate biomechanical risk factors for high medial compartment knee joint loads, but the increased loading rates could place the sound knee at greater risk for cartilage or other tissue damage, even if not localized to the medial compartment. Published by Elsevier Ltd.

  18. Ectopic major transplantation for salvage of upper and lower extremity amputations

    Directory of Open Access Journals (Sweden)

    Nazerani Shahram

    2013-12-01

    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

  19. A clinical trial testing the efficacy of PDT in preventing amputation in diabetic patients.

    Science.gov (United States)

    Tardivo, João Paulo; Adami, Fernando; Correa, João Antonio; Pinhal, Maria Aparecida S; Baptista, Mauricio S

    2014-09-01

    The feet of diabetic patients continue to be an unsolved problem in medicine. Uncontrolled neuropathy, ulceration and infection usually lead to amputation and presently there is no effective and reliable method that can be used to provide an efficient cure. Overall improvement in the salvage strategies, based on comprehensive pre-clinical evaluation, debridement, antibiotic therapy and follow up, has shown improvements in certain hospital settings, but the general picture for patients with diabetic foot is to have some sort of amputation, especially in underserved populations. It is clearly necessary to develop novel treatment strategies for this worldwide health problem. Photodynamic therapy (PDT) is a treatment modality that uses light to generate in situ reactive oxygen species, which can cause cell death. PDT can be used to treat several diseases, including foot infections that do not respond well to antibiotic therapy. There are several characteristics of PDT that make it potentially ideal to treat diabetic feet: the photosensitizer is non-toxic in the dark, but after illumination it becomes a very efficient antimicrobial agent with topical use, and it can regenerate small bones, such as the phalanges. However, PDT is still not used in clinical practice to treat diabetic feet. Therefore, we decided to perform a clinical study to prove that PDT is an effective method to avoid amputation of infected diabetic feet. An inexpensive PDT protocol was developed and applied to 18 patients with osteomyelitis, classified as Grade 3 on the Wagner scale. Only one of these patients suffered amputation. At least two of them were cured from resistant bacteria strains without intravenous antibiotic therapy. In the control group of 16 patients, all of them ended up suffering amputation. The rate of amputation in the PDT group was 0.029 times the rate in the control group and the difference is clearly statistically significant (p=0.002). Copyright © 2014 Elsevier B.V. All

  20. Four limb amputations due to peripheral gangrene from inotrope use – Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Ang Chuan Han

    2015-01-01

    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.

  1. Prevalence and Characteristics of Phantom Limb Pain and Residual Limb Pain in the Long Term after Upper Limb Amputation

    Science.gov (United States)

    Desmond, Deirdre M.; MacLachlan, Malcolm

    2010-01-01

    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…

  2. Impact of a diabetic foot care education program on lower limb amputation rate

    Directory of Open Access Journals (Sweden)

    Abdullah M Al-Wahbi

    2010-10-01

    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

  3. Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation

    Directory of Open Access Journals (Sweden)

    Rajendra Nehete

    2012-01-01

    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.

  4. Yubitsume: ritualistic self-amputation of proximal digits among the Yakuza.

    Science.gov (United States)

    Bosmia, Anand N; Griessenauer, Christoph J; Tubbs, R Shane

    2014-07-01

    Yubitsume is the ritualistic self-amputation of the proximal digits at the distal interphalangeal joint (DIP) among members of the Japanese Mafia, or Yakuza. This practice of self-mutilation is done as a sign of apology for making a mistake deemed punishable by higher-ranking members or violating the code of the Yakuza. Members of the Yakuza may present to emergency departments seeking medical assistance to stop hemorrhage or treat infection at the site of injury following self-amputation or to have the severed portion of the injured finger reattached. .© 2014 KUMS, All rights reserved.

  5. Crossover replantation as a salvage procedure following bilateral transhumeral upper limb amputation: a case report.

    Science.gov (United States)

    Ozçelik, Ismail Bülent; Mersa, Berkan; Kabakaş, Fatih; Saçak, Bülent; Kuvat, Samet Vasfi

    2011-04-01

    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.

  6. Bilateral recurrent discloation of the patella associated with below knee amputation: A case report

    Directory of Open Access Journals (Sweden)

    Lenka Prasanna

    2005-02-01

    Full Text Available Abstract Background Recurrent dislocation of the patella in patients with below knee amputation is a known entity. Abnormally high-riding patella (patella alta and medial patellofemoral ligament insufficiency in these patients predisposes them to patellar instability. The established treatment of this problem is surgical realignment. Case presentation A 25 year old male patient with bilateral below knee amputation presented with bilateral recurrent dislocation of the patella while walking on knees on uneven ground. Clinical and radiographic studies showed patella alta. A simple shoe modification was used to treat this patient. Conclusions A simple shoe modification can be used to treat such a condition which is otherwise treated surgically.

  7. Reconstruction of an amputated glans penis with a buccal mucosal graft: case report of a novel technique.

    Science.gov (United States)

    Aboutaleb, Hamdy

    2014-12-01

    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.

  8. Cosmetic amputation of the fourth ray as possible outcome of the traumatic amputation of the ring finger injury: a case report.

    Science.gov (United States)

    Pedrazzini, Alessio; Calderazzi, Filippo; Bertoni, Nicola; Ceccarelli, Francesco

    2008-12-01

    The aim of this work is to describe a case of traumatic amputation of the fourth finger of the left hand. In its first phase, a treatment which consisted in a disarticulation at the level of the metacarpo-phalangeal joint was carried out; in the second phase, three months after this emergency treatment, a cosmetic amputation of the fourth metacarpal ray was required. Surgery was performed in accordance with the technique described by Bunnell, which consisted in the disarticulation of the fourth metacarpal, together with radial traslation of the fifth ray. Eighteen months after the operation The patient reported the absence of any subjective problems, with complete functional recovery of the hand that had been operated on. By that time she was back at her job; she also was satisfied with the cosmetic results that had been achieved.

  9. Change in health-related quality of life in the first 18 months after lower limb amputation : A prospective, longitudinal study

    NARCIS (Netherlands)

    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

  10. Validity of exploration for suitable vessels for replantation in the distal fingertip amputation in early childhood: replantation or composite graft.

    Science.gov (United States)

    Imaizumi, Atsushi; Ishida, Kunihiro; Arashiro, Ken; Nishizeki, Osamu

    2013-09-01

    Composite grafting, grafting without microvascular anastomoses, has been widely performed for distal fingertip amputation in children with variable results, whereas successful replantation of these amputations using microsurgical technique has been reported. However, most of these reports included a wide age-range and a mix of different amputation levels. This study reviewed our cases of paediatric digital amputation, in order to verify the value of distal fingertip replantation over composite grafting, especially in early childhood. Seventeen young children (aged 3 years and 8 months on average), with single-digit fingertip amputations in Tamai zone I were reviewed from 1993-2008. Each amputation was subdivided into three types: distal, middle, and proximal. There were three distal, 13 middle, and one proximal type zone I amputations. All were crush or avulsion injuries. All three distal-type cases were reattached as primary composite grafts with one success. For middle-type cases, the survival rate of primary composite graft without exploration for possible vessels for anastomosis was 57%. On exploration, suitable vessels for anastomosis were found 50% of the time, in which all replantations were succeeded. The remaining cases were reattached as secondary composite grafts, with one success using the pocket method. Consequently, the success rate after exploration was 67%. The only one proximal-type amputation was failed in replantation. For the middle-type zone I amputation in early childhood, replantation has a high success rate if suitable vessels can be found. Therefore, exploration is recommended for amputations at this level with a view to replantation, irrespective of the mechanism of injury.

  11. Does the benefit of salvage amputation always outweigh disability in drug-failure mycetoma?: A tale of two cases

    Directory of Open Access Journals (Sweden)

    Prasanta K Maiti

    2015-01-01

    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.

  12. Is the Trend of Amputation in Nigeria Changing? A Review of 51 ...

    African Journals Online (AJOL)

    Introduction: Many previous studies from Nigeria have recognized trauma and complications of management of musculoskeletal conditions by traditional bone setters (TBS) as the leading cause of amputation in Nigeria. However, of recent, a number of the studies are showing that diabetes gangrene which used to be an ...

  13. Residual-limb quality and functional mobility 1 year after transtibial amputation caused by vascular insufficiency

    NARCIS (Netherlands)

    H.J. Arwert (Henk); M.H. van Doorn-Loogman (Mirjam); J. Koning (Jan); M. Terburg (Martinus); M. Rol (Mathilde); M.E. Roebroeck (Marij)

    2007-01-01

    textabstractThis study identified which residual-limb quality factors are related to functional mobility 1 year after transtibial (TT) amputation. A group of 28 TT amputees were evaluated with respect to their functional mobility (Prosthesis Evaluation Questionnaire [PEQ], Locomotor Index, Timed Up

  14. Effectiveness of force production in persons with unilateral transtibial amputation during cycling.

    Science.gov (United States)

    Childers, Walter Lee; Gregor, Robert J

    2011-12-01

    Few published reports exist regarding the control of the human/prosthesis interface in persons with unilateral transtibial amputation. To investigate strategies employed by prosthetic users in controlling the human/prosthesis interface to highlight challenges associated with either the amputation or the design of the prosthesis. Randomized controlled trial. Cycling was used as the locomotor task to allow for better control of task mechanics compared to walking. A group of nine cyclists with intact limbs were compared to eight cyclists with transtibial amputation (CTA) during a simulated cycling time trial. The CTA group pedaled with a stiff and flexible prosthetic foot. Reaction forces between the foot and the pedal were measured using an instrumented pedal system. The force effectiveness (FE) ratio was used as the measure of task performance. The FE ratio is the force component normal to the bicycle crank arm divided by the resultant force for both limbs and is commonly used to analyze pedaling technique. The CTA group was equally as effective at applying forces as the intact group. These data suggest that individuals with lower limb loss are able to compensate for their amputation to utilize a similar pedaling technique for locomotor performance. As global strategies, e.g. force effectiveness, appear similar between groups future research should focus on local strategies, e.g. individual joint kinematics and kinetics.

  15. Nonmicrosurgical replantation using a subcutaneous pocket for salvage of the amputated fingertip.

    Science.gov (United States)

    Muneuchi, Gan; Kurokawa, Masato; Igawa, Kazuhiko; Hamamoto, Yusuke; Igawa, Hiroharu H

    2005-05-01

    The pocket principle suggested by Brent in 1979 is an alternative method for use when microsurgical replantation is not feasible. The application and the amputation level for which the method is available, however, have not been well examined. Between 1999 and 2003 we treated 6 patients (7 fingers) by nonmicrosurgical replantation using a subcutaneous pocket (the Brent technique). All patients had sustained complete fingertip amputations across or proximal to the lunula in digits other than the thumb. In every case the amputation was a crush or avulsion-type injury and microsurgical replantation was not feasible; however, cosmetic symmetry was desired strongly by the patient. Of the 7 fingers only one survived completely but became atrophic after 4 months. One finger developed necrosis involving less than half of the replant but a hooked nail deformity developed. Two fingers developed partial necrosis involving more than half of the replant but both fingers were missing the fingernail and the cosmetic results were not acceptable. Three fingers developed total necrosis. In addition a slight flexion contracture not improved with therapy in the digits was noted in 4 patients. The Brent technique should be performed scrupulously for fingertip amputation across or proximal to the lunula because of the poor survival rate and the possibility of contracture in the digits or other proximal joints.

  16. Replantation of multi-level fingertip amputation using the pocket principle (palmar pocket method).

    Science.gov (United States)

    Arata, J; Ishikawa, K; Soeda, H; Kitayama, T

    2003-07-01

    Two cases of multi-level fingertip amputation are presented. In each case, replantation was achieved in a two-stage procedure, involving reattachment, de-epithelialisation and insertion into a palmar pocket in stage 1, followed by removal from the palmar pocket 16 days later. The cases are described and the technique is discussed.

  17. Cross-cultural variation in preference for replantation or revision amputation: Societal and surgeon views.

    Science.gov (United States)

    Maroukis, Brianna L; Shauver, Melissa J; Nishizuka, Takanobu; Hirata, Hitoshi; Chung, Kevin C

    2016-04-01

    Treatment decisions after an injury like finger amputation are made based on injury and patient factors. However, decisions can also be influenced by provider and patient preferences. We compared hand surgeon and societal preferences and attitudes regarding finger amputation treatment in Japan and the US. We performed a cross-sectional survey with subjects derived from large tertiary care academic institutions in the US and Japan. We secured 100% participation of American hand surgeon members of the Finger Replantation and Amputation Multicenter Study and presenting hand surgeons at the 32nd Annual meeting of the Central Japanese Society for Surgery of the Hand. Societal preferences were gathered from volunteers at the 2 universities in the US and Japan. There were no significant differences in estimations of function, sensation, or appearance after replantation; American and Japanese societal participants preferred replantation compared to surgeons, although this was more pronounced in Japan. The Japanese society displayed more negative attitudes toward finger amputees than did Japanese surgeons. American respondents anticipated more public stigmatisation of amputees than did American surgeons. Societal preference for replantation was not caused by inflated expectations of outcomes after replantation. Japanese societal preference was likely driven by negative views of finger amputees. American society noted no decrease in physical health after amputation, but did note a quality of life decrease attributed to public stigmatisation. Japanese society and surgeons had a stronger preference for replantation than American society and surgeons, possibly attributed to cultural differences. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Gait rehabilitation for a patient with an osseointegrated prosthesis following transfemoral amputation

    NARCIS (Netherlands)

    Leijendekkers, R.A.; Hinte, G.J. van; Nijhuis-Van der Sanden, M.W.G.; Staal, J.B.

    2017-01-01

    BACKGROUND: In patients with a transfemoral amputation socket-related problems are associated with reduced prosthetic use, activity, and quality of life. Furthermore, gait asymmetries are present that may explain secondary complaints. Bone-anchored prostheses (BAPs) may help these patients. Two

  19. Limb salvage after subtotal supramalleolar amputation by initial shortening followed by tibial lengthening

    NARCIS (Netherlands)

    Marti, R. K.; de Vries, J. S.; Kloen, P.

    2003-01-01

    Background. We present a patient with a subtotal traumatic supramalleolar amputation of the leg, which was initially treated by a vascular reconstruction with deliberate bone and soft-tissue shortening. Methods. To correct the ensuing complex deformity, which consisted of a varus hindfoot, leg

  20. Plantar pressures and ground reaction forces during walking of individuals with unilateral transfemoral amputation.

    Science.gov (United States)

    Castro, Marcelo Peduzzi de; Soares, Denise; Mendes, Emília; Machado, Leandro

    2014-08-01

    To describe and compare the plantar pressures, temporal foot roll-over, and ground reaction forces (GRFs) between both limbs of subjects with unilateral transfemoral amputation and with those of able-bodied participants during walking. We also verify the relevance of a force plate and a pressure plate to discriminate changes in gait parameters of subjects with limb loss. Cross-sectional study. Biomechanics laboratory. A total of 14 subjects with unilateral transfemoral amputation and 21 able-bodied participants. We used a force plate and a pressure plate to assess biomechanical gait parameters while the participants were walking at their self-selected gait speed. We measured plantar pressure peaks in 6 foot regions and the instant of their occurrence (temporal foot roll-over); and GRF peaks and impulses of anterior-posterior (braking and propulsive phases), medial-lateral, and vertical (load acceptance and thrust phases) components. The thrust, braking, and propulsive peaks, and the braking and propulsive impulses, were statistically significantly lower in the amputated limb than in the sound limb (P guide the rehabilitation of subjects with lower limb amputation. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  1. Total hip arthroplasty in a patient with arthrogryphosis and an ipsilateral above knee amputation.

    LENUS (Irish Health Repository)

    Leonard, Michael

    2010-10-01

    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.

  2. Self-amputation of a healthy hand: a case of body integrity identity disorder.

    Science.gov (United States)

    Sorene, E D; Heras-Palou, C; Burke, F D

    2006-12-01

    A case report is presented of self-amputation of a healthy hand. We have reviewed the literature and seek to broaden the scope of understanding of Body Integrity Identity Disorder. This rare condition can constitute a pitfall for the unsuspecting hand surgeon.

  3. Gait adjustments in obstacle crossing, gait initiation and gait termination after a recent lower limb amputation

    NARCIS (Netherlands)

    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

  4. Bias in Amputation Research; Impact of Subjects Missed from a Prospective Study

    NARCIS (Netherlands)

    Fortington, Lauren V.; Geertzen, Jan H. B.; Bosmans, Joline C.; Dijkstra, Pieter U.

    2012-01-01

    For research findings to be generalized, a sample must be representative of the actual population of interest. Lower limb amputation is most frequently performed in older patients with vascular disease, a population that is often underrepresented in research. The aim of this study was to explore the

  5. Bias in amputation research; impact of subjects missed from a prospective study.

    Directory of Open Access Journals (Sweden)

    Lauren V Fortington

    Full Text Available For research findings to be generalized, a sample must be representative of the actual population of interest. Lower limb amputation is most frequently performed in older patients with vascular disease, a population that is often under-represented in research. The aim of this study was to explore the impact of selection bias by comparing characteristics from a sample included in a prospective study of phantom pain with the actual population who underwent amputation. Only 27% of all potential patients were referred during the first year of the prospective study. The referred patients were 8 years younger (p<0.001 and less likely to have had amputation because of a vascular condition, diabetes or infection (p=0.003 than those not referred. There was also a significant difference in one year survival between the groups; 67% of referred patients survived compared with just 40% of non-referred patients (p=0.004. The biased population in the phantom pain study may have resulted in an underestimation of phantom pain in the original study and subsequent protective factors should be considered within the context of the younger population reported. Selection bias is common in amputation research, and research methods to minimize its impact must be given greater attention.

  6. Attitude and perception of patients towards amputation as a form of ...

    African Journals Online (AJOL)

    Patients and Methods: Structured questionnaires were administered to adults at the Orthopaedic Unit of the University of Calabar Teaching Hospital, Calabar. ... Fifty participants (32%) indicated that they had no alternative to amputation when indicated while 36 (36%) of those who would refuse believed in divine and ...

  7. [The endo-exo prosthesis for patients with a problematic amputation stump].

    NARCIS (Netherlands)

    Frolke, J.P.M.; Meent, H. van de

    2010-01-01

    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

  8. Effects of practice, visual loss, limb amputation, and disuse on motor imagery vividness.

    Science.gov (United States)

    Malouin, Francine; Richards, Carol L; Durand, Anne; Descent, Micheline; Poiré, Diane; Frémont, Pierre; Pelet, Stéphane; Gresset, Jacques; Doyon, Julien

    2009-06-01

    The ability to generate vivid images of movements is variable across individuals and likely influenced by sensorimotor inputs. The authors examined (1) the vividness of motor imagery in dancers and in persons with late blindness, with amputation or an immobilization of one lower limb; (2) the effects of prosthesis use on motor imagery; and (3) the temporal characteristics of motor imagery. Eleven dancers, 10 persons with late blindness, 14 with amputation, 6 with immobilization, and 2 groups of age-matched healthy individuals (27 in control group A; 35 in control group B) participated. The Kinesthetic and Visual Imagery Questionnaire served to assess motor imagery vividness. Temporal characteristics were assessed with mental chronometry. The late blindness group and dance group displayed higher imagery scores than respective control groups. In the amputation and immobilization groups, imagery scores were lower on the affected side than the intact side and specifically for imagined foot movements. Imagery scores of the affected limb positively correlated with the time since walking with prosthesis. Movement times during imagination and execution (amputation and immobilization) were longer on the affected side than the intact side, but the temporal congruence between real and imagined movement times was similar to that in the control group. The mental representation of actions is highly modulated by imagery practice and motor activities. The ability to generate vivid images of movements can be specifically weakened by limb loss or disuse, but lack of movement does not affect the temporal characteristics of motor imagery.

  9. Mobility in Elderly People With a Lower Limb Amputation : A Systematic Review

    NARCIS (Netherlands)

    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

  10. [Replantation of amputated penis in Chinese men: a meta-analysis].

    Science.gov (United States)

    Li, Gui-Zhong; Man, Li-Bo; He, Feng; Huang, Guang-Lin

    2013-08-01

    To evaluate the methods for the replantation of the amputated penis in Chinese men. We performed a meta-analysis on the domestic literature relating replantation of the amputated penis, particularly its successful methods published from 1964 to January 2012. We identified 109 reports on 111 cases of replantation of the amputated penis that met the inclusion criteria, including 103 adults and 8 children. The mean age, warm ischemia time and total ischemia time were 29 +/- 11 years (range 2 - 56 years), 5.2 +/- 5.7 hours (range 0 - 38 hours) and 6.3 +/- 5.7 hours (range 1 - 38 hours). Fifty-three of the cases were treated by microsurgery and 44 by non-microsurgery. Complications occurred in 81 (73%) of the cases, including ED in 14 cases, urethral stricture in 16, urinary fistula in 8, skin necrosis in 58 and skin sensory abnormality in 31. The incidences of ED, urethral stricture and urinary fistula exhibited significant differences between the microsurgery and non-microsurgery groups of the partial amputation patients (P penis and reduction of complications, and therefore can be regarded as a "standard" method for penile replantation in China.

  11. Blindness, Diabetes, and Amputation: Alleviation of Depression and Pain through Thermal Biofeedback Therapy.

    Science.gov (United States)

    Needham, W. E.; And Others

    1993-01-01

    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…

  12. Replantation of traumatic limb amputation above the elbow: a report of 4 cases

    Directory of Open Access Journals (Sweden)

    Faramarz Karimian

    2014-02-01

    Conclusion: Transplantation of the amputated limb can be done in spite of limited resources. Any delay in repairing damaged nerves will result great reduction of final organs’ performance. A limb, made from the own body, always take precedence to prosthesis, even when the efficiency is low.

  13. Sensibility of the Stump in Adults With an Acquired Major Upper Extremity Amputation

    NARCIS (Netherlands)

    van Gils, Willemijn; Reinders-Messelink, Heleen A.; Smit-Klaij, Frida; Bongers, Raoul M.; Dijkstra, Pieter U.; van der Sluis, Corry K.

    2013-01-01

    Objectives: To compare the sensibility of the stump in adults with an acquired major upper extremity amputation with the sensibility of the unaffected side and with the corresponding body parts of healthy controls, as well as to relate the sensibility of the stump to daily functioning. Design: A

  14. The timed "up and go" test : Reliability and validity in persons with unilateral lower limb amputation

    NARCIS (Netherlands)

    Schoppen, Tanneke; Boonstra, Antje; Groothoff, JW; de Vries, J; Goeken, LNH; Eisma, Willem

    Objective: To determine the interrater and interrater reliability and the validity of the Timed "up and go" test as a measure for physical mobility in elderly patients with an amputation of the lower extremity. Design: To test interrater reliability, the test was performed for two observers at

  15. Major limb amputations in a tertiary hospital in North Western Nigeria

    African Journals Online (AJOL)

    Aims and objectives: The aim of this study was to determine the pattern and indications for amputation in Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria; between January 2008 and December 2014, in a bid to proffer preventive measures. Patients and methods: This was a retrospective study of consecutive ...

  16. Effects of lower limb amputation on the mental rotation of feet

    NARCIS (Netherlands)

    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

  17. Review of 345 eye amputations carried out in the period 1996-2003, at Rigshospitalet, Denmark

    DEFF Research Database (Denmark)

    Rasmussen, Marie Louise Roed; Prause, Jan Ulrik; Johnson, Martin

    2008-01-01

    PURPOSE: The aim of this study was to identify the number of eye amputations, and the causative diagnoses, indications for surgery and surgical techniques applied, and to evaluate a possible change in surgical technique in a tertiary referral centre in Denmark. METHODS: The hospital database was ...

  18. Life saving tail amputation in an African lioness ( Panthera leo L) in ...

    African Journals Online (AJOL)

    Healing was uneventful with animal returning to normal activities. Tail amputation is an uncommon procedure in wild species. Its curative indication was warranted in this case. There is need for storage of darting facilities in every zoological garden to aid quick intervention and preservation of animals especially endangered ...

  19. Taking Care of Your New Arm or Leg After an Amputation

    Centers for Disease Control (CDC) Podcasts

    2010-02-18

    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.

  20. A late unusual complication after an open cholecystectomy: Amputation neuroma of the CBD causing obstructive jaundice.

    Science.gov (United States)

    Sleiman, Youssef A; Hassoun, Ziad A; Nasser, Haydar A; Abs, Leila; Allouch, Mustafa

    2017-01-01

    Cholecystectomy is one of the most frequently done procedures in general surgery. There are few reports of amputation neuromas following this procedure. This presentation describes a case of obstructive jaundice due to amputation neuroma in a patient with a history of cholecystectomy. We report about a 53 y o lady who presented with obstructive jaundice, 8 years following open cholecystectomy. Paraclinical investigations were in favor of cholangicarcinoma, however the final pathology revealed an amputation neuroma of the CBD. Amputation neuromas are rarely seen in the era of laparoscopic cholecystectomy. They are benign reparative lesions of the CBD following surgery or manipulation of the extra hepatic biliary tree. It is very difficult to diagnose them pre-operatively. Surgical resection is the first choice of treatment. Traumatic neuromas should always be among the differential diagnosis, when assessing a CBD mass in patients with a previous history of open cholecystectomy or surgery to the gastrointestinal tract. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  1. Novel model for end-neuroma formation in the amputated rabbit forelimb

    Directory of Open Access Journals (Sweden)

    Kuiken Todd A

    2010-03-01

    Full Text Available Abstract Background The forelimb amputee poses many reconstructive challenges in the clinical setting, and there is a paucity of established surgical models for study. To further elucidate the pathogenic process in amputation neuroma formation, we created a reproducible, well-tolerated rabbit forelimb amputation model. Methods Upon approval from the Institutional Animal Care and Use Committee, 5 New Zealand White rabbits underwent left forelimb amputation. During this initial surgery, the median, radial and ulnar nerves were transected 1.6-2.5 (mean 2.0 cm distal to the brachial plexus, transposed onto the anterior chest wall and preserved at length. Six weeks subsequent to the amputation, the distal 5 mm of each neuroma was excised, and the remaining stump underwent histomorphometric analysis. Results The nerve cross sectional areas increased by factors of 1.99, 3.17, and 2.59 in the median (p = 0.077, radial (p Conclusion Given that the surgical model appears well-tolerated by the rabbits and that patterns of morphologic change are consistent and reproducible, we are encouraged to further investigate the utility of this model in the pathogenesis of neuroma formation.

  2. Sequential compression biomechanical device versus primary amputation in patients with critical limb ischemia.

    LENUS (Irish Health Repository)

    Tawfick, Wael A

    2013-10-01

    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.

  3. Life saving tail amputation in an African lioness (Panthera leo L) in ...

    African Journals Online (AJOL)

    ADEYEYE

    2015-08-25

    Aug 25, 2015 ... Abstract. This paper reports surgical management of self- tail mutilation in an African lioness triggered by an irritation of unknown aetiology. ... Keywords: Amputation, Lion, Self-mutilation, Tail, Therapeutic. Received: 12-03- 2015 .... protect human life and livestock) and prey base depletion, habitat loss due ...

  4. Decrease in (Major Amputations in Diabetics: A Secondary Data Analysis by AOK Rheinland/Hamburg

    Directory of Open Access Journals (Sweden)

    Melanie May

    2016-01-01

    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.

  5. Use of angiotensin-converting enzyme inhibitors and freedom from amputation after lower extremity revascularization

    Directory of Open Access Journals (Sweden)

    Kray JE

    2017-07-01

    Full Text Available Jared E Kray,1 Viktor Y Dombrovskiy,2 Todd R Vogel1 1Department of Surgery, Division of Vascular Surgery, School of Medicine, University of Missouri, Columbia, MO, 2Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA Objective: Angiotensin-converting enzyme inhibitors (ACEIs have not been well evaluated in conjunction with lower extremity revascularization (LER. This study evaluated freedom from amputation in patients who underwent either an open (OPEN or endovascular (ENDO revascularization with and without utilization of an ACEI.Materials and methods: Patients who underwent LER were identified from 2007–2008 Medicare Provider Analysis and Review files. Demographics, comorbidities, and disease severity were obtained. Post-procedural use of an ACEI was confirmed using combining them with National Drug Codes and Part D Files. Outcomes were analyzed using chi-square analysis, Kaplan–Meier test, and Cox regression.Results: We identified 22,954 patients who underwent LER: 8,128 (35.4% patients with claudication, 3,056 (13.3% with rest pain, and 11,770 (51.3% with ulceration or gangrene. More patients underwent ENDO (14,353 than OPEN (8,601 revascularization and 38% of the cohort was taking an ACEI. Overall, ACEI utilization compared to patients not taking ACEI was not associated with lower amputation rates at 30 days (13.5% vs. 12.6%, 90 days (17.7% vs. 17.1%, or 1 year (23.9% vs. 22.8% (P>0.05 for all. After adjustment for comorbidities, ACEI utilization was associated with higher amputation rates for patients with rest pain (hazard ratio: 1.4; 95% confidence interval: 1.1–1.8. Conclusion: ACEI utilization was not associated with overall improved rates of amputation-free survival or overall survival in the vascular surgery population. However, an important finding of this study was that patients presenting with a diagnosis of rest pain and taking an ACEI who underwent a LER had statistically higher

  6. Psychological adjustment to amputation: variations on the bases of sex, age and cause of limb loss

    International Nuclear Information System (INIS)

    Ali, S.; Haider, S.K.F.

    2017-01-01

    Amputation is the removal of a limb or part of a limb by a surgical procedure in order to save the life of a person. The underlying reasons behind the occurrence of this tragic incidence may be varied. However, irrespective of its cause limb loss is associated with wide range of life challenges. The study was done to investigate the psychological sequel of an individual after losing a limb and to know the level of strain and pressure they experience after this traumatic event. It also attempts to examine the moderating role of some demographic traits such as age, sex and cause of limb loss in psychosocial adjustment to amputation. Methods: The study includes 100 adult amputees of both genders and the data was collected from major government and private hospitals of Peshawar district. Demographic data sheet was constructed in order to know the demographics traits of amputees and a standardize Psychological Adjustment Scale developed by Sabir (1999) was used to find out the level of psychological adjustment after limb loss. Results: Nearly all the amputees' exhibit signs of psychological maladjustment at varying degrees. Males showed much greater signs of maladjustment than women and young adults were much psychologically shattered and disturbed as a result of limb loss. Amputation caused by planned medical reasons leads to less adjustment issues as compared to unplanned accidental amputation in which patient were not mentally prepare to accept this loss. Conclusion: Psychological aspect of amputation is an important aspect of limb loss which needs to be addressed properly in order to rehabilitate these patients and helps them to adjust successfully to their limb loss. (author)

  7. Retrospective study of emerging themes in the decision-making process of patients considering amputation.

    Science.gov (United States)

    Rassin, Michal; Tzevlin, Valeria; Malul, Einat; Harel, Shimrit; Shakhar, Hadar

    2012-06-01

    How patients make decisions about their future treatment has been sparsely study and with respect to limb amputation, a particularly difficult decision, not at all. An examination of this should furnish nurses vital knowledge about how patients come to the decision to give or refuse this consent. To reach as deep understanding as possible of how from the patients' point of view they reach the decision to consent to the amputation of a lower limb. The research was conducted in the qualitative method. Thirty lower-limb amputees (aged 32-88) took part in the study. In-depth interviews were held with the participants. The data were processed by means of content analysis. The main thematic categories identified were, in the chronological order of their appearance: 'The trail of torment leading to the decision to amputate', 'The turning point--taking the decision' "I just couldn't take any more pain" "We opt for life, we don't want to die". The more protracted and pain-filled the 'the trail of torment' the more mentally prepared patients were to give consent to amputation. Asked to look back on their choice, almost all interviewees had no regrets and even found virtues in it. The patients' decisions represented a mix of their grasp of the medical information supplied them by their doctors, their own personal values--opting for life prevailing over the desire for a whole body, and consideration for their family. The patients saw the decision-making process about amputation as a process of achieving consensus between themselves, their doctors and their family. Copyright © 2012 Society for Vascular Nursing, Inc. Published by Mosby, Inc. All rights reserved.

  8. Proximal major limb amputations – a retrospective analysis of 45 oncological cases

    Directory of Open Access Journals (Sweden)

    Goertz Ole

    2009-02-01

    Full Text Available Abstract Background Proximal major limb amputations due to malignant tumors have become rare but are still a valuable treatment option in palliation and in some cases can even cure. The aim of this retrospective study was to analyse outcome in those patients, including the postoperative course, survival, pain, quality of life, and prosthesis usage. Methods Data of 45 consecutive patients was acquired from patient's charts and contact to patients, and general practitioners. Patients with interscapulothoracic amputation (n = 14, shoulder disarticulation (n = 13, hemipelvectomy (n = 3 or hip disarticulation (n = 15 were included. Results The rate of proximal major limb amputations in patients treated for sarcoma was 2.3% (37 out of 1597. Survival for all patients was 42.9% after one year and 12.7% after five years. Survival was significantly better in patients with complete tumor resections. Postoperative chemotherapy and radiation did not prolong survival. Eighteen percent of the patients with malignant disease developed local recurrence. In 44%, postoperative complications were observed. Different modalities of postoperative pain management and the site of the amputation had no significant influence on long-term pain assessment and quality of life. Eighty-seven percent suffered from phantom pain, 15.6% considered their quality of life worse than before the operation. Thirty-two percent of the patients who received a prosthesis used it regularly. Conclusion Proximal major limb amputations severely interfere with patients' body function and are the last, albeit valuable, option within the treatment concept of extremity malignancies or severe infections. Besides short survival, high complication rates, and postoperative pain, patients' quality of life can be improved for the time they have remaining.

  9. Vascular surgery, microsurgery and supramicrosurgery for treatment of chronic diabetic foot ulcers to prevent amputations.

    Science.gov (United States)

    Schirmer, Steffen; Ritter, Ralf-Gerhard; Fansa, Hisham

    2013-01-01

    Diabetic foot ulcers occur in approximately 2,5% of patients suffering from diabetes and may lead to major infections and amputation. Such ulcers are responsible for a prolonged period of hospitalization and co- morbidities caused by infected diabetic foot ulcers. Small, superficial ulcers can be treated by special conservative means. However, exposed bones or tendons require surgical intervention in order to prevent osteomyelitis. In many cases reconstructive surgery is necessary, sometimes in combination with revascularization of the foot. There are studies on non surgical treatment of the diabetic foot ulcer. Most of them include patients, classified Wagner 1-2 without infection. Patients presenting Wagner 3D and 4D however are at a higher risk of amputation. The evolution of microsurgery has extended the possibilities of limb salvage. Perforator based flaps can minimize the donorsite morbidity. 41 patients were treated with free tissue transfer for diabetic foot syndrome and chronic defects. 44 microvascular flaps were needed. The average age of patients was 64.3 years. 18 patients needed revascularization. 3 patients needed 2 microvascular flaps. In 6 cases supramicrosurgical technique was used. There were 2 flap losses leading to amputation. 4 other patients required amputation within 6 months postoperatively due to severe infection or bypass failure. Another 4 patients died within one year after reconstruction. The remaining patients were ambulated. Large defects of the foot can be treated by free microvascular myocutaneous or fasciocutaneous tissue transfer. If however, small defects, exposing bones or tendons, are not eligible for local flaps, small free microvascular flaps can be applied. These flaps cause a very low donor site morbidity. Arterialized venous flaps are another option for defect closure. Amputation means reduction of quality of life and can lead to an increased mortality postoperatively.

  10. Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot.

    Directory of Open Access Journals (Sweden)

    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.

  11. Crossover replantation of the foot after bilateral traumatic lower extremity amputation.

    Science.gov (United States)

    Cinar, Can; Arslan, Hakan; Ogur, Simin; Pilanci, Ozgur; Yucel, Akin; Cetinkale, Oguz

    2007-06-01

    Bilateral traumatic amputation and limb-threatening injury of the lower extremities is more challenging than the unilateral amputation. Successful replantation of both lower extremities has been reported previously. However, orthotopic implantations may not be possible when amputation of both lower limbs with different levels of section and degrees of damage to surrounding tissues occurs. It was reported that the crossover replanted foot in combination with prosthetic limb is better than 2 artificial limbs. Hence, crossover replantation should be considered when anatomic replantation of both lower extremities is not possible as a result of bilateral total or subtotal amputation. To our knowledge, there are few reports about the crossover replantation of the lower extremity in the literature. A 30-year-old engineer being run over by the train had crushed the bilateral lower limbs in different anatomic levels. We decided to perform the crossover replantation of the right foot to the stump of the left leg to provide the patient with at least 1 weight-bearing sensate extremity. At the latest follow-up examination, 30 months after the operation, he had mild pain, especially in toes of the replanted foot. There was no ulceration in both the replanted extremity and the right amputation stump. The sole has maintained complete protective sensation. The patient described the functional result of the reimplanted leg as satisfying and better than the prosthesis that has caused much more problems than the replanted extremity. He had no complaint about the cosmetic result. He stated that he would have the crossover replantation again under the same condition. He was able to return to his previous job. Moreover, he affirmed that he is able to carry on his all social activities as he had done before the accident except for playing football. In conclusion, the possibility of the crossover replantation should be considered while evaluating the patient with bilateral lower limb

  12. [Treatment of adult congenital muscular torticollis by multiple sternocleidomastoid head amputation].

    Science.gov (United States)

    Fu, Ronggang; Yin, Xiuqing; Yu, Rong

    2012-02-01

    To investigate the therapeutic method and effectiveness of multiple sternocleidomastoid head amputation for adult congenital muscular torticollis. Between March 2009 and February 2011, 19 patients with congenital muscular torticollis were treated with multiple sternocleidomastoid head amputation. There were 13 males and 6 females, aged 16-32 years (mean, 23.5 years). The X-ray films showed that 12 cases were accompanied with some extent cervical lateral bending and wedge change. Ten patients were with ipsilateral facial bradygenesis. Four patients had received single sternocleidomastoid head amputation. All of the 19 patients were treated with multiple sternocleidomastoid head amputation, then plaster support and neck collar were used after operation for 3-6 months. The wounds of all the 19 patients healed primarily, without infection or hematoma. Sixteen patients were followed up 5 months to 2 years (mean, 8 months). The head and neck malformations were ameliorated significantly. The effectiveness was assessed 2 weeks later, in 7 patients without cervical vertebral malformation results were excellent; in 12 patients with cervical vertebral malformation, the results were excellent in 1 case, good in 7 cases, and fair in 4 cases. The length between mastoid process and sternoclavicular joints was elongated (1.88 +/- 0.30) cm significantly after operation in patients without cervical vertebral malformation (t = 6.24, P = 0.00), showing no significant difference when compared with normal value (t = 1.87, P = 0.11); the length was elongated (3.38 +/- 0.30) cm significantly (t = 11.37, P = 0.00) after operation in patients with cervical vertebral malformation, but it was significant shorter than normal value (t = 12.19, P = 0.00). Multiple sternocleidomastoid head amputation is a safe and effective method for adult congenital muscular torticollis, which can improve the neck rotation function.

  13. Clinical factors associated with replantation after traumatic major upper extremity amputation.

    Science.gov (United States)

    Larson, John V; Kung, Theodore A; Cederna, Paul S; Sears, Erika D; Urbanchek, Melanie G; Langhals, Nicholas B

    2013-10-01

    Little knowledge exists concerning replantation following traumatic major upper extremity amputation. This study characterizes the injury patterns and outcomes of patients suffering major upper extremity amputation and ascertains clinical factors associated with the decision to attempt replantation. A retrospective cohort study was conducted on patients treated at a Level I trauma center between June of 2000 and August of 2011. Patients who experienced traumatic upper extremity amputation at or proximal to the radiocarpal joint were included in the study. The subset of patients subsequently undergoing replantation was identified. Medical records were reviewed and bivariate analysis was performed to identify factors associated with attempted replantation and replant survival. Sixty-two patients were treated for traumatic upper extremity amputation and 20 patients underwent replantation. Injury factors associated with attempted replantation included a sharp/penetrating injury (p = 0.004), distal level of amputation (p = 0.017), Injury Severity Score less than 16 (p = 0.020), absence of avulsion (p = 0.002), absence of significant contamination (p ≤ 0.001), and lack of multilevel involvement (p = 0.007). Replantation exhibited a complete replant survival rate of 70 percent. An Injury Severity Score of 16 or more was associated with replant failure (p = 0.004). Patients who underwent replantation demonstrated increased rates of secondary surgical revisions (p ≤ 0.001) and complications (p = 0.023) and had a greater length of hospital stay (p = 0.024). Several injury characteristics are associated with the decision to attempt replantation of the major upper extremity. A high global injury severity (Injury Severity Score ≥ 16) is associated with replantation failure when attempted. Patients who undergo replantation demonstrate higher resource use, warranting further cost-analysis and outcomes investigation. Risk, III.

  14. Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot.

    Science.gov (United States)

    Tardivo, João Paulo; Baptista, Maurício S; Correa, João Antonio; Adami, Fernando; Pinhal, Maria Aparecida Silva

    2015-01-01

    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.

  15. Postural control in response to altered sensory conditions in persons with dysvascular and traumatic transtibial amputation.

    Science.gov (United States)

    Jayakaran, Prasath; Johnson, Gillian M; Sullivan, S John

    2015-02-01

    To compare the postural control of persons with a dysvascular transtibial amputation and traumatic transtibial amputation with able-bodied adults with and without a dysvascular condition in altered sensory testing conditions. Cross-sectional study. University balance clinic. The study participants (N=35) included: participants with a dysvascular transtibial amputation (n=9), participants with a traumatic transtibial amputation (n=9), age-matched able-bodied adults without a dysvascular condition (n=9), and able-bodied adults with a dysvascular condition (n=8). Six Sensory Organization Test (SOT) conditions, which included standing with eyes open (condition 1) and closed (condition 2) on a static force platform with visual surround; standing with eyes open on a static force platform with movable visual surround (condition 3); standing with eyes open (condition 4) and closed (condition 5) on a movable force platform with static visual surround; and standing with eyes open on a movable force platform with movable visual surround (condition 6). Bilateral anteroposterior (AP) and mediolateral (ML) center of pressure variables, namely root mean square distance (RMSD) and mean velocity (mVel), for each of the 6 SOT conditions. The dysvascular transtibial amputation group demonstrated a higher AP RMSD (P≤.04) on the sound side than did the able-bodied adults without a dysvascular condition and the able-bodied adults with a dysvascular condition in SOT conditions 1 and 2, respectively. Both the dysvascular transtibial amputation group and the traumatic transtibial amputation group demonstrated a higher AP RMSD (P≤.002) than the able-bodied adults without a dysvascular condition in SOT conditions 3 and 4. The dysvascular transtibial amputation group showed higher AP mVel (P≤.002) on the sound side for SOT conditions 2 and 3, whereas both amputation groups showed higher AP mVel for SOT conditions 1 and 4 than the able-bodied adults with and without a dysvascular

  16. Severe extremity amputations in surviving Palestinian civilians caused by explosives fired from drones during the Gaza War.

    Science.gov (United States)

    Heszlein-Lossius, Hanne; Al-Borno, Yahya; Shaqoura, Samar; Skaik, Nashwa; Giil, Lasse Melvær; Gilbert, Mads

    2018-02-21

    During four separate Israeli military attacks on Gaza (2006, 2009, 2012, and 2014), about 4000 Palestinians were killed and more than 17 000 injured (412 killed and 1264 injured in 2006; 1383 killed and more than 5300 injured in 2009; 130 killed and 1399 injured in 2012; and 2251 killed and 11 231 injured in 2014). An unknown number of people had traumatic amputations of one or more extremities. Use of unmanned Israeli drones for surveillance and armed attacks on Gaza was evident, but exact figures on numbers of drone strikes on Gaza are not available. The aim of this study was to explore the medical consequences of strikes on Gaza with different weapons, including drones. We studied a cohort of civilians in the Gaza Strip who had one of more traumatic limb amputation during the Israeli military attacks between 2006 and 2016. The study was done at The Artificial Limb and Polio Center (ALPC) in the Gaza Strip where most patients are treated and trained after amputation. We used standardised forms and validated instruments to record date and mechanism of injury, self-assessed health, socioeconomic status, anatomical location and length of amputation, comorbidity, and the results of a detailed clinical examination. The studied cohort consisted of 254 Paletinian civilians (234 [92%] men, 20 [8%] women, and 43 [17%] children aged 18 years and younger) with traumatic amputations caused by different weapons. 216 (85%) people had amputations proximal to wrist or ankle, 131 (52%) patients had more than one major amputation or an amputation above the knee, or both, and 136 (54%) people were injured in attacks with Israeli drones, including eight (40%) of the women. The most severe amputations were caused by drone attacks (p=0·0001). Extremity injuries after drone attacks led to immediate amputation more often than with other weapons (p=0·014). Patients injured during cease-fire periods were younger than patients injured during periods of declared Israeli military

  17. Goal pursuit, goal adjustment, and affective well-being following lower limb amputation.

    Science.gov (United States)

    Coffey, Laura; Gallagher, Pamela; Desmond, Deirdre; Ryall, Nicola

    2014-05-01

    This study examined the relationships between tenacious goal pursuit (TGP), flexible goal adjustment (FGA), and affective well-being in a sample of individuals with lower limb amputations. Cross-sectional, quantitative. Ninety-eight patients recently admitted to a primary prosthetic rehabilitation programme completed measures of TGP, FGA, positive affect, and negative affect. Hierarchical regression analyses revealed that TGP and FGA accounted for a significant proportion of the variance in both positive and negative affect, controlling for sociodemographic and clinical characteristics. TGP was significantly positively associated with positive affect, while FGA was significantly negatively associated with negative affect. Moderated regression analyses indicated that the beneficial effect of FGA on negative affect was strongest at high levels of amputation-related pain intensity and low levels of TGP. TGP and FGA appear to influence subjective well-being in different ways, with TGP promoting the experience of positive affect and FGA buffering against negative affect. TGP and FGA may prove useful in identifying individuals at risk of poor affective outcomes following lower limb amputation and represent important targets for intervention in this patient group. What is already known on this subject? The loss of a limb has a significant impact on several important life domains. Although some individuals experience emotional distress following amputation, the majority adjust well to their limb loss, with some achieving positive change or growth as a result of their experiences. Theories of self-regulation propose that disruptions in goal attainment have negative affective consequences. The physical, social, and psychological upheaval caused by limb loss is likely to threaten the attainment of valued goals, which may leave individuals vulnerable to negative psychosocial outcomes if they do not regulate their goals in response to these challenges. According to the dual

  18. Incidence of ipsilateral postoperative deep venous thrombosis in the amputated lower extremity of patients with peripheral obstructive arterial disease.

    Science.gov (United States)

    Matielo, Marcelo Fernando; Presti, Calógero; Casella, Ivan Benaduce; Netto, Baptista Muraco; Puech-Leão, Pedro

    2008-12-01

    Patients undergoing amputation of the lower limb due to peripheral arterial disease (PAD) are at risk of developing deep venous thrombosis (DVT). Few studies in the research literature report the incidence of DVT during the early postoperative period or the risk factors for the development of DVT in the amputation stump. This prospective study evaluated the incidence of DVT during the first 35 postoperative days in patients who had undergone amputation of the lower extremity due to PAD and its relation to comorbidities and death. Between September 2004 and March 2006, 56 patients (29 men), with a mean age of 67.25 years, underwent 62 amputations, comprising 36 below knee amputations (BKA) and 26 above knee amputations (AKA). Echo-Doppler scanning was performed preoperatively and on postoperative days 7 and 31 (approximately). All patients received acetylsalicylic acid (100 mg daily) preoperatively and postoperatively, but none received prophylactic anticoagulation. DVT occurred in 25.8% of extremities with amputations (10 AKA and 6 BKA). The cumulative incidence in the 35-day postoperative period was 28% (Kaplan-Meier). There was a significant difference (P = .04) in the incidence of DVT between AKA (37.5%) and BKA (21.2%). Age >or=70 years (48.9% vs 16.8%, P = .021) was also a risk factor for DVT in the univariate analysis. Of the 16 cases, 14 (87.5%) were diagnosed during outpatient care. The time to discharge after amputation was averaged 6.11 days in-hospital stay (range, 1-56 days). One symptomatic nonfatal pulmonary embolism occurred in a patient already diagnosed with DVT. There was no relation between other comorbidities and DVT. The multivariate analysis showed no association between risk factors and the occurrence of DVT in the amputated extremity. DVT ipsilateral to the amputation did not influence the mortality rate (9.7%). The incidence of DVT in the early postoperative period (or=70 years and for AKA. Patients with PAD who have recently undergone

  19. Functional Performance Evaluation of the Northwestern University Flexible Subischial Vacuum (NU-FlexSIV) Socket for Persons with Transfemoral Amputation

    Science.gov (United States)

    2016-10-01

    Socket for Persons with Transfemoral Amputation PRINCIPAL INVESTIGATOR: Dr. Stefania Fatone, PhD CONTRACTING ORGANIZATION: Northwestern...University Flexible Subischial Vacuum (NU-FlexSIV) Socket for Persons with Transfemoral Amputation 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-15-1...0708 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Stefania Fatone, PhD 5d. PROJECT NUMBER 5e. TASK NUMBER E-Mail: s-fatone@northwestern.edu 5f. WORK

  20. Predictors of secondary amputation in patients with grade IIIC lower limb injuries: A retrospective analysis of 35 patients.

    Science.gov (United States)

    Song, Wenhao; Zhou, DongSheng; Dong, Jinlei

    2017-06-01

    The aim of this study was to identify risk factors for failure of limb salvage surgery in grade IIIC lower extremity injuries.A single-institution, retrospective review was performed of all patients with grade IIIC lower limb injuries presenting from January 2009 to April 2014. We gathered the data on each patient who underwent limb salvage and analyzed the final outcome for these patients (limb salvage vs secondary amputation).Grade IIIC lower limb injuries were identified in 41 patients. Primary amputation was performed in 6 patients (15%) as the initial procedure. Thirty-five patients (85%) underwent vascular reconstruction and other surgical procedures to salvage the limb. Limb salvage was successful in 23 patients (66%); 12 patients (34%) ultimately underwent secondary amputation. The median time from injury to secondary amputation was 22.5 days (range 4-380 days). The mean Mangled Extremity Severity Score (MESS) was 7.2 ± 1.5 (range 5-10). The MESS was significantly higher in the secondary amputation group compared with the limb salvage group. Additionally, statistical testing revealed that the limb ischemia time, complex fractures, rate of fasciotomy, and number of vascular reconstruction were significantly higher in the secondary amputation group. Muscle necrosis and extensive soft tissue defect were the main reasons for secondary amputation.The findings indicate that MESS of 7 or greater, complex fractures, limb ischemia time equal to or greater than 6 hours, and osteofascial compartment syndrome were associated with an increased risk of delayed amputation. The MESS is highly prognostic but not perfect; decision-making in patients with an MESS of 7 or greater should be re-evaluated for clinical use.

  1. Lower-limb amputation following foot ulcers in patients with diabetes: classification systems, external validation and comparative analysis.

    Science.gov (United States)

    Monteiro-Soares, Matilde; Martins-Mendes, Daniela; Vaz-Carneiro, António; Dinis-Ribeiro, Mário

    2015-07-01

    This study aimed to validate and compare the existing systems developed to stratify subjects with diabetic foot ulcers by risk of consequent lower extremity amputation. We conducted a prospective cohort study on a consecutive series of patients (mean age of 68 years; 64% male) with active ulcer who were attending our Hospital Diabetic Foot Clinic (n = 293) from January 2010 to March 2013. At baseline, we collected information on the participants' characteristics and the relevant variables. Afterwards, we assessed the predictive value of each variable and each system's prognostic accuracy for amputation occurrence. During a median follow-up of 91 days (interquartile range of 98), ulcers healed in 62% of the subjects. Major amputation occurred in 7% and minor occurred in 17%. Previous ulcer or amputation, ulcer area, and gangrene were associated with amputation occurrence. Nephropathy, pulses number, ulcer aetiology, depth, and number were associated with risk of amputation. Systems typically presented sensitivity values ≥80% and negative likelihood ratios ≤0.5 for the highest risk group; area under the receiver operating characteristic curve ranged from 0.56 to 0.83 and positive likelihood ratios from 1.0 to 5.9. If one chose only major amputation as an outcome, positive predictive values were lower, and negative predictive values tended to be higher. System stages, grades, scores, and/or prognostics were generally associated with amputation, presenting overall substantial accuracy values. Nevertheless, great improvement is possible. A multicentre study validating and refining the existing systems is needed to improve clinical decision-making in this area. Copyright © 2014 John Wiley & Sons, Ltd.

  2. Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: A case report

    OpenAIRE

    Jun Yao; Albert Chen; Todd Kuiken; Carolina Carmona; Julius Dewald

    2015-01-01

    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...

  3. Dynamic stability of running: The effects of speed and leg amputations on the maximal Lyapunov exponent

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2013-12-15

    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.

  4. The role of qualitative research in understanding diabetic foot ulcers and amputation.

    Science.gov (United States)

    Kuhnke, Janet L; Bailey, Patricia Hill; Woodbury, M Gail; Burrows, Mona

    2014-04-01

    To enhance the learner's competence with knowledge about using qualitative methodologies to understand diabetic foot ulcers and amputations. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Analyze qualitative research methodologies.2. Summarize how conclusions from qualitative research relate to diabetes mellitus and its complications. Persons living with diabetes are at high risk for foot complications, lower extremity trauma, injury, ulceration, infection, and potential amputation. Qualitative health research helps to explore and understand more fully the complexities of diabetes. Qualitative health research seeks to understand what is happening and going on for the individual and his/her support persons. In addition, qualitative health research enables clinicians to appreciate how different qualitative research approaches can explore illness from the perspective of the individual living with the disease.

  5. Use of Forehead Flap for Nasal Tip Reconstruction after Traumatic Nasal Amputation.

    Science.gov (United States)

    Ahmadi Moghadam, Mohamad; Ahmadi Moghadam, Shokofeh

    2017-09-01

    Nose is one of the most important aesthetic unit of the face.Management of nasal trauma plays a significant role in the practices of the majority of facial and reconstructive surgeons. Replantation, although technically very challenging, is undoubtedly the procedure of choice following traumatic nasal amputation. Here we present an illustrative case report of the traumatic amputation of a nasal tip that was treated successfully with a paramedian forehead flap and further nasal reconstructive surgery. Use of the forehead flap was performed five hours after the occurrence of trauma and was followed by surgical repair about three weeks later. This case presents evidence that a forehead flap as a full-thickness composite graft can survive with an acceptable clinical outcome. In this particular case, the final result was satisfactory.

  6. Dynamic stability of running: The effects of speed and leg amputations on the maximal Lyapunov exponent

    International Nuclear Information System (INIS)

    Look, Nicole; Arellano, Christopher J.; Grabowski, Alena M.; Kram, Rodger; McDermott, William J.; Bradley, Elizabeth

    2013-01-01

    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

  7. Amputees by choice: body integrity identity disorder and the ethics of amputation.

    Science.gov (United States)

    Bayne, Tim; Levy, Neil

    2005-01-01

    Should surgeons be permitted to amputate healthy limbs if patients request such operations? We argue that if such patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder (BIID), such operations might be permissible. We examine rival accounts of the origins of the desire for healthy limb amputations and argue that none are as plausible as the BIID hypothesis. We then turn to the moral arguments against such operations, and argue that on the evidence available, none is compelling. BIID sufferers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests.

  8. Three cases of feet and hand amputation from Medieval Estremoz, Portugal.

    Science.gov (United States)

    Fernandes, Teresa; Liberato, Marco; Marques, Carina; Cunha, Eugénia

    2017-09-01

    Peri-mortem limb amputations are rarely reported in the paleopathological literature. The cases reported here concern severing of both hands and feet observed in three adult male skeletons, exhumed from the medieval Portuguese necropolis of Rossio do Marquês de Pombal, Estremoz, Portugal. The fact that they were found in the same site, in graves placed side by side, that all are young males, and that the three skeletons show similar perimortem injuries, make this a unique case meriting detailed analysis. Considering the lesions' location and pattern, as well as historical data, we hypothesize that this is a case of amputation as a consequence of judicial punishment. Estremoz was an important city in sustaining the Royal power at a regional scale during the medieval period. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Wound healing in above-knee amputations in relation to skin perfusion pressure

    DEFF Research Database (Denmark)

    Holstein, P; Dovey, H; Lassen, N A

    1979-01-01

    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...

  10. The distal blood pressure predicts healing of amputations on the feet

    DEFF Research Database (Denmark)

    Holstein, P

    1984-01-01

    The healing of digital and transmetatarsal forefoot amputations was compared with the systolic digital and ankle blood pressure, both measured with a strain-gauge, and with the skin perfusion pressure on the forefoot measured with the isotope washout technique. In 85 out of 134 legs (63 per cent......) the amputation healed. The frequency of healing correlated statistically significantly with all three measures of distal blood pressures, the closest correlation being with the systolic digital blood pressure (SDBP). As measured in 110 cases the healing rates were: SDBP less than 20 mm Hg: four out of 23; SDBP...... 20-29 mm Hg: 13 out of 22; SDBP greater than or equal to 30 mm Hg: 51 out of 65. Ankle pressures and skin perfusion pressures were less useful. Invasive infection was present in 40 out of 102 diabetic legs and, next to ischaemia, was the major determinant of the healing results....

  11. Bilateral transtibial amputation with concomitant thoracolumbar vertebral collapse in a Sichuan earthquake survivor

    Directory of Open Access Journals (Sweden)

    Lau Herman

    2010-07-01

    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.

  12. Motor and sensory rehabilitation after lower limb amputation: state of art and perspective of change.

    Science.gov (United States)

    Casale, Roberto; Maini, Maurizio; Bettinardi, Ornella; Labeeb, Alaa; Rosati, Vanessa; Damiani, Carlo; Mallik, Maryam

    2013-01-01

    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.

  13. Culture results and amputation rates in high-pressure paint gun injuries of the hand.

    Science.gov (United States)

    Mirzayan, R; Schnall, S B; Chon, J H; Holtom, P D; Patzakis, M J; Stevanovic, M V

    2001-06-01

    High-pressure paint gun injuries have been well described in the literature, and the use of antibiotics is recommended as part of their management. However, there is no scientific evidence to support the use of antibiotics. In addition, the type of paint injected (water- versus oil-based) has never been investigated to determine the extent of morbidity resulting from these injuries. This study examines the organisms cultured in wounds resulting from these injuries and whether the type of paint injected had an influence on amputation rates. Charts of 35 patients with high-pressure paint gun injuries to their hands were reviewed. The amputation rate was 50% with oil-based paints and 0% with water-based paints. Forty-seven percent of wound cultures were positive, with gram-negative bacteria found in 58% of isolates. Our findings support the use of antibiotics, which should cover both gram-positive and gram-negative organisms.

  14. Psychosocial and functional outcomes in long-term survivors of osteosarcoma: a comparison of limb-salvage surgery and amputation.

    Science.gov (United States)

    Robert, Rhonda S; Ottaviani, Giulia; Huh, Winston W; Palla, Shana; Jaffe, Norman

    2010-07-01

    Traditionally, physicians have believed that limb-salvage surgery has functional and cosmetic advantages over amputation, yet the literature is equivocal. Therefore, we sought to compare the psychosocial and functional outcomes in osteosarcoma survivors after limb-salvage surgery and amputation. We hypothesized there to be neither psychosocial nor functional outcome differences between groups. Participants received treatment of extremity osteosarcoma, had received their cancer diagnosis at least 2 years prior, and were at least 16 years old. A comprehensive set of validated psychosocial and functional measures was used to assess outcome. Fifty-seven patients participated in this study (33 who underwent limb-salvage surgery and 24 who underwent amputation). Participants had gone 12-24 years since diagnosis and were 16-52 years old at study participation. We used multiple linear regression models to examine differences in quality of life, body image, self-esteem, and social support between the two groups and found no differences. Lower limb function was a significant predictor of quality of life (P surgery type did not impact this relationship. Body image was rated significantly worse by those who underwent late amputation, amputation after failed limb salvage, than by those who did not. Participants with more functional lower limbs had better quality of life than did those with less functional lower limbs regardless of whether they underwent amputation or limb-salvage surgery. Copyright 2010 Wiley-Liss, Inc.

  15. The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices.

    Science.gov (United States)

    Cross, A M; Davis, C; Penn-Barwell, J; Taylor, D M; De Mello, W F; Matthews, J J

    2014-01-01

    A frequently-seen injury pattern in current military experience is traumatic lower limb amputation as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb amputation. A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb amputation in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures. Of 77 consecutive patients with traumatic lower limb amputations, 17 (22%) had an associated pelvic fracture (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). Unilateral amputees (n = 31) had a 10% incidence of associated pelvic fracture, whilst 30 % of bilateral amputees (n = 46) had a concurrent pelvic fracture. However, in bilateral, trans-femoral amputations (n = 28) the incidence of pelvic fracture was 39%. The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group.

  16. Goal pursuit, goal adjustment, and affective well-being following lower limb amputation

    OpenAIRE

    Coffey, Laura; Gallagher, Pamela; Desmond, Deirdre; Ryall, Nicola

    2014-01-01

    Objectives. This study examined the relationships between tenacious goal pursuit (TGP), flexible goal adjustment (FGA), and affective well-being in a sample of individuals with lower limb amputations. Design. Cross-sectional, quantitative. Methods. Ninety-eight patients recently admitted to a primary prosthetic rehabilitation programme completed measures of TGP, FGA, positive affect, and negative affect. Results. Hierarchical regression analyses revealed that TGP and FGA accounted fo...

  17. Composite grafting with pulp adipofascial advancement flaps for treating non-replantable fingertip amputations.

    Science.gov (United States)

    Lai, Hsin-Ti; Wu, Sheng-Hua; Lai, Ya-Wei; Hsieh, Tung-Ying; Lee, Su-Shin; David Wang, Hui-Min; Chang, Kao-Ping; Lin, Sin-Daw; Lai, Chung-Sheng; Huang, Shu-Hung

    2016-11-01

    Non-replantable fingertip amputation is still a clinical challenge. We performed modified composite grafting with pulp adipofascial advancement flap for Hirase IIA fingertip amputations. Results from a series of patients are presented and achieved better outcome than traditional composite grafting. From September 2012 to April 2014, fourteen patients with sixteen digits were included in our study. Mean age of patients was 43.9 years (20-71 years). All of our patients underwent this procedure under digital block anesthesia. We performed pulp adipofascial advancement flap for better soft tissue coverage of bone exposure stump first. The amputated parts were defatted, trimming, and reattached as composite graft. Age and gender of patients, injured finger, Hirase classification, mechanism of trauma, overall graft survival area, two-point discrimination (2PD) (mm) at six-month, length of shortening of digit, The average disabilities of the arm, shoulder, and hand (DASH) score and subjective self-evaluation questionnaire at 6 month were recorded. Average graft survival area was 89% (75-100%). Average length of shortening was 2.2 mm (1.8-3.5 mm). 2PD at six-month after surgery was 6.3 mm in average (5-8 mm). Average DASH score at 6 month was 1.45 (0.83-2.5). The self-evaluated aesthetic results showed twelve patients (85.7%) were very satisfied, and no patient was completely unsatisfied. In Hirase zone IIA traumatic fingertip amputation where replantation is difficult, our modified technique of composite grafting with pulp adipofascial advancement flap provided an alternative choice with high successful rate, acceptable functional and aesthetic outcomes. © 2016 Wiley Periodicals, Inc. Microsurgery, 2016. © 2015 Wiley Periodicals, Inc. Microsurgery 36:651-657, 2016. © 2016 Wiley Periodicals, Inc.

  18. Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post-Amputation Pain

    Science.gov (United States)

    2013-10-01

    unavailable due to the area covered by dressing”. c. Sensory and Motor Deficit: For exam of an injured, non-amputated limb, evidence of sensory...deficit outside of the area tissue injury or motor deficit will be noted...Pain 2006;2:24. 53 Nassar MA, Stirling LC, Forlani G, et al. Nociceptor- specific gene deletion reveals a major role for Nav1.7 (PN1) in acute and

  19. Tophaceous gout in an amputation stump in a patient with chronic myelogenous leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Christine B.; Mohana-Borges, Aurea; Pathria, Mini [Department of Radiology, UCSD and VAHCS, 3350 La Village Drive, La Jolla, CA 92161 (United States)

    2003-07-01

    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.)

  20. A Population-Based Study of Replantation After Traumatic Thumb Amputation, 2007-2012.

    Science.gov (United States)

    Mahmoudi, Elham; Huetteman, Helen E; Chung, Kevin C

    2017-01-01

    The recommended surgical treatment after thumb amputation is replantation. In the United States, fewer than 40% of thumb amputation injuries are replanted, and little is known about factors associated with the probability of replantation. We aimed to investigate recent trends and examine patient and hospital characteristics that are associated with increased probability of attempted thumb replantation. We hypothesized that higher-volume teaching hospitals and level-I trauma centers attempted more replantations. We used 2007-2012 data from the National Trauma Data Bank. Our final sample included 2,206 traumatic thumb amputation patients treated in 1 of 365 centers during the study period. First, we used a 2-level hierarchical logistic model to estimate the odds of replantation. In addition, we used a treatment effect estimation method, with the inverse propensity score weighting to examine the difference in thumb replantation if the only variation among patients was their presumptive payer. There was a higher probability of attempted replantation at teaching hospitals than nonteaching hospitals (odds ratio [OR], 1.40). Patients were less likely to undergo replantation at a level II (OR, 0.53) or a level III (OR, 0.33) trauma center. The uninsured were less likely to undergo replantation (OR, 0.61) than those with private insurance. Having insurance coverage and being treated in a high-volume, teaching, level-I trauma hospital increased the odds of replantation after traumatic thumb amputation. Regionalization may lead to a higher number of indicated cases of replantation actually being attempted. Therapeutic II. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial.

    Science.gov (United States)

    Armstrong, David G; Lavery, Lawrence A

    2005-11-12

    Diabetic foot wounds, particularly those secondary to amputation, are very complex and difficult to treat. We investigated whether negative pressure wound therapy (NPWT) improves the proportion and rate of wound healing after partial foot amputation in patients with diabetes. We enrolled 162 patients into a 16-week, 18-centre, randomised clinical trial in the USA. Inclusion criteria consisted of partial foot amputation wounds up to the transmetatarsal level and evidence of adequate perfusion. Patients who were randomly assigned to NPWT (n=77) received treatment with dressing changes every 48 h. Control patients (n=85) received standard moist wound care according to consensus guidelines. NPWT was delivered through the Vacuum Assisted Closure (VAC) Therapy System. Wounds were treated until healing or completion of the 112-day period of active treatment. Analysis was by intention to treat. This study has been registered with , number NCT00224796. More patients healed in the NPWT group than in the control group (43 [56%] vs 33 [39%], p=0.040). The rate of wound healing, based on the time to complete closure, was faster in the NPWT group than in controls (p=0.005). The rate of granulation tissue formation, based on the time to 76-100% formation in the wound bed, was faster in the NPWT group than in controls (p=0.002). The frequency and severity of adverse events (of which the most common was wound infection) were similar in both treatment groups. NPWT delivered by the VAC Therapy System seems to be a safe and effective treatment for complex diabetic foot wounds, and could lead to a higher proportion of healed wounds, faster healing rates, and potentially fewer re-amputations than standard care.

  2. Newly diagnosed type 1 diabetes complicated by ketoacidosis and peripheral thrombosis leading to transfemoral amputation

    DEFF Research Database (Denmark)

    Bisgaard Jørgensen, Line; Skov, Ole; Yderstræde, Knud Bonnet

    2014-01-01

    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....

  3. Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation.

    Science.gov (United States)

    Jeon, Byung-Joon; Choi, Hwan Jun; Kang, Jin Seok; Tak, Min Sung; Park, Eun Soo

    2017-06-01

    Diabetes mellitus is a common metabolic disorder. Among various complications, diabetic neuropathy and peripheral vascular disorders are closely associated with diabetic foot ulcers (DFUs). Lower extremity ulcers and amputations are ongoing problems among individuals with diabetes. There are several classification systems for DFUs; however, no prognostic system has to date been accepted as the gold standard or the optimum prediction tool for amputations. A retrospective study was designed. Demographic data and baseline laboratory data were gathered and scored or evaluated using five representative DFU classification systems. These included (i) the diabetic ulcer severity score (DUSS); (ii) University of Texas (UT) diabetic wound classification; (iii) Meggitt-Wagner classification; (iv) depth of the ulcer, extent of bacterial colonisation, phase of ulcer and association aetiology (DEPA) scoring system; and (v) site, ischaemia, neuropathy, bacterial infection and depth (SINBAD) score. Finally, a statistical analysis was performed. A total of 137 patients were included in this study. During the follow-up, DFU had healed in 51·1% of subjects and 48·9% of the individuals underwent lower extremity amputations (LEAs). In a univariable logistic regression analysis, history of previous DFU, hypertension, neuropathy, haemoglobin, C-reactive protein (CRP) and ankle-brachial index (ABI) showed a statistically significant difference between the healed group and the LEA group. Moreover, the stages, grades or overall prognostic ability of all five classifications were highly associated with the overall occurrence of LEA. On multivariable logistic regression analysis of the risk of LEA, all classifications showed a significant positive trend with an increased number of amputations. All the five classification systems exhibited high sensitivity, specificity, classification accuracy, positive predictive, negative predictive and area under the curve (AUC) values. They showed

  4. Brain activity elicited by viewing pictures of the own virtually amputated body predicts xenomelia.

    Science.gov (United States)

    Oddo-Sommerfeld, Silvia; Hänggi, Jürgen; Coletta, Ludovico; Skoruppa, Silke; Thiel, Aylin; Stirn, Aglaja V

    2018-01-08

    Xenomelia is a rare condition characterized by the persistent desire for the amputation of physically healthy limbs. Prior studies highlighted the importance of superior and inferior parietal lobuli (SPL/IPL) and other sensorimotor regions as key brain structures associated with xenomelia. We expected activity differences in these areas in response to pictures showing the desired body state, i.e. that of an amputee in xenomelia. Functional magnetic resonance images were acquired in 12 xenomelia individuals and 11 controls while they viewed pictures of their own real and virtually amputated body. Pictures were rated on several dimensions. Multivariate statistics using machine learning was performed on imaging data. Brain activity when viewing pictures of one's own virtually amputated body predicted group membership accurately with a balanced accuracy of 82.58% (p = 0.002), sensitivity of 83.33% (p = 0.018), specificity of 81.82% (p = 0.015) and an area under the ROC curve of 0.77. Among the highest predictive brain regions were bilateral SPL, IPL, and caudate nucleus, other limb representing areas, but also occipital regions. Pleasantness and attractiveness ratings were higher for amputated bodies in xenomelia. Findings show that neuronal processing in response to pictures of one's own desired body state is different in xenomelia compared with controls and might represent a neuronal substrate of the xenomelia complaints that become behaviourally relevant, at least when rating the pleasantness and attractiveness of one's own body. Our findings converge with structural peculiarities reported in xenomelia and partially overlap in task and results with that of anorexia and transgender research. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Sensibility of the stump in adults with an acquired major upper extremity amputation.

    Science.gov (United States)

    van Gils, Willemijn; Reinders-Messelink, Heleen A; Smit-Klaij, Frida; Bongers, Raoul M; Dijkstra, Pieter U; van der Sluis, Corry K

    2013-11-01

    To compare the sensibility of the stump in adults with an acquired major upper extremity amputation with the sensibility of the unaffected side and with the corresponding body parts of healthy controls, as well as to relate the sensibility of the stump to daily functioning. A survey with matched controls. A tertiary referral center. A referred sample of patients (n=30) with an acquired upper extremity amputation, at least 1 year after amputation, and control subjects (n=30) matched for age, sex, and hand dominance were evaluated. Not applicable. Three different modalities of sensibility were measured: (1) touch-pressure sensibility, tested using Semmes-Weinstein monofilaments; (2) stereognosis, detected using the Shape and Texture Identification test; and (3) kinesthesia. Daily functioning was assessed using the Upper Extremity Functional Status Module of the Orthotics and Prosthetics Users' Survey. The mean time ± SD since amputation was 20±17.8 years. Twenty patients used a prosthesis. The stump sensibility was similar to that of unaffected hands and tended to be less than that of unaffected arms (P=.08). The patients using a prosthesis had significantly poorer touch-pressure sensibility in the stump compared with the nonusers (P=.04). However, touch-pressure sensibility and stereognosis were worse in the patients than in controls (Psensibility. The touch-pressure sensibility in the stumps of patients using prostheses was poorer than the sensibility in nonusers, and remarkably, the unaffected extremities of the amputees were less sensitive than the extremities of the controls. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. COMPARISON OF A SIMPLE AND CHEAP IMMEDIATE POSTOPERATIVE PROSTHESIS WITH SOFT DRESSING IN LOWER LIMB AMPUTATIONS

    Directory of Open Access Journals (Sweden)

    Shashank Yeshwant Kothari

    2017-05-01

    Full Text Available BACKGROUND Removal of a part of a limb through one or more bones termed amputation is done for various causes. Properly performed amputation is a reconstructive procedure. Effective postoperative rehabilitation reduces disability and helps in proper shaping of the residual limb leading to final prosthetic fitment. The aim of the study is to compare effect of rigid dressing and Immediate Postoperative Prosthesis (IPOP using a simple and cheap pylon developed by the first author with soft dressing in respect of stump maturation and function in lower limb amputees. MATERIALS AND METHODS Fifty one patients with lower limb amputations were included in the study and randomised into two groups. Twenty four patients completed follow-up in the study group of rigid dressing with early postoperative prosthetic fitting while twenty patients completed with soft dressing. Stump maturation as measured by girth and volumetric assessment and complications of residual pain and phantom pain were compared at six weeks and twelve weeks with baseline data. Statistical Analysis- Done with SPSS for Windows version 17. Independent-T test was used for comparison of continuous variables and Chi-square and Fischer exact test was used for comparison of dichotomous responses. Settings and Design- The study was done in a multispecialty teaching hospital of a metro city. It was a well-structured comparative study done after addressing all safety and ethical issues. RESULTS Stump maturation was significantly better and the stump complications reduced in the study group. CONCLUSION Rigid dressing with IPOP has proven to be significantly superior to soft dressing in terms of maturation of stump and residual complications in lower limb amputations.

  7. Heterotopic Ossification Following Extremity Blast Amputation: An Animal Model in the Sprague Dawley Rat

    Science.gov (United States)

    2012-10-01

    substantially increased in recent history , with greater than 88% of 6 reported events in the Iraq conflict being survivable 1 . Unfortunately, the use of...ossification in cases 20 of combat-related amputations has received little attention throughout history . Despite being 21 documented as far back as the... Buprenorphine (0.05 mg/kg) and 12 enrofloxacin (5 mg/kg) were administered subcutaneously for preemptive analgesia and 13 prophylactic antibacterial

  8. Heterotopic Ossification Following Extremity Blast Amputation: An Animal Model in the Sprague Dawley Rat

    Science.gov (United States)

    2016-03-01

    treatment of acetabular fractures , the HO prophylactic potential of any of these treatment modalities in the setting of trauma or trauma related amputation...regulation of normal skeletogenesis and frequently is encountered in other orthopaedic settings, including THA and elbow fracture [1, 3, 11, 20–22, 24, 25...among reviewers. Regarding HO type, the rats’ fibulae typically shattered into many pieces, making it difficult to ascertain whether bone in the sur

  9. A Longitudinal Study of Social Participation After Dysvascular Lower Extremity Amputation.

    Science.gov (United States)

    Roepke, Ann Marie; Williams, Rhonda M; Turner, Aaron P; Henderson, Alison W; Norvell, Daniel C; Henson, Helene; Hakimi, Kevin N; Czerniecki, Joseph M

    2017-10-01

    This study examined patterns of social participation among individuals experiencing their first dysvascular lower extremity amputation. We identified the types of social participation valued by this population and explored factors that were associated with individuals' levels of participation and their subjective satisfaction with participation. A prospective cohort was recruited from four Veterans Administration Medical Centers and followed for 1 yr after amputation. Social participation was measured with a modified version of the Community Integration Questionnaire. Potential correlates included the Patient Health Questionnaire-9, Modified Social Support Survey, Locomotor Capability Index 5, Short Portable Mental Status Questionnaire, and self-rated health. At 1-yr postamputation, participants indicated that the most valued aspects of social participation were maintaining close friendships, visiting loved ones, and managing finances. Levels of social participation and satisfaction with participation were modest at 1-yr postamputation. Higher levels of social participation at 1 yr were related to better baseline mental status, better premorbid mobility, and lower amputation level. Higher satisfaction with participation was related to greater baseline social support. Individuals' social participation may be influenced by physical and cognitive factors, whereas their satisfaction with participation may be influenced by psychosocial factors. Rehabilitation specialists are encouraged to address both aspects of social participation when formulating and pursuing rehabilitation goals.

  10. Venous thromboembolism after traumatic amputation: an analysis of 366 combat casualties.

    Science.gov (United States)

    Hannon, Matthew; Tadlock, Matthew D; Melcer, Ted; Walker, Jay; Bandle, Jesse; Nieses, Kameran; Galarneau, Michael

    2016-08-01

    We sought to determine the incidence, risk factors, and time course for deep vein thrombosis and pulmonary embolism (DVT/PE) after combat-related major limb amputations. Patients with amputation in Iraq or Afghanistan from 2009 through 2011 were eligible. Details of postinjury care, date of diagnosis of DVT/PE, and injury specific data were collected. Military databases and chart reviews were used. In 366 patients, 103 (28%) had DVT/PE; PE was diagnosed in 59 (16%) and DVT in 59 (16%). Most DVT (69%) and PE (66%) occurred within 10 days. Increasing ventilator days (odds ratio [OR], 1.97; 95% CI, 1.16 to 3.37) and units of blood transfused (OR, 1.72; 95% CI, 1.11 to 2.68) were associated with DVT. Increasing units of fresh-frozen plasma were associated with PE (OR, 1.31; 95% CI, 1.10 to 1.55). The incidence of DVT/PE is high after combat-related amputation. Most DVT/PE occur early and prophylaxis is indicated. Published by Elsevier Inc.

  11. Stump infections after major lower-limb amputation: a 10-year retrospective study.

    Science.gov (United States)

    Dutronc, H; Gobet, A; Dauchy, F-A; Klotz, R; Cazanave, C; Garcia, G; Lafarie-Castet, S; Fabre, T; Dupon, M

    2013-12-01

    There is little published data on the diagnostic and therapeutic management of lower-limb stump infections (excluding toe and forefoot amputations). We made a retrospective observational study of 72 patients having undergone a major lower-limb amputation for a vascular or traumatic reason, complicated by post-surgical stump infection, between January 1, 2000 and December 31, 2009. Stump infection was diagnosed more than 6weeks after amputation in half of the patients. Staphylococcus was the most frequently isolated bacterium. Ultrasonography and CT scan combined with fistulography were useful to confirm the diagnosis and to determine the extension of infection. Thirty-two patients (44%) needed surgical revision in addition to antibiotic treatment. Patients diagnosed with bone infection more frequently required complementary surgery than those with soft tissue infection (P<0.001). The optimal management of this type of infection requires obtaining reliable bacteriological documentation (abscess aspiration in case of soft tissue infection or bone biopsy in case of osteomyelitis) to adapt to the antibiotic treatment. The management should be multidisciplinary (orthopedic or vascular surgeons, rehabilitation specialists, and infectious diseases physicians). Most patients may use prosthesis once the infection is treated. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  12. Global trends in incidence of lower limb amputation: a review of the literature

    Directory of Open Access Journals (Sweden)

    L. Godlwana

    2008-01-01

    Full Text Available The aim of this paper was to compile a literature report on the global epidemiology of lower limb amputations. Specifically it aimed at capturing information on the incidence of traumatic and non-traumatic lowerlimb amputations throughout the world, to identify the etiology including diseases and lifestyle habits associated with lower limb amputees (LLA in boththe developed and the developing countries, to identify the demographiccharacteristics, age, sex, race, geographical location of the people undergoing LLA including the levels of amputation as pointed out by the literature. Aliterature search was conducted. Different keyword combinations were used togather as much literature on the subject as possible. The authors systemicallyreviewed literature from some parts of Europe, Asia, North and South America and South Africa. The data was analyzed and presented under various themes. The existing literature shows that diabetes is the leading cause of LLA and trauma accounts for the minority of these cases. The incidence of LLA can be predicted by gender, age, maritalstatus, level of education and socio-economic status. Information on LLA in South Africa is almost absent.

  13. A training programme to improve hip strength in persons with lower limb amputation.

    Science.gov (United States)

    Nolan, Lee

    2012-03-01

    To investigate the effect of a 10-week training programme on persons with a lower limb amputation and to determine if this training is sufficient to enable running. Seven transtibial, 8 transfemoral and 1 bilateral amputee (all resulting from trauma, tumour or congenital) were randomly assigned to a training (n  =8) or control group (n = 8). Isokinetic hip flexor and extensor strength at 60 and 120º/s and oxygen consumption while walking at 1.0 m/s were tested pre- and post- a 10-week period. The training group followed a twice weekly hip strengthening programme, while the control group continued with their usual activities. Running ability was determined pre-testing, and attempted after post-testing for the training group only. The training group increased hip strength and decreased oxygen consumption. Six amputees who were previously unable to run were able to after training. The control group decreased intact limb hip extensor strength. The training programme is sufficient to improve hip strength and enable running in persons with a lower limb amputation. As hip strength was reduced in those not following the training programme, it is recommended that strength training be undertaken regularly in order to avoid losing limb strength following amputation.

  14. Quality of life and functionality after lower limb amputations: comparison between uni- vs. bilateral amputee patients.

    Science.gov (United States)

    Akarsu, Selim; Tekin, Levent; Safaz, Ismail; Göktepe, Ahmet Salim; Yazicioğlu, Kamil

    2013-02-01

    It is difficult for the lower limb amputee patients to adapt to their new lifestyles. To compare the life quality and functionality of patients with bilateral vs. unilateral lower extremity amputations. Cross-sectional study. Fifteen bilateral and 15 unilateral lower extremity amputee patients were enrolled. Demographics, cause and level of amputations, frequency and duration of prosthesis use were evaluated. SF-36, Satisfaction with Prosthesis Questionnaire (SAT-PRO), Amputee Body Image Scale. (ABIS), Houghton Scale (HS), six-minute walk test (6MWT), and 10-metre walk test (10 MWT) were performed. Physical function, physical and emotional role scores of SF-36 were significantly lower in the bilateral amputee group in comparison with the unilateral group. SAT-PRO and ABIS total scores were similar between the groups. There was a positive correlation between the frequency of prosthetic use and SF-36 subgroups (except pain). The unilateral amputee group had significantly better scores than the bilateral amputee group in terms of HS, 6MWT and 10 MWT. Physical capacity of bilateral lower extremity amputee patients is lower than the unilateral amputee patients; satisfaction with prosthesis and body image are not related with the amputation level; and the life quality and satisfaction with prostheses are increased in parallel with the use of the prostheses. Clinical relevance Although differences exist between the groups, in terms of quality of life and functionality, patients can reach an acceptable life standard with good rehabilitation and a suitable prosthesis.

  15. Continuous activity monitoring in persons at high risk for diabetes-related lower-extremity amputation.

    Science.gov (United States)

    Armstrong, D G; Abu-Rumman, P L; Nixon, B P; Boulton, A J

    2001-10-01

    This study evaluated the magnitude and location of activity of diabetic patients at high risk for foot amputation. Twenty subjects aged 64.6 +/- 1.8 years with diabetes, neuropathy, deformity, or a history of lower-extremity ulceration or partial foot amputation were dispensed a continuous activity monitor and a log book to record time periods spent in and out of their homes for 1 week. The results indicate that patients took more steps per hour outside their home, but took more steps per day inside their homes. Although 85% of the patients wore their physician-approved shoes most or all of the time while they were outside their homes, only 15% continued to wear them at home. Focusing on protection of the foot during in-home ambulation may be an important factor on which to focus future multidisciplinary efforts to reduce the incidence of ulceration and amputation. The ability to continuously monitor the magnitude, duration, and time of activity ultimately may assist clinicians in dosing activity just as they dose drugs.

  16. Does First Ray Amputation in Diabetic Patients Influence Gait and Quality of Life?

    Science.gov (United States)

    Aprile, Irene; Galli, Marco; Pitocco, Dario; Di Sipio, Enrica; Simbolotti, Chiara; Germanotta, Marco; Bordieri, Corrado; Padua, Luca; Ferrarin, Maurizio

    It has recently been suggested that first ray amputation in diabetic patients with serious foot complications can prolong bipedal ambulatory status, and reduce morbidity and mortality. However, no data are available on gait analysis and quality of life after this procedure. In the present case-control study (6 amputee and 6 nonamputee diabetics, 6 healthy non-diabetic), a sample of amputee diabetic patients were evaluated and compared with a sample of nonamputee diabetic patients and a group of age-matched healthy subjects. Gait biomechanics, quality of life, and pain were evaluated. Compared with the other 2 groups, amputee patients displayed a lower walking speed and greater variability and lower ankle, knee, and hip range of motion values. They also tended to have a more flexed hip profile. Pain and lower quality of life were related to worsening biomechanical data. Our study results have shown that gait biomechanics in diabetic patients with first ray amputation are abnormal, probably owing to the severity of diabetes and the absence of the push-off phase provided by the hallux. Tailored orthotics and rehabilitation programs and a specific pain management program should be considered to improve the gait and quality of life of diabetic patients with first ray amputation. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Diabetic foot wounds in haemodialysis patients: 2-year outcome after percutaneous transluminal angioplasty and minor amputation.

    Science.gov (United States)

    Matsuzaki, Kyoichi; Miyamoto, Akira; Hakamata, Naohiro; Fukuda, Masahiro; Yamauchi, Yasutaka; Akita, Takako; Kuhara, Ryoji; Tezuka, Shingo

    2012-12-01

    Critical limb ischaemia (CLI) is known to be associated with high mortality. In some patients, surgery cannot be performed due to high risk of perioperative death and complications. In other cases, there is only pain at rest but no wound. Therefore, it is difficult to accurately predict the prognosis of individual patients. We examined the prognosis of CLI cases in which therapeutic footwear was made for ambulation after wounds healed. The subjects were 31 haemodialysis patients with diabetic foot wounds, which were treated with percutaneous transluminal angioplasty and minor amputation. The subjects were 22 men and 9 women. Female patients were significantly older than male patients (P = 0.046). Two-year postoperative outcomes were survival in 19 patients and death in 12 patients. Eight of twelve deceased patients had a history of coronary intervention. There were 8 deaths among 13 patients with such history, indicating a marginally significant increase in the mortality rate (P = 0.060). Re-amputation was performed in 6 of 19 patients who survived. Two years postoperatively, 41.9% of patients overall survived without re-amputation. It is important to increase the number of cases for further study to improve the well-being of CLI patients and to examine medical economics. © 2012 The Authors. International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

  18. [Methicillin resistant Staphylococcus aureus infection postoperatory complications and prognosis of patients with lower extremity amputations].

    Science.gov (United States)

    del Río-Solá, M Lourdes; San Norberto-García, Enrique; González-Fajardo, José A; Carrera-Díaz, Santiago; Gutiérrez-Alonso, Vicente; Vaquero-Puerta, Carlos

    2006-02-04

    Methicillin-resistant Staphylococcus aureus (MRSA) is associated with an increasing morbimortality when compared with other microorganisms. The aim of this study was to examine the complications and prognosis of the presence of MRSA in vascular patients with amputation of lower limbs. We included patients who had lower extremity amputation in our department in 2004 and displayed positive surgical wounds cultures. We compared patients with MRSA positive cultures with other microrganisms. We evaluated general characteristics, operative indications, surgical wounds microbiology, reamputations, morbimortality and mean time of stay in hospital. 117 patients (median age 73, 68% male) underwent lower extremity amputation. 82 of them had positive cultures and MRSA were isolated in 30% cases. Two two groups were comparable and no statistical differences were found in relation to reamputation rate, morbimortality and mean time of stay in hospital. Presence of MRSA does not represent an additional risk of reamputation or an increase of postoperative complications. Careful wound surveillance, through wound debridement and optimal administration of antibiotics must be applied to all patients, regardless of the bacterial flora.

  19. Evaluation of Gait Performance of a Hemipelvectomy Amputation Walking with a Canadian Prosthesis

    Directory of Open Access Journals (Sweden)

    M. T. Karimi

    2014-01-01

    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.

  20. Perceptions of low back pain in people with lower limb amputation: a focus group study.

    Science.gov (United States)

    Devan, Hemakumar; Carman, Allan B; Hendrick, Paul A; Ribeiro, Daniel Cury; Hale, Leigh A

    2015-01-01

    This study explored the perceptions of people with a lower limb amputation as to important factors contributing to their low back pain (LBP). Semi-structured interviews were conducted (three focus groups and two individual interviews), with 11 participants with lower limb amputation and on-going LBP. The discussions were analysed using the General Inductive Approach. Five major categories were identified with "uneven posture and compensatory movements" of the back perceived to be the main contributor to LBP. "Fatigue" during functional activities and "prosthesis-related factors" may affect the "uneven movements" of the back further leading to LBP. "Multiple pain conditions" (i.e. phantom limb pain, non-amputated limb pain) could influence the pain perceptions contributing to LBP. "Self-management strategies" in the form of maintaining optimal physical fitness and support from health care professionals helped to manage LBP symptoms, thereby assisted in preventing chronicity. The results suggest "uneven movements" of the back affected by "fatigue" and "prosthesis-related factors" may alter the mechanical loading of the spine during functional activities and contribute to LBP. While being physically active helped participants cope with their LBP, identifying and addressing "uneven movements" in the back during the performance of functional activities may be important to devise prevention strategies for LBP.

  1. Active dorsiflexing prostheses may reduce trip-related fall risk in people with transtibial amputation.

    Science.gov (United States)

    Rosenblatt, Noah J; Bauer, Angela; Rotter, David; Grabiner, Mark D

    2014-01-01

    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.

  2. [Basic principles and difficulties relating to rehabilitation in diabetic patients following amputation].

    Science.gov (United States)

    Jindra, Martin; Věchtová, Bohuslava; Bielmeierová, Jana

    2015-06-01

    Vascular diseases as a result of diabetes mellitus are the most frequent indication for amputation in the Czech republic. Diabetic patients following amputation, unlike the other amputees, very frequently suffer multiple complications. These are both of general and local nature and pose a limitation to rehabilitation care as well as a prosthesis use. The main goal of therapeutic rehabilitation is the practice of locomotion with a prosthesis (artificial limb) and the patients full return to normal life. A team of closely cooperating specialists is involved. The rehabilitation care of amputees is divided into acute and aftercare. Within preoperative care we try to improve the patients physical and psychological condition. Following surgery we verticalize the patient as soon as possible depending on his/her possibilities and condition, we carry out breathing and vascular gymnastics and prevention of thromboembolic disease and we start the care of the stump. When the stump has been healed and shaped, the patient is provided with an artificial limb. The patients equipped with an artificial limb take a walking course where they learn how to handle the limb as well as walk indoors and outdoors and cope with common terrain unevenness.Key words: amputation - diabetes mellitus - walking with an artificial limb - prosthesis - lower limb prosthetics.

  3. Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project.

    Science.gov (United States)

    Nnamani, Nina S; Janak, Judson C; Hudak, Steven J; Rivera, Jessica C; Lewis, Eluned A; Soderdahl, Douglas W; Orman, Jean A

    2016-11-01

    In Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), genitourinary (GU) wounds have occurred in unprecedented numbers. Severe concomitant injuries, including extremity amputations, are common. The epidemiology of GU injury and extremity amputation in OEF/OIF has not been described. The Department of Defense Trauma Registry was queried from October 2001 through August 2013 to identify all surviving US male service members with GU injuries sustained in OEF/OIF. Genitourinary injury was defined as sustaining one or more injuries to any organ or structure within the genitourinary and/or reproductive system(s) based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was quantified based on Abbreviated Injury Scale scores and overall Injury Severity Scores. The incidence, nature, and severity of GU injuries and extremity amputations are described. Of the 1,367 service members with GU injury included in this analysis, 433 (31.7%) had one or more extremity amputations. Most GU injuries were to the external genitalia [scrotum (55.6%), testes (33.0%), penis (31.0%), and urethra (9.1%)] vs. the kidneys (21.1%). Those with amputation(s) had greater GU injury severity (Abbreviated Injury Scale score ≥ 3) than those without amputations (50.1% vs. 30.5%, respectively; p injury had an upper extremity amputation only, 8.9% had both lower and upper extremity amputation(s), and 19.4% had lower extremity amputation(s) only. Of the 387 patients with GU injury and lower extremity amputations, 87 (22.5%) had amputations below the knee and 300 (77.5%) had amputation(s) at/above the knee. In OEF/OIF, concomitant GU injury and extremity amputation are common and have serious implications for health and quality of life. This wounding pattern presents new challenges to the military medical and research and development communities to prevent, mitigate, and treat these battlefield injuries. Epidemiologic

  4. Reduced prosthetic stiffness lowers the metabolic cost of running for athletes with bilateral transtibial amputations.

    Science.gov (United States)

    Beck, Owen N; Taboga, Paolo; Grabowski, Alena M

    2017-04-01

    Inspired by the springlike action of biological legs, running-specific prostheses are designed to enable athletes with lower-limb amputations to run. However, manufacturer's recommendations for prosthetic stiffness and height may not optimize running performance. Therefore, we investigated the effects of using different prosthetic configurations on the metabolic cost and biomechanics of running. Five athletes with bilateral transtibial amputations each performed 15 trials on a force-measuring treadmill at 2.5 or 3.0 m/s. Athletes ran using each of 3 different prosthetic models (Freedom Innovations Catapult FX6, Össur Flex-Run, and Ottobock 1E90 Sprinter) with 5 combinations of stiffness categories (manufacturer's recommended and ± 1) and heights (International Paralympic Committee's maximum competition height and ± 2 cm) while we measured metabolic rates and ground reaction forces. Overall, prosthetic stiffness [fixed effect (β) = 0.036; P = 0.008] but not height ( P ≥ 0.089) affected the net metabolic cost of transport; less stiff prostheses reduced metabolic cost. While controlling for prosthetic stiffness (in kilonewtons per meter), using the Flex-Run (β = -0.139; P = 0.044) and 1E90 Sprinter prostheses (β = -0.176; P = 0.009) reduced net metabolic costs by 4.3-4.9% compared with using the Catapult prostheses. The metabolic cost of running improved when athletes used prosthetic configurations that decreased peak horizontal braking ground reaction forces (β = 2.786; P = 0.001), stride frequencies (β = 0.911; P < 0.001), and leg stiffness values (β = 0.053; P = 0.009). Remarkably, athletes did not maintain overall leg stiffness across prosthetic stiffness conditions. Rather, the in-series prosthetic stiffness governed overall leg stiffness. The metabolic cost of running in athletes with bilateral transtibial amputations is influenced by prosthetic model and stiffness but not height. NEW & NOTEWORTHY We measured the

  5. Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults.

    Science.gov (United States)

    Johnson, Mark I; Mulvey, Matthew R; Bagnall, Anne-Marie

    2015-08-18

    This is the first update of a Cochrane review published in Issue 5, 2010 on transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Pain may present in a body part that has been amputated (phantom pain) or at the site of amputation (stump pain), or both. Phantom pain and stump pain are complex and multidimensional and the underlying pathophysiology remains unclear. The condition remains a severe burden for those who are affected by it. The mainstay treatments are predominately pharmacological, with increasing acknowledgement of the need for non-drug interventions. TENS has been recommended as a treatment option but there has been no systematic review of available evidence. Hence, the effectiveness of TENS for phantom pain and stump pain is currently unknown. To assess the analgesic effectiveness of TENS for the treatment of phantom pain and stump pain following amputation in adults. For the original version of the review we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, PEDRO and SPORTDiscus (February 2010). For this update, we searched the same databases for relevant randomised controlled trials (RCTs) from 2010 to 25 March 2015. We only included RCTs investigating the use of TENS for the management of phantom pain and stump pain following an amputation in adults. Two review authors independently assessed trial quality and extracted data. We planned that where available and appropriate, data from outcome measures were to be pooled and presented as an overall estimate of the effectiveness of TENS. In the original review there were no RCTs that examined the effectiveness of TENS for the treatment of phantom pain and stump pain in adults. For this update, we did not identify any additional RCTs for inclusion. There were no RCTs to judge the effectiveness of TENS for the management of phantom pain and stump pain. The published literature on TENS

  6. Management of Work–Related Injuries Leading to Amputation and Its Relation with Treatment Outcome

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    Iravan Masoudi-Asl

    2011-04-01

    Full Text Available Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal" mso-tstyle-rowband-size:0 mso-tstyle-colband-size:0 mso-style-noshow:yes mso-style-priority:99 mso-style-parent:"" mso-padding-alt:0mm 5.4pt 0mm 5.4pt mso-para-margin-top:0mm mso-para-margin-right:0mm mso-para-margin-bottom:10.0pt mso-para-margin-left:0mm line-height:115% mso-pagination:widow-orphan font-size:11.0pt font-family:"Calibri","sans-serif" mso-ascii-font-family:Calibri mso-ascii-theme-font:minor-latin mso-hansi-font-family:Calibri mso-hansi-theme-font:minor-latin mso-bidi-font-family:Arial mso-bidi-theme-font:minor-bidi}   Objective: Work related accidents are considered as a significant health problem of working population. The goal of this study was to determine relation of treatment management with treatment outcome of Work-Related injuries leading to amputation.   Materials & Methods: current study was based on correlation method which was evidence based and was based on actual data of medical records of occupational accidents leading to amputations. Study population included all injuries that suffered limb amputation due to work and were referred to Laleh hospital during 2005 to 2009 (N=135. The data were collected by check list and analyzed by descriptive and inferential Statistics.   Results: Taking care method had a considerable effect on success of replant operation of that limb (P<0.001 so that in 95.23% of injuries whom principles of primary care had been done for them during transportation of amputated limb to hospital, had a successful operation. Treatment results of injuries in large limbs have had a strong relation to interval of incident occurrence to start of operation (P=0.038 How to refer injuries to hospital has not had a meaningful impact on treatment outcome (P=0.469 although referring injuries from health centers of workplace directly to hospital had more successful result comparing to

  7. Limb- and Person-Level Risk Factors for Lower-Limb Amputation in the Prospective Seattle Diabetic Foot Study.

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    Boyko, Edward J; Seelig, Amber D; Ahroni, Jessie H

    2018-04-01

    Diabetes is the leading cause of nontraumatic lower-limb amputations in the U.S., but no research has prospectively examined associations between limb-specific measurements and amputation risk among patients without foot ulcer. We investigated amputation risk by limb in relation to the same limb- and person-level factors. We conducted a 22-year prospective study among 1,461 male patients with diabetes without foot ulcer (mean age 62.4 years), with 2,893 lower limbs among subjects recruited between 1990 and 2002 from one Department of Veterans Affairs general internal medicine clinic. The following information was collected: demographic, lifestyle, and diabetes characteristics; visual acuity; kidney function (estimated glomerular filtration rate [eGFR]); and lower-limb measurements including presence of Charcot deformity, sensory neuropathy by 10-g monofilament, dorsal foot transcutaneous oximetry (TcPO 2 ) at 44°C, and ankle-brachial index (ABI). Over 25,735 limb-years, 136 amputations occurred. A multivariable Cox model identified multiple independent risk factors: sensory neuropathy (hazard ratio 3.09 [95% CI 2.02-4.74]), ABI ≤0.5 vs. >0.9 to 0.9 to 70 years vs. <57 years (0.13 [0.04-0.38]). Although TcPO 2 was not significantly associated with amputation overall, TcPO 2 <26 mmHg significantly predicted a higher risk in the ABI ≥1.3 category. Arterial disease and neuropathy emerged as the only limb-specific risk factors for amputation, but these and several person-level factors may be amenable to prevention or treatment interventions to potentially reduce diabetic amputation risk. © 2018 by the American Diabetes Association.

  8. Risk factors for amputation in patients with diabetic foot ulcer in southwest Iran: a matched case-control study

    Directory of Open Access Journals (Sweden)

    Mohammad Kogani

    2015-10-01

    Full Text Available OBJECTIVES: Amputation is a multifactorial complication in diabetic patients. The aim of this study was to determine the risk factors associated with amputation in patients with diabetic foot ulcers. METHODS: This matched case-control study was conducted based on new cases of amputation from March 2012 to November 2014. We selected new cases who had undergone amputation, and the control group was chosen from the cities or areas where the cases resided. Each case was matched with two controls based on the duration of diabetes and location. Conditional logistic regression was used to evaluate the associations between potential risk factors and amputation. RESULTS: A total of 131 cases were compared with 262 controls. The results of the adjusted model showed that sex (odds ratio [OR], 8.66; 95% confidence interval [CI], 2.68 to 27.91, fewer than two hemoglobin A1c (HbA1c tests per year (OR, 13.97; 95% CI, 4.97 to 39.26, unsuitable shoes (OR, 5.50; 95% CI, 2.20 to 13.77, smoking (OR, 3.44; 95% CI, 1.45 to 8.13, and body mass index (OR, 1.20; 95% CI, 1.03 to 1.41 were associated with amputation in diabetic patients. CONCLUSIONS: The most important factors associated with amputation were females, irregular monitoring of HbA1c levels, improper footwear, and smoking. Developing educational programs and working to ensure a higher quality of care for diabetic patients are necessary steps to address these issues.

  9. Systematic Review of Measures of Impairment and Activity Limitation for Persons With Upper Limb Trauma and Amputation.

    Science.gov (United States)

    Resnik, Linda; Borgia, Matt; Silver, Ben; Cancio, Jill

    2017-09-01

    (1) To identify outcome measures used in studies of persons with traumatic upper limb injury and/or amputation; and (2) to evaluate focus, content, and psychometric properties of each measure. Searches of PubMed and CINAHL for terms including upper extremity, function, activities of daily living, outcome assessment, amputation, and traumatic injuries. Included articles had a sample of ≥10 adults with limb trauma or amputation and were in English. Measures containing most items assessing impairment of body function or activity limitation were eligible. There were 260 articles containing 55 measures that were included. Data on internal consistency; test-retest, interrater, and intrarater reliability; content, structural, construct, concurrent, and predictive validity; responsiveness; and floor/ceiling effects were extracted and confirmed by a second investigator. The mostly highly rated performance measures included 2 amputation-specific measures (Activities Measure for Upper Limb Amputees and University of New Brunswick Test of Prosthetic Function skill and spontaneity subscales) and 2 non-amputation-specific measures (Box and Block Test and modified Jebsen-Taylor Hand Function Test light and heavy cans tests). Most highly rated self-report measures were Disabilities of the Arm, Shoulder and Hand; Patient Rated Wrist Evaluation; QuickDASH; Hand Assessment Tool; International Osteoporosis Foundation Quality of Life Questionnaire; and Patient Rated Wrist Evaluation functional recovery subscale. None were amputation specific. Few performance measures were recommended for patients with limb trauma and amputation. All top-rated self-report measures were suitable for use in both groups. These results will inform choice of outcome measures for these patients. Published by Elsevier Inc.

  10. Perceptions and experiences of nutritional care following the overwhelming experience of lower extremity amputation: A qualitative study.

    Science.gov (United States)

    Jensen, Pia Søe; Green, Sue M; Petersen, Janne; Andersen, Ove; Poulsen, Ingrid

    2017-11-29

    Good nutritional care of people following major lower extremity amputation is essential as poor nutritional status can lead to delayed wound healing. Working with patients to identify their perspectives on food, views on nutritional care and the need for dietary counselling enables the development of optimised nutritional care. To explore hospital patients' perspectives on food, dietary counselling and their experiences of nutritional care following lower extremity amputation. A qualitative, explorative study design was employed. An inductive content analysis of semi-structured interviews with a purposive sample of 17 people over 50 years of age, who had recently undergone major lower extremity amputation, was undertaken. The study was reported according to the consolidated criteria for reporting qualitative research guideline. Three themes emerged: responsible for own dietary intake, diet based on preferences and experiences with dietary counselling and feeling overwhelmed. The participants expressed motivation to ensure their nutritional needs were met but described feeling emotionally overwhelmed by the experience of amputation. They appeared not to expect nursing staff to focus on nutritional issues as they expressed belief that they themselves were solely responsible for their dietary intake. They described being motivated to receive nutritional counselling but indicated advice should be compatible with their lifestyle and eating habits. Lower extremity amputation can be an overwhelming experience which affects nutritional intake. People appear to consider themselves responsible for their nutritional care and describe not experiencing or expecting nursing staff to engage in this aspect of care. Dietary counselling by nurses who respect and incorporate patient preferences and experiences following amputation has the potential to enhance nutritional care. This study illustrates that nurses caring for people who undergo lower extremity amputation need to

  11. Outcomes of Critical Limb Ischemia in an Urban, Safety Net Hospital Population with High WIfI Amputation Scores.

    Science.gov (United States)

    Ward, Robert; Dunn, Joie; Clavijo, Leonardo; Shavelle, David; Rowe, Vincent; Woo, Karen

    2017-01-01

    Patients presenting to a public hospital with critical limb ischemia (CLI) typically have advanced disease with significant comorbidities. The purpose of this study was to assess the influence of revascularization on 1-year amputation rate of CLI patients presenting to Los Angeles County USC Medical Center, classified according to the Society for Vascular Surgery Wound, Ischemia and foot Infection (WIfI). A retrospective review of patients who presented to a public hospital with CLI from February 2010 to July 2014 was performed. Patients were classified according to the WIfI system. Only patients with complete data who survived at least 12 months after presentation were included. Ninety-three patients with 98 affected limbs were included. The mean age was 62.8 years. Eighty-two patients (84%) had hypertension and 71 (72%) had diabetes. Fifty (57.5%) limbs had Trans-Atlantic Inter-Society Consensus (TASC) C or D femoral-popliteal lesions and 82 (98%) had significant infrapopliteal disease. The majority had moderate or high WIfI amputation and revascularization scores. Eighty-four (86%) limbs underwent open, endovascular, or hybrid revascularization. Overall, one year major amputation (OYMA) rate was 26.5%. In limbs with high WIfI amputation score, the OYMA was 34.5%: 21.4% in those who were revascularized and 57% in those who were not. On univariable analysis, factors associated with increased risk of OYMA were nonrevascularization (P = 0.005), hyperlipidemia (P = 0.06), hemodialysis (P = 0.005), gangrene (P = 0.02), ulcer classification (P = 0.05), WIfI amputation score (P = 0.026), and WIfI wound grade (P = 0.04). On multivariable analysis, increasing WIfI amputation score (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.0-3.39) was associated with increased risk of OYMA while revascularization (OR 0.24, 95% CI 0.07-0.80) was associated with decreased risk of OYMA. The OYMA rates in this population were consistent with those predicted by the

  12. Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity: Rehabilitation process and prosthetics. Part 2.

    Science.gov (United States)

    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

    2015-10-01

    A structured, multidisciplinary approach in the rehabilitation process after amputation is needed that includes a greater focus on the involvement of both (para)medics and prosthetists. There is considerable variation in prosthetic prescription concerning the moment of initial prosthesis fitting and the use of replacement parts. To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 2 focuses on rehabilitation process and prosthetics. Systematic literature design. Literature search in five databases and quality assessment on the basis of evidence-based guideline development. An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity. The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for treatment and reintegration of patients undergoing amputation of a lower extremity and can be used to provide patient information. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. © The International Society for Prosthetics and Orthotics 2014.

  13. Very low survival rates after non-traumatic lower limb amputation in a consecutive series: what to do?†

    Science.gov (United States)

    Kristensen, Morten Tange; Holm, Gitte; Kirketerp-Møller, Klaus; Krasheninnikoff, Michael; Gebuhr, Peter

    2012-01-01

    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% trans-femoral) were studied. Their mean age was 75.8 years; 21 (23%) were admitted from a nursing home and 87 (92%) were amputated due to a vascular disease and/or diabetes. Thirty days and 1-year mortality were 30 and 54%, respectively. Cox regression analysis demonstrated that the 30-day mortality was associated with older age (P = 0.01), and the number of co-morbidities (P = 0.04), when adjusted for gender, previous amputations, cause of and amputation level, and residential status. Thus, a patient with 4 or 5 co-morbidities (n = 20) was seven times more likely to die within 30 days, compared with a patient with 1 co-morbidity (n = 16). Further, the risk of not surviving increased with 7% per each additional year the patient got older. Of concern, almost one-third of patients died within 1 month. This may be unavoidable, but a multidisciplinary, optimized, multimodal pre- and postoperative programme should be instituted, trying to improve the outcome. PMID:22298857

  14. Increased peripheral vascular resistance in male patients with traumatic lower limb amputation: one piece of the cardiovascular risk puzzle.

    Science.gov (United States)

    Paula-Ribeiro, Marcelle; Garcia, Marília M N; Martinez, Daniel G; Lima, Jorge R P; Laterza, Mateus C

    2015-12-01

    The increased morbidity and mortality in traumatic lower limb amputees can be explained by the development of risk factors, among which high blood pressure plays an important role. However, the possible mechanisms underlying increased blood pressure levels observed in this population remain unclear. Thus, we aimed to test the hypothesis that peripheral vascular resistance is increased at rest in patients with traumatic lower limb amputation. In a cross-sectional study, eight patients with traumatic unilateral lower limb amputation (amputee group) and eight healthy individuals without amputation (control group) were included. Resting blood pressure, heart rate, and forearm blood flow were recorded simultaneously and thus, forearm vascular resistance was calculated. The amputee group showed higher systolic (126±2 vs. 118±5 mmHg, Ptraumatic lower limb amputation presented increased peripheral vascular resistance at rest compared with the control group (31.3±3.8 vs. 25.7±6.5 U, P=0.05). Patients with traumatic amputation present increased peripheral vascular resistance. Our findings clarify one possible mechanism underlying the higher blood pressure levels observed in this population.

  15. Free fillet flap application to cover forequarter or traumatic amputation of an upper extremity: A case report.

    Science.gov (United States)

    Scaglioni, Mario F; Lindenblatt, Nicole; Barth, André A; Fuchs, Bruno; Weder, Walter; Giovanoli, Pietro

    2016-11-01

    Reusing tissue of amputated or unsalvageable limbs to reconstruct soft tissue defects is one aspect of the "spare parts concept." Using a free fillet flap in such situations enables the successful formation of a proximal stump with the length needed to cover a large defect from forequarter amputation without risking additional donor-site morbidity. The use of free fillet flaps for reconstruction after forequarter and traumatic upper extremity amputations is illustrated here in a case report. A 41-year old patient required a forequarter amputation to resect a desmoid tumor, resulting in an extensive soft-tissue defect of the upper extremity. A free fillet flap of the amputated arm and an additional local epaulette flap were used to reconstruct the defect. At 9 months after the procedure, a satisfactory result with a very well healed flap was attained. Free fillet flaps can be used successfully for reconstruction of large upper extremity defects, without risking additional donor-site morbidity. © 2015 Wiley Periodicals, Inc. Microsurgery 36:700-704, 2016. © 2016 Wiley Periodicals, Inc.

  16. To lump or to split? Comparing individuals with traumatic and nontraumatic limb loss in the first year after amputation.

    Science.gov (United States)

    Kratz, Anna L; Williams, Rhonda M; Turner, Aaron P; Raichle, Katherine A; Smith, Doug G; Ehde, Dawn

    2010-05-01

    To compare individuals with traumatic (TE) vs. nontraumatic (NTE) amputation etiology on pain, psychological, and social variables over the first 12 months postamputation, and to explore changes in mean levels of and correlations between these variables over time. There were 111 adults with newly acquired limb loss. A VA medical center and a Level I trauma hospital in a large metropolitan area. Characteristic Pain Severity, Pain Interference, Patient Health Questionnaire depression module, Posttraumatic Stress Disorder Checklist, Social Constraints Scale, Aversive Emotional Support Scale, Centers for Disease Control and Prevention single item Social Support measure, single item loneliness measure. The NTE group was significantly older, had lower income, and had greater medical comorbidity, preamputation pain, and physical disability. The etiology groups did not differ significantly in mean levels of outcome variables except that the TE group reported greater aversive emotional support at 6 and 12 months. The TE group demonstrated a quadratic change in pain interference, with highest levels at 6 months and a linear increase in social constraints. Both etiology groups showed a linear increase in PTSD symptoms over time. Correlations between physical, psychological, and social distress were observed earlier in the year for the NTE group. Despite significant demographic and preamputation experience differences, few differences in outcomes emerged by etiology group in the first year after amputation. Findings suggest that the year after amputation may be a time of greater change for those with traumatic amputation compared to those with nontraumatic amputation.

  17. Very low survival rates after non-traumatic lower limb amputation in a consecutive series: what to do?

    Science.gov (United States)

    Kristensen, Morten Tange; Holm, Gitte; Kirketerp-Møller, Klaus; Krasheninnikoff, Michael; Gebuhr, Peter

    2012-05-01

    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% trans-femoral) were studied. Their mean age was 75.8 years; 21 (23%) were admitted from a nursing home and 87 (92%) were amputated due to a vascular disease and/or diabetes. Thirty days and 1-year mortality were 30 and 54%, respectively. Cox regression analysis demonstrated that the 30-day mortality was associated with older age (P = 0.01), and the number of co-morbidities (P = 0.04), when adjusted for gender, previous amputations, cause of and amputation level, and residential status. Thus, a patient with 4 or 5 co-morbidities (n = 20) was seven times more likely to die within 30 days, compared with a patient with 1 co-morbidity (n = 16). Further, the risk of not surviving increased with 7% per each additional year the patient got older. Of concern, almost one-third of patients died within 1 month. This may be unavoidable, but a multidisciplinary, optimized, multimodal pre- and postoperative programme should be instituted, trying to improve the outcome.

  18. Below-knee amputations as a result of land-mine injuries: comparison of primary closure versus delayed primary closure.

    Science.gov (United States)

    Ateşalp, A S; Erler, K; Gür, E; Solakoglu, C

    1999-10-01

    Antipersonnel land mines are designed to maim by mutilating the lower extremities, and these injuries are at higher risk for infection than injuries from other weapon systems. The results of 474 unilateral traumatic below-knee amputations as a result of land-mine injuries were reviewed. If the delay in evacuation between the injury and arrival to the battle field hospital was less than 6 hours, 392 amputation stumps (group I) were closed primarily after meticulous debridement. Open amputation was performed after debridement in the remaining 82 amputation stumps (group II), because there was a suspicion of ineffective debridement, although they were evacuated in less than 6 hours or delay was more than 6 hours. Eleven patients in group I (2.8%) were reoperated because of wound sepsis of the stump. Wound sepsis was not encountered in group II. A total of 87.4% of stumps in group I and 81.2% of stumps in group II had healed without a problem. No gas gangrene or tetanus was encountered in any cases. Our results reveal that primary closure may be done in traumatic below-knee amputations caused by land-mine injuries with an acceptable infection rate, if the evacuation time is less than 6 hours, and if there is meticulous debridement.

  19. Comparison of the risk of non-traumatic lower extremity amputation between haemodialysis and peritoneal dialysis patients with end-stage renal disease.

    Science.gov (United States)

    Wang, I-Kuan; Hsu, Chung-Ho; Tsai, Chun-Hao; Chang, Shih-Sheng; Lin, Cheng-Li; Yen, Tzung-Hai; Lin, Shih-Yi; Lin, Chung-Chih; Liu, Jiung-Hsiun; Chang, Chiz-Tzung; Sung, Fung-Chang

    2018-01-01

    We used insurance claims data of Taiwan to compare the risk of non-traumatic lower extremity amputation between haemodialysis (HD) and peritoneal dialysis (PD) patients. We identified 77 669 HD patients and 10 035 PD patients without prior amputation from 2000 to 2010. Incidence rates and hazard ratios (HRs) of lower extremity amputation, and subsequent 30-day mortality after amputation were evaluated up to 31 December 2011. There were 2427 and 216 patients undergoing lower extremity amputation during follow-up in the HD and PD groups with incidence rates of 8.35 and 5.79 per 1000 person-years, respectively. Compared with the HD group, the overall adjusted HR of lower extremity amputation for the PD group was 1.27 (95% CI = 1.10-1.46). The impact of diabetes status on the risk of lower extremity amputation interacted with dialysis modality significantly (P amputation, whereas those without diabetes had an adjusted HR of 0.58 (95% CI = 0.36-0.95). The subsequent 30-day mortality rates after amputation were not significantly different between the HD and PD groups (8.45% vs. 9.72%) with an adjusted odds ratio of 1.41 (95% CI = 0.87-2.28, PD versus HD). Compared with corresponding HD patients, the amputation risk is higher for PD patients with diabetes, while the risk is lower for PD patients without diabetes. Dialysis patients have a high 30-day mortality risk after amputation. © 2016 Asian Pacific Society of Nephrology.

  20. Decellularized Matrix and Supplemental Fat Grafting Leads to Regeneration following Traumatic Fingertip Amputation.

    Science.gov (United States)

    Sivak, Wesley N; Ruane, Edward J; Hausman, Steven J; Rubin, J Peter; Spiess, Alexander M

    2016-10-01

    Decellularized scaffold materials are capable of regenerating missing tissues when utilized under appropriate conditions. Fat grafting also has reported advantages in revitalizing damaged tissue beds. This report details a case of traumatic fingertip amputation treated with a combination of decellularized materials in conjunction with fat grafting, resulting in a supple and functional reconstruction of the affected digit. After traumatic fingertip amputation, a patient was initially treated with decellularized porcine urinary bladder matrix powder. As a second stage, the healed tip scar tissue was reexcised, and a second application of powder was applied. As a third stage, the tip scar tissue was reexcised and a decellularized bilayer was sewn into the soft tissues of the debrided tip, resulting in an improved soft tissue envelope. As a final stage, the restored fingertip soft tissue envelope was fat grafted for additional bulk. Patient underwent treatment every other day with decellularized porcine urinary bladder matrix (powder and bilayer) and was able to reasonably regenerate the traumatic fingertip soft tissue envelope. This resulted in an envelope that was further enhanced with fat grafting. The resulting digit was sensate with maintained length, and possessed a more normal appearance than would be achieved by healing by secondary intention, or local flap or graft coverage. Decellularized materials can be utilized in conjunction with fat grafting to treat traumatic fingertip amputations in select patients. This combination approach is able to achieve a sensate fingertip and regain length lost in the affected digit. Additionally, we describe a novel technique that can be employed to maximize the amount of soft tissue regenerated by the decellularized products.

  1. Protective effect of spirolactone on kidney damage in rats after amputation and its mechanism

    Directory of Open Access Journals (Sweden)

    Ying ZHANG

    2015-07-01

    Full Text Available Objective To explore the protective effect and its possible mechanism of spirolactone against kidney injury in rats after amputation. Methods Forty-two male Wistar rats were randomly divided into 6 groups: normal control, 6 hours, 24 hours, 48 hours, 72 hours after the operation and spirolactone intervention groups (n=7, each. Plasma angiotensin Ⅱ (Ang Ⅱ, aldosterone (ALD, myeloperoxidase (MPO, malondialdehyde (MDA, interleukin-6 (IL-6, nitric oxide (NO, urea nitrogen (Ur, creatinine (Cr concentration and renal tissue ALD, MPO, MDA and calcineurin (CaN mRNA levels were determined. Renal pathological changes were observed by light microscopy. Results At 6h after amputation, traumatic changes in rat kidney tissue were seen, and the levels of Cr, AngⅡ, MDA, MPO, IL-6 and CaN-mRNA were significantly elevated, while NO concentration was significantly lowered. Spirolactone intervention reduced the damage of kidney tissue, and the levels of MPO, IL-6, Ang Ⅱ in plasman, contents of MPO and ALD and expression level of CaN mRNA in kidney tissue were significantly lowered, but the levels of Cr, Ur, MDA and ALD in plasma and content of MDA in kidney tissue showed no significant change. Conclusion Spirolactone can provide protective effect against renal damage in rats after amputation, and it may be related to the mechanism that spirolactone inhibits secretion of ALD and lowers the expression and activation of CaN mRNA, thus reducing the release of pro-inflammatory factors. DOI: 10.11855/j.issn.0577-7402.2015.07.10

  2. Long-term outcome following upper extremity replantation after major traumatic amputation.

    Science.gov (United States)

    Mattiassich, G; Rittenschober, F; Dorninger, L; Rois, J; Mittermayr, R; Ortmaier, R; Ponschab, M; Katzensteiner, K; Larcher, L

    2017-02-10

    Amputations in general and amputations of upper extremities, in particular, have a major impact on patients' lives. There are only a few long-term follow-up reports of patients after macro-replantation. We present our findings in contrast with the existing literature. Sixteen patients with traumatic macro-amputation of an upper extremity were eligible for inclusion in this study. Altogether, the patients underwent replantation in 3 institutions between 1983 and 2011. Twelve male and four female patients with an average age at injury of 40.6 years (range, 14-61 years) were included in this study. The mean follow-up period was 13.5 years (range, 4.4-32.6 years; SD, 5.7 years). The mean disabilities of the arm, shoulder and hand (DASH) outcome measure was 41 (range, 5.2-94.8; SD, 18.2), functional independence measurement (FIM) was 125 (range, 120-126; SD, 1.8). Chen I representing very good function was accounted in six, Chen II representing good function in eight, Chen III (fair) in one and Chen IV (bad function) in one patient. We found that while the majority of the included patients exhibited good or very good function of the extremity, none of the replanted appendages regained normal levels of functionality. In addition, all participants were very satisfied with their outcomes. Positive long-term results with high rates of subjective satisfaction are possible after replantation of upper extremities.

  3. The potential for non-invasive brain stimulation to improve function after amputation.

    Science.gov (United States)

    G Hordacre, Brenton; C Ridding, Michael; V Bradnam, Lynley

    2016-07-01

    Lower limb amputee rehabilitation has traditionally focussed on restoration of gait and balance through use of prosthetic limbs and mobility aids. Despite these efforts, some amputees continue to experience difficulties with mastering prosthetic mobility. Emerging techniques in rehabilitation, such as non-invasive brain stimulation (NIBS), may be an appropriate tool to enhance prosthetic rehabilitation outcomes by promoting "normal" brain reorganisation and function. The purpose of this review is to highlight the potential of NIBS to improve functional outcomes for lower limb amputees. To demonstrate the rationale for applying NIBS to amputees, this study will first review literature regarding human motor control of gait, followed by neurophysiological reorganisation of the motor system after amputation and the relationship between brain reorganisation and gait function. We will conclude by reviewing literature demonstrating application of NIBS to lower limb muscle representations and evidence supportive of subsequent functional improvements. Imaging, brain stimulation and behavioural evidence indicate that the cortex contributes to locomotion in humans. Following amputation both hemispheres reorganise with evidence suggesting brain reorganisation is related to functional outcomes in amputees. Previous studies indicate that brain stimulation techniques can be used to selectively promote neuroplasticity of lower limb cortical representations with improvements in function. We suggest NIBS has the potential to transform lower limb amputee rehabilitation and should be further investigated. Implications for Rehabilitation Despite extensive rehabilitation some amputees continue to experience difficulty with prosthetic mobility Brain reorganisation following amputation has been related to functional outcomes and may be an appropriate target for novel interventions Non-invasive brain stimulation is a promising tool which has potential to improve functional outcomes for

  4. Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion.

    Science.gov (United States)

    Pereira, Erlick A C; Boccard, Sandra G; Linhares, Paulo; Chamadoira, Clara; Rosas, Maria José; Abreu, Pedro; Rebelo, Virgínia; Vaz, Rui; Aziz, Tipu Z

    2013-09-01

    Fifteen hundred patients have received deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy over the last half-century, but few during the last decade. Deep brain stimulation for neuropathic pain has shown variable outcomes and gained consensus approval in Europe but not the US. This study prospectively evaluated the efficacy at 1 year of DBS for phantom limb pain after amputation, and deafferentation pain after brachial plexus avulsion (BPA), in a single-center case series. Patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, 36-Item Short-Form Health Survey (SF-36), Brief Pain Inventory (BPI), and University of Washington Neuropathic Pain Score (UWNPS). Twelve patients were treated over 29 months, receiving contralateral, ventroposterolateral sensory thalamic DBS. Five patients were amputees and 7 had BPAs, all from traumas. A postoperative trial of externalized DBS failed in 1 patient with BPA. Eleven patients proceeded to implantation and gained improvement in pain scores at 12 months. No surgical complications or stimulation side effects were noted. In the amputation group, after 12 months the mean VAS score improved by 90.0% ± 10.0% (p = 0.001), SF-36 by 57.5% ± 97.9% (p = 0.127), UWNPS by 80.4% ± 12.7% (p stimulation demonstrated efficacy at 1 year for chronic neuropathic pain after traumatic amputation and BPA. Clinical trials that retain patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.

  5. Osseointegrated Prosthetic Limb for the treatment of lower limb amputations : Experience and outcomes.

    Science.gov (United States)

    Al Muderis, Munjed; Lu, William; Li, Jiao Jiao

    2017-04-01

    Osseointegration has emerged over the past two decades as a dramatically different approach for the treatment of lower limb amputations, which involves direct attachment of the prosthesis to the skeletal residuum. This approach can address many of the socket-interface issues associated with socket prostheses which represent the current standard of care for amputees. The Osseointegrated Prosthetic Limb (OPL) is an osseointegration implant with a new design and improved features compared to other available implant systems. To report on the experience and outcomes of using the OPL for osseointegrated reconstruction of lower limb amputations. This is a retrospective study of 22 patients who received the OPL implant between December 2013 and November 2014. Clinical outcomes were obtained pre- and post-operatively, with results reported at the 1‑year follow-up. Outcome measures included the Questionnaire for persons with a Trans-Femoral Amputation (Q-TFA), Short Form Health Survey 36 (SF-36), Six-Minute Walk Test (6MWT), and Timed Up and Go (TUG). Adverse events were also recorded. Compared to the mean pre-operative values obtained while patients were using socket prostheses or were wheelchair-bound, the mean post-operative values for all four validated outcome measures were significantly improved. There were 15 episodes of minor infections in 12 patients, all of which responded to antibiotics. Soft tissue refashioning was performed electively on 6 patients. No other adverse events were recorded. The results demonstrate that osseointegration surgery using the OPL is a relatively safe and effective procedure for the reconstruction and rehabilitation of lower limb amputees.

  6. [The endo-exo prosthesis treatment concept : Improvement in quality of life after limb amputation].

    Science.gov (United States)

    Hoffmeister, T; Schwarze, F; Aschoff, H H

    2017-05-01

    Osseointegrated, percutaneous implants as the force bearer for exoprosthetics after limb amputation have been used in individual cases for clinical rehabilitation of amputees during the past years. Most experience in this field in Germany has been accumulated at the Sana Klinik in Lübeck with the so-called endo-exo prosthesis (EEP) system. The two-step implantation procedure can now be considered as reliable. Following a well-documented learning curve initial soft tissue problems concerning the cutaneous stoma can now be regarded as exceptions. The retrospective examination of the results concerning by now more than 100 patients provided with an endo-exo femoral prosthesis (EEFP) showed a very satisfying outcome concerning objective as well as subjective values, such as duration of daily use and wearing comfort of the exoprosthesis. Regaining the ability of osseoperception due to the intraosseous fixation is described by the patients as a great advantage. The step from a socket prosthesis to an EEP is felt to be a big increase in quality of life by nearly all patients included into the follow-up. Nearly all of the patients questioned would choose an endo-exo prosthesis again. Meanwhile, the success of the EEP resulted in the broadening of indications from above-knee amputations to transtibial as well as transhumeral amputations. The results are likewise encouraging. The use of EEP for the upper limbs leads to substantial improvement in the range of motion of the shoulder joint with the intramedullary anchored percutaneous implant. Furthermore, new pathbreaking possibilities in the fixation of myoelectrically controlled arm prostheses may arise from the EEP technique.

  7. Relationships among perceived functional capacity, self-efficacy, and disability after dysvascular amputation.

    Science.gov (United States)

    Miller, Matthew J; Magnusson, Dawn M; Lev, Guy; Fields, Thomas T; Cook, Paul F; Stevens-Lapsley, Jennifer E; Christiansen, Cory L

    2018-03-23

    Prosthesis rehabilitation after dysvascular transtibial amputation (TTA) is focused on optimizing functional capacity with limited emphasis on promoting health self-efficacy. Self-efficacy interventions decrease disability for people living with chronic disease, but the influence of self-efficacy on disability is unknown for people with dysvascular TTA. To identify if self-efficacy mediates the relationship between self-reported functional capacity and disability after dysvascular TTA. Cross-sectional, secondary data analysis. Outpatient rehabilitation facilities. Thirty-eight men (63.6 ± 9.1 years old) with dysvascular TTA. Participants were tested who had been living 1-5 years with amputation and using walking as their primary form of locomotion using a prosthesis. The independent variable, functional capacity, was measured using the Prosthesis Evaluation Questionnaire - Mobility Scale (PEQ-MS). The proposed mediator, self-efficacy, was measured with the Self-Efficacy of Managing Chronic Disease questionnaire (SEMCD). Disability was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire. The relationship between self-reported functional capacity and disability is partially mediated by self-efficacy. Relationships between WHODAS 2.0 and PEQ-MS (r = -0.61), WHODAS 2.0 and SEMCD (r = -0.51), and PEQ-MS and SEMCD (r = 0.44) were significant (P WHODAS 2.0 remained significant (P disability is partially mediated by self-efficacy after dysvascular TTA. The longitudinal effect of self-efficacy should be further examined to identify causal pathways of disability after dysvascular amputation. Furthermore, additional factors contributing to the relationship between self-reported functional capacity and disability need to be identified. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  8. Femoral head and neck excision in a dog that had previously undergone contralateral hind limb amputation.

    Science.gov (United States)

    Carpenter, L G; Oulton, S A; Piermattei, D L

    1996-03-01

    A German Shepherd Dog that underwent left hind limb amputation at 6 weeks of age because of quadriceps contracture developed arthritis of the remaining coxofemoral joint when it was 6 months old. The dog subsequently underwent femoral head and neck excision, and following rehabilitation that included intensive physical therapy, the dog was able to walk and run without signs of pain or disability. Strength and agility were maintained during a 4.5-year follow-up period. This case demonstrates the importance of postoperative management in the successful outcome of femoral head and neck excision in a large dog with only 1 hind limb.

  9. Physical Rehabilitation for Disabled People with Insulin-independent Diabetes after Single Leg Amputation

    Directory of Open Access Journals (Sweden)

    Nataliya A. Pilosyan

    2012-11-01

    Full Text Available The article presents the program of physical rehabilitation for the disabled people with insulin-independent diabetes, who came through single leg amputation. The program includes phantom-impulsive gymnastics, exercises for the remaining leg, back and shoulders, for the improvement of stump functional state, equilibrium exercises and exercises for arms supporting function development. Set of therapeutic exercises involves exercise machine training. The application of the developed physical rehabilitation program at the stage of preparation for fitting the prosthesis and learning to walk on prosthetic leg has proved its efficiency according to test results, biomedical methods of research and increases the motor activity of 100% percent of patients.

  10. [Prosthetics and Orthotics: Prosthetic Fitting in Lower Extremity in Transfemoral Amputation].

    Science.gov (United States)

    Greitemann, Bernhard

    2017-12-01

    Modern prosthetic equipment often enables reintegration of patients with the amputation of a lower limb into their private life, their professional and social environment to a large extent. Provisioning of the lower extremity with artificial limbs aims at a life as normal as possible for the involved individual. The modules are selected in an interdisciplinary team. An optimal fitting of the socket, the correct static set-up, the appropriate fitting as well as cosmetic aspects are the essential basis for a sufficient provisioning. Knee and foot components should be chosen according to the individual patient's situation including their prognostic mobility classification. Georg Thieme Verlag KG Stuttgart · New York.

  11. Chronic Low Back Pain in Individuals with Lower-limb Amputation

    Directory of Open Access Journals (Sweden)

    Ademir Kušljugić

    2006-05-01

    Full Text Available Low back pain (LBP is a common condition in individuals which experienced psychology and physical trauma. LBP is usually found in persons with lower-limb amputation (LLA, as the most common sign of somatisation or inappropriately made prostheses. Our goal was to investigate cases of chronic pain syndrome in persons with LLA and to determine factors, which influence their functional inability due to LBP. Pain after LLA has been studied. 37 persons, including 26 war veterans (70.2 % and 11 (29.8 % civilians with LLA due to an illness, were examined. All participants gave their informed consent and filled Oswestry index of disability due to chronic LBP, divided into 10 sections with 6 questions each, with marks in the range 0-5. The average age of 37 analyzed participants with LLA was 46.2+-10.92 years. 30 participants (81.1 % were married, 4 (10.8 % were single and 3 (8.1 % were widows. 27 (73.0 % participants had below the knee amputation, 5 (13.5 % had above the knee amputation and 5 (13.5 % had foot amputation. 33 (89.6 % participants experienced chronic LBP in the last 2-10 years and 4 (10.8 % did not have pains. According to Oswestry index for chronic pain higher level of social functionality was found in civilian amputees than in war veterans (p<0.05. Married civilian amputees have higher level of disability during seating (p<0.01, sleeping (p<0.01 and traveling (p<0.05. Higher level of social disorder among civilian amputees is due to the fact that they belong to older group of participants which usually have social integration at the lower degree. More serious problems during seating, traveling and sleeping among this group are probably due to co morbidity. Chronic LBP was found among 89.6 % of the participants. Higher level of social disorder, problems during seating, traveling and sleeping were identified in the civilian amputees and the married participants.

  12. Dual-task related gait changes in individuals with trans-tibial lower extremity amputation.

    Science.gov (United States)

    Hunter, Susan W; Frengopoulos, Courtney; Holmes, Jeffrey; Viana, Ricardo; Payne, Michael W C

    2018-03-01

    The improvement of gait and mobility are major rehabilitation goals following lower extremity amputations. However, when living in the community many daily activities require the multitasking of motor and cognitive tasks. The dual-task paradigm can be used to evaluate the concurrent performance of mobility and cognitive tasks. The purpose of this study was to evaluate the effects of dual-task gait testing in older adults with trans-tibial amputations. Twenty-four people (15 men, mean age ± SD, 62.72 ± 8.59) with trans-tibial amputation walked on an electronic walkway at i) self-selected comfortable pace and ii) self-selected comfortable pace while counting backwards by threes from a number randomly selected between 100 and 150. Cognitive performance, in the form of corrected response rate, was also evaluated as a single-task. The dual-task testing produced poorer performance in velocity (single-task = 58.15 ± 23.16 cm/s, dual-task = 50.92 ± 21.16 cm/s, p = 0.008), cadence (single-task = 76.65 ± 15.84 steps/min, dual-task = 67.85 ± 15.76 steps/min, p = 0.002) and stride time (single-task = 1094 ± 458.28 ms, dual-task = 1241.44 ± 513.73 ms, p = 0.005). Step length, stance time and single limb support time symmetry were also affected, such that less time was spent on the amputated limb during the dual-task testing. Dual-task testing demonstrated interference resulting in a poor performance in both gait and cognitive performance in trans-tibial amputees. Further research is suggested to evaluate the change in cognition-mobility effects over time and the relationship of this value to future adverse events such as falls and successful outcomes such as community ambulation and reintegration. Copyright © 2018 Elsevier B.V. All rights reserved.

  13. Crural Amputation of a Newborn as a Consequence of Intraosseous Needle Insertion and Calcium Infusion

    DEFF Research Database (Denmark)

    Oesterlie, Gorm Erlend; Petersen, Klaus Kjaer; Knudsen, Lars

    2014-01-01

    Intraosseous needle insertion and infusion is considered an easy and reliable method of achieving a vascular access in acute circulatory collapse where other methods have not been successful within reasonable time. Complications are considered few but may be serious. We present a case of a newborn...... girl, where intraosseous cannulation of the tibia was lifesaving. Despite following most standard recommendations, the treatment resulted in transtibial amputation due to necrosis. We suspect that the necrosis was a consequence of extravasation of tissue-toxic calcium infusion....

  14. Penile amputation and scrotal urethrostomy followed by chemotherapy in a dog with penile hemangiosarcoma.

    Science.gov (United States)

    Bolfer, Luiz; Schmit, Joanna M; McNeill, Amy L; Ragetly, Chantal A; Bennett, R Avery; McMichael, Maureen

    2015-01-01

    A 7 yr old castrated male standard poodle weighing 25 kg was presented with a 5 day history of hematuria, dysuria, and the presence of a 2.5 cm, firm swelling within the prepuce. Abdominal radiographs revealed a soft-tissue mass on the distal prepuce and lysis of the cranial margin of the os penis. The patient was sedated and an ulcerated hemorrhagic mass was identified at the tip of the penis. The mass was diagnosed as hemangiosarcoma via incisional biopsy. A penile amputation with scrotal urethrostomy was performed followed by chemotherapy with doxorubicin.

  15. Improving Surgical Techniques of Finger Amputation and Treatment of Patients with Diabetic Foot Syndrome

    OpenAIRE

    M.O. Prystupiuk; B.Р. Bezrodnyi

    2015-01-01

    We have performed surgeries in 31 patients with diabetes mellitus complicated by diabetic foot syndrome of neuropathic and neuroischemic origin. The study group consisted of 11 men aged 60.50 ± 1.50 years and 20 women aged 70.95 ± 1.45 years on the average. The control group included 30 patients. Groups were representative by the age, gender and comorbidity. All patients underwent amputation of the phalanges using the proposed method. In the treatment of wounds in patients of the study group,...

  16. Reliability, Validity, and Responsiveness of the QuickDASH in Patients With Upper Limb Amputation.

    Science.gov (United States)

    Resnik, Linda; Borgia, Matthew

    2015-09-01

    To examine the internal consistency, test-retest reliability, validity, and responsiveness of the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in persons with upper limb amputation. Cross-sectional and longitudinal. Three sites participating in the U.S. Department of Veterans Affairs Home Study of the DEKA Arm. A convenience sample of upper limb amputees (N=44). Training with a multifunction upper limb prosthesis. Multiple outcome measures including the QuickDASH were administered twice within 1 week, and for a subset of 20 persons, after completion of in-laboratory training with the DEKA Arm. Scale alphas and intraclass correlation coefficient type 3,1 (ICC3,1) were used to examine reliability. Minimum detectable change (MDC) scores were calculated. Analyses of variance, comparing QuickDASH scores by the amount of prosthetic use and amputation level, were used for known-group validity analyses with alpha set at .05. Pairwise correlations between QuickDASH and other measures were used to examine concurrent validity. Responsiveness was measured by effect size (ES) and standardized response mean (SRM). QuickDASH alpha was .83, and ICC was .87 (95% confidence interval, .77-.93). MDC at the 95% confidence level (MDC95%) was 17.4. Full- or part-time prosthesis users had better QuickDASH scores compared with nonprosthesis users (P=.021), as did those with more distal amputations at both baseline (P=.042) and with the DEKA Arm (P=.024). The QuickDASH was correlated with concurrent measures of activity limitation as expected. The ES and SRM after training with the DEKA Arm were 0.6. This study provides evidence of reliability and validity of the QuickDASH in persons with upper limb amputation. Results provide preliminary evidence of responsiveness to prosthetic device type/training. Further research with a larger sample is needed to confirm results. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by

  17. Preoperative determination of the level of amputation in chronic arterial occlusion. 2. /sup 133/Xe muscle clearance

    Energy Technology Data Exchange (ETDEWEB)

    Geissler, U.; Brueckner, L. (Karl-Marx-Universitaet, Leipzig (German Democratic Republic))

    1985-10-01

    Two quantitative methods of blood flow measuring, venous occlusion plethysmography and /sup 133/Xe muscle clearance, were compared with regard to their suitability in determining the level of amputation preoperatively. The examinations were performed in 38 patients and 20 healthy control subjects. In differentiation between stump healing and distinctive disturbances of wound healing after lower leg amputation the best results could be obtained by the /sup 133/Xe clearance test (p < 0.05), followed by /sup 133/Xe clearance ischemia test and venous occlusion plethysmography. Blood flow measurements are in connection with clinical data auxiliaries in determining the level of amputation. Their application as absolute determinants seems to be not sensible. Considerable scattering of the measured values reduces the usefulness of the two methods.

  18. Pendulating-A grounded theory explaining patients' behavior shortly after having a leg amputated due to vascular disease.

    Science.gov (United States)

    Madsen, Ulla Riis; Hommel, Ami; Bååth, Carina; Berthelsen, Connie Bøttcher

    2016-01-01

    Although the group of vascular leg amputated patients constitutes some of the most vulnerable and frail on the orthopedic wards, previous research of amputated patients has focused on patients attending gait training in rehabilitation facilities leaving the patient experience shortly after surgery unexplored. Understanding patients' behavior shortly after amputation could inform health professionals in regard to how these vulnerable patients' needs at hospital can be met as well as how to plan for care post-discharge. To construct a grounded theory (GT) explaining patients' behavior shortly after having a leg amputated as a result of vascular disease. In line with constructivist GT methodology, data from ethnographic observations and interviews were simultaneously collected and analyzed using the constant comparative method covering the patients' experiences during the first 4 weeks post-surgery. Data collection was guided by theoretical sampling and comprised 11 patients. A GT was constructed. Patients went through a three-phased process as they realized they were experiencing a life-changing event. The first phase was "Losing control" and comprised the sub-categories "Being overwhelmed" and "Facing dependency." The second phase was "Digesting the shock" and comprised the sub-categories "Swallowing the life-changing decision," "Detecting the amputated body" and "Struggling dualism." The third phase was "Regaining control" and comprised the sub-categories "Managing consequences" and "Building-up hope and self-motivation." "Pendulating" was identified as the core category describing the general pattern of behavior and illustrated how patients were swinging both cognitively and emotionally throughout the process. The theory of "Pendulating" offers a tool to understand the amputated patients' behavior and underlying concerns and to recognize where they are in the process. Concepts from the theory could be used by health professionals who support patients coping with

  19. Principal component analysis in ground reaction forces and center of pressure gait waveforms of people with transfemoral amputation.

    Science.gov (United States)

    Soares, Denise Paschoal; de Castro, Marcelo Peduzzi; Mendes, Emilia Assunção; Machado, Leandro

    2016-12-01

    The alterations in gait pattern of people with transfemoral amputation leave them more susceptible to musculoskeletal injury. Principal component analysis is a method that reduces the amount of gait data and allows analyzing the entire waveform. To use the principal component analysis to compare the ground reaction force and center of pressure displacement waveforms obtained during gait between able-bodied subjects and both limbs of individuals with transfemoral amputation. This is a transversal study with a convenience sample. We used a force plate and pressure plate to record the anterior-posterior, medial-lateral and vertical ground reaction force, and anterior-posterior and medial-lateral center of pressure positions of 12 participants with transfemoral amputation and 20 able-bodied subjects during gait. The principal component analysis was performed to compare the gait waveforms between the participants with transfemoral amputation and the able-bodied individuals. The principal component analysis model explained between 74% and 93% of the data variance. In all ground reaction force and center of pressure waveforms relevant portions were identified; and always at least one principal component presented scores statistically different (p analysis was able to discriminate many portions of the stance phase between both lower limbs of people with transfemoral amputation compared to the able-bodied participants. Principal component analysis reduced the amount of data, allowed analyzing the whole waveform, and identified specific sub-phases of gait that were different between the groups. Therefore, this approach seems to be a powerful tool to be used in gait evaluation and following the rehabilitation status of people with transfemoral amputation. © The International Society for Prosthetics and Orthotics 2015.

  20. Early utilization of hypertonic peritoneal dialysate and subsequent risks of non-traumatic amputation among peritoneal dialysis patients: a nationwide retrospective longitudinal study.

    Science.gov (United States)

    Lin, Shih-Yi; Lin, Che-Chen; Lin, Chung-Chih; Chung, Chi-Jung; Yeh, Horng-Che; Wang, I-Kuan; Ting, I-Wen; Huang, Chiu-Chin; Sung, Fung-Chang

    2013-06-20

    The hemodialysis (HD) population has a particularly high incidence of amputation, which is likely associated with decreased tissue oxygenation during HD. However, information about the risk factors leading to amputation in peritoneal dialysis (PD) patients is limited. Here, we have investigated the association between the use of hypertonic peritoneal dialysate (HPD) and subsequent amputation in PD patients. Based on the data from the Taiwan National Health Insurance research database, this observational cohort study enrolled 203 PD patients who had received HPD early during treatment and had not undergone amputation and 296 PD controls who had not undergone amputation. Subjects were followed through until the end of 2009 and the event rates of new non-traumatic amputation were compared between groups. The incidence of amputation was 3 times higher for the HPD cohort than for the comparison cohort (23.68 vs. 8.01 per 1000 person-years). The hazard ratio (HR) for this group, estimated using a multivariable Cox model, was 2.48 (95% confidence interval [CI] = 1.06-5.79). The HR for patients with both diabetes and early adoption of HPD increased to 44.34 (95% CI = 5.51-357.03), compared to non-HPD non-diabetic PD controls. Early utilization of HPD in PD patients is associated with increasing risk of amputation; this risk considerably increases for those with concomitant diabetes.

  1. Trends in the incidence of lower extremity amputations in people with and without diabetes over a five-year period in the Republic of Ireland.

    LENUS (Irish Health Repository)

    Buckley, Claire M

    2012-01-01

    To describe trends in the incidence of non-traumatic amputations among people with and without diabetes and estimate the relative risk of an individual with diabetes undergoing a lower extremity amputation compared to an individual without diabetes in the Republic of Ireland.

  2. Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary team work and continuous prospective audit.

    Science.gov (United States)

    Krishnan, Singhan; Nash, Fiona; Baker, Neil; Fowler, Duncan; Rayman, Gerry

    2008-01-01

    To assess changes in diabetic lower-extremity amputation rates in a defined relatively static population over an 11-year period following the introduction of a multidisciplinary foot team. All diabetic patients with foot problems admitted to Ipswich Hospital, a large district general hospital, were identified by twice-weekly surveillance of all relevant in-patient areas and outcomes including amputations recorded. The incidence of major amputations fell 62%, from 7.4 to 2.8 per 100,000 of the general population. Total amputation rates also decreased (40.3%) but to a lesser extent due to a small increase in minor amputations. Expressed as incidence per 10,000 people with diabetes, total amputations fell 70%, from 53.2 to 16.0, and major amputations fell 82%, from 36.4 to 6.7. Significant reductions in total and major amputation rates occurred over the 11-year period following improvements in foot care services including multidisciplinary team work.

  3. Elective amputation of the upper limb is an option in the treatment of traumatic injuries of the brachial plexus?

    Science.gov (United States)

    Siqueira, Mário Gilberto; Martins, Roberto Sérgio; Heise, Carlos Otto; Foroni, Luciano

    2017-09-01

    The treatment of complete post-traumatic brachial plexus palsy resulting in a flail shoulder and upper extremity remains a challenge to peripheral nerve surgeons. The option of upper limb amputation is controversial and scarcely discussed in the literature. We believe that elective amputation still has a role in the treatment of select cases. The pros and cons of the procedure should be intensely discussed with the patient by a multidisciplinary team. Better outcomes are usually achieved in active patients who strongly advocate for the procedure.

  4. Perceptions and experiences of nutritional care following the overwhelming experience of lower extremity amputation; a qualitative study

    DEFF Research Database (Denmark)

    Jensen, P S; Green, S M; Petersen, J

    2018-01-01

    INTRODUCTION: Good nutritional care of people following major lower extremity amputation is essential as poor nutritional status can lead to delayed wound healing. Working with patients to identify their perspectives on food, views on nutritional care and the need for dietary counselling enables......-structured interviews with a purposive sample of 17 people over 50 years of age, who had recently undergone major lower extremity amputation, was undertaken. The study was reported according to the COREQ guideline. FINDINGS: Three themes emerged; Responsible for own dietary intake, Diet based on preferences...

  5. Surgical Fixation of a Comminuted Inter-Trochanteric Fracture in a Patient with Bilateral Below Knee Amputation

    Directory of Open Access Journals (Sweden)

    Lee BH

    2018-03-01

    Full Text Available Surgical fixation of hip fractures in patients with below knee amputation is challenging due to the difficulty in obtaining optimal traction for reduction of the fracture. Surgeons may face difficulty in positioning such patients on the traction table due to the absence of the foot and distal lower limb. There are several techniques described to overcome this technical difficulty. In this case report, we present a case of a 64-year old gentleman with bilateral below knee amputation presenting with a comminuted right intertrochanteric fracture. We highlight a simple and effective method of applying skin traction to obtain adequate reduction for hip fracture fixation.

  6. Continuous Infraclavicular Block for Forearm Amputation After Being Bitten by a Saltwater Crocodile (Crocodylus Porosus: A Case Report

    Directory of Open Access Journals (Sweden)

    Chin-Hsi Chiu

    2009-08-01

    Full Text Available Two important issues after a complete right forearm amputation are replantation and ongoing pain management. There are no reports of successful forearm replantation as a consequence of a crocodile bite. Here, we discuss our pain management in a case of complete forearm amputation after a bite from a saltwater crocodile (Crocodylus porosus, which necessitated six further operations to achieve successful replantation. Continuous infraclavicular brachial plexus block was effective for acute pain control in this case. We strongly recommend performing the block with an indwelling catheter under ultrasound guidance for higher accuracy and safety.

  7. Outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review for the development of shared decision-making resources.

    Science.gov (United States)

    Dillon, Michael P; Quigley, Matthew; Fatone, Stefania

    2017-03-14

    Dysvascular partial foot amputation (PFA) is a common sequel to advanced peripheral vascular disease. Helping inform difficult discussions between patients and practitioners about the level of PFA, or the decision to have a transtibial amputation (TTA) as an alternative, requires an understanding of the current research evidence on a wide range of topics including wound healing, reamputation, quality of life, mobility, functional ability, participation, pain and psychosocial outcomes, and mortality. The aim of this review was to describe a comprehensive range of outcomes of dysvascular PFA and compare these between levels of PFA and TTA. The review protocol was registered in PROSPERO (CRD42015029186). A systematic search of the literature was conducted using MEDLINE, EMBASE, psychINFO, AMED, CINAHL, ProQuest Nursing and Allied Health, and Web of Science. These databases were searched using MeSH terms and keywords relating to different amputation levels and outcomes of interest. Peer reviewed studies of original research-irrespective of the study design-were included if published in English between 1 January 2000, and 31 December 2015, and included discrete cohort(s) with dysvascular PFA or PFA and TTA. Outcomes of interest were rate of wound healing and complications, rate of ipsilateral reamputation, quality of life, functional ability, mobility, pain (i.e., residual limb or phantom pain), psychosocial outcomes (i.e., depression, anxiety, body image and self-esteem), participation, and mortality rate. Included studies were independently appraised by two reviewers. The McMaster Critical Review Forms were used to assess methodological quality and identify sources of bias. Data were extracted based on the Cochrane Consumers and Communication Review Group's data extraction template by a primary reviewer and checked for accuracy and clarity by a second reviewer. Findings are reported as narrative summaries given the heterogeneity of the literature, except for mortality

  8. Financial analysis of diabetic patients hospitalizations submitted to lower limb amputation in a public hospital

    Directory of Open Access Journals (Sweden)

    Renata Santos Silva

    2015-03-01

    Full Text Available This study is a documental descriptive analysis which aimed to verify the cost established in 2006, in relation to the hospitalization of 21 diabetic patients submitted to the lower limb amputation in a public hospital and the value transferred by the Unified Health System (SUS regarding this procedure. Among the studied patients, 57.14% were female and 42.86% male, aged 40 to 90 years. The time of diagnosis varied from 5 to 25 years. The average of hospitalization was 14 days per patient. The cost to the hospital was R$ 99,455.74, average cost per patient was R$ 4,735.98. The total amount transferred by SUS to the hospital was R$ 27,740.15, a cost 3.6 times lower than the hospital costs. The SUS transferring is in accordance with the predetermined values for its table of procedure. Prevention is the only alternative to reduce the rate of amputation and improve survival of diabetes patients. It is necessary an early diagnosis and better control of diabetes mellitus with appropriate government and institutional policies.

  9. Evaluation of an instrument-assisted dynamic prosthetic alignment technique for individuals with transtibial amputation.

    Science.gov (United States)

    Chen, Caroline Wen Jia; Heim, Winfried; Fairley, Karen; Clement, Russell J; Biddiss, Elaine; Torres-Moreno, Ricardo; Andrysek, Jan

    2016-08-01

    A prosthesis that is not optimally aligned can adversely influence the rehabilitation and health of the amputee. Very few studies to date evaluate the effectiveness and utility of instrument-assisted alignment techniques in clinical practice. To compare an instrument-assisted dynamic alignment technique (Compas(™)) to conventional methods. In a crossover study design, dynamic prosthetic alignments were provided to nine individuals with unilateral transtibial amputations to compare conventional and instrument-assisted alignment techniques. The instrument-assisted technique involved a commercially available force and torque sensing dynamic alignment system (Compas). Cadence, pelvic accelerations, and socket moments were assessed. A custom questionnaire was used to gather user perceptions. No differences between alignment techniques were found in global gait measures including cadence and pelvic accelerations. No significant alignment differences were achieved by examination of angular changes between the socket and foot; however, significantly higher below-the-socket moments were found with the instrument-assisted technique. From the questionnaire, six amputees had no preference, while three preferred the conventional alignment. The use of Compas appears to produce similar alignment results as conventional techniques, although with slightly higher moments at the socket. This study provides new information about the clinical utilization of instrument-assisted prosthetic alignment techniques for individuals with transtibial amputation. © The International Society for Prosthetics and Orthotics 2015.

  10. The morphology of amputated human teeth and its relation to mechanical properties after restoration treatment

    Science.gov (United States)

    Gugger, Jonas; Krastl, Gabriel; Huser, Marius; Deyhle, Hans; Müller, Bert

    2010-09-01

    The increased susceptibility to fracture of root canal- and post-treated teeth is less affected by alterations of the dentin structure, but seems to crucially depend on the loss of coronal tooth substance. The surface, available for adhesion of the composite material in the root canal and in the coronal part of the tooth, is assumed to be of key importance for the fracture resistance. Thus, an appropriate three-dimensional method should be identified to determine the adhesive surface with necessary precision. For this purpose, severely decayed teeth were simulated decapitating clinical crowns. After root canal filling and post space preparation, impressions of the root canal and the amputation surface were obtained using silicone. Micro computed tomography scans of these impressions were acquired. For one selected specimen, an additional high-resolution scan was recorded at a synchrotron radiation source. Software of ImageLab served for the extraction of the amputation interface, the post surface and the post volume from the tomography data, which have been finally correlated with the Young's modulus and the maximal load derived from mechanical tests. The morphological parameters show a realistic relationship to the mechanical tests performed after the restoration treatments and are consequently important for improving the dental skills.

  11. Use of CytoSorb in Traumatic Amputation of the Forearm and Severe Septic Shock

    Directory of Open Access Journals (Sweden)

    Heinz Steltzer

    2017-01-01

    Full Text Available Severe trauma associated with later disability and mortality still constitutes a major health and socioeconomic problem throughout the world. While primary morbidity and mortality are mostly related to initial injuries and early complications, secondary lethality is strongly linked to the development of systemic inflammatory response syndrome, sepsis, and ultimately multiple organ dysfunction syndrome. We herein report on a 49-year-old male patient who was admitted to the hospital after a traumatic amputation of his right forearm that was cut off while working on a landfill. After initial treatment for shock, he received immediate replantation and was transferred to the ICU. Due to the anticipated risk of a complex infection, continuous renal replacement therapy in combination with CytoSorb was initiated. During the course of the combined treatment, a rapid improvement in hemodynamics was noticed, as well as a significant reduction of IL-6 and lactate levels. Despite a recurring septic episode and the necessity for amputation, the patient clinically stabilized and underwent complete recovery. The early treatment with a combination of CVVHDF and CytoSorb was accompanied by an attenuation of the systemic inflammatory reaction, which subsided without major or permanent organ damage, despite the impressive pathogen spectrum and the pronounced local damage.

  12. Use of Hyperbaric Oxygen as Adjunct in Salvage of Near-complete Ear Amputation

    Directory of Open Access Journals (Sweden)

    Alvaro M. Bada, MD

    2013-04-01

    Full Text Available Summary: There have been several cases of microvascular repair of traumatically avulsed or amputated ears in the literature. It seems that, if possible at the time of operation, microsurgical techniques yield the best results. However, because of the nature, complexity, and acuity of traumatic injuries, this option is not always feasible. Although the possibility of microsurgical repair exists, the small size of these vessels is often prohibitive, even for a skilled microsurgeon. Here, we present the case of a 4-year-old boy with almost complete amputation of the left ear attached by an inferior narrow skin pedicle after a dog bite. He was treated with primary repair and postoperative hyperbaric oxygen therapy (HBOT with good results. This case is another example that even a narrow skin pedicle can contain artery and vein that can supply a large segment of the auricle, making primary repair feasible because of the vascular anatomy and communicating helical arcade. Also, this case demonstrates the successful use of HBOT with a pediatric patient as an adjuvant postoperative therapy.

  13. Partial calcanectomy and Ilizarov external fixation may reduce amputation need in severe diabetic calcaneal ulcers.

    Science.gov (United States)

    Akkurt, Mehmet Orçun; Demirkale, Ismail; Öznur, Ali

    2017-01-01

    Objective : The treatment of diabetic hindfoot ulcers is a challenging problem. In addition to serial surgical debridements, hyperbaric oxygen therapy and local wound care play important roles in the surgeon's armamentarium, for both superficial infection and gangrene of the soft tissue, often complicated by osteomyelitis of the calcaneus. The purpose of this study was to evaluate the results of an aggressive approach from diagnosis to treatment of calcaneal osteomyelitis in foot-threatening diabetic calcaneal ulcers. Methods : The study included 23 patients with diabetic hindfoot ulcers who were treated with radical excision of the necrotic tissue and application of circular external fixation. The treatment protocol was a combination of magnetic resonance imaging (MRI)-guided debridement of the necrotic tissues and application of an Ilizarov external fixator in plantarflexion to decrease the soft-tissue defect. Primary outcome measures were total cure of infection and obvious healing of the osteomyelitis at 12 weeks determined by MRI, and clinical cure through objective assessment of the appearance of the wound. Results : The wounds healed in 18 of the 23 patients (78%), partial recovery occurred and subsequent flap operation was performed in three patients (13%), and below-the-knee amputation was performed in two patients (9%). Conclusions : This surgical protocol is effective in ameliorating diabetic hindfoot ulcers with concomitant calcaneal osteomyelitis, and satisfactorily reduces the need for amputation.

  14. Expression of secreted Wnt pathway components reveals unexpected complexity of the planarian amputation response.

    Science.gov (United States)

    Gurley, Kyle A; Elliott, Sarah A; Simakov, Oleg; Schmidt, Heiko A; Holstein, Thomas W; Sánchez Alvarado, Alejandro

    2010-11-01

    Regeneration is widespread throughout the animal kingdom, but our molecular understanding of this process in adult animals remains poorly understood. Wnt/β-catenin signaling plays crucial roles throughout animal life from early development to adulthood. In intact and regenerating planarians, the regulation of Wnt/β-catenin signaling functions to maintain and specify anterior/posterior (A/P) identity. Here, we explore the expression kinetics and RNAi phenotypes for secreted members of the Wnt signaling pathway in the planarian Schmidtea mediterranea. Smed-wnt and sFRP expression during regeneration is surprisingly dynamic and reveals fundamental aspects of planarian biology that have been previously unappreciated. We show that after amputation, a wounding response precedes rapid re-organization of the A/P axis. Furthermore, cells throughout the body plan can mount this response and reassess their new A/P location in the complete absence of stem cells. While initial stages of the amputation response are stem cell independent, tissue remodeling and the integration of a new A/P address with anatomy are stem cell dependent. We also show that WNT5 functions in a reciprocal manner with SLIT to pattern the planarian mediolateral axis, while WNT11-2 patterns the posterior midline. Moreover, we perform an extensive phylogenetic analysis on the Smed-wnt genes using a method that combines and integrates both sequence and structural alignments, enabling us to place all nine genes into Wnt subfamilies for the first time. Copyright © 2010 Elsevier Inc. All rights reserved.

  15. Amputation effects on the underlying complexity within transtibial amputee ankle motion

    Energy Technology Data Exchange (ETDEWEB)

    Wurdeman, Shane R., E-mail: shanewurdeman@gmail.com [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); Advanced Prosthetics Center, Omaha, Nebraska 68134 (United States); Myers, Sara A. [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); Stergiou, Nicholas [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska 68198 (United States)

    2014-03-15

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed “more appropriate” and the other “less appropriate” based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a “more appropriate” prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a “less appropriate” prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.

  16. Amputation effects on the underlying complexity within transtibial amputee ankle motion

    Science.gov (United States)

    Wurdeman, Shane R.; Myers, Sara A.; Stergiou, Nicholas

    2014-03-01

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed "more appropriate" and the other "less appropriate" based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a "more appropriate" prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a "less appropriate" prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.

  17. Strength and endurance training of an individual with left upper and lower limb amputations.

    Science.gov (United States)

    Donachy, J E; Brannon, K D; Hughes, L S; Seahorn, J; Crutcher, T T; Christian, E L

    2004-04-22

    The purpose of this article is to describe the development of a strength and endurance training programme designed to prepare an individual with a left glenohumeral disarticulation and transtibial amputation for a bike trip across the USA. The subject was scheduled for training three times per week over a two-month period followed by two times per week for an additional two months. Training consisted of a resistance training circuit using variable resistance machines, cycling using a recumbent stationary bike, and core stability training using stability ball exercises. Changes in strength were assessed using 10 RM tests on the resistance machines and changes in peak VO(2) were monitored utilizing the Cosmed K4b pulmonary function tester. The subject demonstrated a 30.3% gain in peak VO(2). The subject's 10 RM for left single limb leg press increased 36.8% and gains of at least 7.7% were seen for all other muscle groups tested. The strength and endurance training programme adapted to compensate for this subject's limb losses was effective in increasing both strength and peak VO(2). Adapting exercise programmes to compensate for limb loss may allow individuals with amputations to participate in physically challenging activities that otherwise may not be available to them.

  18. Bilateral changes in somatosensory sensibility after unilateral below-knee amputation.

    Science.gov (United States)

    Kavounoudias, Anne; Tremblay, Camille; Gravel, Denis; Iancu, Andreea; Forget, Robert

    2005-04-01

    To evaluate possible alteration in proprioceptive and cutaneous sensibility in the nonamputated leg of unilateral transtibial amputees. Cross-sectional study with between-subjects (amputees vs controls) and within-subjects (nonamputated vs amputated leg) comparisons. Canadian rehabilitation hospital research laboratory. Two groups of amputees (34 due to traumatic causes, 14 due to vascular causes), recruited more than 1 year after their prosthetic training; and 2 groups (n=34, n=14) of age-matched control subjects. Not applicable. Threshold of movement detection and touch-pressure perception at the knee and foot levels. In the traumatic group, the sensory thresholds of the nonamputated leg were significantly higher than the control values in the 2 modalities tested. The movement detection was reduced at the knee and ankle levels, whereas a decrease in touch-pressure sensibility was observed only at the plantar site. As expected, a large proportion of the vascular amputees presented with severe sensory deficits in the nonamputated leg, particularly a loss in touch-pressure perception at the foot. The thresholds of movement detection were similar and correlated at both knees in the 2 groups of amputees. For the touch-pressure thresholds, no significant relationship was found between sides at the knee level. Sensory changes observed in the nonamputated leg suggest that central sensory adaptations occur after amputation. For movement detection, they were marked by a matching of perception on both sides of the body. Functional significance of these changes remains to be determined.

  19. Leg amputation following intramuscular injection of iron dextran in a 32 year old woman

    Directory of Open Access Journals (Sweden)

    Gloria Shalviri

    2015-10-01

    Full Text Available To inform healthcare professionals of a rare serious reaction leading to leg amputation following intramuscular injection of iron dextran and report comments for preventing such reactions.A case of leg amputation following intramuscular injection of iron dextran reported to Iranian Pharmacovigilance Center was reviewed. Patient and reaction data was collected by assessing the reported yellow card, patient chart review and interviewing with patient and physicians. World Health Organization definition for serious reactions was used to determine the seriousness of the reaction. Naranjo algorithm was used to determine probability scale. The probability of the reaction was determined based on questionnaire of Schumock et al. The studied case is classified as a rare and serious but preventable reaction induced by intramuscular injection of iron dextran in a 32 year old woman. The probability of the reaction is appeared to be “probable” based on Naranjo algorithm. It seems that Iron dextran could cause serious and life threatening adverse effects. It is necessary for healthcare professionals to be informed of such rare but serious reaction in order to apply preventive actions.

  20. Rehabilitation and multiple limb amputations: A clinical report of patients injured in combat.

    Science.gov (United States)

    Melcer, Ted; Pyo, Jay; Walker, Jay; Quinn, Kimberly; Lebedda, Martin; Neises, Kamaran; Nguyen, Christina; Galarneau, Michael

    2016-01-01

    This clinical report describes the outpatient rehabilitation program for patients with multiple limb amputations enrolled in the Comprehensive Combat and Complex Casualty Care facility at the Naval Medical Center San Diego. Injury-specific data for 29 of these patients wounded by blast weaponry in Afghanistan in 2010 or 2011 were captured by the Expeditionary Medical Encounter Database at the Naval Health Research Center and were reviewed for this report. Their median Injury Severity Score was 27 (N = 29; range, 11-54). Patients averaged seven moderate to serious injuries (Abbreviated Injury Scale scores ≥2), including multiple injuries to lower limbs and injuries to the torso and/or upper limbs. All patients received care from numerous clinics, particularly physical therapy during the first 6 mo postinjury. Clinic use generally declined after the first 6 mo with the exception of prosthetic devices and repairs. The clinical team implemented the Mayo-Portland Adaptability Inventory, 4th Revision (MPAI-4) to assess functioning at outpatient program initiation and discharge (n = 23). At program discharge, most patients had improved scores for the MPAI-4 items assessing mobility, pain, and transportation, but not employment. Case reports described rehabilitation for two patients with triple amputations and illustrated multispecialty care and contrasting solutions for limb prostheses.

  1. Soccer Practice and Functional and Social Performance of Men With Lower Limb Amputations

    Directory of Open Access Journals (Sweden)

    Monteiro Rogeria

    2014-12-01

    Full Text Available Practicing sports together with rehabilitative treatment improves the development of motor, social and emotional abilities of lower limb amputees. The aim of this study was to compare the functional and social performance of individuals with lower limb amputations between those who played soccer and those who did not engage in any sports activities. A total of 138 individuals participated in the study and were divided into two groups: soccer players (n = 69, 34 ± 8.1 years and non-athletes (n = 69, 38 ± 8.9 years. A checklist, based on the International Classification of Functioning, Disability and Health, was used. Data were analyzed using the Chi-square and Mann-Whitney tests. The soccer players group showed significantly better performance than the non-athletes group in most items of body function, body structure, occupational performance components and daily activities (p < 0.001 for all, and also in some important items of social and environment factors (p < 0.001 for all. The results strongly suggest that amputee soccer significantly improves the functional and social performance in individuals with lower limb amputations.

  2. Amputation effects on the underlying complexity within transtibial amputee ankle motion

    International Nuclear Information System (INIS)

    Wurdeman, Shane R.; Myers, Sara A.; Stergiou, Nicholas

    2014-01-01

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed “more appropriate” and the other “less appropriate” based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a “more appropriate” prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a “less appropriate” prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users

  3. Amputation effects on the underlying complexity within transtibial amputee ankle motion.

    Science.gov (United States)

    Wurdeman, Shane R; Myers, Sara A; Stergiou, Nicholas

    2014-03-01

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed "more appropriate" and the other "less appropriate" based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a "more appropriate" prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a "less appropriate" prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.

  4. QUALITY-OF-LIFE IN BONE-TUMOR PATIENTS COMPARING LIMB SALVAGE AND AMPUTATION OF THE LOWER-EXTREMITY

    NARCIS (Netherlands)

    POSTMA, A; KINGMA, A; DERUITER, JH; KOOPS, HS; VETH, RPH; GOEKEN, LNH; KAMPS, WA

    In 33 long-term survivors of lower extremity bone cancer quality-of-life data were studied following limb salvage compared to amputation. Self-report questionnaires, semistructured interviews and visual analog scales were used to measure psychoneurotic and somatical distress, activities of daily

  5. Langtidsbehandling med spinal cord-stimulation hos en patient med kronisk regionalt smertesyndrom type 1 og fantomsmerter efter amputation

    DEFF Research Database (Denmark)

    Enggaard, Thomas Peter; Scherer, Christian; Nikolajsen, Lone

    2008-01-01

    The development of stump and phantom pain after limb amputation in patients with complex regional pain syndrome (CRPS) is very frequent. Stump pain is typically recurred CRPS and the possibilities for effective pharmacological pain relief are often limited. Spinal cord stimulation (SCS) has a well...

  6. Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity : Rehabilitation process and prosthetics. Part 2

    NARCIS (Netherlands)

    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

    2015-01-01

    Background: A structured, multidisciplinary approach in the rehabilitation process after amputation is needed that includes a greater focus on the involvement of both (para)medics and prosthetists. There is considerable variation in prosthetic prescription concerning the moment of initial prosthesis

  7. Explaining modified 2-min walk test outcomes in male Veterans with traumatic or nontraumatic lower-limb amputation.

    Science.gov (United States)

    Loyd, Brian J; Fields, Thomas T; Stephenson, Ryan O; Stevens-Lapsley, Jennifer; Christiansen, Cory L

    2016-01-01

    Little evidence exists to support the presence of differences in spatiotemporal gait parameters and ambulation ability between those individuals with traumatic and nontraumatic lower-limb amputation (LLA). We conducted an exploratory study of 81 male Veterans with unilateral amputation to quantify differences in spatiotemporal gait parameters and ambulatory mobility between Veterans with traumatic and nontraumatic LLA. Furthermore, we identified variables that significantly contributed to the explanation of variability in modified 2-min walk test distance. All participants completed the modified 2-min walk test and a spatiotemporal gait analysis using an instrumented walkway during a routine physical therapy visit. Veterans with nontraumatic LLA walked significantly shorter mean distances during a modified 2-min walk test than Veterans with traumatic LLA. Variables identified as significant contributors to modified 2-min walk test variability were amputated limb stance time, amputated limb step length, and percentage of the gait cycle spent in double support. These findings demonstrate that differences in spatiotemporal gait parameters and ambulatory mobility exist between Veterans with traumatic and nontraumatic LLA and identify important spatiotemporal parameters of gait contributing to this decline. These parameters should be considered as targets for intervention and future investigation.

  8. Second-toe transfer for traumatic thumb amputation in children under 5 years: bone and soft-tissue growth.

    Science.gov (United States)

    Wolff, German; Posso, Carolina

    2014-12-01

    Posttraumatic thumb amputations in children under 5 years are uncommon. The final clinical long-term results have been reported shortly in literature. We report our clinical experience in children under 5 years with traumatic amputation of the thumb that were reconstructed using a second-toe transfer. There were 7 boys and 2 girls between the ages of 1 and 5 years. The follow-up was between 6 and 14 years. The average age at the time of transfer was 2.8 years, and the average follow-up was 10.7 years (range, between 6 and 14 y). The most frequent cause of amputation was avulsion (33.3%). All the transferred toes survived and achieved bone union and static 2-point discrimination was averaged at 5 mm. They acquired good prehensile pinch and grasp. All of the structures of the transferred toes showed substantial growth. Second-toe transfer for traumatic amputation of the thumb continues to be one of the best choices. Children require secondary procedures less often and in some cases late functional recovery can be expected. It is a safe procedure and there are fewer complications and a better success rate.

  9. Can real-time visual feedback during gait retraining reduce metabolic demand for individuals with transtibial amputation?

    Directory of Open Access Journals (Sweden)

    Elizabeth Russell Esposito

    Full Text Available The metabolic demand of walking generally increases following lower extremity amputation. This study used real-time visual feedback to modify biomechanical factors linked to an elevated metabolic demand of walking in individuals with transtibial amputation. Eight persons with unilateral, traumatic transtibial amputation and 8 uninjured controls participated. Two separate bouts of real-time visual feedback were provided during a single session of gait retraining to reduce 1 center of mass sway and 2 thigh muscle activation magnitudes and duration. Baseline and post-intervention data were collected. Metabolic rate, heart rate, frontal plane center of mass sway, quadriceps and hamstrings muscle activity, and co-contraction indices were evaluated during steady state walking at a standardized speed. Visual feedback successfully decreased center of mass sway 12% (p = 0.006 and quadriceps activity 12% (p = 0.041; however, thigh muscle co-contraction indices were unchanged. Neither condition significantly affected metabolic rate during walking and heart rate increased with center-of-mass feedback. Metabolic rate, center of mass sway, and integrated quadriceps muscle activity were all not significantly different from controls. Attempts to modify gait to decrease metabolic demand may actually adversely increase the physiological effort of walking in individuals with lower extremity amputation who are young, active and approximate metabolic rates of able-bodied adults.

  10. Prediction of imminent amputation in patients with non-reconstructible leg ischemia by means of microcirculatory investigations

    NARCIS (Netherlands)

    Ubbink, D. T.; Spincemaille, G. H.; Reneman, R. S.; Jacobs, M. J.

    1999-01-01

    We investigated the usefulness of skin microcirculatory investigations to predict imminent major amputation in patients with non-reconstructible critical limb ischemia. One hundred eleven patients with non-reconstructible chronic rest pain or small ulcers and an ankle blood pressure of 50 mm Hg or

  11. REHABILITATION IN SKILLED NURSING CENTRES FOR ELDERLY PEOPLE WITH LOWER LIMB AMPUTATIONS : A MIXED-METHODS, DESCRIPTIVE STUDY

    NARCIS (Netherlands)

    Fortington, Lauren V.; Rommers, Gerardus M.; Wind-Kral, Anne; Dijkstra, Pieter U.; Geertzen, Jan H. B.

    2013-01-01

    Objectives: To describe the current set-up, barriers and potential for providing rehabilitation to people with lower limb amputation in skilled nursing centres. Design: Survey and interviews. Subjects/participants: Elderly care physicians, physiotherapists. Methods: In 2011, clinicians from 34

  12. The Desire for Amputation or Paralyzation : Evidence for Structural Brain Anomalies in Body Integrity Identity Disorder (BIID)

    NARCIS (Netherlands)

    Blom, Rianne M; van Wingen, Guido A; van der Wal, Sija J; Luigjes, Judy; van Dijk, Milenna T; Scholte, H Steven; Denys, D.

    2016-01-01

    BACKGROUND: Body Integrity Identity Disorder (BIID) is a condition in which individuals perceive a mismatch between their internal body scheme and physical body shape, resulting in an absolute desire to be either amputated or paralyzed. The condition is hypothesized to be of congenital nature, but

  13. The Desire for Amputation or Paralyzation: Evidence for Structural Brain Anomalies in Body Integrity Identity Disorder (BIID)

    NARCIS (Netherlands)

    Blom, Rianne M.; van Wingen, Guido A.; van der Wal, Sija J.; Luigjes, Judy; van Dijk, Milenna T.; Scholte, H. Steven; Denys, Damiaan

    2016-01-01

    Body Integrity Identity Disorder (BIID) is a condition in which individuals perceive a mismatch between their internal body scheme and physical body shape, resulting in an absolute desire to be either amputated or paralyzed. The condition is hypothesized to be of congenital nature, but evidence for

  14. Translation, Adaptation or Amputation? Arctic Explorer-Writer-Anthropologist Peter Freuchen's Little-Known Danish Translation of Moby Dick

    DEFF Research Database (Denmark)

    Klitgård, Ida

    2015-01-01

    . The translation was made by the internationally famous Arctic explorer and writer Peter Freuchen, and his version of the novel has been so drastically cut down to the bare skeleton of the plot that we may speak of amputation rather than adaptation. The result is a so-called real “man’s book”, as is pronounced...

  15. A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients.

    Science.gov (United States)

    Brånemark, R; Berlin, O; Hagberg, K; Bergh, P; Gunterberg, B; Rydevik, B

    2014-01-01

    Patients with transfemoral amputation (TFA) often experience problems related to the use of socket-suspended prostheses. The clinical development of osseointegrated percutaneous prostheses for patients with a TFA started in 1990, based on the long-term successful results of osseointegrated dental implants. Between 1999 and 2007, 51 patients with 55 TFAs were consecutively enrolled in a prospective, single-centre non-randomised study and followed for two years. The indication for amputation was trauma in 33 patients (65%) and tumour in 12 (24%). A two-stage surgical procedure was used to introduce a percutaneous implant to which an external amputation prosthesis was attached. The assessment of outcome included the use of two self-report questionnaires, the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and the Short-Form (SF)-36. The cumulative survival at two years' follow-up was 92%. The Q-TFA showed improved prosthetic use, mobility, global situation and fewer problems (all p reported following treatment with osseointegrated percutaneous prostheses.

  16. THE BIOMECHANICAL RESPONSE OF PERSONS WITH TRANSFEMORAL AMPUTATION TO VARIATIONS IN PROSTHETIC KNEE ALIGNMENT DURING LEVEL WALKING

    Science.gov (United States)

    Koehler-McNicholas, Sara R.; Lipschutz, Robert D.; Gard, Steven A.

    2017-01-01

    Prosthetic alignment is an important factor in the overall fit and performance of a lower-limb prosthesis. However, the association between prosthetic alignment and control strategies used by persons with transfemoral amputation to coordinate the movement of a passive prosthetic knee is poorly understood. This study investigated the biomechanical response of persons with transfemoral amputation to systematic perturbations in knee joint alignment during a level walking task. Quantitative gait data were collected for three alignment conditions: bench alignment, 2 cm anterior knee translation (ANT), and 2 cm posterior knee translation (POST). In response to a destabilizing alignment perturbation (ANT), subjects significantly increased their early-stance hip extension moment, confirming that persons with transfemoral amputation rely on a hip extensor strategy to maintain knee joint stability. However, subjects also decreased the rate at which they loaded their prosthesis, decreased their step length, increased their trunk flexion, and maintained their limb in a more vertical posture at the time of opposite toe off. Collectively, these results suggest that persons with transfemoral amputation rely on a combination of strategies to coordinate stance-phase knee flexion. Further, no significant changes were observed in response to the POST condition, suggesting that a bias toward posterior alignment may have fewer implications in terms of stance-phase, knee-joint control. PMID:28355034

  17. Prosthetic fitting in a patient with a transtibial amputation due to a congenital vascular malformation of the right leg

    NARCIS (Netherlands)

    Simmelink, Elisabeth K.; Rommers, Gerardus M.; Gardeniers, Jean W. M.; Zijlstra, Henk

    Background: The problems of prescribing a prosthesis for a young girl with severe congenital vascular malformation deformity leading to a transtibial amputation. Case description and methods: Due to the high risk of recurrent bleeding and limitations regarding full weight bearing of the stump, a

  18. Nationwide diabetes-related lower extremity amputation rates in secondary care treated patients with diabetes in the Netherlands (DUDE-7)

    NARCIS (Netherlands)

    Nijenhuis-Rosien, Leonie; Hendriks, Steven Hans; Kleefstra, Nanne; Bilo, Hendricus Jozef Gerardus; Landman, Gijs Wilhelmus Diederik

    Aims: To estimate the annual amputation rate in all secondary care treated patients with diabetes in the Netherlands and specifically in patients known with diabetic retinopathy. Methods: A nationwide population-based retrospective cohort study was performed including the years 2007-2011. Data of

  19. Operant conditioning of a multiple degree-of-freedom brain-machine interface in a primate model of amputation.

    Science.gov (United States)

    Balasubramanian, Karthikeyan; Southerland, Joshua; Vaidya, Mukta; Qian, Kai; Eleryan, Ahmed; Fagg, Andrew H; Sluzky, Marc; Oweiss, Karim; Hatsopoulos, Nicholas

    2013-01-01

    Operant conditioning with biofeedback has been shown to be an effective method to modify neural activity to generate goal-directed actions in a brain-machine interface. It is particularly useful when neural activity cannot be mathematically mapped to motor actions of the actual body such as in the case of amputation. Here, we implement an operant conditioning approach with visual feedback in which an amputated monkey is trained to control a multiple degree-of-freedom robot to perform a reach-to-grasp behavior. A key innovation is that each controlled dimension represents a behaviorally relevant synergy among a set of joint degrees-of-freedom. We present a number of behavioral metrics by which to assess improvements in BMI control with exposure to the system. The use of non-human primates with chronic amputation is arguably the most clinically-relevant model of human amputation that could have direct implications for developing a neural prosthesis to treat humans with missing upper limbs.

  20. A young female patient with reflex sympathetic dystrophy of the upper limb in whom amputation became inevitable

    NARCIS (Netherlands)

    Geertzen, JHB; Rietman, JS; Smit, AJ; Zimmerman, KW

    Reflex sympathetic dystrophy (RSD) is characterized mostly by: (burning) pain, restricted range of motion, oedema and autonomic disturbances. Amputations in case of RSD patients should only be performed in cases of a dysfunctional limb, life threatening conditions such as untreatable infections or

  1. Can external lateral stabilization reduce the energy cost of walking in persons with a lower limb amputation?

    NARCIS (Netherlands)

    IJmker, T.; Noten, S.; Lamoth, C. J.; Beek, P. J.; van der Woude, L. H. V.; Houdijk, H.

    The aim of this study was to examine whether impaired balance control is partly responsible for the increased energy cost of walking in persons with a lower limb amputation (LLA). Previous studies used external lateral stabilization to evaluate the energy cost for balance control; this caused a

  2. Construct Validity and Test-Retest Reliability of the Walking Questionnaire in People With a Lower Limb Amputation

    NARCIS (Netherlands)

    de Laat, Fred A.; Rommers, Gerardus M.; Geertzen, Jan H.; Roorda, Leo D.

    Objective: To investigate the construct validity and test-retest reliability of the Walking Questionnaire, a patient-reported measure of activity limitations in walking in people with a lower limb amputation. Design: Cross-sectional study. Setting: Outpatient department of a rehabilitation center.

  3. Growth differentiation factor 15 is associated with major amputation and mortality in patients with peripheral artery disease

    NARCIS (Netherlands)

    De Haan, Judith J.; Haitjema, Saskia; den Ruijter, Hester M.; Pasterkamp, Gerard; de Borst, Gert J.; Teraa, Martin; Verhaar, Marianne C.; Gremmels, Hendrik; de Jager, Saskia C.A.

    2017-01-01

    Background--Peripheral artery disease (PAD) is one of the most common clinical presentations of atherosclerosis, and its prevalence is still increasing. Despite improvement of health care, morbidity and mortality risks remain high, including the risk of amputation. GDF15 (growth differentiation

  4. [Investigation of new classification and repair methods for fingertip traverse amputation].

    Science.gov (United States)

    Zhou, Xiao; Xu, Yajun; Rui, Yongjun; Yao, Qun

    2008-09-01

    To investigate new classification and repair methods for the traverse amputated fingertip. From March 2000 to October 2006, 20 cases of 20 fingers with traverse amputated fingertip, including 13 males and 7 females aged 17-47 years, were treated. Twenty patients (9 crush injuries, 5 cutting injuries and 6 sawing injuries) were classified into 4 types, namely type I (the distal one third of nail bed), type II (the middle of nail bed), type III (the proximal one third of nail bed), and type IV (the root of nail bed). There were 3 patients (2 index fingers and 1 little finger) of type I, 8 patients (2 thumbs, 3 index fingers and 3 middle fingers) of type II, 5 patients (3 index fingers, 1 ring finger and 1 little finger) of type III, and 4 patients (2 thumbs, 1 middle finger and 1 little finger) of type IV. The soft tissue defect ranged from 1.2 cm x 1.2 cm to 1.5 cm x 1.2 cm. The time from injury to surgery was 3-10 hours. Fingers of type I and type II were treated with forward flow axial flap and modified nail bed lengthening. Fingers of type III and type IV were treated with forward flow axial flap and partial nail bed replantation as well as modified nail bed lengthening. The flaps ranged in size from 1.5 cm x 1.2 cm to 2.0 cm x 1.4 cm. Twenty patients incisions healed by first intention and the flaps, nails and skin grafting survived. All donor sites healed by first intention. All patients were followed up for 2-6 months (4 months on average). The appearances of fingertips were good. The texture of the flap was soft, and the fingers had no tenderness and motor disturbance. The two-point discrimination was 4.5-6.5 mm. The finger nails of type I and type II extended 3-4 mm after operation, while the finger nails of type III and type IV extended 8-10 mm after operation. All finger nails were smooth and flat without pain. Hook nail happened in 1 case 6 months after operation. Classification of the injured fingers according to the condition of the amputation base is

  5. The role of amputation as an outcome measure in cellular therapy for critical limb ischemia: implications for clinical trial design

    Directory of Open Access Journals (Sweden)

    Pearl Gregory J

    2011-09-01

    Full Text Available Abstract Background Autologous bone marrow-derived stem cells have been ascribed an important therapeutic role in No-Option Critical limb Ischemia (NO-CLI. One primary endpoint for evaluating NO-CLI therapy is major amputation (AMP, which is usually combined with mortality for AMP-free survival (AFS. Only a trial which is double blinded can eliminate physician and patient bias as to the timing and reason for AMP. We examined factors influencing AMP in a prospective double-blinded pilot RCT (2:1 therapy to control of 48 patients treated with site of service obtained bone marrow cells (BMAC as well as a systematic review of the literature. Methods Cells were injected intramuscularly in the CLI limbs as either BMAC or placebo (peripheral blood. Six month AMP rates were compared between the two arms. Both patient and treating team were blinded of the assignment in follow-up examinations. A search of the literature identified 9 NO-CLI trials, the control arms of which were used to determine 6 month AMP rates and the influence of tissue loss. Results Fifteen amputations occurred during the 6 month period, 86.7% of these during the first 4 months. One amputation occurred in a Rutherford 4 patient. The difference in amputation rate between patients with rest pain (5.6% and those with tissue loss (46.7%, irrespective of treatment group, was significant (p = 0.0029. In patients with tissue loss, treatment with BMAC demonstrated a lower amputation rate than placebo (39.1% vs. 71.4%, p = 0.1337. The Kaplan-Meier time to amputation was longer in the BMAC group than in the placebo group (p = 0.067. Projecting these results to a pivotal trial, a bootstrap simulation model showed significant difference in AFS between BMAC and placebo with a power of 95% for a sample size of 210 patients. Meta-analysis of the literature confirmed a difference in amputation rate between patients with tissue loss and rest pain. Conclusions BMAC shows promise in improving AMP

  6. [Vacuum sealing drainage combined with free skin graft in repairing cutaneous deficiency of traumatic shank amputation stump].

    Science.gov (United States)

    Zhao, Xiao-fei; Li, Chun-you; Jin, Guo-qiang; Ming, Xiao-feng; Wang, Guo-jie

    2014-12-01

    To observe clinical efficacy in treating cutaneous deficiency of traumatic shank amputation stump with full-thickness skin graft combined with vacuum sealing drainage. From September 2009 to December 2012, 15 patients with cutaneous deficiency of traumatic shank amputation stump were treated with full-thickness skin graft combined with vacuum sealing drainage. Among patients, there were 11 males and 4 females with an average age of 41.5 (ranged from 25 to 62) years old. Ten cases were caused by traffic accident and 5 cases were caused by heavy object, 9 cases on left and 6 cases on right. Six patients with smashed wound were treated with debridement and amputation, combined with vacuum aspiration in-emergency; 9 patients caused by infection and necrosis were treated with debridement and amputation, combined with vacuum aspiration, and full-thickness skin graft were performed at stage II. The skin defect area of residual limbs ranged from 40 cm x 20 cm to 25 cm x 15 cm. All patients were followed up from 3 months to 1 year. Full-thickness skin graft of residual limbs were survived,and obtained satisfactory walking function with prosthetic. Residual skin increased thicken, wearproof without rupture and pain. Full-thickness skin graft combined with vacuum sealing drainage in treating cutaneous deficiency of traumatic shank amputation stump could reserve the length of residual limbs, increase survival rate of skin graft with less scar of survival skin, get good wearability and it is conducive to prosthetic wear. It is a simple and easy treatment method.

  7. Reclaiming Autologous Amputated Tissue for Limb Salvage of a Diabetic Foot Burn with Underlying Critical Limb Ischemia.

    Science.gov (United States)

    Tchanque-Fossuo, Catherine N; Wishy, Andrew M; West, Kaitlyn I M; Dawson, David L; Dahle, Sara E; Carson, John G

    2018-01-01

    Diabetes mellitus is a worldwide pandemic that impacts more than 387 million people, with 29 million individuals affected in the United States alone. Diabetic patients have a 25% lifetime risk of developing a diabetic foot ulcer (DFU). Having a DFU is associated with a risk of recurrence approaching 70%. In addition, 1 in 6 patients with DFU will have a lower-limb amputation, with an associated increase in mortality ranging from 47% to 70%. Therefore, limb salvage is critical in patients with DFU. This article describes the case of a 70-year-old man with diabetes mellitus, end-stage renal disease, and peripheral arterial occlusive disease who presented with a 1.5% total-body-surface-area, third-degree burn to the left hallux with dry gangrene extending to the midfoot. Ankle brachial indexes were 0.66 on the left and 0.64 on the right. Toe pressures on the left were absent because of extensive dry gangrene. His right foot had a prior transmetatarsal amputation. Using a retrograde pedal approach, a chronic total occlusion of the left posterior tibial artery was recanalized with balloon angioplasty. He then underwent a transmetatarsal amputation with closure, except that the plantar medial side could not be closed without tension. Therefore, an autologous full-thickness skin graft, from the amputation specimen, was used to bridge the defect. At 32-week follow-up, the wound was healed, the graft had fully incorporated, and the patient was ambulating well using custom orthotic footwear. The creative use of amputated tissue to assist with wound coverage has not been well described in the literature.

  8. Diabetic foot ulcer carries high amputation and mortality rates, particularly in the presence of advanced age, peripheral artery disease and anemia.

    Science.gov (United States)

    Costa, Rafael Henrique Rodrigues; Cardoso, Natália Anício; Procópio, Ricardo Jayme; Navarro, Túlio Pinho; Dardik, Alan; de Loiola Cisneros, Ligia

    2017-12-01

    Foot ulcer is also a clinical marker for limb amputation and for death in diabetic patients. The purpose of this study was to determine amputation and mortality rates and its associated factors in patients with diabetic foot ulcerations in a tertiary hospital in Brazil. Retrospective medical records from 654 diabetic foot patients were reviewed. The risk factors were determined using the conditional logistic regression model analysis. The mean patient age was 63.1 years (SD 12.20). Peripheral arterial disease was present in 160 patients (24.5%). Major amputations were performed in 135 (21%). The in-hospital mortality rate was 12% and the mortality rate of the amputees was 22.2%. The lowest hemoglobin level, the median value was 9.50g/dL, (4.0-17.0). Anemia was detected in 89.6% of patients submitted to amputation and in 82,1% of those who died. Hemoglobin foot ulcer is associated with high amputation and mortality rates. Old age, peripheral arterial disease and low hemoglobin level are risk factor for major amputation. Old age, major amputation and low hemoglobin level are risk factors for death. Copyright © 2017. Published by Elsevier Ltd.

  9. Self injury of extremities leading to amputation while handling local bomb.

    Science.gov (United States)

    Bhadani, Umesh Kumar

    2013-05-01

    Self injury while making material which has a tendency to blast is dangerous- whether it is fire cracker or local bomb. Some villagers living nearby forest make bomb to scare wild animals to protect their pet animals. A 22-year old girl while making this kind of local bomb, got injured badly. The injury was sustained while making bomb in a sitting position with face down as it is evident form type of injury. There was lacerated injury of both hands leading to amputation of both hands above wrists. Lacerated injury was present on medial sides of both thighs and gun powder marks on face. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  10. Metastatic Invasive Sweat Gland Adenocarcinoma of the Hand with Upper Limb Amputation/Shoulder Reconstruction

    Science.gov (United States)

    Capildeo, Kavi

    2015-01-01

    Summary: A rare case of metastatic invasive sweat gland adenocarcinoma of hand in a 78-year-old woman is presented. From this analysis of the available literature, it seems that these rare primary tumors of the hand are aggressive tumors with little known about their biological behavior. Fluoropyrimidines, taxanes, and cisplatin have been reported to be active agents for metastatic sweat gland carcinomas. Further, these tumors have historically been considered radioresistant, but responses to radiation have been documented in the setting of recurrent disease, and the use of adjuvant radiotherapy has been advocated for tumors at high risk of local recurrence. We advocate an aggressive approach of high amputation and axillary lymph node dissection with adjuvant treatment using chemotherapy as the mainstay with close follow-up for metastases. PMID:26495225

  11. Genital self-amputation or the Klingsor syndrome: Successful non-microsurgical penile replantation

    Directory of Open Access Journals (Sweden)

    Y El harrech

    2013-01-01

    Full Text Available Self-mutilations of the external genitals in psychiatric patients also known as Klingsor syndrome is a rare urologic trauma. Men with religious conflicts, low self-esteem, unresolved transsexual issues and feelings of guilt are the most vulnerable. This condition requires immediate surgical intervention. Currently replantation involves meticulous microsurgery and has become the primary method for managing these patients. In this paper, we report a case of self amputation of penis in a patient with a psychiatric history significant for schizopfrenia. Because of the unavailability of a microscope in our department, a non-microsurgical replantation without microscopic magnification was attempted. After surgery, normal appearance and function including a good normal voiding, sensation, and erections were observed.

  12. Wound healing in below-knee amputations in relation to skin perfusion pressure

    DEFF Research Database (Denmark)

    Holstein, P; Sager, P; Lassen, N A

    1979-01-01

    In 60 below-knee amputations the 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 131I- or 125I--antipyrine mixed with histamine. Of the eight cases with an SPP below 20 mm......Hg, no less than six (75 per cent) failed to heal and required reamputation at the above-knee level. Of the 12 cases with an SPP between 20 and 30 mmHg four cases (33 per cent) failed to heal but of the 40 cases with an SPP above 30 mmHg, there were only four cases (10 per cent) which did not heal...... closely to the postoperative clinical course. We conclude that a low SPP can be used to predict ischaemic wound complications, leading to reamputation at a higher level....

  13. Experiences in the creation of an electromyography database to help hand amputated persons.

    Science.gov (United States)

    Atzori, Manfredo; Gijsberts, Arjan; Heynen, Simone; Hager, Anne-Gabrielle Mittaz; Castellimi, Claudio; Caputo, Barbara; Müller, Henning

    2012-01-01

    Currently, trans-radial amputees can only perform a few simple movements with prosthetic hands. This is mainly due to low control capabilities and the long training time that is required to learn controlling them with surface electromyography (sEMG). This is in contrast with recent advances in mechatronics, thanks to which mechanical hands have multiple degrees of freedom and in some cases force control. To help improve the situation, we are building the NinaPro (Non-Invasive Adaptive Prosthetics) database, a database of about 50 hand and wrist movements recorded from several healthy and currently very few amputated persons that will help the community to test and improve sEMG-based natural control systems for prosthetic hands. In this paper we describe the experimental experiences and practical aspects related to the data acquisition.

  14. The Progression of Male 100 m Sprinting with a Lower-Limb Amputation 1976–2012

    Directory of Open Access Journals (Sweden)

    Bryce Dyer

    2015-02-01

    Full Text Available Sprinting with a lower-limb amputation over 100 m has taken place in the Paralympic Games for over three decades. The aim of this paper is to statistically evaluate the performances and participation levels of such athletes during this period. The level of performance improvement over a 36-year period was proposed to be significantly greater than the able-bodied equivalent. Coupled with this, a major spike in amputee running performance improvement was shown to occur from 1984–1988. This supports previously recorded accounts of a major technological change being made at this time. Finally, whilst the average performance of the medallists has increased consistently over the 36-year history, the overall participation in the event fell significantly after 1988 and did not recover until 2012.

  15. Characterization of short- and long-term mechanical sensitisation following surgical tail amputation in pigs

    DEFF Research Database (Denmark)

    Di Giminiani, Pierpaolo; Edwards, Sandra A.; Malcolm, Emma M.

    2017-01-01

    Commercial pigs are frequently exposed to tail mutilations in the form of preventive husbandry procedures (tail docking) or as a result of abnormal behaviour (tail biting). Although tissue and nerve injuries are well-described causes of pain hypersensitivity in humans and in rodent animal models......, there is no information on the changes in local pain sensitivity induced by tail injuries in pigs. To determine the temporal profile of sensitisation, pigs were exposed to surgical tail resections and mechanical nociceptive thresholds (MNT) were measured in the acute (one week post-operatively) and in the long......-term (either eight or sixteen weeks post-surgery) phase of recovery. The influence of the degree of amputation on MNTs was also evaluated by comparing three different tail-resection treatments (intact, ‘short tail’, ‘long tail’). A significant reduction in MNTs one week following surgery suggests...

  16. [Self-inflicted finger-amputation: insurance fraud or accidental injury?].

    Science.gov (United States)

    Hildebrand, E; Hitzer, K; Püschel, K

    2006-03-01

    A 50-year-old surgeon was working with his electrical circle saw as a do-it-yourselfer. He was alone, nobody witnessed his mishap when he amputated his left index finger. He claimed high financial compensation from two accident insurance companies because of his disability. A long series of medical expertises followed. The juridical procedures took 12 years in total. All higher authorities had to deal with the forensic medical implications. Finally, the high court (Bundesgerichtshof) decided that the complainant would receive no compensation because he gave two very different descriptions. Concerning the reconstruction of the accident, the first version was unlikely from a biomechanical point of view. The decision of the court was solely based on the violation of the obligation to give a clear presentation of the course of events (Obliegenheitsverletzung).

  17. Trends in the incidence of lower extremity amputations in people with and without diabetes over a five-year period in the Republic of Ireland.

    Directory of Open Access Journals (Sweden)

    Claire M Buckley

    Full Text Available AIMS: To describe trends in the incidence of non-traumatic amputations among people with and without diabetes and estimate the relative risk of an individual with diabetes undergoing a lower extremity amputation compared to an individual without diabetes in the Republic of Ireland. METHODS: All adults who underwent a nontraumatic amputation during 2005 to 2009 were identified using HIPE (Hospital In-patient Enquiry data. Participants were classified as having diabetes or not having diabetes. Incidence rates were calculated using the number of discharges for diabetes and non-diabetes related lower extremity amputations as the numerator and estimates of the resident population with and without diabetes as the denominator. Age-adjusted incidence rates were used for trend analysis. RESULTS: Total diabetes-related amputation rates increased non-significantly during the study period; 144.2 in 2005 to 175.7 in 2009 per 100,000 people with diabetes (p = 0.11. Total non-diabetes related amputation rates dropped non-significantly from 12.0 in 2005 to 9.2 in 2009 per 100,000 people without diabetes (p = 0.16. An individual with diabetes was 22.3 (95% CI 19.1-26.1 times more likely to undergo a nontraumatic amputation than an individual without diabetes in 2005 and this did not change significantly by 2009. DISCUSSION: This study provides the first national estimate of lower extremity amputation rates in the Republic of Ireland. Diabetes-related amputation rates have remained steady despite an increase in people with diabetes. These estimates provide a base-line and will allow follow-up over time.

  18. Occupational amputations in Illinois 2000-2007: BLS vs. data linkage of trauma registry, hospital discharge, workers compensation databases and OSHA citations.

    Science.gov (United States)

    Friedman, Lee; Krupczak, Colin; Brandt-Rauf, Sherry; Forst, Linda

    2013-05-01

    Workplace amputation is a widespread, disabling, costly, and preventable public health problem. Thousands of occupational amputations occur each year, clustering in particular economic sectors, workplaces, and demographic groups such as young workers, Hispanics, and immigrants. To identify and describe work related amputations amongst Illinois residents that occur within Illinois as reported in three legally mandated State databases; to compare these cases with those identified through the BLS-Survey of Occupational Illnesses and Injuries (SOII); and to determine the extent of direct intervention by the Occupational Safety and Health Administration (OSHA) for these injuries in the State. We linked cases across three databases in Illinois - trauma registry, hospital discharge, and workers compensation claims. We describe amputation injuries in Illinois between 2000 and 2007, compare them to the BLS-SOII, and determine OSHA investigations of the companies where amputations occurred. There were 3984 amputations identified, 80% fingertips, in the Illinois databases compared to an estimated 3637, 94% fingertips, from BLS-SOII. Though the overall agreement is close, there were wide fluctuations (over- and under-estimations) in individual years between counts in the linked dataset and federal survey estimates. No OSHA inspections occurred for these injuries. Increased detection of workplace amputations is essential to targeting interventions and to evaluating program effectiveness. There should be mandatory reporting of all amputation injuries by employers and insurance companies within 24h of the event, and every injury should be investigated by OSHA. Health care providers should recognise amputation as a public health emergency and should be compelled to report. There should be a more comprehensive occupational injury surveillance system in the US that enhances the BLS-SOII through linkage with state databases. Addition of industry, occupation, and work

  19. Comparison of stability limits in men with traumatic transtibial amputation and a nonamputee control group.

    Science.gov (United States)

    Molero-Sánchez, Alberto; Molina-Rueda, Francisco; Alguacil-Diego, Isabel M; Cano-de la Cuerda, Roberto; Miangolarra-Page, Juan Carlos

    2015-02-01

    Currently, knowledge is lacking about whether subjects with traumatic unilateral transtibial amputation (UTA) have a compromised ability to voluntarily move their center of gravity (COG) to positions within the limits of stability. To analyze the ability to voluntarily move the COG to positions within the limits of stability in a sample of subjects with traumatic UTA. Observational, case-control study. University department. Ten men with traumatic UTA and 10 control subjects without amputation. Computerized dynamic posturography SMART EquiTEST System version 8.0 was used for measuring stability limits in both groups. The Limits of Stability test was used to assess the participants' ability to voluntarily sway to various locations in space (8 predetermined target positions). End point excursion achieved statistically significant differences in the prosthetic (P = .02) and backward (P = .03) directions in the subjects with UTA. A statistically significant decrease was observed in the maximum excursion to backward direction (P = .05) in the subjects with UTA. Directional control only reached statistically significant differences in the prosthetic backward direction (P = .05) compared with the control group. Movement velocity was statistically significantly lower in the subjects with UTA toward prosthetic (P = .03), backward (P = .05), sound (P = .01), and sound forward (P = .03) directions in relation to the control group. Persons with traumatic UTA have a reduced ability to move their COG within stability limits (restricted displacement, inadequate directional control, and reduced velocity). These findings should be considered when developing rehabilitation programs for these persons. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  20. Protein expression profiling in head fragments during planarian regeneration after amputation.

    Science.gov (United States)

    Chen, Xiaoguang; Xu, Cunshuan

    2015-04-01

    Following amputation, a planarian tail fragment can regrow into a complete organism including a well-organized brain within about 2-3 weeks, thus restoring the structure and function to presurgical levels. Despite the enormous potential of these animals for regenerative medicine, our understanding of the exact mechanism of planarian regeneration is incomplete. To better understand the molecular nature of planarian head regeneration, we applied two-dimensional electrophoresis (2-DE)/matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF)/time-of-flight mass spectrometry (TOF MS) technique to analyze the dynamic proteomic expression profiles over the course of 6 to 168 h post-decapitation. This approach identified a total of 141 differentially expressed proteins, 47 of which exhibited exceptionally high fold changes (≥3-fold change). Of these, Rx protein, an important regulator of head and brain development, was considered to be closely related to planarian head regeneration because of its exceptional high expression almost throughout the time course of regeneration process. Functional annotation analysis classified the 141 proteins into eight categories: (1) signaling, (2) Ca(2+) binding and translocation, (3) transcription and translation, (4) cytoskeleton, (5) metabolism, (6) cell protection, (7) tissue differentiation, and (8) cell cycle. Signaling pathway analysis indicated that Wnt1/Ca(2+) signaling pathway was activated during head regeneration. Integrating the analyses of proteome expression profiling, functional annotation, and signaling pathway, amputation-induced head reformation requires some mechanisms to promote cell proliferation and differentiation, including differential regulation of proapoptotic and antiapoptotic proteins, and the regulation of proliferation and differentiation-related proteins. Importantly, Wnt1/Ca(2+) signaling pathway upregulates Rx expression, finally facilitating the differentiation of neoblasts into various