WorldWideScience

Sample records for amputations

  1. Amputation

    Science.gov (United States)

    ... of illnesses and disabilities Your health Everyday living Parenting Your rights Women veterans with disabilities Caregiver support ... partially cut off due to an accident or violence. With surgical amputation, a limb or part of ...

  2. Amputation surgery.

    Science.gov (United States)

    Schnur, David; Meier, Robert H

    2014-02-01

    The best level of amputation must take into consideration the newest socket designs, methods of prosthetic suspension, and technologically advanced components. In some instances stump revision should be considered, to provide a better prosthetic fitting and function. Targeted reinnervation is a new neural-machine interface that has been developed to help improve the function of electrically powered upper prosthetic limbs. Osseointegrated implants for prosthetic suspension offer amputees an alternative to the traditional socket suspension, and are especially useful for transfemoral and transhumeral levels of amputation. Cadaver bone can be used to lengthen an extremely short residual bony lever arm.

  3. [Upper leg amputation. Transfemoral amputation].

    Science.gov (United States)

    Baumgartner, R

    2011-10-01

    Objective. Amputation through the diaphysis of the femur at the most peripheral level possible. The stump, covered with soft tissue flaps, is free from pain. It can be fitted with a total contact prosthetic socket. The hip joint is preserved with its full range of motion.Indications. When no possibility to amputate at a more distal level through the tibia or the knee joint exists.Contraindications. When it is possible to amputate at a more distal level.Surgical technique. Symmetrical flaps in the frontal plane are recommended. Asymmetrical flaps and flaps in the sagittal plane can also be made. Their muscles are fixed to each other (myodesis) or the bone end by means of transosseous sutures (myopexy). The ischial nerve has to be shortened about 2 inches proximal to the end of the femur.In peripheral vascular diseases, this procedure is not suitable. An alternative technique is suggested.In chronic osteomyelitis (e.g., after intramedullary nailing), the ventral half of the femur can be removed and the medullary cavity cleansed and filled with a muscular flap in order to maintain length. Lengthening procedures of the femur are discussed.Postoperative management. Avoid active or passive movement of the stump for the first 2 weeks in order not to disturb healing of the muscle sutures. Physical therapy, prosthetic fitting after 4–6 weeks, according to the expected functional level 0–4. Aids: crutches, wheel chair, adjustable bed, modified hand-controlled automobile.The walking ability of a patient with a double amputation above the knee is severely limited and in patients with peripheral artery disease remains the exception.

  4. [Upper leg amputation. Transfemoral amputation].

    Science.gov (United States)

    Baumgartner, R

    2011-10-01

    Objective. Amputation through the diaphysis of the femur at the most peripheral level possible. The stump, covered with soft tissue flaps, is free from pain. It can be fitted with a total contact prosthetic socket. The hip joint is preserved with its full range of motion.Indications. When no possibility to amputate at a more distal level through the tibia or the knee joint exists.Contraindications. When it is possible to amputate at a more distal level.Surgical technique. Symmetrical flaps in the frontal plane are recommended. Asymmetrical flaps and flaps in the sagittal plane can also be made. Their muscles are fixed to each other (myodesis) or the bone end by means of transosseous sutures (myopexy). The ischial nerve has to be shortened about 2 inches proximal to the end of the femur.In peripheral vascular diseases, this procedure is not suitable. An alternative technique is suggested.In chronic osteomyelitis (e.g., after intramedullary nailing), the ventral half of the femur can be removed and the medullary cavity cleansed and filled with a muscular flap in order to maintain length. Lengthening procedures of the femur are discussed.Postoperative management. Avoid active or passive movement of the stump for the first 2 weeks in order not to disturb healing of the muscle sutures. Physical therapy, prosthetic fitting after 4–6 weeks, according to the expected functional level 0–4. Aids: crutches, wheel chair, adjustable bed, modified hand-controlled automobile.The walking ability of a patient with a double amputation above the knee is severely limited and in patients with peripheral artery disease remains the exception. PMID:21975907

  5. 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 ...

  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 ...... studied. These findings suggest that vascular surgery may be responsible for the lower amputation rate.......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...... a marked rise in the rate of femorodistal reconstruction. Moreover, regional variation in vascular surgical activity correlated with percentage reduction in amputation rate (rS = 0.65, P

  7. [Coping psychologically with amputation].

    Science.gov (United States)

    Schulz, M

    2009-02-01

    An amputation is a "tragic event" in someone's biography which causes a dramatic change in the outer appearance, the loss of mobility, independence and self esteem. The following article is about how people learn to cope with this difficult situation; with the practical problems of everyday life as well as their emotional problems. It is important for the amputees to go through the different stages of mourning: The first stage is the rejection of the situation. Repression and denial of the loss protects the patient from emotional overstrain. Confrontation is the next step: emotionally as well as mentally. "How could it happen?", (understanding the reasons why ...) "What will my future be like?", "How will I cope?" (ability of coping) "Why did it happen to me?" (sense) The last stage of coping with the amputation is to accept and deal with the new situation and to build up new self-confidence. A successful process of coping leads to a new identity. If a person fails to adapt to the new situation, he will develop an inferiority complex and fall into a depression. He might also try to look for culprit and blame the situation on someone else. About two thirds of all amputees don't cope with their amputation and become depressive. 15% develop symptoms of anxiety. Therefore it is important to offer help. The patients should get together in self helping groups and talk about their experiences and problems. If they need more intensive and individual help, they should have the opportunity to contact a psychologist. During the process of coping with their amputation the patients often alternate between optimistic and pessimistic moods. Sometimes they fall back into a negative and resigned state of mind. This is natural and part of the process as long as they find their own way to a positive attitude and view of life. PMID:19259934

  8. Stump problems in traumatic amputation.

    Science.gov (United States)

    Hirai, M; Tokuhiro, A; Takechi, H

    1993-12-01

    Stump problems in amputations resulting from employment related injuries were investigated in 397 cases in the Chugoku and Shikoku districts of Japan between 1987 and 1991. Ninety-seven patients (24%) had stump problems which interfered the prosthetic fitting. Stump problems of the upper extremity were seen in about 9% (17 amputees), two thirds of which were skin troubles. Stump problems of the lower extremity were seen in about 37% (80 amputees). Certain complaints were associated with specific methods of amputation; abnormal keratosis in Syme's amputation, equinus deformity in Chopart's amputation, reduced muscle power in above the knee (A/K) amputation and joint dysfunction in below the knee (B/K) amputation. Adequate prosthetic fitting was achieved by the modification of the socket and alignment in almost all amputees with stump problems. In only two cases, Chopart's amputation required subsequent Syme's amputation due to equinus deformity with abnormal keratosis. In almost every case, stump problems are avoidable by means of surgeons' deliberate evaluation of the affected limb and adequate choice of the amputation level.

  9. Amputation and prostheses in Khartoum.

    Science.gov (United States)

    Mohamed, I A; Ahmed, A R; Ahmed, M E

    1997-08-01

    One hundred and seventy patients with major lower limb amputation (MLLA) presenting to The National Prosthetic-Orthotic Centre (NPOC) in Khartoum over a 1-year period were studied. There were 141 males and 29 females giving a M:F ratio of 4.9: 1.0, with mean age of 37 years (range 5-72 years). Forty-one patients (24%) underwent amputation of diabetic septic foot, 30 patients (17.6%) underwent amputation as a result of trauma from road traffic accidents and Madura foot, and war injuries accounted for 29 amputations (17%). One hundred and eleven patients had below knee amputation (BKA), 52 had above knee amputation (AKA) and seven patients had Syme's amputation. Diabetic amputees had higher rate of revisional surgery compared with others because of sepsis and/or flap necrosis. Stump pain was reported by amputees with excessive scarring of the stump and those with undue prominence of bony ends. There are two types of prostheses provided by the NPOC for both BKA and AKA: the peg leg and the conventional prostheses. The Syme's amputees were fitted with either simple hoof or articulated prostheses with solid ankle cushion heel (SACH). The peg leg consists of a leather lined side bearing metal socket connected to a rocker base by side steels. It is used by the country natives as it suits different weather and job conditions, particularly farming, and it can be repaired locally. The urban population use the conventional prostheses which is lighter in weight, can be put on and taken off easily and is cosmetically acceptable. However, these prostheses are more expensive and require frequent repair or replacement. The functional outcome of patient's rehabilitation with the prostheses was significantly affected by the level and indication of amputation. Those with BKA and those amputated because of trauma or Madura foot experienced better functional outcome compared with the diabetics, independent of age. 50% of patients with the AKA and 19% of those with BKA reported poor

  10. Pain Management: Post-Amputation Pain

    Science.gov (United States)

    Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java Required Print page Save and share ... by G. Edward Jeffries, MD, FACS Post-Amputation Pain Post-amputation pain is one of the most ...

  11. Distal amputations for the diabetic foot

    Directory of Open Access Journals (Sweden)

    Aziz Nather

    2013-07-01

    Full Text Available Minor amputations in diabetic patients with foot complications have been well studied in the literature but controversy still remains as to what constitutes successful or non-successful limb salvage. In addition, there is a lack of consensus on the definition of a minor or distal amputation and a major or proximal amputation for the diabetic population. In this article, the authors review the existing literature to evaluate the efficacy of minor amputations in this selected group of patients in terms of diabetic limb salvage and also propose several definitions regarding diabetic foot amputations.

  12. 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......, orbital exenteration or secondary implantation of an orbital implant in the period between 1993 and 2003. A total of 267 patients were identified and invited to participate; of these, 173 agreed to participate. These patients’ medical records were reviewed. A structured interview focusing on pain...... was conducted by a trained interviewer. Results: Of the 173 patients in the study, 39 experienced phantom pain. The median age of patients who had experienced phantom pain was 45 years (range: 19–88). Follow-up time from eye amputation to participation in the investigation was 4 years (range: 2–46). Phantom...

  13. Functional results after a Krukenberg amputation

    NARCIS (Netherlands)

    Freire, J; Schiappacasse, C; Heredia, A; Martina, JD; Geertzen, JHB

    2005-01-01

    This case report presents a 51 year old female patient who had a train accident in 1999. She suffered bilateral trans-tibial and bilateral trans-radial amputations. In this paper, the evolution of the right trans-radial amputation where eventually a Krukenberg procedure was performed, is described a

  14. Forequarter amputation for recurrent breast cancer

    Directory of Open Access Journals (Sweden)

    Krishna N. Pundi

    2015-01-01

    Conclusion: Forequarter amputation can be judiciously used for patients with recurrent or metastatic breast cancer. Patients with recurrent disease without evidence of distant metastases may be considered for curative amputation, while others may receive palliative benefit; disappointingly our patient achieved neither of these outcomes. In the long term, these patients may still have significant psychological problems.

  15. Amputations

    Science.gov (United States)

    ... in the workplace? Yes. The Occupational Safety and Health Administration (OSHA) has the following standards in Title 29 ... gov. U.S. Department of Labor Occupational Safety and Health Administration 2002

  16. CT scanning in patients with amputated legs

    International Nuclear Information System (INIS)

    CT scanning after above-knee amputation and below-knee amputation helps to determine the calcium salt content of the examined bones, and to differentiate changes in the surrounding soft parts. By comaring the sides, it is quite easy to detect osteoporotic changes shortly after amputation which would otherwise remain undetected by X-ray film examination. It is equally easy to verify muscular changes, whereas characteristic changes in density allow to determine the share of vacant fat in muscular atrophy. Initial examinations proved the usefulness of CT diagnosis for early detection of dystrophic osseous and muscular changes and also show the possibilities of early therapy control of dystrophy treatment. (orig.)

  17. 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.

  18. Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation

    OpenAIRE

    Karmarkar, Amol M.; Graham, James E.; Reistetter, Timothy A.; Amit Kumar; Jacqueline M. Mix; Paulette Niewczyk; Granger, Carl V.; Ottenbacher, Kenneth J.

    2014-01-01

    The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the ...

  19. Diabetic foot resulting in amputation: our experience

    Directory of Open Access Journals (Sweden)

    K. G. Patel

    2014-02-01

    Conclusions: Foot ulceration in diabetic patients is a resource consuming, disabling morbidity that often is the first step towards lower extremity amputation. Prevention is the best treatment. [Int J Res Med Sci 2014; 2(1.000: 210-214

  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. Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation

    Directory of Open Access Journals (Sweden)

    Amol M. Karmarkar

    2014-01-01

    Full Text Available The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501. The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4 and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days and lowest functional rating at discharge (average 79.4. Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25 generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research.

  2. Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation.

    Science.gov (United States)

    Karmarkar, Amol M; Graham, James E; Reistetter, Timothy A; Kumar, Amit; Mix, Jacqueline M; Niewczyk, Paulette; Granger, Carl V; Ottenbacher, Kenneth J

    2014-01-01

    The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4) and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days) and lowest functional rating at discharge (average 79.4). Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25) generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research. PMID:25400948

  3. Advanced prosthetic techniques for below knee amputations.

    Science.gov (United States)

    Staats, T B

    1985-02-01

    Recent advances in the evaluation of the amputation stump, the materials that are available for prosthetic application, techniques of improving socket fit, and prosthetic finishings promise to dramatically improve amputee function. Precision casting techniques for providing optimal fit of the amputation stump using materials such as alginate are described. The advantages of transparent check sockets for fitting the complicated amputation stump are described. Advances in research that promise to provide more functional prosthetic feet and faster and more reliable socket molding are the use of CAD-CAM (computer aided design-computer aided manufacturing) and the use of gait analysis techniques to aid in the alignment of the prosthesis after socket fitting. Finishing techniques to provide a more natural appearing prosthesis are described. These advances will gradually spread to the entire prosthetic profession.

  4. 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......-administered questionnaire containing health-related quality of life (SF-36), the perceived stress scale and answered questions about self-rated health, job changes because of illness or disability and socioeconomic status. These results were compared with findings from the Danish Health Interview Survey 2005. Results......% of the study population has retired or changed to a part-time job because of eye disease. The percentage of eye amputated patients, who were divorced or separated, was twice as high as in the general population. Conclusion: The impact of an eye amputation is considerable. The quality of life, perceived stress...

  5. 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.

  6. Successful Replantation of Amputated Penile Shaft following Industrial Injury

    Directory of Open Access Journals (Sweden)

    A Ariafar

    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.

  7. 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 year

  8. Contralateral Total Hip Arthroplasty After Hindquarter Amputation

    Science.gov (United States)

    Sommerville, Scott M. M.; Patton, James T.; Luscombe, Jonathan C.; Grimer, Robert J.

    2006-01-01

    We describe the management and outcome of a 62-year old lady who developed severe osteoarthritis of the hip, nine years after a hindquarter amputation for radiation-induced sarcoma of the contralateral pelvis. The difficulties of stabilising the pelvis intraoperatively and the problems of postoperative rehabilitation are outlined. The operation successfully relieved her pain and restored limited mobility. PMID:17496994

  9. 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.

  10. Body Image, Relationships and Sexuality After Amputation

    Science.gov (United States)

    Body Image, Relationships and Sexuality after Amputation Original article by Sandra Houston, PhD First Step - Volume 4, 2005 Translated into plain language by Helen Osborne of Health Literacy Consulting Text size Larger text Smaller text Java Required Print page Save and share ...

  11. [Psychological adjustment following lower limb amputation].

    Science.gov (United States)

    Panyi, Lilla Krisztina; Lábadi, Beatrix

    2015-09-27

    Rehabilitation of lower limb amputees and the fitting of their prosthesis depend highly on the psychological adjustment process and motivational state of the patient. The loss of a limb is extremely challenging and can cause various physical and psychological problems. Depression, anxiety, decreased well-being and quality of life, body image dissatisfaction and changes in self-concept and identity are frequent after lower limb amputation. In the interest of adjustment patients have to cope with the emerging changes and difficulties in their lifes as well as the problems in psychological functioning. It is important for them to accept the alterations in their body and identity, and integrate them in a new self-concept in which process motivation is a fundamental issue. The aim of this article is to review the literature on psychological consequences of lower limb amputation, and to propose an integrative way of rehabilitation for lower limb amputees. PMID:26550913

  12. Obesity paradox in amputation risk among nonelderly diabetic men.

    Science.gov (United States)

    Sohn, Min-Woong; Budiman-Mak, Elly; Oh, Elissa H; Park, Michael S; Stuck, Rodney M; Stone, Neil J; Pearce, William B

    2012-02-01

    The association between BMI and amputation risk is not currently well known. We used data for a cohort of diabetic patients treated in the US Department of Veterans Affairs Healthcare System in 2003. Men aged amputation risk and amputation-free survival during the next 5 years (2004-2008). Compared to overweight individuals (BMI 25-29.9 kg/m(2)), the risks of amputation and treatment failure (amputation or death) were higher for patients with BMI amputations (HR = 0.53; 95% CI, 0.39-0.73) during follow-up as overweight individuals. While the amputation risk continued to decrease for higher BMI, amputation-free survival showed a slight upturn at BMI >40 kg/m(2). The association between obesity and amputation risk in our data shows a pattern consistent with "obesity paradox" observed in many health conditions. More research is needed to better understand pathophysiological mechanisms that may explain the paradoxical association between obesity and lower-extremity amputation (LEA) risk.

  13. Amputations in Sickle Cell Disease: Case Series and Literature Review.

    Science.gov (United States)

    Maximo, Claudia; Olalla Saad, Sara T; Thome, Eleonora; Queiroz, Ana Maria Mach; Lobo, Clarisse; Ballas, Samir K

    2016-06-01

    In this study, we describe four new patients with sickle cell disease who had limb amputations. Two of the patients had sickle cell anemia [Hb S (HBB: c.20A > T) (β(S)/β(S))] with refractory leg ulcers that required amputations. The third patient had sickle cell trait with an extensive leg ulcer that was associated with epidermoid carcinoma. The fourth patient had amputations of both forearms and feet due to a misdiagnosis of dactylitis. Review of the literature showed that the indications for amputations in sickle cell disease included three distinct categories: mythical beliefs, therapeutic and malpractice. All therapeutic amputations were for severely painful, large, recalcitrant leg ulcers that failed non-interventional therapies. Amputation resulted in pain relief and better quality of life. Phantom neuropathic pain was not a major issue post-operatively. It was absent, transient or well controlled with antidepressants. Limb function was restored post-amputation with prosthetic artificial limbs, wheelchairs or crutches. Malpractice amputations were due to misdiagnosis or to cryotherapy by exposing the painful limb to ice water resulting in thrombosis, gangrene and amputation. We strongly suggest that leg amputations should be considered in the management of certain patients with severe extensive refractory leg ulcers, and topical cryotherapy should never be used to manage sickle cell pain. PMID:27117565

  14. Prosthetic fitting problems of the quasi-Syme amputation.

    Science.gov (United States)

    Rubin, G

    1981-10-01

    Unless the original Syme amputation technique has been precisely followed, an amputation stump capable of tolerating little or no end-bearing will frequently result. Such a stump must be fitted with a below knee type of prosthesis as if the patient were a below-knee amputee. Even though it is not designed for other than a below-knee amputation, the socket can be modified to provide a satisfactory prosthesis for a Quasi-Syme stump.

  15. Pirogow’s Amputation: A Modification of the Operation Method

    OpenAIRE

    Bueschges, M.; Muehlberger, T.; Mauss, K. L.; Bruck, J. C.; Ottomann, C.

    2013-01-01

    Introduction. Pirogow's amputation at the ankle presents a valuable alternative to lower leg amputation for patients with the corresponding indications. Although this method offers the ability to stay mobile without the use of a prosthesis, it is rarely performed. This paper proposes a modification regarding the operation method of the Pirogow amputation. The results of the modified operation method on ten patients were objectified 12 months after the operation using a patient questionnaire (...

  16. 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...... cannot be ruled out by clinical assessment alone and that preoperative determination of the SPP can be used in determining the chance of healing in BK amputations....

  17. Lower-limb amputation and body weight changes in men

    Directory of Open Access Journals (Sweden)

    Alyson J. Littman, PhD

    2015-06-01

    Full Text Available Little is known about the relationship between lower-limb amputation (LLA and subsequent changes in body weight. We conducted a retrospective cohort study using clinical and administrative databases to identify and follow weight changes in 759 males with amputation (partial foot amputation [PFA], n = 396; transtibial amputation [TTA], n = 267; and transfemoral amputation [TFA], n = 96 and 3,790 men without amputation frequency-matched (5:1 on age, body mass index, diabetes, and calendar year from eight Department of Veterans Affairs medical care facilities in the Pacific Northwest. We estimated and compared longitudinal percent weight change from baseline up to 39 mo of follow-up in men with and without amputation. Weight gain in the 2 yr after amputation was significantly more in men with an amputation than without, and in men with a TTA or TFA (8%–9% increase than in men with a PFA (3%–6% increase. Generally, percent weight gain peaked at 2 yr and was followed by some weight loss in the third year. These findings indicate that LLA is often followed by clinically important weight gain. Future studies are needed to better understand the reasons for weight gain and to identify intervention strategies to prevent excess weight gain and the deleterious consequences that may ensue.

  18. Predicting prosthetic prescription after major lower-limb amputation

    Directory of Open Access Journals (Sweden)

    Linda Resnik, PT, PhD, OCS

    2015-09-01

    Full Text Available We describe prosthetic limb prescription in the first year following lower-limb amputation and examine the relationship between amputation level, geographic region, and prosthetic prescription. We analyzed 2005 to 2010 Department of Veterans Affairs (VA Inpatient and Medical Encounters SAS data sets, Vital Status death data, and National Prosthetic Patient Database data for 9,994 Veterans who underwent lower-limb amputation at a VA hospital. Descriptive statistics and bivariates were examined. Cox proportional hazard models identified factors associated with prosthetic prescription. Analyses showed that amputation level was associated with prosthetic prescription. The hazard ratios (HRs were 1.41 for ankle amputation and 0.46 for transfemoral amputation compared with transtibial amputation. HRs for geographic region were Northeast = 1.49, Upper Midwest = 1.26, and West = 1.39 compared with the South (p < 0.001. African American race, longer length of hospital stay, older age, congestive heart failure, paralysis, other neurological disease, renal failure, and admission from a nursing facility were negatively associated with prosthetic prescription. Being married was positively associated. After adjusting for patient characteristics, people with ankle amputation were most likely to be prescribed a prosthesis and people with transfemoral amputation were least likely. Geographic variation in prosthetic prescription exists in the VA and further research is needed to explain why.

  19. 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

  20. 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 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.

  1. 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 length of hospital stay, older age, congestive heart failure, paralysis, other neurological disease, renal failure, and admission from a nursing facility were negatively associated with prosthetic prescription. Being married was positively associated. After adjusting for patient characteristics, people with ankle amputation were most likely to be prescribed a prosthesis and people with transfemoral amputation were least likely. Geographic variation in prosthetic prescription exists in the VA and further research is needed to explain why. PMID:26562228

  2. Classification of the pattern of intrauterine amputations of the upper limb in constriction ring syndrome.

    Science.gov (United States)

    Al-Qattan, M M

    2000-06-01

    Twenty patients with congenital upper limb amputations caused by constriction rings were reviewed to classify the pattern of these amputations. In the 20 patients studied, 31 upper limbs had congenital amputations. The pattern of amputation was classified into three types. Proximal upper limb amputation was considered type I and was only seen in one limb. The most common pattern of amputation was digital amputation associated with "coning" or "superimposition" of the digits (type II) and was seen in 20 hands. Type II amputations were subclassified according to the involvement of all, ulnar, radial, or central digits by the constriction ring. In type III amputations (N = 10 limbs), there was no associated coning or superimposition of the digits. This type of amputation was subclassified into type IIIA (multiple-digit amputations within the same hand) and type III B (single-digit amputation). Associated anomalies are reviewed and the pathogenesis of constriction rings is discussed.

  3. FROM CULTURAL IMPOTENCE TO CULTURAL AMPUTATION

    Directory of Open Access Journals (Sweden)

    Sukhanov Vyacheslav Vladimirovich

    2013-02-01

    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.

  4. Mucormycosis: a rare complication of an amputation.

    Science.gov (United States)

    de Chaumont, Arthus; Pierret, Charles; Janvier, Frédéric; Goudard, Yvain; de Kerangal, Xavier; Chapuis, Olivier

    2014-05-01

    Mucormycosis is a rare but serious opportunistic fungal infection. Several clinical forms have been described, including cutaneous localization that is frequently associated with soft tissue trauma or burns. We report a case of cutaneous mucormycosis in a diabetic patient with severe occlusive arterial disease. The diagnosis was made early with mold growth on an amputation wound and the presence of nonseptate hyphae on direct microscopic examination, later identified on culture as Lichtheimia ramosa. Aggressive treatment, including the control of underlying diseases, systemic and local amphotericin B, and extensive surgical debridement permitted successful outcomes.

  5. Lower-limb amputation and body weight changes in men.

    Science.gov (United States)

    Littman, Alyson J; Thompson, Mary Lou; Arterburn, David E; Bouldin, Erin; Haselkorn, Jodie K; Sangeorzan, Bruce J; Boyko, Edward J

    2015-01-01

    Little is known about the relationship between lower-limb amputation (LLA) and subsequent changes in body weight. We conducted a retrospective cohort study using clinical and administrative databases to identify and follow weight changes in 759 males with amputation (partial foot amputation [PFA], n = 396; transtibial amputation [TTA], n = 267; and transfemoral amputation [TFA], n = 96) and 3,790 nondisabled persons frequency-matched (5:1) on age, body mass index, diabetes, and calendar year from eight Department of Veterans Affairs medical care facilities in the Pacific Northwest. We estimated and compared longitudinal percent weight change from baseline during up to 39 mo of follow-up in participants with and without amputation. Weight gain in the 2 yr after amputation was significantly more in men with an amputation than without, and in men with a TTA or TFA (8%-9% increase) than in men with a PFA (3%-6% increase). Generally, percent weight gain peaked at 2 yr and was followed by some weight loss in the third year. These findings indicate that LLA is often followed by clinically important weight gain. Future studies are needed to better understand the reasons for weight gain and to identify intervention strategies to prevent excess weight gain and the deleterious consequences that may ensue.

  6. Lower-limb amputation and body weight changes in men.

    Science.gov (United States)

    Littman, Alyson J; Thompson, Mary Lou; Arterburn, David E; Bouldin, Erin; Haselkorn, Jodie K; Sangeorzan, Bruce J; Boyko, Edward J

    2015-01-01

    Little is known about the relationship between lower-limb amputation (LLA) and subsequent changes in body weight. We conducted a retrospective cohort study using clinical and administrative databases to identify and follow weight changes in 759 males with amputation (partial foot amputation [PFA], n = 396; transtibial amputation [TTA], n = 267; and transfemoral amputation [TFA], n = 96) and 3,790 nondisabled persons frequency-matched (5:1) on age, body mass index, diabetes, and calendar year from eight Department of Veterans Affairs medical care facilities in the Pacific Northwest. We estimated and compared longitudinal percent weight change from baseline during up to 39 mo of follow-up in participants with and without amputation. Weight gain in the 2 yr after amputation was significantly more in men with an amputation than without, and in men with a TTA or TFA (8%-9% increase) than in men with a PFA (3%-6% increase). Generally, percent weight gain peaked at 2 yr and was followed by some weight loss in the third year. These findings indicate that LLA is often followed by clinically important weight gain. Future studies are needed to better understand the reasons for weight gain and to identify intervention strategies to prevent excess weight gain and the deleterious consequences that may ensue. PMID:26244755

  7. 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....

  8. 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...

  9. 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

  10. Minor amputations for diabetic foot salvage

    Directory of Open Access Journals (Sweden)

    Salah Y. Habel

    2015-10-01

    Full Text Available Foot ulceration in diabetic patients is a frequent complication of diabetes mellitus (DM, necessitating hospitalization for control of infection, wound care and glycemic control. These patients are at risk for potential loss of the involved limb as well as for future loss of the contralateral limb. Diabetic foot is the consequence of peripheral neuropathy complicated by infrapopliteal peripheral vascular disease. Most of the patients present with chronic plantar ulceration and with cellulitis or an abscess. In a significant number of patients, it is observed that the frequency of life or limb threatening infection is less with an intact skin cover. Limb salvage employs the use of culture specific antibiotics, sharp debridement or a minor amputation, wound care and/or skin cover as the situation demands.

  11. A modified scintigrafic technique for amputation level selection in diabetics

    International Nuclear Information System (INIS)

    A modified 123I-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. (orig.)

  12. Pirogow’s Amputation: A Modification of the Operation Method

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    M. Bueschges

    2013-01-01

    Full Text Available Introduction. Pirogow’s amputation at the ankle presents a valuable alternative to lower leg amputation for patients with the corresponding indications. Although this method offers the ability to stay mobile without the use of a prosthesis, it is rarely performed. This paper proposes a modification regarding the operation method of the Pirogow amputation. The results of the modified operation method on ten patients were objectified 12 months after the operation using a patient questionnaire (Ankle Score. Material and Methods. We modified the original method by rotating the calcaneus. To fix the calcaneus to the tibia, Kirschner wire and a 3/0 spongiosa tension screw as well as a Fixateur externe were used. Results. 70% of those questioned who were amputated following the modified Pirogow method indicated an excellent or very good result in total points whereas in the control group (original Pirogow’s amputation only 40% reported excellent or very good result. In addition, the level of pain experienced one year after the completed operation showed different results in favour of the group being operated with the modified way. Furthermore, patients in both groups showed differences in radiological results, postoperative leg length difference, and postoperative mobility. Conclusion. The modified Pirogow amputation presents a valuable alternative to the original amputation method for patients with the corresponding indications. The benefits are found in the significantly reduced pain, difference in reduced radiological complications, the increase in mobility without a prosthesis, and the reduction of postoperative leg length difference.

  13. Prospective comparison of noninvasive techniques for amputation level selection

    International Nuclear Information System (INIS)

    This study prospectively compared the following tests for their accuracy in amputation level selection: transcutaneous oxygen, transcutaneous carbon dioxide, transcutaneous oxygen-to-transcutaneous carbon dioxide, foot-to-chest transcutaneous oxygen, intradermal xenon-133, ankle-brachial index, and absolute popliteal artery Doppler systolic pressure. All metabolic parameters had a high degree of statistical accuracy in predicting amputation healing whereas none of the other tests had statistical reliability. Amputation site healing was not affected by the presence of diabetes mellitus nor were the test results for any of the metabolic parameters

  14. The social and economic consequences of finger amputations.

    Science.gov (United States)

    Hovgaard, C; Angermann, P; Hovgaard, D

    1994-06-01

    120 patients with amputation of at least 1 of the 4 ulnar fingers were admitted to hospital. In none was replantation considered to be possible because of serious damage to the soft tissues and bone. 12 (3-18) years after the accident 80 percent of the patients assessed their condition as good or fair, even those with proximal amputation or loss of 2 or 3 fingers. Our observations do not support replantation when only one of the second-to-fifth fingers have been amputated.

  15. Obesity and metabolic disorders in adults with lower limb amputation.

    Science.gov (United States)

    Kurdibaylo, S F

    1996-10-01

    Anthropometric and biochemical research was conducted on 94 subjects with various levels of lower limb amputation. The purpose of the work was to investigate the features of obesity progression and disorders of cholesterin metabolism, as well as to develop adequate training exercises. Anthropometric research was conducted by calipermetry; the biochemical research was done by various methods to determine exempt and total cholesterin and triglycerides in the blood serum. The research establishes the frequency of obesity progression relative to the level of amputation, as well as the features of the excessive body mass. Type 11A hyperlipoproteidemia was evident. It is characterized by rapid progress of atherosclerotic vascular disease and coronary disease (CD). Cyclic and acyclic exercises were developed for prophylaxis and therapy. Anthropometric research on the determination of body fat mass was conducted on 68 subjects with various levels of lower limb amputation. The nondirect method of measuring skin folds of several parts of the body was used to determine the extent of lipogenesis. Biochemical research of cholesterin metabolism was conducted on 26 subjects with lower limb amputation (a different group). Anthropometric research revealed an increase of body fat mass directly related to the level of amputation. The largest amount of fat in the body mass was noted for the subjects with bilateral transfemoral (above-knee) amputation or transfemoral plus transtibial (below-knee) amputation. Both groups averaged 25.9%. The body fat mass increased chiefly in the subcutaneous fat. Increase of the internal fat mass was less noticeable. The frequency of obesity progression in subjects with unilateral transtibial amputation equaled 37.9%; in subjects with transfemoral amputation, 48.0%; and in subjects with bilateral transfemoral or transfemoral plus transtibial amputation, 64.2%. Young subjects demonstrated obesity progression during the first year after amputation

  16. Estimation of amputation level with a laser Doppler flowmeter

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Jørgensen, J P; Vollmer-Larsen, B;

    1989-01-01

    Leg amputation levels were decided in 24 patients suffering from atherosclerosis, using the conventional techniques of segmental blood pressure and radioisotope skin clearance. The skin microcirculation was measured and recorded before operation with a laser doppler flowmeter. A high correlation...

  17. Sciatic Neuroma Presenting Forty Years After Above-Knee Amputation

    OpenAIRE

    Kitcat, M; Hunter, J. E.; C.M. Malata

    2009-01-01

    We report a case of a sciatic neuroma presenting forty years after above knee amputation. Patients developing neuroma following a limb amputation can present with stump pain which is commonly resistant to medical intervention. The length of interval from the initial injury to presentation is widely variable. Diagnosis relies on clinical suspicion and accurate assessment, radiological imaging and, if indicated, surgical exploration. MRI provides a better soft tissue definition than CT and is m...

  18. Vascular surgery reduces the frequency of lower limb major amputations

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Bøvling, Søren; Fasting, H;

    1994-01-01

    In June 1988 a Department of Vascular Surgery was established in the county of Viborg, Denmark. In this retrospective study of the periods 1986-87 and 1989-90, we have observed a significant rise in the number of patients evaluated by a vascular surgeon before amputation, from 19 to 49...... surgical activity. The frequency of major amputations in the county in 1986-87 of 40.9 per 100,000 per year declined by 25% to 30.9 per 100,000 per year in 1989-90. We conclude that vascular surgery reduces the number of major lower limb amputations and consequently all patients threatened with amputation......%. At the same time the number of major lower limb amputations significantly decreased. This reduction was most marked in 1990 probably due to a rise of 43% in the number of distal reconstructions. The distribution between below knee, through knee and mid-thigh amputation was unaffected by the increased vascular...

  19. 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.

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

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    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

  1. 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. PMID:26478562

  2. The scope of amputations in a Nigerian teaching hospital.

    Science.gov (United States)

    Solagberu, B A

    2001-09-01

    In developing countries, amputations have been performed due to trauma and infections; whereas in developed counties, trauma, diabetes and peripheral vascular diseases are the usual indications. Current practice in Nigeria suggests a change of relative indications, hence, this study. A five-year (July 1994 to June 1999) review of amputation records from the medical records, operating theatre, wards and physiotherapy department was carried out retrospectively. Amputation types, age, sex and indications were analysed. Fifty-eight amputations were performed in 56 patients (47 males, nine females, M: F = 5.2 : 1, age range 7-70 years, mean 33.3 +/- S.D 18.2). There were 42 lower and 16 upper limbs. Trauma accounted for 48.3%; followed by diabetes (29.3%), tumours (12.1%), infections (8.6%) and one indeterminate cause (1.7%). There was bias for sex, age and type of extremity as trauma was the commonest indication in male patients aged 30 years and below (and in the upper limb) whereas diabetes predominated in female patients above 30 years (and in the lower limb). Infection, as an indication for amputation, has now become a rear guard indication. Diabetes, previously uncommon, now appears in the forefront. These findings call for early detection and aggressive management of diabetic foot lesions.

  3. Transmetatarsal Amputation: A Case Series and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Ryan McCallum

    2012-01-01

    Full Text Available Foot ulceration is a major cause of morbidity amongst patients with diabetes. In severe cases of ulceration, osteomyelitis and amputation can ensue. A distinct lack of agreement exists on the most appropriate level of amputation in cases of severe foot ulceration/infection to provide predictable healing rates. This paper provides an overview of the transmetatarsal amputation (TMA as a limb salvage procedure and is written with the perspective and experiences of the Department of Podiatric Surgery at West Middlesex University Hospital (WMUH. We have reflected on the cases of 11 patients (12 feet and have found the TMA to be an effective procedure in the management of cases of severe forefoot ulceration and infection.

  4. Preventing amputation in adults with diabetes: identifying the risks.

    Science.gov (United States)

    Thomas, Eleanor

    2015-06-01

    Good management of diabetes can reduce the risk of complications of the disease. When not well managed, diabetes is associated with the complications of heart disease, stroke, blindness, kidney disease and amputations. Diabetes can reduce the blood supply to the feet and cause a loss of feeling. As a result, foot injuries do not heal well and the person may not realise that their foot is sore or injured. Damage to the foot may lead to the development of foot ulcers, which if left untreated may result in amputation of the limb. Preventive care is a priority, but when complications occur the next step is to halt progression. Therefore, effective foot care and timely treatment of foot ulcers are important in preserving foot function and mobility, and preventing amputation in adults with diabetes. PMID:26036406

  5. The use of bone bridges in transtibial amputations

    Directory of Open Access Journals (Sweden)

    Okamoto Auro Mitsuo

    2000-01-01

    Full Text Available We sought to describe the bone bridge technique in adults, and present a variation for use in children, as well as to present its applicability as an option in elective transtibial amputations. This paper presents a prospective study of 15 transtibial amputations performed between 1992 and 1995 in which the bone bridge technique was employed. The patients' ages ranged from 8 to 48 years, with an average of 22.5 years. This technique consisted of the preparation of a cylinder of periosteum extracted from the tibia and with cortical bone fragments attached to it to promote a tibiofibular synostosis on the distal extremity of the amputation stump. We noted that the cortical bone fragments were dispensable when the technique was employed in children, due to the increased osteogenic capacity of the periosteum. This led to a variation of the original technique, a bone bridge without the use of the cortical bone fragments. RESULTS: The average time spent with this procedure, without any significant variation between adults and children, was 171 minutes. The adaptation to the definitive prosthesis was accomplished between 20 and 576 days, with an average of 180 days. Revision of the procedure was necessary in 3 amputations. CONCLUSIONS: This technique may be employed in transtibial amputations in which the final length of the stump lies next to the musculotendinous transition of the gastrocnemius muscle, as well as in the revision of amputation stumps in children, where the procedure has been shown to be effective in the prevention of lesions due to excessive bone growth.

  6. 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 amputati

  7. [Antibiotic treatment in patients amputated for ischemic diabetic foot].

    Science.gov (United States)

    Fernández Montequín, J I; McCook Martínez, J; Lima Santana, B; Velasco Armas, N; Montalvo Diago, J; Mahía Vilas, M

    1991-01-01

    Thirty diabetic patients submitted to a major amputation were tested by humo-celullar assays (retarded hypersensibility assays). Reactive patients were subdivided into two groups: one group was treated postoperatively with antibiotics, and the other group was not treated. Both groups were homogeneous in age, hemoglobin concentrations, hematocrit, total proteins, glucemy and history of sepsis or leukocytosis. Five patients treated with antibiotics (33.3%) presented sepsis, one patient was reamputated and one patient died. Between the not treated patients, only three presented sepsis (20%) without any other complications. Authors conclude that the development of sepsis in reactive, diabetic, amputated patients is independent of antibiotic treatment. PMID:1755544

  8. Amputated Lower Limb Fixation to the Fracture Table.

    Science.gov (United States)

    Gamulin, Axel; Farshad, Mazda

    2015-11-01

    Fractures of the proximal and diaphyseal femur are frequently internally fixed using a fracture table with fracture reduction obtained by traction and adequate rotation exerted on the slightly abducted extremity. Although rare, these fractures may occur on an amputated limb. If so, standard use of a fracture table is not possible. To address this situation, the authors describe a simple novel technique allowing rigid fixation of the amputated limb to the traction device of the fracture table that provides accurate control of reduction in all planes. PMID:26558660

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

    OpenAIRE

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

    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...

  10. Reduced incidence of lower-extremity amputations in a Danish diabetes population from 2000 to 2011

    DEFF Research Database (Denmark)

    Jørgensen, M E; Almdal, T P; Faerch, K

    2014-01-01

    Diabetic foot disease and amputations severely reduce quality of life and have major economic consequences. The aim of this study was to estimate time trends in the incidence of lower-extremity amputations in Danish people with diabetes.......Diabetic foot disease and amputations severely reduce quality of life and have major economic consequences. The aim of this study was to estimate time trends in the incidence of lower-extremity amputations in Danish people with diabetes....

  11. 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

  12. Reduction of residual limb volume in people with transtibial amputation

    Directory of Open Access Journals (Sweden)

    Audrey T. Tantua, MD

    2014-11-01

    Full Text Available The early postoperative phase after transtibial amputation is characterized by rapid residual limb volume reduction. Accurate measurement of residual limb volume is important for the timing of fitting a prosthesis. The aim of this study was to analyze the reduction of residual limb volume in people with transtibial amputation and to correlate residual limb volume with residual limb circumference. In a longitudinal cohort study of 21 people who had a transtibial amputation, residual limb volume was measured using a laser scanner and circumference was measured using a tape measure 1 wk postamputation and every 3 wk thereafter until 24 wk postamputation. A linear mixed model analysis was performed with weeks postamputation transformed according to the natural logarithm as predictor. Residual limb volume decreased significantly over time, with a large variation between patients. Residual limb volume did not correlate well with circumference. On average, residual limb volume decreased 200.5 mL (9.7% of the initial volume per natural logarithm of the weeks postamputation. The decrease in residual limb volume following a transtibial amputation was substantial in the early postamputation phase, followed by a leveling off. It was not possible to determine the specific moment at which the residual limb volume stabilized.

  13. 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.

  14. The incidence of symptomatic neuroma in amputation and neurorrhaphy patients

    NARCIS (Netherlands)

    van der Avoort, D. J. J. C.; Hovius, S. E. R.; Selles, R. W.; van Neck, J. W.; Coert, J. H.

    2013-01-01

    Purpose: The incidence of symptomatic neuroma in finger nerve injuries varies widely in the literature. In this retrospective study, we evaluated the incidence of symptomatic neuroma after repair of digital nerve injuries (neurorrhaphy) and after amputation of one or more fingers. We also determined

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

    OpenAIRE

    Jandrić Slavica; Topić Brano

    2002-01-01

    The results of below-knee amputations in 36 war wounded (mean age 35,42) were reviewed. The majority of the patients was wounded by land mines (94.4%). Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation) in 30 (83.3%) amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7%) average 4.61 ± 11.67 days a...

  16. Assessment of quality of life in patients after lower limb amputation

    Directory of Open Access Journals (Sweden)

    Knežević Aleksandar

    2015-01-01

    Full Text Available Introduction. Lower extremity amputation is a surgical procedure resulting in important anatomical, functional, psychological, and social consequences that can influence the quality of life of these patients. The aim of this research was to compare the quality of life of patients with lower extremity amputation and people without amputation taking into account gender differences as well as the amputation level. Material and Methods. The study was designed as a cross-sectional study which included 56 subjects. The patients from the experimental group underwent prosthetic rehabilitation treatment at the Department of Medical Rehabilitation, Clinical Centre of Vojvodina. The experimental group included 28 patients (21 male, 7 female with lower extremity amputation, their average age being 65.36±13.64. The control group consisted of 28 age and gender matching subjects without amputation. Research ANd Development (RAND 36 - Item Health Survey 1.0 (SF - 36 was used to measure the quality of life. Results. The results showed that patients with lower extremity amputation scored lower than the control group on all SF- 36 variables (p0.05. Seventeen (61% patients were with transfemoral, and 11 (39% with transtibial level of amputation. The patients with transtibial amputations scored higher on physical functioning and general health status variables (p<0.05. Conclusion. The patients with lower extremity amputations have numerous limitations compared to the control group, regardless of gender, while the patients with lower level of amputation have a higher level of physical functioning.

  17. Pattern of injury in those dying from traumatic amputation caused by bomb blast.

    Science.gov (United States)

    Hull, J B; Bowyer, G W; Cooper, G J; Crane, J

    1994-08-01

    Traumatic amputation of limbs caused by bomb blast carries a high risk of mortality. This paper describes 73 amputations in 34 deaths from bomb blast in Northern Ireland. The principal aim was to determine the sites of traumatic amputation to provide a biophysical basis for the development of protective measures. Few amputations were through joints; nearly all were through the bone shafts. The most common site in the tibia was the upper third. The distribution of femoral sites resulting from car bombs differed from that characterizing other types of explosion. For car bombs the principal site of amputation was the upper third; for other types of device it was the lower third. It is concluded that flailing is not a notable contributor to limb avulsion. The pattern of amputation is consistent with direct local pressure loads leading to bone fracture; the amputation itself is a secondary event arising from the flow of combustion products. PMID:7953338

  18. Pattern of injury in those dying from traumatic amputation caused by bomb blast.

    Science.gov (United States)

    Hull, J B; Bowyer, G W; Cooper, G J; Crane, J

    1994-08-01

    Traumatic amputation of limbs caused by bomb blast carries a high risk of mortality. This paper describes 73 amputations in 34 deaths from bomb blast in Northern Ireland. The principal aim was to determine the sites of traumatic amputation to provide a biophysical basis for the development of protective measures. Few amputations were through joints; nearly all were through the bone shafts. The most common site in the tibia was the upper third. The distribution of femoral sites resulting from car bombs differed from that characterizing other types of explosion. For car bombs the principal site of amputation was the upper third; for other types of device it was the lower third. It is concluded that flailing is not a notable contributor to limb avulsion. The pattern of amputation is consistent with direct local pressure loads leading to bone fracture; the amputation itself is a secondary event arising from the flow of combustion products.

  19. Lower limb amputations: differences between the genders and long-term survival.

    Science.gov (United States)

    Heikkinen, M; Saarinen, J; Suominen, V P; Virkkunen, J; Salenius, J

    2007-09-01

    The purpose of the study was to evaluate possible differences between genders in amputation incidence, revascularization activity before and survival after amputation. This population-based study was carried out in a well-defined geographical area, where all vascular surgical consultations and reconstructions are performed in one university hospital. All amputations performed in the region during 1990 - 1999 were identified from the hospital central registers. According to patient's identity codes, the Cause of Death Registry of Statistics Finland provided death data. Amputation data were cross-linked with the local vascular registry using identity codes. Women were found to be 8 years older than men (p < 0.0001). Major amputations comprised 73.4% in males and 77.7% in females. The age-standardized amputation incidence among males was 338 and among females 226 (per 10(6) inhabitants/year) (p < 0.001). The most prominent difference was seen in amputations due to trauma, where the age-adjusted major amputation incidence was over three-fold among males compared to females. The proportion of patients who had undergone vascular procedure before amputation was 23% in both genders. Median survival after amputation was 943 days in men and 716 in women (p = 0.01). When the higher age of women was considered, there was no significant difference between the genders. Survival was poorer among diabetics in both genders and the difference was significant in males. The amputation incidence was found to be higher in men compared to women in all etiologic subgroups except malignant tumour. Almost one in 4 patients had undergone vascular surgical reconstruction before amputation in both genders. There was no significant difference between the genders in survival after amputation. Subjects with diabetes had a poorer survival after major amputation than those without diabetes. PMID:17979013

  20. 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 < 0.001), whereas motorcyclists (86.2% vs 13.8%, P < 0.001) and pedestrians (91.9% vs 8.1%, P < 0.001) had more LEA. Patients with LEA were more likely to require discharge to a skilled nursing facility; whereas those with UEA were more likely to be discharged home. 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.

  1. Epidemiological Study on Reasons for Leg Amputation in Japanese

    OpenAIRE

    Hayashi, Yoshitaka; IMAKI, Masahide; Ogawa, Yukiko; FUCHOKA, Satoshi; OKUDA, Kuniharu

    2006-01-01

    This study was conducted, with special reference to elucidating the causes for lower limb amputation, which would have the most significant effect on "locomotion", the basis of independence of the aged. The subjects were leg amputees for whom artificial limbs had been fitted financed by various insurance policies in Osaka prefecture. The survey was conducted on 3, 138 subjects, from whom acceptable responses were obtained from 1, 460 (recovery rate, 46.5%). Questionnaires were mailed to each ...

  2. Classifying prosthetic use via accelerometry in persons with transtibial amputations

    Directory of Open Access Journals (Sweden)

    Morgan T. Redfield, MSEE

    2013-12-01

    Full Text Available Knowledge of how persons with amputation use their prostheses and how this use changes over time may facilitate effective rehabilitation practices and enhance understanding of prosthesis functionality. Perpetual monitoring and classification of prosthesis use may also increase the health and quality of life for prosthetic users. Existing monitoring and classification systems are often limited in that they require the subject to manipulate the sensor (e.g., attach, remove, or reset a sensor, record data over relatively short time periods, and/or classify a limited number of activities and body postures of interest. In this study, a commercially available three-axis accelerometer (ActiLife ActiGraph GT3X+ was used to characterize the activities and body postures of individuals with transtibial amputation. Accelerometers were mounted on prosthetic pylons of 10 persons with transtibial amputation as they performed a preset routine of actions. Accelerometer data was postprocessed using a binary decision tree to identify when the prosthesis was being worn and to classify periods of use as movement (i.e., leg motion such as walking or stair climbing, standing (i.e., standing upright with limited leg motion, or sitting (i.e., seated with limited leg motion. Classifications were compared to visual observation by study researchers. The classifier achieved a mean +/– standard deviation accuracy of 96.6% +/– 3.0%.

  3. Classifying prosthetic use via accelerometry in persons with transtibial amputations.

    Science.gov (United States)

    Redfield, Morgan T; Cagle, John C; Hafner, Brian J; Sanders, Joan E

    2013-01-01

    Knowledge of how persons with amputation use their prostheses and how this use changes over time may facilitate effective rehabilitation practices and enhance understanding of prosthesis functionality. Perpetual monitoring and classification of prosthesis use may also increase the health and quality of life for prosthetic users. Existing monitoring and classification systems are often limited in that they require the subject to manipulate the sensor (e.g., attach, remove, or reset a sensor), record data over relatively short time periods, and/or classify a limited number of activities and body postures of interest. In this study, a commercially available three-axis accelerometer (ActiLife ActiGraph GT3X+) was used to characterize the activities and body postures of individuals with transtibial amputation. Accelerometers were mounted on prosthetic pylons of 10 persons with transtibial amputation as they performed a preset routine of actions. Accelerometer data was postprocessed using a binary decision tree to identify when the prosthesis was being worn and to classify periods of use as movement (i.e., leg motion such as walking or stair climbing), standing (i.e., standing upright with limited leg motion), or sitting (i.e., seated with limited leg motion). Classifications were compared to visual observation by study researchers. The classifier achieved a mean +/- standard deviation accuracy of 96.6% +/- 3.0%.

  4. 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.

  5. 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

  6. Clinical effect and necessity of interventional treatment in diabetic foot before and after amputation

    International Nuclear Information System (INIS)

    Objective: To assess the clinical effect and necessity of interventional treatment in diabetic foot before and after amputation. Methods: Combined intravascular angioplasty with intraarterial medicine perfusing were carried out in fourteen patients with diabetic foot including 10 patients treated before amputation and 4 after amputation involving superficial femoral, deep femoral, tibial and fitular arteries. Among them seventeen vessels with irregular stenosis and obstruction were treated by intravascular angioplasty through balloon dilation. Results: The technical successful rate was 100%, no complication happened. The symptoms were relieved in all patients after treatment, including promotion of lower extremity arterial blood perfusion, reducing range of amputation and wound healing after amputation. Conclusions: Intravascular interventional treatment is safe, effective and valuable in diabetic foot before and after amputation. (authors)

  7. 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...... rating above two. Patient characteristics and other factors potentially influencing early amputation failure within 30 days were evaluated. RESULTS: Eleven patients died (16%) and 11 (16%) had a re-amputation at a higher level, whereas four (6%) had a major revision at the same level within 30 days...

  8. 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.

  9. Hip Arthroscopy in Patients With Lower-Extremity Amputations: Patient Positioning and Traction Technique.

    Science.gov (United States)

    McCabe, Michael P; Davila, Jeffrey

    2015-12-01

    Improved battlefield survival rates have resulted in a significant number of young active patients with lower-extremity amputations. Because of the increased demands placed on their hips, patients with amputations may be more susceptible to the sequelae of hip pathology and femoroacetabular impingement. Arthroscopic management of hip pathology may be successfully performed in patients with ipsilateral, contralateral, or bilateral lower-extremity amputations. We describe our experience in this unique patient population. A technique for secure patient positioning that provides sufficient countertraction in the case of contralateral amputation is described, as is the use of skeletal traction with a temporary external fixator for joint distraction in patients with ipsilateral amputations. Considerations specific to patients with high transfemoral amputations are discussed as well. PMID:27284510

  10. 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

    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...

  11. 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.

  12. Evaluation of variations of neck to shaft of femur in amputations above knee

    OpenAIRE

    Naraghi M; Hedayatpoor A

    1997-01-01

    In this study, we investigated variations of the angle between neck and shaft of femur after amputation of tigh above the knee. In amputated tigh the angle between neck and shaft of the femur is decreased than normal (nearly 90° degrees) (coax vara). The angle of the normal femur usually increases due to weight bearing (coax valga). In the patients that both tighs have been amputated the changes of the angle are equal.

  13. Evaluation of variations of neck to shaft of femur in amputations above knee

    Directory of Open Access Journals (Sweden)

    Naraghi M

    1997-09-01

    Full Text Available In this study, we investigated variations of the angle between neck and shaft of femur after amputation of tigh above the knee. In amputated tigh the angle between neck and shaft of the femur is decreased than normal (nearly 90° degrees (coax vara. The angle of the normal femur usually increases due to weight bearing (coax valga. In the patients that both tighs have been amputated the changes of the angle are equal.

  14. The morphology and functions of the muscles around the hip joint after a unilateral transfemoral amputation

    OpenAIRE

    Jaegers, Sonja Maria Héléne José

    1993-01-01

    This dissertation is concerned with the consequences of a transfemoral amputation for the morphology and functions of the muscles around the hip joint. Knowledge about and insight into the changes appearing in the morphology and functions of the hip muscles of transfemoral amputees are important to amputation surgery as well as to prosthetics. Amputation surgery and prosthetics are interrelated and cannot be separated one from another. .... Zie: Summary

  15. A Clinical and Histological Analysis of Mesenchymal Stem Cells in Amputation

    Science.gov (United States)

    2016-07-20

    Ischemia; Peripheral Arterial Disease; Peripheral Vascular Disease; Vascular Disease; Arterial Occlusive Disease; Arteriosclerosis; Atherosclerosis; Cardiovascular Disease; Pathologic Processes; Orthopedic Procedures; Amputation

  16. Reducing treatment by means of physical rehabilitation after lower limb amputation

    Directory of Open Access Journals (Sweden)

    Liana Dugina

    2015-04-01

    Full Text Available Purpose: the main approaches to the assignment of physical rehabilitation restorative treatment after lower limb amputations. Material and Methods: theoretical analysis and synthesis of modern scientific and methodological literature data on methods of comprehensive rehabilitation after lower limb amputations. Results: the features of the application of physical rehabilitation after lower limb amputations, tasks and presents the main approaches to the appointment of medical physical training, therapeutic massage and physical therapy in preparation for prosthetics. Conclusions: demonstrated that therapeutic physical training, therapeutic massage and physical therapy are effective means of physical rehabilitation of patients after lower limb amputations.

  17. Analysis of 24 Patients Who Were Amputated Due to a Malignant Tumor in the Skeleton

    Directory of Open Access Journals (Sweden)

    Hasan Gocer

    2014-11-01

    Full Text Available Aim: The purpose of the study was to assess the cases that were amputated in our clinic due to primary malignant and metastatic bone and soft tissue tumor. Material and Method: 24 cases that were amputated due to primary malignant and metastatic bone and soft tissue tumor between January 1987 and January 2012 were examined retrospectively. The cases were assessed in terms of age, gender, pathological diagnosis, localization, type of amputation, survival and characteristics. The data obtained were transferred to SPSS 15.0 program and analyzed. Normality distributions of the data were analyzed with Shapiro-Wilk test. Results: Of the 24 cases, 17 (70% were men, while 7 (30% were women and the average age was 42 (between 12 and 68. The most common reasons for amputation were skin cancer (25%, Ewing sarcoma (20.8%, Osteosarcoma (16.6% and others (Malignant mesenchymal tumor, chondrosarcoma, synovial sarcoma, metastatic tumor. 16 of these patients had previously received an intervention in a different centre at least once. The most common type of amputation was above-knee amputation (58.3%, below-knee amputation (25% and others (hip disarticulation, below-elbow amputation. 8 patients were found to have skin problems and debridement was performed on 6. 14 cases died within the postoperative first year. Discussion: Amputation can be performed for the treatment of the patient’s other health problems and fast and local controls of advanced malignant extremity tumors.

  18. Lower extremity amputations in diabetic Mexican American elders: incidence, prevalence and correlates.

    Science.gov (United States)

    Otiniano, Max E; Du, Xianglin; Ottenbacher, Kenneth; Black, Sandra A; Markides, Kyriakos S

    2003-01-01

    This study was designed to determine the incidence and prevalence of amputations in diabetic Mexican American elders and to identify correlates of lower extremity amputations. Data for this study came from baseline and two follow-up interviews of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE) conducted in five southwestern states (Texas, California, New Mexico, Colorado and Arizona) in 1993-1994. Of the 3050 subjects aged 65 and older, 690 reported diabetes, and from these, 60 (8%) reported having at least one lower extremity amputation. Losing a leg was the most common type of amputation (53%). Twelve percent of respondents reported a new amputation and 40% of amputees reported a second amputation during follow-up. Mortality among amputees was 46% during a 5-year follow-up. Multiple logistic regression analysis showed that being male and having eye problems, hip fracture and diabetes for 10 or more years were significantly associated with lower extremity amputations at baseline, whereas obesity, stroke and 10 or more years with diabetes were significantly associated with new amputations at 5-year follow-up. Gender and disease history were associated with lower extremity amputations at baseline and follow-up. These variables may be useful in developing patient education and intervention programs.

  19. Prosthetic options for below knee amputations after osteomyelitis and nonunion of the tibia.

    Science.gov (United States)

    Moshirfar, A; Showers, D; Logan, P; Esterhai, J L

    1999-03-01

    Below the knee amputation after trauma is an appropriate option for many patients with recalcitrant infection and nonunion of the tibia. Patients who have had transtibial amputations have lower energy expenditure, heart rate, and oxygen cost when ambulating with their prostheses than when using a three-point gait with crutches without their artificial limb. Innovative prosthetists have improved each of the five essential components of the limb amputated below the knee: socket, insert, shaft and pylon, foot and ankle assembly, and suspension system. Prosthetists are integral members of the patient's healthcare team. Their recommendations and direct patient care are essential to optimizing the functional ability of patients who have had amputations.

  20. 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.

  1. 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. PMID:17115518

  2. 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. PMID:8302899

  3. Traumatic Amputation of Finger From an Alligator Snapping Turtle Bite.

    Science.gov (United States)

    Johnson, Robert D; Nielsen, Cynthia L

    2016-06-01

    Legend states that the alligator snapping turtle (Macrochelys temminckii) should be handled with extreme caution as it has jaw strength powerful enough to bite a wooden broomstick in half. Tales of bite injuries from what is the largest freshwater turtle in North America exist anecdotally, yet there are few descriptions of medical encounters for such. The risk of infection from reptilian bites to the hand in an aquatic environment warrants thorough antibiotic treatment in conjunction with hand surgery consultation. We present the first case report of a near total amputation of an index finger in an adolescent boy who had been bitten by a wild "gator snapper." PMID:27116923

  4. A case of psychosis who amputated his finger

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    Mehmet Cemal Kaya

    2013-03-01

    Full Text Available Self-harm behavior is defined as the person’s intentional,direct injuring of some body tissue or the whole body mostoften done without suicidal intentions. Mild types of selfmutilationis seen frequently however more severe onesare rarely seen. Severe self-mutilation is generally a signof a serious psychiatric disorder and it can result in organand/or organ functionality loss. In this study we aimed topresent a schizophrenic patient with repetitive self-mutilation.As a conclusion, practicing clinicians should takeinto consideration the possibility of self-harm behavior inschizophrenia patients especially if they have high riskproperties.Key words: Schizophrenia, self-mutilation, amputation

  5. Surgical Management of Traumatic Penile Amputation: A Case Report and Review of the World Literature

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    Omer A. Raheem, MD

    2015-03-01

    Conclusion: 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.

  6. 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

  7. 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

  8. Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review

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    Hemakumar Devan, MPhty

    2015-04-01

    Full Text Available Following amputation, people with transfemoral amputation (TFA and transtibial amputation (TTA adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1 amputated and intact leg and (2 amputated and referent leg of nondisabled controls were included (26 articles. Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.

  9. Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review.

    Science.gov (United States)

    Devan, Hemakumar; Carman, Allan; Hendrick, Paul; Hale, Leigh; Ribeiro, Daniel Cury

    2015-01-01

    Following amputation, people with transfemoral amputation (TFA) and transtibial amputation (TTA) adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1) amputated and intact leg and (2) amputated and referent leg of nondisabled controls were included (26 articles). Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.

  10. Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review.

    Science.gov (United States)

    Devan, Hemakumar; Carman, Allan; Hendrick, Paul; Hale, Leigh; Ribeiro, Daniel Cury

    2015-01-01

    Following amputation, people with transfemoral amputation (TFA) and transtibial amputation (TTA) adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1) amputated and intact leg and (2) amputated and referent leg of nondisabled controls were included (26 articles). Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking. PMID:26186283

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

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    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.

  12. Kinematic analysis of males with transtibial amputation carrying military loads

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    Barri L. Schnall, MPT

    2015-03-01

    Full Text Available The biomechanical responses to load carriage, a common task for dismounted troops, have been well studied in nondisabled individuals. However, with recent shifts in the rehabilitation and retention process of injured servicemembers, there remains a substantial need for understanding these responses in persons with lower-limb amputations. Temporal-spatial and kinematic gait parameters were analyzed among 10 male servicemembers with unilateral transtibial amputation (TTA and 10 uninjured male controls. Participants completed six treadmill walking trials in all combinations of two speeds (1.34 and 1.52 m/s and three loads (none, 21.8, and 32.7 kg. Persons with TTA exhibited biomechanical compensations to carried loads that are comparable to those observed in uninjured individuals. However, several distinct gait changes appear to be unique to those with TTA, notably, increased dorsiflexion (deformation of the prosthetic foot/ankle, less stance knee flexion on the prosthetic limb, and altered trunk forward lean/excursion. Such evidence supports the need for future work to assess the risk for overuse injuries with carried loads in this population in addition to guiding the development of adaptive prosthetic feet/components to meet the needs of redeployed servicemembers or veterans/civilians in physically demanding occupations.

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

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    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.

  14. Lower extremity amputation in peripheral artery disease: improving patient outcomes

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    Swaminathan A

    2014-07-01

    Full Text Available Aparna Swaminathan,1 Sreekanth Vemulapalli,1,2 Manesh R Patel,1,2 W Schuyler Jones1,2 1Department of Medicine, Duke University Medical Center, Durham, NC, USA; 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA Abstract: Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE amputation (LEA, although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. Keywords: peripheral artery disease, lower extremity amputation, mortality

  15. Early interfaced neural activity from chronic amputated nerves

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    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. .

  16. Reduced Incidence of Foot-Related Hospitalisation and Amputation amongst Persons with Diabetes in Queensland, Australia.

    Directory of Open Access Journals (Sweden)

    Peter A Lazzarini

    Full Text Available To determine trends in the incidence of foot-related hospitalisation and amputation amongst persons with diabetes in Queensland (Australia between 2005 and 2010 that coincided with changes in state-wide ambulatory diabetic foot-related complication management.All data from cases admitted for the principal reason of diabetes foot-related hospitalisation or amputation in Queensland from 2005-2010 were obtained from the Queensland Hospital Admitted Patient Data Collection dataset. Incidence rates for foot-related hospitalisation (admissions, bed days used and amputation (total, minor, major cases amongst persons with diabetes were calculated per 1,000 person-years with diabetes (diabetes population and per 100,000 person-years (general population. Age-sex standardised incidence and age-sex adjusted Poisson regression models were also calculated for the general population.There were 4,443 amputations, 24,917 hospital admissions and 260,085 bed days used for diabetes foot-related complications in Queensland. Incidence per 1,000 person-years with diabetes decreased from 2005 to 2010: 43.0% for hospital admissions (36.6 to 20.9, 40.1% bed days (391 to 234, 40.0% total amputations (6.47 to 3.88, 45.0% major amputations (2.18 to 1.20, 37.5% minor amputations (4.29 to 2.68 (p < 0.01 respectively. Age-sex standardised incidence per 100,000 person-years in the general population also decreased from 2005 to 2010: 23.3% hospital admissions (105.1 to 80.6, 19.5% bed days (1,122 to 903, 19.3% total amputations (18.57 to 14.99, 26.4% major amputations (6.26 to 4.61, 15.7% minor amputations (12.32 to 10.38 (p < 0.01 respectively. The age-sex adjusted incidence rates per calendar year decreased in the general population (rate ratio (95% CI; hospital admissions 0.949 (0.942-0.956, bed days 0.964 (0.962-0.966, total amputations 0.962 (0.946-0.979, major amputations 0.945 (0.917-0.974, minor amputations 0.970 (0.950-0.991 (p < 0.05 respectively.There were significant

  17. Reconstruction of an Amputated Glans Penis With a Buccal Mucosal Graft: Case Report of a Novel Technique

    OpenAIRE

    Aboutaleb, Hamdy

    2014-01-01

    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. Peni...

  18. Cardiovascular disease risk factors in combat veterans after traumatic leg amputations.

    Science.gov (United States)

    Rose, H G; Schweitzer, P; Charoenkul, V; Schwartz, E

    1987-01-01

    Traumatic leg amputation, but not arm amputation, in World War II combat veterans has been associated with subsequent increased ischemic heart disease mortality. In a pilot project we examined a group of 19 high-risk Vietnam War veterans with bilateral above-knee amputations in comparison with a control group with unilateral below-elbow amputations. Nine of the 19 above-knee amputees were hypertensive (p = 0.05) and obese by hydrostatic weighing (p less than 0.001). Obesity was strongly associated with hypertension, decreased glucose tolerance, and marked hyperinsulinemia. Cigarette smoking, blood lipid abnormalities, and decreased cardiovascular fitness were not implicated as significant risk factors. Long-term risks of amputation may be related to metabolic and hemodynamic sequelae of excessive maturity-onset weight gain in young men immobilized by loss of lower limbs.

  19. Mediolateral angular momentum changes in persons with amputation during perturbed walking.

    Science.gov (United States)

    Sheehan, Riley C; Beltran, Eduardo J; Dingwell, Jonathan B; Wilken, Jason M

    2015-03-01

    Over 50% of individuals with lower limb amputation fall at least once each year. These individuals also exhibit reduced ability to effectively respond to challenges to frontal plane stability. The range of whole body angular momentum has been correlated with stability and fall risk. This study determined how lateral walking surface perturbations affected the regulation of whole body and individual leg angular momentum in able-bodied controls and individuals with unilateral transtibial amputation. Participants walked at fixed speed in a Computer Assisted Rehabilitation Environment with no perturbations and continuous, pseudo-random, mediolateral platform oscillations. Both the ranges and variability of angular momentum for both the whole body and both legs were significantly greater (pangular momentum range or variability during unperturbed walking. The range of frontal plane angular momentum was significantly greater for those with amputation than for controls for all segments (pangular momentum ranges were greater for patients with amputation. However, for the prosthetic leg, angular momentum ranges were less for patients than controls. Patients with amputation were significantly more affected by the perturbations. Though patients with amputation were able to maintain similar patterns of whole body angular momentum during unperturbed walking, they were more highly destabilized by the walking surface perturbations. Individuals with transtibial amputation appear to predominantly use altered motion of the intact limb to maintain mediolateral stability.

  20. Patterns of extremity traumas leading to amputation in lran:results of Iranian National Trauma Project

    Institute of Scientific and Technical Information of China (English)

    Majid Moini; Mohammad R Rasouli; Ali Khaji; Farshad Farshidfar; Pedram Heidari

    2009-01-01

    Obiective: To determine the patterns of traumatic extremity injuries leading to amputation in Iran.Methotis: Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation.This project was conducted in 8 major cities during 2000-2004.Results: of 17 753 traumatic Patients,164 (0.92%) had injuries to the extremities that resulted in the limb amputation.Of these,143 (87.2%) were men.The patient's mean age was 29.0 years±15.4 years and the highest incidence was seen in the age group of 21 to 30 years (34.1%).One hundred and four cases were occupational accidents (63.4%).Blunt trauma was in 54.9% of the cases.The most common reasons for amputation were respectively stabbings (37.8%) and crush injuries (31.7%).Amputation of hand fingers was the most frequent type of amputation (125 cases,76.2%).One patient died from severe associated injuries.Conclusions: This study shows the patterns of traumatic limb amputation in Iran,a developing country.Resuits of this study may be used in preventive strategic planning.

  1. Quality of Life among Egyptian Patients with Upper and Lower Limb Amputation: Sex Differences

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    Salwa A. Mohammed

    2014-01-01

    Full Text Available Background. Limb amputation is a life-changing event that can cause significant disruptions in many important areas of existence. Aim of this study. To evaluate the quality of life (QOL of patients with limb amputation and identify the factors affecting the quality of life of patients with limb amputation among Egyptian patients. Research Design. It was a descriptive exploratory design. Setting. The study was conducted in Orthopedics and Surgical Department in Emergency Hospital at Mansoura University Hospitals. Sample. A sample of convenience of 100 adult male and female patients who met the inclusion criteria was included. Tools. (a Structured interview questionnaire (SIQ was used to collect personal data, (b short form (36 health status questionnaires: this part was utilized to assess the quality of life among Egyptian patients with amputation. Results. The result of this study indicates that most participants experienced a change in the quality of life. There is a statistically significant difference between total QOL aspects and each of the following: age, gender, educational level, and type of work. Conclusion. Limb amputation tends to cause increased disability for those amputated patients. The age, gender, place of amputation, and marital status are found as statistically significant factors with physical component and psychological component.

  2. Physical functioning, pain and quality of life after amputation for musculoskeletal tumours: a national survey.

    Science.gov (United States)

    Furtado, S; Grimer, R J; Cool, P; Murray, S A; Briggs, T; Fulton, J; Grant, K; Gerrand, C H

    2015-09-01

    Patients who have limb amputation for musculoskeletal tumours are a rare group of cancer survivors. This was a prospective cross-sectional survey of patients from five specialist centres for sarcoma surgery in England. Physical function, pain and quality of life (QOL) outcomes were collected after lower extremity amputation for bone or soft-tissue tumours to evaluate the survivorship experience and inform service provision. Of 250 patients, 105 (42%) responded between September 2012 and June 2013. From these, completed questionnaires were received from 100 patients with a mean age of 53.6 years (19 to 91). In total 60 (62%) were male and 37 (38%) were female (three not specified). The diagnosis was primary bone sarcoma in 63 and soft-tissue tumour in 37. A total of 20 tumours were located in the hip or pelvis, 31 above the knee, 32 between the knee and ankle and 17 in the ankle or foot. In total 22 had hemipelvectomy, nine hip disarticulation, 35 transfemoral amputation, one knee disarticulation, 30 transtibial amputation, two toe amputations and one rotationplasty. The Toronto Extremity Salvage Score (TESS) differed by amputation level, with poorer scores at higher levels (p amputation level is linked to physical function, but not QOL or pain measures. Pain and physical function significantly impact on QOL. These results are helpful in managing the expectations of patients about treatment and addressing their complex needs.

  3. Physical functioning, pain and quality of life after amputation for musculoskeletal tumours: a national survey.

    Science.gov (United States)

    Furtado, S; Grimer, R J; Cool, P; Murray, S A; Briggs, T; Fulton, J; Grant, K; Gerrand, C H

    2015-09-01

    Patients who have limb amputation for musculoskeletal tumours are a rare group of cancer survivors. This was a prospective cross-sectional survey of patients from five specialist centres for sarcoma surgery in England. Physical function, pain and quality of life (QOL) outcomes were collected after lower extremity amputation for bone or soft-tissue tumours to evaluate the survivorship experience and inform service provision. Of 250 patients, 105 (42%) responded between September 2012 and June 2013. From these, completed questionnaires were received from 100 patients with a mean age of 53.6 years (19 to 91). In total 60 (62%) were male and 37 (38%) were female (three not specified). The diagnosis was primary bone sarcoma in 63 and soft-tissue tumour in 37. A total of 20 tumours were located in the hip or pelvis, 31 above the knee, 32 between the knee and ankle and 17 in the ankle or foot. In total 22 had hemipelvectomy, nine hip disarticulation, 35 transfemoral amputation, one knee disarticulation, 30 transtibial amputation, two toe amputations and one rotationplasty. The Toronto Extremity Salvage Score (TESS) differed by amputation level, with poorer scores at higher levels (p amputation level is linked to physical function, but not QOL or pain measures. Pain and physical function significantly impact on QOL. These results are helpful in managing the expectations of patients about treatment and addressing their complex needs. PMID:26330598

  4. 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

  5. Assessment of gait stability, harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations.

    Science.gov (United States)

    Iosa, Marco; Paradisi, Francesco; Brunelli, Stefano; Delussu, Anna Sofia; Pellegrini, Roberto; Zenardi, Daniele; Paolucci, Stefano; Traballesi, Marco

    2014-01-01

    Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.

  6. Assessment of gait stability, harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations.

    Science.gov (United States)

    Iosa, Marco; Paradisi, Francesco; Brunelli, Stefano; Delussu, Anna Sofia; Pellegrini, Roberto; Zenardi, Daniele; Paolucci, Stefano; Traballesi, Marco

    2014-01-01

    Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used. PMID:25144175

  7. A functional and psychosocial assessment of patients with post-Sudeck atrophy amputation.

    Science.gov (United States)

    Szeinberg-Arazi, D; Heim, M; Nadvorna, H; Ner, I Z; Szeinberg, A; Azaria, M

    1993-04-01

    Twelve patients with reflex sympathetic dystrophy were referred to a comprehensive orthopaedic rehabilitation center after failure of conservative management. Ten underwent amputation of the affected limb and, although functional improvement occurred in the patients undergoing lower limb amputation, psychosocial dysfunction persisted. All the patients required psychological support. In cases of post-Sudeck amputation, early orthopaedic diagnosis and referral to a comprehensive treatment center are recommended. In the 12 cases described here, apart from the obvious limb pathology, severe psychological inadequacies were found to be present. PMID:7682058

  8. [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.

  9. 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

    OBJECTIVE Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation...... of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. RESEARCH DESIGN AND METHODS We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries...... the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively). CONCLUSIONS For individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score...

  10. Physical rehabilitation of patients with amputation stump of thigh because of trauma

    Directory of Open Access Journals (Sweden)

    Efremova O.V.

    2009-10-01

    Full Text Available The article is exposition essence of problem of renewal of ability to work of a problem of restoration after amputation at the hip. The analysis of the standard program of the standard in traumatology programs of physical rehabilitation of patients after amputation and presents the results of the developed physical rehabilitation of patients with amputating the thigh stumps due to injury. The authors propose to use the means of physical rehabilitation in accordance with the flow dynamics of the reparative processes after amputation and clinical features of injury. All this contributes to the development of compensatory own human capabilities, resulting in remission. Since these funds most physiological, their correct application does not cause complications.

  11. Revisiting risks associated with mortality following initial transtibial or transfemoral amputation

    OpenAIRE

    Barbara E. Bates, MD; Dawei Xie, PhD; Jibby E. Kurichi, MPH; Diane Cowper Ripley, PhD; Pui L. Kwong, MPH; Margaret G. Stineman, MD

    2013-01-01

    This study’s objective was to determine how treatment-, environmental-, and facility-level characteristics contribute to postdischarge mortality prediction. The study included 4,153 Veterans who underwent lower-limb amputation in Department of Veterans Affairs facilities during fiscal years 2003 and 2004. Veterans were followed 1 yr postamputation. A Cox regression identified characteristics associated with mortality risk after hospital discharge following amputation. Older age, higher amputa...

  12. Bilateral upper limb amputations in victims of high tension electrical injuries: Three case studies

    Directory of Open Access Journals (Sweden)

    Cajetan Nwadinigwe

    2015-02-01

    Full Text Available Bilateral upper limb amputations result in severe disability. High voltage electrical injury is a rare cause of such an outcome and injuries often occur as occupational hazards. We present three case reports of accidental high voltage injuries that occurred in a non-occupational setting. Victims were all initially managed at other centres before referral to our hospital and all subsequently had bilateral upper limb amputations. The high cost of treatment, importance of prevention, and need for rehabilitation are highlighted.

  13. Painful neuroma requiring surgical excision after lower limb amputation caused by landmine explosions

    OpenAIRE

    Sehirlioglu, Ali; Ozturk, Cagatay; Yazicioglu, Kamil; Tugcu, Ilknur; Yilmaz, Bilge; Goktepe, Ahmet Salim

    2007-01-01

    This article reports an analysis of 75 consecutive lower limb amputees who developed painful neuroma requiring surgical excision after lower limb amputation following landmine explosions. This retrospective study analyses the results of 75 patients who were treated for painful neuroma after lower limb amputation following landmine explosions between the years 2000 and 2006. The average time period from use of prosthesis to start of symptoms suggesting neuroma was 9.6 months. The average time ...

  14. [The importance of soft tissue stabilization in trans-femoral amputation].

    Science.gov (United States)

    Gottschalk, F

    2015-06-01

    Transfemoral amputations with more proximal amputation levels have the problem of secondary development into flexion and abduction contractures. This is induced by muscle imbalance, especially the loss of adductor muscle insertions when abductor muscle insertions are preserved. This causes considerable problems when fitting prosthetics. Myodesis with insertion of the distally detached adductor magnus muscle to the lateral femoral cortex, introduced here, results in a stronger stump with good muscle balance, and prosthetics fitting is significantly improved.

  15. Hip arthroplasty in a patient with transfemoral amputation: a new tip.

    Science.gov (United States)

    Boussakri, Hassan; Alassaf, Ihab; Hamoudi, Samir; Elibrahimi, Abdelhalim; Ntarataz, Philbert; ELMrini, Abdelmajid; Dumez, Jean Francois

    2015-01-01

    Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations.

  16. Hip Arthroplasty in a Patient with Transfemoral Amputation: A New Tip

    Directory of Open Access Journals (Sweden)

    Hassan Boussakri

    2015-01-01

    Full Text Available Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations.

  17. The importance of soft tissue stabilization in trans-femoral amputation : English version.

    Science.gov (United States)

    Gottschalk, F

    2016-03-01

    Transfemoral amputations with more proximal amputation levels have the problem of secondary development into flexion and abduction contractures. This is induced by muscle imbalance, especially the loss of adductor muscle insertions when abductor muscle insertions are preserved. This causes considerable problems when fitting prosthetics. Myodesis with insertion of the distally detached adductor magnus muscle to the lateral femoral cortex, introduced here, results in a stronger stump with good muscle balance, and prosthetics fitting is significantly improved.

  18. [The importance of soft tissue stabilization in trans-femoral amputation].

    Science.gov (United States)

    Gottschalk, F

    2015-06-01

    Transfemoral amputations with more proximal amputation levels have the problem of secondary development into flexion and abduction contractures. This is induced by muscle imbalance, especially the loss of adductor muscle insertions when abductor muscle insertions are preserved. This causes considerable problems when fitting prosthetics. Myodesis with insertion of the distally detached adductor magnus muscle to the lateral femoral cortex, introduced here, results in a stronger stump with good muscle balance, and prosthetics fitting is significantly improved. PMID:25971242

  19. Hip arthroplasty in a patient with transfemoral amputation: a new tip.

    Science.gov (United States)

    Boussakri, Hassan; Alassaf, Ihab; Hamoudi, Samir; Elibrahimi, Abdelhalim; Ntarataz, Philbert; ELMrini, Abdelmajid; Dumez, Jean Francois

    2015-01-01

    Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations. PMID:25737790

  20. The importance of soft tissue stabilization in trans-femoral amputation : English version.

    Science.gov (United States)

    Gottschalk, F

    2016-03-01

    Transfemoral amputations with more proximal amputation levels have the problem of secondary development into flexion and abduction contractures. This is induced by muscle imbalance, especially the loss of adductor muscle insertions when abductor muscle insertions are preserved. This causes considerable problems when fitting prosthetics. Myodesis with insertion of the distally detached adductor magnus muscle to the lateral femoral cortex, introduced here, results in a stronger stump with good muscle balance, and prosthetics fitting is significantly improved. PMID:25875228

  1. Hip Arthroplasty in a Patient with Transfemoral Amputation: A New Tip

    OpenAIRE

    Hassan Boussakri; Ihab Alassaf; Samir Hamoudi; Abdelhalim Elibrahimi; Philbert Ntarataz; Abdelmajid ELMrini; Jean Francois Dumez

    2015-01-01

    Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations.

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

    OpenAIRE

    Gary E Mason; Lele eAung; Sarah eGall; Meyers, Paul A; Robert eButler; Sarah eKrug; Mimi eKim; Healey, John H.; Richard eGorlick

    2013-01-01

    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 lon...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    Jiang, Guangyao; Yin, Xuntao; Li, Chuanming; Li, Lei; Zhao, Lu; Evans, Alan C.; Jiang, Tianzi; Wu, Jixiang; Wang, Jian

    2015-01-01

    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. PMID:26587289

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

    Directory of Open Access Journals (Sweden)

    Carly S. Eckard, MS, RD

    2015-09-01

    Full Text Available Body composition and metabolism may change considerably after traumatic amputation because of muscle atrophy and an increase in adiposity. The purpose of this study was to quantify changes in weight, body composition, and metabolic rate during the first year following traumatic amputation in military servicemembers. Servicemembers without amputation were included for comparison. Participants were measured within the first 12 wk after amputation (baseline and at 6, 9, and 12 mo after amputation. Muscle mass, fat mass, weight, and metabolic rate were measured at each time point. There was a significant increase in weight and body mass index in the unilateral group between baseline and all follow-up visits (p < 0.01. Over the 12 mo period, total fat mass and trunk fat mass increased in both unilateral and bilateral groups; however, these changes were not statistically significant over time. Muscle mass increased in both the unilateral and bilateral groups despite percent of lean mass decreasing. No changes in resting metabolism or walking energy expenditure were observed in any group. The results of this study conclude that weight significantly increased because of an increase in both fat mass and muscle mass in the first year following unilateral and bilateral amputation.

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

    Directory of Open Access Journals (Sweden)

    Elizabeth Russell Esposito, PhD

    2015-01-01

    Full Text Available Previous literature reports greater metabolic demand of walking following transtibial amputation. However, most research focuses on relatively older, less active, and often dysvascular amputees. Servicemembers with traumatic amputation are typically young, fit, and highly active before and often following surgical amputation of their lower limb. This study compared the metabolic demand of walking in young, active individuals with traumatic unilateral transtibial amputation (TTA and nondisabled controls. Heart rate (HR, rate of oxygen consumption, and rating of perceived exertion (RPE were calculated as subjects walked at a self-selected velocity and at five standardized velocities based on leg length. The TTA group completed a Prosthetics Evaluation Questionnaire. Oxygen consumption (p = 0.89, net oxygen consumption (p = 0.32, and RPE (p = 0.14 did not differ between groups. Compared with controls, HR was greater in the TTA group and increased to a greater extent with velocity (p < 0.001. Overall, the TTA group rated their walking abilities as high (mean: 93% out of 100%. This is the first study to report equivalent metabolic demand between persons with amputation and controls walking at the same velocity. These results may reflect the physical fitness of the young servicemembers with traumatic amputations and may serve to guide outcome expectations in the future.

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

    Directory of Open Access Journals (Sweden)

    Colby Hansen, MD

    2015-04-01

    Full Text Available To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60 yr, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Persons with unilateral transfemoral amputation have altered lumbosacral kinetics during sitting and standing movements.

    Science.gov (United States)

    Hendershot, Brad D; Wolf, Erik J

    2015-07-01

    Increases in spinal loading have been related to altered movements of the lower back during gait among persons with lower limb amputation, movements which are self-perceived by these individuals as contributing factors in the development of low back pain. However, the relationships between altered trunk kinematics and associated changes in lumbosacral kinetics during sit-to-stand and stand-to-sit movements in this population have not yet been assessed. Three-dimensional lumbosacral kinetics (joint moments and powers) were compared between 9 persons with unilateral transfemoral amputation (wearing both a powered and passive knee device), and 9 uninjured controls, performing five consecutive sit-to-stand and stand-to-sit movements. During sit-to-stand movements, lumbosacral joint moments and powers were significantly larger among persons with transfemoral amputation relative to uninjured controls. During stand-to-sit movements, lumbosacral joint moments and powers were also significantly larger among persons with transfemoral amputation relative to uninjured controls, with the exception of sagittal joint powers. Minimal differences in kinetic measures were noted between the powered and passive knee devices among persons with transfemoral amputation across all conditions. Altered lumbosacral kinetics during sitting and standing movements, important activities of daily living, may play a biomechanical role in the onset and/or recurrence of low back pain or injury among persons with lower-limb amputation.

  10. Persons with unilateral transfemoral amputation have altered lumbosacral kinetics during sitting and standing movements.

    Science.gov (United States)

    Hendershot, Brad D; Wolf, Erik J

    2015-07-01

    Increases in spinal loading have been related to altered movements of the lower back during gait among persons with lower limb amputation, movements which are self-perceived by these individuals as contributing factors in the development of low back pain. However, the relationships between altered trunk kinematics and associated changes in lumbosacral kinetics during sit-to-stand and stand-to-sit movements in this population have not yet been assessed. Three-dimensional lumbosacral kinetics (joint moments and powers) were compared between 9 persons with unilateral transfemoral amputation (wearing both a powered and passive knee device), and 9 uninjured controls, performing five consecutive sit-to-stand and stand-to-sit movements. During sit-to-stand movements, lumbosacral joint moments and powers were significantly larger among persons with transfemoral amputation relative to uninjured controls. During stand-to-sit movements, lumbosacral joint moments and powers were also significantly larger among persons with transfemoral amputation relative to uninjured controls, with the exception of sagittal joint powers. Minimal differences in kinetic measures were noted between the powered and passive knee devices among persons with transfemoral amputation across all conditions. Altered lumbosacral kinetics during sitting and standing movements, important activities of daily living, may play a biomechanical role in the onset and/or recurrence of low back pain or injury among persons with lower-limb amputation. PMID:26050872

  11. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    Science.gov (United States)

    Swaminathan, Aparna; Vemulapalli, Sreekanth; Patel, Manesh R; Jones, W Schuyler

    2014-01-01

    Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. PMID:25075192

  12. Influence of Hallux Rigidus on Reamputation in Patients With Diabetes Mellitus After Partial Hallux Amputation.

    Science.gov (United States)

    Oliver, Noah G; Attinger, Christopher E; Steinberg, John S; Evans, Karen K; Vieweger, David; Kim, Paul J

    2015-01-01

    Diabetic foot ulceration of the plantar hallux is a challenging condition and can require partial hallux amputation when complicated by infection. Lower extremity biomechanics play an important role in the development of hallux ulcers, and hallux rigidus (HR) could influence the outcomes after partial hallux amputation. We hypothesized that radiographic evidence of HR in patients with diabetes would be associated with greater ulcer recurrence and reamputation rates after partial hallux amputation. We performed a retrospective review of all patients with diabetes who had undergone a partial hallux amputation from January 2005 to December 2012. The subjects were divided into 2 cohorts according to the presence or absence of HR identified on preoperative radiographs. Baseline characteristics and outcomes were compared using a 2-sample Student's t test for continuous variables, and categorical variables were compared using the chi-square test for homogeneity and Fisher's exact test. A total of 52 patients were included, with 16 (31%) positive for radiographic evidence of HR at partial hallux amputation. Differences in the patient demographics and comorbidities were not significant between 2 cohorts with and without HR or reamputation. Reamputation was required in 5 subjects (31%) with HR and 2 (6%) without HR (p = .023). The average follow-up duration was 126 ± 89 weeks. Our results have demonstrated that the reamputation rate after partial hallux amputation is significantly greater in patients with than in those without radiographic evidence of HR. Surgeons should evaluate patients for HR when planning partial hallux amputation and use adjuvant methods of offloading when HR is evident to prevent recurrent ulceration and reamputation.

  13. 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.

  14. Scintigraphic Evaluation of the Stump Region After Extremity Amputation and the Effect of Scintigraphy on Treatment

    Science.gov (United States)

    Sadic, Murat; Atilgan, Hasan Ikbal; Baskin, Aylin; Cinar, Alev; Koca, Gokhan; Demirel, Koray; Comak, Aylin; Ozyurt, Sinem; Yildirim, Sule; Korkmaz, Meliha

    2016-01-01

    Background We evaluated the stump region with scintigraphy and compared the correlation of treatment modalities and scintigraphic results. Methods Sixty-eight cases with extremity amputation were included in the study. Amputation applied cases underwent four-phase Tc-99m hydroxymethylene diphosphonate scintigraphy. Groups were performed according to the scanning time after amputation and amputation regions. After scintigraphic evaluation, results were recorded into five groups: osteomyelitis, soft-tissue infection, reactive changes secondary to surgery, chronic osteomyelitis, and normal. Post-surgical treatment modalities of the patients were determined and compared with scintigraphic results. Results In the scintigraphic evaluation of stump regions of the 68 amputated cases, 34 patients had acute osteomyelitis, one had chronic osteomyelitis, 16 had soft-tissue infection, and eight had changes secondary to the surgery. Nine of 68 cases had normal scintigraphic features. In the scintigraphic evaluation, 43 patients took antibiotic treatment and 16 had surgery. There was a strong correlation between scintigraphic results and treatment approach (P < 0.0001, r = 0.803) by means of preferred therapy and effectiveness of the therapy according to the scintigraphic results. Scintigraphy need increases with age after amputation and a negative correlation between patient age and scintigraphic need was found (P < 0.02, r = -0.339). There was no pathology in the follow-up in the cases that were scintigraphically normal. Conclusion Bone scintigraphy is a cost-effective, non-invasive, and efficient method that directs treatment in the evaluation of the stump region after amputation. PMID:26858796

  15. Predictors of major lower limb amputation among type II diabetic patients admitted for diabetic foot problems

    Science.gov (United States)

    Yusof, Nazri Mohd; Rahman, Jamalludin Ab; Zulkifly, Ahmad Hafiz; Che-Ahmad, Aminudin; Khalid, Kamarul Ariffin; Sulong, Ahmad Fadzli; Vijayasingham, Naveen

    2015-01-01

    INTRODUCTION Diabetes mellitus (DM) is the most common cause of amputations in Malaysia. This study aimed to identify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to a hospital, in order to reduce its likelihood. METHODS This cross-sectional study involved 218 patients with T2DM who were admitted to Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, for diabetic foot problems from June 2011 to July 2012. A form was developed to document the patients’ profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise logistic regression analysis. RESULTS A total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The following factors were found to be associated with the incidence of major lower limb amputations: T2DM duration ≥ 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C-reactive protein, urea and creatinine levels. However, only T2DM duration ≥ 10 years, positive bacterial culture and albumin levels were significant on stepwise logistic regression analysis. CONCLUSION T2DM duration ≥ 10 years, positive bacterial culture and low albumin levels were found to be significant predictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems. PMID:26668408

  16. 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...

  17. Clinical Factors affecting Minor Amputation in Diabetic Foot Disease at Tengku Ampuan Afzan Hospital, Kuantan

    Science.gov (United States)

    ZAKARIA, Zamzuri; AFIFI, Mustaqim; SHARIFUDIN, Mohd Ariff

    2015-01-01

    Background: Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. Methods: A cross-sectional study enrolling patients admitted to orthopaedic wards of a single tertiary hospital for diabetic foot disease was conducted. Patients who had undergone major amputation or with medical condition above the ankle joint were not included. Clinical data were collected by measurement of ankle brachial systolic index and Semmes-Weinstein 5.07 gauge monofilament test with foot clinical evaluation using King’s classification respectively. Results: The total number of patients included was 138, with mean age of 59.7 years (range 29 to 94 years old). Fifty patients (36.2%) had minor amputations. Poor compliance to diabetic treatment, King’s classification stage 5, low measures of ankle brachial systolic index, sensory neuropathy, high serum C-Reactive protein and high serum creatinine are significant predictive factors for minor amputation (P < 0.05). Conclusion: Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot. PMID:26023294

  18. Somatotype of the individuals with lower extremity amputation and its association with cardiovascular risk.

    Science.gov (United States)

    Mozumdar, Arupendra; Roy, Subrata K

    2008-03-01

    Anthropometric somatotyping is one of the methods to describe the shape of the human body, which shows some associations with an individual's health and disease condition, especially with cardiovascular diseases (CVD). Individuals with lower extremity amputation (LEA) are known to be more vulnerable to the cardiovascular risk. The objectives of the present study are to report the somatotype of the individuals having lower extremity amputation, to study the possible variation in somatotype between two groups of amputated individuals, and to study the association between cardiovascular disease risk factor and somatotype components among individuals with locomotor disability. 102 adult male individuals with unilateral lower-extremity amputation residing in Calcutta and adjoining areas were investigated. The anthropometric data for somatotyping and data on cardiovascular risk traits (such as body mass index, blood pressure measurements, blood lipids) have been collected. The somatotyping technique of Carter & Heath (1990) has been followed. The result shows high mean values of endomorphy and mesomorphy components and a low mean value of the ectomorphy component among the amputated individuals having cardiovascular risks. The results of both discriminant analysis and logistic regression analysis show a significant relationship between somatotype components and CVD risk among the individuals with LEA. The findings of the present study support the findings of similar studies conducted on the normal population. Diagnosis of CVD risk condition through somatotyping can be utilized in prevention/treatment management for the individuals with LEA. PMID:18435209

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

    Directory of Open Access Journals (Sweden)

    W. Lee Childers, PhD, CP

    2015-01-01

    Full Text Available 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 amputated limb compared with the control condition. There were no differences in joint kinematics between the contralateral and amputated limbs during the CRANK condition. Pedaling asymmetries did not differ and were 23.0% +/– 9.8% and 23.2% +/– 12.0% for the control and CRANK conditions, respectively. Our results suggest that minimizing kinematic asymmetries does not relate to kinetic asymmetries as clinically assumed. We propose that future research should concentrate on defining acceptable asymmetry.

  20. The relationship between pelvis-trunk coordination and low back pain in individuals with transfemoral amputations.

    Science.gov (United States)

    Russell Esposito, Elizabeth; Wilken, Jason M

    2014-09-01

    Low back pain (LBP) is common in individuals with transfemoral amputation and may result from altered gait mechanics associated with prosthetic use. Inter-segmental coordination, assessed through continuous relative phase (CRP), has been used to identify specific patterns as risk factors. The purpose of this study was to explore pelvis and trunk inter-segmental coordination across three walking speeds in individuals with transfemoral amputations with and without LBP. Nine individuals with transfemoral amputations with LBP and seven without pain were compared to twelve able-bodied subjects. Subjects underwent a gait analysis while walking at slow, moderate, and fast speeds. CRP and CRP variability were calculated from three-dimensional pelvis and trunk segment angles. A two-way ANOVA and post hoc tests assessed statistical significance. Individuals with transfemoral amputation demonstrated some coordination patterns that were different from able-bodied individuals, but consistent with previous reports on persons with LBP. The patient groups maintained transverse plane CRP consistent with able-bodied participants (p = 0.966), but not sagittal (p amputations and without LBP exhibited few differences. Only frontal and transverse CRP shifted toward out-of-phase as speed increased in the patient group with LBP. Although a cause and effect relationship between CRP and future development of back pain has yet to be determined, these results add to the literature characterizing biomechanical parameters of back pain in high-risk populations.

  1. Prosthetic fitting, use, and satisfaction following lower-limb amputation: A prospective study

    Directory of Open Access Journals (Sweden)

    Joseph B. Webster, MD

    2013-01-01

    Full Text Available Providing a satisfactory, functional prosthesis following lower-limb amputation is a primary goal of rehabilitation. The objectives of this study were to describe the rate of successful prosthetic fitting over a 12 mo period; describe prosthetic use after amputation; and determine factors associated with greater prosthetic fitting, function, and satisfaction. The study design was a multicenter prospective cohort study of individuals undergoing their first major lower-limb amputation because of vascular disease and/or diabetes. At 4 mo, unsuccessful prosthetic fitting was significantly associated with depression, prior arterial reconstruction, diabetes, and pain in the residual limb. At 12 mo, 92% of all subjects were fit with a prosthetic limb and individuals with transfemoral amputation were significantly less likely to have a prosthesis fit. Age older than 55 yr, diagnosis of a major depressive episode, and history of renal dialysis were associated with fewer hours of prosthetic walking. Subjects who were older, had experienced a major depressive episode, and/or were diagnosed with chronic obstructive pulmonary disease had greater functional restriction. Thus, while most individuals achieve successful prosthetic fitting by 1 yr following a first major nontraumatic lower-limb amputation, a number of medical variables and psychosocial factors are associated with prosthetic fitting, utilization, and function.

  2. The relationship between pelvis-trunk coordination and low back pain in individuals with transfemoral amputations.

    Science.gov (United States)

    Russell Esposito, Elizabeth; Wilken, Jason M

    2014-09-01

    Low back pain (LBP) is common in individuals with transfemoral amputation and may result from altered gait mechanics associated with prosthetic use. Inter-segmental coordination, assessed through continuous relative phase (CRP), has been used to identify specific patterns as risk factors. The purpose of this study was to explore pelvis and trunk inter-segmental coordination across three walking speeds in individuals with transfemoral amputations with and without LBP. Nine individuals with transfemoral amputations with LBP and seven without pain were compared to twelve able-bodied subjects. Subjects underwent a gait analysis while walking at slow, moderate, and fast speeds. CRP and CRP variability were calculated from three-dimensional pelvis and trunk segment angles. A two-way ANOVA and post hoc tests assessed statistical significance. Individuals with transfemoral amputation demonstrated some coordination patterns that were different from able-bodied individuals, but consistent with previous reports on persons with LBP. The patient groups maintained transverse plane CRP consistent with able-bodied participants (p = 0.966), but not sagittal (p amputations and without LBP exhibited few differences. Only frontal and transverse CRP shifted toward out-of-phase as speed increased in the patient group with LBP. Although a cause and effect relationship between CRP and future development of back pain has yet to be determined, these results add to the literature characterizing biomechanical parameters of back pain in high-risk populations. PMID:25155692

  3. Feedforward control strategies of subjects with transradial amputation in planar reaching

    Directory of Open Access Journals (Sweden)

    Anthony J. Metzger, MBE

    2010-05-01

    Full Text Available The rate of upper-limb amputations is increasing, and the rejection rate of prosthetic devices remains high. People with upper-limb amputation do not fully incorporate prosthetic devices into their activities of daily living. By understanding the reaching behaviors of prosthesis users, researchers can alter prosthetic devices and develop training protocols to improve the acceptance of prosthetic limbs. By observing the reaching characteristics of the nondisabled arms of people with amputation, we can begin to understand how the brain alters its motor commands after amputation. We asked subjects to perform rapid reaching movements to two targets with and without visual feedback. Subjects performed the tasks with both their prosthetic and nondisabled arms. We calculated endpoint error, trajectory error, and variability and compared them with those of nondisabled control subjects. We found no significant abnormalities in the prosthetic limb. However, we found an abnormal leftward trajectory error (in right arms in the nondisabled arm of prosthetic users in the vision condition. In the no-vision condition, the nondisabled arm displayed abnormal leftward endpoint errors and abnormally higher endpoint variability. In the vision condition, peak velocity was lower and movement duration was longer in both arms of subjects with amputation. These abnormalities may reflect the cortical reorganization associated with limb loss.

  4. 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

    2015-01-01

    Introduction The traumatic injuries to the tongue can go form section to partial or complete amputation, the latter being a rare presentation in the setting of facial trauma or even in patients with mental illness. Case report We present 25-year-old patient with traumatic partial amputation of the tongue who presented to the emergency department with successful surgical repair with good functional and esthetic outcome. Discussion The tongue can suffer a broad type of traumatic injuries, in the setting of active bleeding, the muscular planes must be closed with absorbable sutures to stop the hemorrhage and prevent hematoma formation. Tongue surgical repair in the setting of a total section requires integrity of arterial and venous flow, so anastomosis must be executed. Conclusion Amputation of the tongue can put the patient's life at risk and its management needs to be mastered by the surgeons treating polytraumatized patients. PMID:26900463

  5. A review of the long-term health outcomes associated with war-related amputation.

    Science.gov (United States)

    Robbins, Christopher B; Vreeman, Daniel J; Sothmann, Mark S; Wilson, Stephen L; Oldridge, Neil B

    2009-06-01

    The rate of war-related amputations in current U.S. military personnel is now twice that experienced by military personnel in previous wars. We reviewed the literature for health outcomes following war-related amputations and 17 studies were retrieved with evidence that (a) amputees are at a significant risk for developing cardiovascular disease; (b) insulin may play an important role in regulating blood pressure in maturity-onset obesity; (c) lower-extremity amputees are at risk for joint pain and osteoarthritis; (d) transfemoral amputees report a higher incidence of low back pain than transtibial amputees; and (e) 50 to 80% report phantom limb pain, with many amputees stating they were either told that their pain was imagined or their mental state was questioned. The consistency of the observations on health outcomes in these studies warrants careful examination for their implication in the contemporary treatment of war-related amputation.

  6. Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations

    Directory of Open Access Journals (Sweden)

    Amanda Lezanski Gujda

    2015-01-01

    Full Text Available Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hyperhidrosis treatment after traumatic limb amputation. Articles discussing hyperhidrosis treatment for amputations secondary to chronic medical conditions were excluded. Seven case studies published over the last 12 years have demonstrated positive outcomes of this treatment strategy. Overall, there is little data examining this topic and current publications focus primarily on small case series. A larger, double-blind, placebo-controlled study would likely benefit veterans, service members, and civilians.

  7. Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations.

    Science.gov (United States)

    Lezanski-Gujda, Amanda; Bingham, Jonathan L; Logemann, Nicholas F

    2015-01-01

    Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hyperhidrosis treatment after traumatic limb amputation. Articles discussing hyperhidrosis treatment for amputations secondary to chronic medical conditions were excluded. Seven case studies published over the last 12 years have demonstrated positive outcomes of this treatment strategy. Overall, there is little data examining this topic and current publications focus primarily on small case series. A larger, double-blind, placebo-controlled study would likely benefit veterans, service members, and civilians. PMID:25657907

  8. Does Graft on Flap Method Work on Sequela of Fingertip Amputation?

    Science.gov (United States)

    Sano, Kazufumi; Ozeki, Satoru

    2016-10-01

    The graft on flap method, a useful option for the restoration of fresh fingertip amputation, was applied to the reconstruction of the short fingertip stumps resulting from the initial amputated stump plasties. As a modification, a nail bed graft from the big toe and a small cubic iliac bone graft were substituted for the lost tissues normally reduced as a composite graft in fresh cases. Upon follow-up ranging from 1 to 8 years, the grafted bone was found to have been resorpted in all cases. For the reconstruction of short fingertip stumps after the initial amputated stump plasties, acceptable results have not yet been achieved using the graft on flap method. PMID:27595968

  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. Combat-related bridge synostosis versus traditional transtibial amputation: comparison of military-specific outcomes.

    Science.gov (United States)

    Plucknette, Benjamin F; Krueger, Chad A; Rivera, Jessica C; Wenke, Joseph C

    2016-04-01

    The aim of our study was to determine military-specific outcomes for transtibial amputations of US Service members using either the traditional technique (Burgess) or the Ertl technique. All US Service members sustaining transtibial, combat-related amputation from September 2001 through July 2011 were reviewed. Amputation type, mechanism of injury, time interval to amputation, age, sex, branch of service, rank, force, nature, and injury severity score were recorded. Outcomes were determined by analyzing military-specific medical review results, to include the following: Physical Evaluation Board Liaison Office (PEBLO) rating (0-100), PEBLO outcome (permanent retirement, temporary disability retirement, separation without benefits, continuation of active duty, or fit for redeployment), and the rate of redeployment. Amputation type (Ertl vs. Burgess) was determined by reviewing postoperative radiographs and radiology reports. Data from all of the above categories were compared for both Ertl and Burgess amputees. Of 512 subjects identified, 478 had radiographs or radiology reports distinguishing between Ertl or Burgess transtibial amputation. A total of 406 subjects underwent the Burgess procedure, and 72 subjects underwent the Ertl procedure. There was not a significant difference between the two groups in review board rating (p = 0.858), review board outcome (p = 0.102), or ability to deploy (p = 0.106); however, subjects that underwent the Ertl procedure remained on active duty at a significantly higher rate (p = 0.021). There is a higher rate of remaining on active duty using the Ertl technique. This study suggests that there is an improvement in functional outcome with the Ertl technique. PMID:26644067

  11. Physical activity, functional capacity, and step variability during walking in people with lower-limb amputation.

    Science.gov (United States)

    Lin, Suh-Jen; Winston, Katie D; Mitchell, Jill; Girlinghouse, Jacob; Crochet, Karleigh

    2014-01-01

    Physical activity is important for general health. For an individual with amputation to sustain physical activity, certain functional capacity might be needed. Gait variability is related to the incidence of falls. This study explored the relationship between physical activity and a few common performance measures (six-minute walk test, step length variability, step width variability, and comfortable walking speed) in individuals with unilateral lower-limb amputation. Twenty individuals completed the study (age: 50±11yrs). Twelve of them had transtibial amputation, seven had transfemoral amputation, and one had through-knee amputation. Gait data was collected by the GaitRite instrumented walkway while participants performed a 3-min comfortable walking trial followed by a six-minute walk test. Physical activity was indicated by the mean of 7-day step counts via a pedometer. Gait variability was calculated by the coefficient of variation. Pearson correlation analysis was conducted between physical activity level and the 4 performance measures. Significance level was set at 0.05. Physical activity correlates strongly to comfortable walking speed (r=0.76), six-minute walk distance (r=0.67), and correlates fairly to step width variability (r=0.44). On the contrary, physical activity is inversely related to step length variability of the prosthetic leg (r=-0.46) and of the sound leg (r=-0.47). Having better functional capacity and lateral stability might enable an individual with lower-limb amputation to engage in a higher physical activity level, or vise versa. However, our conclusions are only preliminary as limited by the small sample size.

  12. Physical activity, functional capacity, and step variability during walking in people with lower-limb amputation.

    Science.gov (United States)

    Lin, Suh-Jen; Winston, Katie D; Mitchell, Jill; Girlinghouse, Jacob; Crochet, Karleigh

    2014-01-01

    Physical activity is important for general health. For an individual with amputation to sustain physical activity, certain functional capacity might be needed. Gait variability is related to the incidence of falls. This study explored the relationship between physical activity and a few common performance measures (six-minute walk test, step length variability, step width variability, and comfortable walking speed) in individuals with unilateral lower-limb amputation. Twenty individuals completed the study (age: 50±11yrs). Twelve of them had transtibial amputation, seven had transfemoral amputation, and one had through-knee amputation. Gait data was collected by the GaitRite instrumented walkway while participants performed a 3-min comfortable walking trial followed by a six-minute walk test. Physical activity was indicated by the mean of 7-day step counts via a pedometer. Gait variability was calculated by the coefficient of variation. Pearson correlation analysis was conducted between physical activity level and the 4 performance measures. Significance level was set at 0.05. Physical activity correlates strongly to comfortable walking speed (r=0.76), six-minute walk distance (r=0.67), and correlates fairly to step width variability (r=0.44). On the contrary, physical activity is inversely related to step length variability of the prosthetic leg (r=-0.46) and of the sound leg (r=-0.47). Having better functional capacity and lateral stability might enable an individual with lower-limb amputation to engage in a higher physical activity level, or vise versa. However, our conclusions are only preliminary as limited by the small sample size. PMID:24731451

  13. 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

  14. Barriers and Facilitators of Participation in Sports : A Qualitative Study on Dutch Individuals with Lower Limb Amputation

    NARCIS (Netherlands)

    Bragaru, Mihai; van Wilgen, C. P.; Geertzen, Jan H. B.; Ruijs, Suzette G. J. B.; Dijkstra, Pieter U.; Dekker, Rienk

    2013-01-01

    Introduction: Although individuals with lower limb amputation may benefit from participation in sports, less than 40% do so. Aim: To identify the barriers and facilitators that influence participation in sports for individuals with lower limb amputation. Design: Qualitative study. Participants: Twen

  15. 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.

  16. Risk factors for amputation in extremities vascular injuries in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Al Wahbi A

    2016-05-01

    Full Text Available Abdullah Al Wahbi, Salman Aldakhil, Saud Al Turki, Abdulrahman El Kayali, Hussein Al Kohlani , Abdulaziz Al Showmer Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia Abstract: Amputation is most closely associated with blunt, lower limb injuries associated with vascular trauma. These vascular injuries require a special attention to prevent life and limb loss. Patient outcomes can also be improved by organizing vascular trauma data into appropriate systems to facilitate future studies. Keywords: vascular injuries, extremities trauma, amputation, ischemia

  17. 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

  18. Stepwise surgical approach to diabetic partial foot amputations with autogenous split thickness skin grafting

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2016-06-01

    Full Text Available In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations.

  19. Stepwise surgical approach to diabetic partial foot amputations with autogenous split thickness skin grafting.

    Science.gov (United States)

    Ramanujam, Crystal L; Zgonis, Thomas

    2016-01-01

    In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations. PMID:27283728

  20. Pain and pain-related interference in adults with lower-limb amputation: Comparison of knee-disarticulation, transtibial, and transfemoral surgical sites

    OpenAIRE

    Behr, James; Friedly, Janna; Molton, Ivan; Morgenroth, David; Jensen, Mark P.; Smith, Douglas G.

    2009-01-01

    Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study was to determine whether individuals with knee-disarticulation amputations have worse pain and pain-related interference with physical function than do individuals with transtibial or transfemoral amputations. We analyzed cross-sectional survey data provided by 42 adults with lower-limb amputations. These...

  1. 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.

  2. 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.

  3. 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…

  4. 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

    2011-01-01

    Background and Aim: Education programmes of the International Society for Prosthetics and Orthotics (ISPO) are directed primarily at prosthetists and orthotists. In a multidisciplinary setting, greater attention should be given to other professionals working in the field of amputation, prosthetics a

  5. Computed tomography in low-back-pain after femur-amputation for osteogenic sarcoma

    International Nuclear Information System (INIS)

    Following amputation of a lower extremity for osteogenic sarcoma, the lumbar muscles receive an asymmetric strain. This predisposes to low-back-pain. When this occurs, tumour-recurrence must be excluded. This report demonstrates the usefulness of high-resolution computer tomography (CT) in this clinical situation. (orig.)

  6. 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

    2009-01-01

    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

  7. 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.

  8. 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.

    2012-01-01

    Elderly people with a lower limb amputation impose a heavy burden on health resources, requiring extensive rehabilitation and long term care. Mobility is key to regaining independence; however, the impact of multiple comorbidities in this patient group can make regaining mobility a particularly chal

  9. Identification of trunk and pelvis movement compensations in patients with transtibial amputation using angular momentum separation.

    Science.gov (United States)

    Gaffney, Brecca M; Murray, Amanda M; Christiansen, Cory L; Davidson, Bradley S

    2016-03-01

    Patients with unilateral dysvascular transtibial amputation (TTA) have a higher risk of developing low back pain than their healthy counterparts, which may be related to movement compensations used in the absence of ankle function. Assessing components of segmental angular momentum provides a unique framework to identify and interpret these movement compensations alongside traditional observational analyses. Angular momentum separation indicates two components of total angular momentum: (1) transfer momentum and (2) rotational momentum. The objective of this investigation was to assess movement compensations in patients with dysvascular TTA, patients with diabetes mellitus (DM), and healthy controls (HC) by examining patterns of generating and arresting trunk and pelvis segmental angular momenta during gait. We hypothesized that all groups would demonstrate similar patterns of generating/arresting total momentum and transfer momentum in the trunk and pelvis in reference to the groups (patients with DM and HC). We also hypothesized that patients with amputation would demonstrate different (larger) patterns of generating/arresting rotational angular momentum in the trunk. Patients with amputation demonstrated differences in trunk and pelvis transfer angular momentum in the sagittal and transverse planes in comparison to the reference groups, which indicates postural compensations adopted during walking. However, patients with amputation demonstrated larger patterns of generating and arresting of trunk and pelvis rotational angular momentum in comparison to the reference groups. These segmental rotational angular momentum patterns correspond with high eccentric muscle demands needed to arrest the angular momentum, and may lead to consequential long-term effects such as low back pain.

  10. Amputation after failure or complication of total knee arthroplasty: prevalence, etiology and functional outcomes

    Directory of Open Access Journals (Sweden)

    Alan de Paula Mozella

    2013-09-01

    Full Text Available OBJECTIVE: Identify the etiology and incidence, as well to assess functional outcomes of patients, undergoing lower limb amputation after failure or complication of total knee arthroplasty. These patients were treated at the Center for Knee Surgery at the National Institute of Traumatology and Orthopedics (INTO, during the period of January 2001 to December 2010. METHODS: The patients were interviewed and their charts were retrospectively analyzed to evaluate their functional outcome. RESULTS: The incidence of amputation due to failure or complication of total knee arthroplasty was 0.41% in 2409 cases. Recurrent deep infection was the cause of amputation in 81% of cases, being Staphylococcus aureus and Pseudomonas aeruginosa the most frequent germs. Vascular complications and periprosthetic fracture associated to metaphyseal bone loss were also causes of amputation. In our study, 44% of amputees patients were using orthesis and 62.5% have had the ability to walk. CONCLUSION: Incidence of 0.41%, being the main cause recurrent infection. The functional outcome is limited, and the fitting achieved in 44% of patients and only 62.5% are ambulatory.

  11. 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.

  12. 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.

  13. Instrumented Measurement of Balance and Postural Control in Individuals with Lower Limb Amputation: A Critical Review

    Science.gov (United States)

    Jayakaran, Prasath; Johnson, Gillian M.; Sullivan, S. John; Nitz, Jennifer C.

    2012-01-01

    Measurement of balance and postural performance that underpins activities of daily living is important in the rehabilitation of individuals with a lower limb amputation (LLA), and there are a number of methods and strategies available for this purpose. To provide an evidence-based choice of approach, this review aims to critically review the tasks…

  14. The morphology and functions of the muscles around the hip joint after a unilateral transfemoral amputation

    NARCIS (Netherlands)

    Jaegers, Sonja Maria Héléne José

    1993-01-01

    This dissertation is concerned with the consequences of a transfemoral amputation for the morphology and functions of the muscles around the hip joint. Knowledge about and insight into the changes appearing in the morphology and functions of the hip muscles of transfemoral amputees are important to

  15. Lower limb amputation in Northern Netherlands : Unchanged incidence from 1991-1992 to 2003-2004

    NARCIS (Netherlands)

    Fortington, Lauren V.; Rommers, Gerardus M.; Postema, Klaas; van Netten, Jaap J.; Geertzen, Jan H. B.; Dijkstra, Pieter U.

    2013-01-01

    Background: Investigating population changes gives insight into effectiveness and need for prevention and rehabilitation services. Incidence rates of amputation are highly varied, making it difficult to meaningfully compare rates between studies and regions or to compare changes over time. Study Des

  16. 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.

  17. Resilience in patients with amputation because of Complex Regional Pain Syndrome type I

    NARCIS (Netherlands)

    Bodde, Marlies I.; Schrier, Ernst; Krans, Hilde K.; Geertzen, J.H.B.; Dijkstra, Pieter U.

    2014-01-01

    Purpose: Although controversial, an amputation for longstanding and therapy-resistant Complex Regional Pain Syndrome Type I (CRPS-I) may improve quality of life and pain intensity. Resilience, the way people deal with adversity in a positive way may be related to these positive outcomes. This study

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

    Institute of Scientific and Technical Information of China (English)

    Shahram Nazerani; Hamed Vaseghi; Saied Hesami; Tina Nazerani

    2013-01-01

    Objective:Ectopic tissue transplantation is not a new idea.Godina and his colleagues pioneered this method in the 1980s.This method is a last resort method of preserving an amputated body part,which consists of banking the amputated segment in an ectopic area and returning it to its native place at a later date.In this article we present our experience with this demanding procedure.Methods:Debridement was the mainstay of this procedure.The stump and amputated part are carefully debrided and the stump was either closed primarily or covered by a flap.The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting.Results:Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study.The overall success rate was about 70%,lower than expected but these are cases of severe crush injury.Although the functional recovery of these patients are very low,all of the successful cases except one could find a job as a janitor or light manual worker.No patient could return to his previous job.Conclusion:Ectopic transplantation of body parts is an accepted method of treatment of severely crushed extremity or finger injuries.In our country an amputee has very little chance of finding a job instead a disabled person can.In addition in Iran cultures amputation is seen as punishment of either the God or the society,so it is not well accepted and many patients persist on saving the limb even with no functional recovery.None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers.

  19. 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.

  20. Prevalence and Risk Factors for Diabetic Lower Limb Amputation: A Clinic-Based Case Control Study

    Science.gov (United States)

    Rodrigues, Beverly T.; Vangaveti, Venkat N.

    2016-01-01

    Objective. The aim of the study was to evaluate the prevalence of and risk factors for lower limb amputation in a specialist foot clinic-based setting. Methods. A retrospective quantitative study was conducted, using clinical and biochemical profiles of diabetic foot patients attending the High Risk Foot Clinic at The Townsville Hospital, Australia, between January 1, 2011, and December 31, 2013. Results. The total study sample included 129 subjects, comprising 81 males and 48 females with M : F ratio of 1.7 : 1. Twenty-three subjects were Indigenous Australians, representing 17.8% of the study population. The average age of the cohort was 63.4 years ± 14.1 years [CI 90.98–65.89]. Lower limb amputation was identified as a common and significant outcome (n = 44), occurring in 34.1%, more commonly amongst the Indigenous Australians (56.5% versus 29.2%; p = 0.94, OR 0.94). Risk factors most closely associated with amputation included diabetic retinopathy (p = 0.00, OR 4.4), coronary artery bypass graft (CABG) surgery (p = 0.01, OR 4.1), Charcot's arthropathy (p = 0.01, OR 2.9), and Indigenous ethnicity (p = 0.01, OR 3.4). Although average serum creatinine, corrected calcium, and glycosylated haemoglobin A1c (Hba1c) levels were higher amongst amputees they were statistically insignificant. Conclusions. Lower limb amputation is a common outcome and linked to ethnicity and neurovascular diabetic complications amongst subjects with diabetic foot ulcer. Further research is needed to identify why risk of lower limb amputation seems to differ according to ethnicity.

  1. Assessment of gait stability, harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations

    Directory of Open Access Journals (Sweden)

    Marco Iosa, PhD

    2014-07-01

    Full Text Available Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p < 0.001, harmony (p < 0.001, and symmetry (p < 0.001 of walking, with general trends following the noted order of subjects, but with the lowest laterolateral harmony in subjects with transtibial amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.

  2. Popliteal artery injuries in an urban trauma center with a rural catchment area: do delays in definitive treatment affect amputation?

    Science.gov (United States)

    Simmons, Jon D; Gunter, Joseph W; Schmieg, Robert E; Manley, Justin D; Rushton, Fred W; Porter, John M; Mitchell, Marc E

    2011-11-01

    Extended length of time from injury to definitive vascular repair is considered to be a predictor of amputation in patients with popliteal artery injuries. In an urban trauma center with a rural catchment area, logistical issues frequently result in treatment delays, which may affect limb salvage after vascular trauma. We examined how known risk factors for amputation after popliteal trauma are affected in a more rural environment, where patients often experience delays in definitive surgical treatment. All adult patients admitted to the Level I trauma center, the University of Mississippi Medical Center, with a popliteal artery injury between January 2000 and December of 2007 were identified. Demographic information management and outcome data were collected. Body mass index, mangled extremity severity score (MESS), Guistilo open fracture score, injury severity score, and time from injury to vascular repair were examined. Fifty-one patients with popliteal artery injuries (53% blunt and 47% penetrating) were identified, all undergoing operative repair. There were nine amputations (17.6%) and one death. Patients requiring amputation had a higher MESS, 7.8 versus 5.3 (P amputation rate compared with those with penetrating trauma, 25.9 per cent versus 8.3 per cent (P = non significant). MESS, though not perfect, is the best predictor of amputation in patients with popliteal artery injuries. Morbid obesity is not a significant predictor for amputation in patients with popliteal artery injuries. Time from injury to repair of greater than 6 hours was not predictive of amputation. This study further demonstrates that a single scoring system should be used with caution when determining the need for lower extremity amputation.

  3. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb

    DEFF Research Database (Denmark)

    Raffin, Estelle; Richard, Nathalie; Giraux, Pascal;

    2016-01-01

    A substantial body of evidence documents massive reorganization of primary sensory and motor cortices following hand amputation, the extent of which is correlated with phantom limb pain. Many therapies for phantom limb pain are based upon the idea that plastic changes after amputation...... for the maladaptative plasticity model, we demonstrate for the first time that motor capacities of the phantom limb correlate with post-amputation reorganization, and that this reorganization is not limited to the face and hand representations but also includes the proximal upper-limb....

  4. Walking Ability and Quality of Life in Subjects With Transfemoral Amputation: A Comparison of Osseointegration With Socket Prostheses.

    NARCIS (Netherlands)

    Meent, H. van de; Hopman, M.T.E.; Frolke, J.P.M.

    2013-01-01

    OBJECTIVE: To investigate walking ability and quality of life of osseointegrated leg prostheses compared with socket prostheses. DESIGN: Prospective case-control study. SETTING: University medical center. PARTICIPANTS: Subjects (N=22) with transfemoral amputation (1 bilateral) referred to our center

  5. 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...

  6. PERCEIVED INDEPENDENCE AND LIMITATIONS IN RISING AND SITTING DOWN AFTER REHABILITATION FOR A LOWER-LIMB AMPUTATION

    OpenAIRE

    de Laat, Fred A.; Dijkstra, Pieter U.; Rommers, Gerardus M.; Geertzen, Jan H. B.; Roorda, Leo D

    2014-01-01

    Objective: To study perceived independence in rising and perceived limitations in rising and sitting down in persons after a lower-limb amputation and the relationship of these perceptions with personal and clinical characteristics. Design: Cross-sectional study. Subjects/patients: Persons with a lower-limb amputation wearing a prosthesis (n=172). Methods: Perceived independence in rising was assessed with the Locomotor Capabilities Index. Limitations in rising and sitting down were assessed ...

  7. Dynamic Stability of Superior vs. Inferior Body Segments in Individuals with Transtibial Amputation Walking in Destabilizing Environments✰

    OpenAIRE

    Beurskens, Rainer; Wilken, Jason M.; Dingwell, Jonathan B.

    2014-01-01

    Interestingly, young and highly active people with lower limb amputation appear to maintain a similar trunk and upper body stability during walking as able bodied individuals. Understanding the mechanisms underlying how this stability is achieved after lower leg amputation is important to improve training regimens for improving walking function in these patients. This study quantified how superior (i.e., head, trunk, and pelvis) and inferior (i.e., thigh, shank, and feet) segments of the body...

  8. Types of psychological reactions in patients with lower-extremity amputations

    Directory of Open Access Journals (Sweden)

    Platiša Nedeljko

    2006-01-01

    Full Text Available The aim of this study was to establish types of psychological reactions and conditions in patients with lower-extremity amputations. Apart from using psychological interviews, detection was performed using psychometric tests: Minnesota Multiphasic Personality Inventory and Beck Depression Inventory. Psychometric parameters were analyzed in a group of 20 examinees treated at the Medical Rehabilitation Clinic in Novi Sad. Out of the whole sample. 45% of patients presented with adaptive reactions to amputation and consequent disability, whereas 55% presented with maladaptive responses. The registered psychopathological symptoms included nosologic categories: reaction to stressful events and adjustment disorder (predominantly affecting other emotions: mixed disorder of conduct and emotions: prolonged depressive reaction and dysthymia. When working with lower-extremity amputees, apart from adaptive, nonpathological forms of behavior, one also encounters maladaptive responses with predomination of mood disorders due to severe somatic stress. .

  9. Prosthetic ambulation in a paraplegic patient with a transfemoral amputation and radial nerve palsy.

    Science.gov (United States)

    Shin, J C; Park, C; Kim, D Y; Choi, Y S; Kim, Y K; Seong, Y J

    2000-08-01

    Great importance and caution should be placed on prosthetic fitting for a paraplegic patient with an anesthetic residual limb if functional ambulation is to be achieved. The combination of paraplegia with a transfemoral amputation and radial nerve palsy is a complex injury that makes the rehabilitation process difficult. This article describes a case of L2 paraplegia with a transfemoral amputation and radial nerve palsy on the right side. Following the rehabilitation course, the patient independently walked using a walker at indoor level with a transfemoral prosthesis with ischial containment socket, polycentric knee assembly, endoskeletal shank and multiaxis foot assembly and a knee ankle foot orthosis on the sound side. The difficulties of fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed. PMID:10992814

  10. 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...

  11. 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.

  12. Canonical and non-canonical Wnt signaling control the regeneration of amputated rodent vibrissae follicles.

    Science.gov (United States)

    Yuan, Yan-Ping; Huang, Keng; Xu, Yan-Min; Chen, Xian-Cai; Li, Hai-Hong; Cai, Bo-Zhi; Liu, Yang; Zhang, Huan; Li, Yu; Lin, Chang-Min

    2016-02-01

    Although mammals are notoriously poor at regeneration compared with many lower-order species, the hair follicle, particular to mammals, is capable of regeneration following partial amputation. The detailed internal mechanism of this phenomenon is still unclear. Development and regrowth of the hair follicle depends on dermal-epidermal interaction within the hair follicle. Previous studies have shown that Wnt/β-catenin, Shh, Bmp, PDGF, TGF and Notch signals all take part in the development and growth of the hair follicle, and the Wnt/β-catenin signaling additionally plays an indispensable role in hair follicle morphogenesis and regrowth. In this study, we investigated the localization, as well as, protein levels of Wnt/β-catenin signaling molecules during amputated whisker follicle regeneration. PMID:26742765

  13. 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. PMID:15948330

  14. Amputation-Free Survival after Crural Percutaneous Transluminal Angioplasty for Critical Limb Ischemia

    DEFF Research Database (Denmark)

    Strøm, M; Konge, L; Lönn, L;

    2016-01-01

    BACKGROUND AND AIM: To evaluate the amputation-free survival after below the knee percutaneous transluminal angioplasty in a consecutive group of patients with critical ischemia of the lower extremity. MATERIALS AND METHODS: A total of 70 consecutive patients with critical ischemia were treated...... with below the knee percutaneous transluminal angioplasty at the vascular center at Rigshospitalet with the purpose of limb salvage. All patients were deemed unfit for major surgery due to anatomical limitations or severe co-morbidity, and no prior attempts of revascularization were performed. Follow...... within the first year. Complications after percutaneous transluminal angioplasty were rare. Cumulative mortality after 1 and 2 years was 22% and 34%, respectively. Amputation-free survival at 1 and 2 years of follow-up was 68% and 58%, respectively. There were no association between known risk factors...

  15. 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....

  16. Trip recoveries of people with unilateral, transfemoral or knee disarticulation amputations: Initial findings.

    Science.gov (United States)

    Crenshaw, Jeremy R; Kaufman, Kenton R; Grabiner, Mark D

    2013-07-01

    The purpose of this report is to provide novel findings from the kinematics of five amputees following a laboratory-induced trip. Only amputees with a unilateral, transfemoral or knee disarticulation amputation were included in this study. When the prosthesis was obstructed, all subjects used a lowering strategy, resulting in three harness-assisted recoveries and one fall. When the non-prosthetic limb was obstructed, one subject fell using an elevating strategy, one subject fell using a lowering strategy, and one subject, who was harness-assisted, used a hopping strategy. These results can be used to guide further studies of how to limit prosthetic knee flexion due to weight-bearing during a lowering strategy, implement compensatory step training to reduce fall risk, and identify appropriate, context-specific recovery strategies for people with transfemoral or knee disarticulation amputations.

  17. Crossover replantation after bilateral traumatic lower limb amputations: a case report

    Directory of Open Access Journals (Sweden)

    Fang Jun

    2012-07-01

    Full Text Available Abstract Introduction Replantation of a limb to the contralateral stump after bilateral traumatic amputations is rare. To the best of our knowledge, there are only a few reports of crossover lower limb replantation in the literature. Case presentation We treated a 37-year-old Chinese woman with bilateral lower limb crush injuries sustained in a traffic accident. Her lower limb injuries were at different anatomic levels. We performed emergency bilateral amputations followed by crossover replantation. Five years later, the woman had recovered well, and had perfect movement and stability in her replanted leg. After reviewing the literature, we thought that presentation of our patient’s case might provide useful information for clinicians. Conclusions Crossover replantation should be considered when evaluating a patient with bilateral lower limb injuries, thus allowing the patient to touch the ground and stand using their own foot.

  18. Effect of traumatic brain injury among U.S. servicemembers with amputation

    OpenAIRE

    Mitchell J. Rauh, PhD, PT, MPH; Hilary J. Aralis, MS; Ted Melcer, PhD; Caroline A. Macera, PhD; Pinata Sessoms, PhD; Jamie Bartlett, PhD; Michael R. Galarneau, MS

    2013-01-01

    Servicemembers with combat-related limb loss often require substantial rehabilitative care. The prevalence of traumatic brain injury (TBI), which may impair cognitive and functional abilities, among servicemembers has increased. The primary objectives of this study were to determine the frequency of TBI among servicemembers with traumatic amputation and examine whether TBI status was associated with discharge to civilian status and medical and rehabilitative service use postamputation. U.S. s...

  19. Solitary Giant Intramuscular Myxoid Neurofibroma Resulting in an above Elbow Amputation

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    Gururajaparasad Chennakeshaviah

    2012-01-01

    Full Text Available Neurofibromas are uncommon benign tumours and are still rarer in intramuscular locations. They are not detected until they cause a significant damage to the neighbouring tissues. We present a case of a giant intramuscular myxoid neurofibroma of the left forearm which eroded the radius and ulna, restricting the movements at the elbow and wrist joints and causing wrist drop resulting in an above elbow amputation. It was diagnosed by histopathology and was later confirmed by immunohistochemistry.

  20. Solitary Giant Intramuscular Myxoid Neurofibroma Resulting in an above Elbow Amputation

    Science.gov (United States)

    Chennakeshaviah, Gururajaparasad; Ravishankar, Sunila; Maggad, Rangaswamy; Manjunath, G. V.

    2012-01-01

    Neurofibromas are uncommon benign tumours and are still rarer in intramuscular locations. They are not detected until they cause a significant damage to the neighbouring tissues. We present a case of a giant intramuscular myxoid neurofibroma of the left forearm which eroded the radius and ulna, restricting the movements at the elbow and wrist joints and causing wrist drop resulting in an above elbow amputation. It was diagnosed by histopathology and was later confirmed by immunohistochemistry. PMID:23198230

  1. Bionic ankle–foot prosthesis normalizes walking gait for persons with leg amputation

    OpenAIRE

    Herr, Hugh M.; Grabowski, Alena M

    2011-01-01

    Over time, leg prostheses have improved in design, but have been incapable of actively adapting to different walking velocities in a manner comparable to a biological limb. People with a leg amputation using such commercially available passive-elastic prostheses require significantly more metabolic energy to walk at the same velocities, prefer to walk slower and have abnormal biomechanics compared with non-amputees. A bionic prosthesis has been developed that emulates the function of a biolog...

  2. Genital self-amputation or the Klingsor syndrome: Successful non-microsurgical penile replantation

    OpenAIRE

    El Harrech, Y.; Abaka, N.; Ghoundale, O.; D Touiti

    2013-01-01

    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...

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

    Science.gov (United States)

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

    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.

  4. Transfemoral unilateral computerized analysis of march in amputated individuals with endoskeletal and exoskeletal prothesis

    OpenAIRE

    Claudia Patricia Pinzón✝,; Gina Paola López; Cárol Ávila; Jorge Enrique Correa; Melba Geomar Rodríguez

    2003-01-01

    Title: Computerized Gait Analysis in UnilateralTrans-Femoral Amputees with Endo-Skeleticand Exo-Skeletic Prosthesis. Case Study.The purpose of this study is to perform a computerized gait analysis in subjects with unilateraltrans-femoral amputation with endo-skeleticand exo-skeletic prosthesis. Method: Theparticipants were two soldiers of The ColombianNational Army, with trans-femoral (AK) unilateralamputation, because of traumatic cause, age(25+/-10 years). The Software Ariel PerformanceAnal...

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

    International Nuclear Information System (INIS)

    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 132I--or 125I--antipyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mmHg 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<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 previously been shown to be the case in below-knee amputations. (author)

  6. Active dorsiflexing prostheses may reduce trip-related fall risk in people with transtibial amputation

    Directory of Open Access Journals (Sweden)

    Noah J. Rosenblatt, PhD

    2015-01-01

    Full Text Available People with amputation are at increased risk of falling compared with age-matched, nondisabled individuals. This may partly reflect amputation-related changes to minimum toe clearance (MTC that could increase the incidence of trips and fall risk. This study determined the contribution of an active dorsiflexing prosthesis to MTC. We hypothesized that regardless of speed or incline the active dorsiflexion qualities of the ProprioFoot would significantly increase MTC and decrease the likelihood of tripping. Eight people with transtibial amputation walked on a treadmill with their current foot at two grades and three velocities, then repeated the protocol after 4 wk of accommodation with the ProprioFoot. A mixed-model, repeated-measures analysis of variance was used to compare MTC. Curves representing the likelihood of tripping were derived from the MTC distributions and a multiple regression was used to determine the relative contributions of hip, knee, and ankle angles to MTC. Regardless of condition, MTC was approximately 70% larger with the ProprioFoot (p < 0.001 and the likelihood of tripping was reduced. Regression analysis revealed that MTC with the ProprioFoot was sensitive to all three angles, with sensitivity of hip and ankle being greater. Overall, the ProprioFoot may increase user safety by decreasing the likelihood of tripping and thus the pursuant likelihood of a fall.

  7. Pediatric Traumatic Limb Amputation: The Principles of Management and Optimal Residual Limb Lengths.

    Science.gov (United States)

    Khan, Muhammad Adil Abbas; Javed, Ammar Asrar; Rao, Dominic Jordan; Corner, J Antony; Rosenfield, Peter

    2016-01-01

    Pediatric traumatic limb amputations are rare and their acute and long term management can be challenging in this subgroup of patients. The lengthy and costly hospital stays, and resulting physical and psychological implications leads to significant morbidity. We present a summary of treatment principles and the evidence base supporting the management options for this entity. The initial management focuses on resuscitating and stabilization of the patients, administration of appropriate and adequate analgesics, and broad spectrum antibiotics. The patient should ideally be managed by an orthopedic or a plastic surgeon and when an amputation is warranted, the surgical team should aim to conserve as much of the viable physis as possible aimed at allowing bone development in a growing child. A subsequent wound inspection should be performed to assess for signs of ischemia or non-viability of tissue. Depending on the child's age, approximations of the ideal residual limb length can be calculated using our guidelines, allowing an ideal stump length at skeletal maturity for a well-fitting and appropriate prosthesis. Myodesis and myoplasties can be performed according to the nature of the amputation. Removable rigid dressings are safe and cost effective offering better protection of the stump. Complications such as necrosis and exostosis, on subsequent examination, warrant further revisions. Other complications such as neuromas can be prevented by proximal division of the nerves. Successful rehabilitation can be accomplished with a multidisciplinary approach, involving physiotherapist, play therapist and a child psychiatrist, in addition to the surgeon and primary care providers. PMID:27308235

  8. Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients.

    Science.gov (United States)

    Moura Neto, Arnaldo; Zantut-Wittmann, Denise Engelbrecht; Fernandes, Tulio Diniz; Nery, Marcia; Parisi, Maria Candida Ribeiro

    2013-08-01

    Treatment strategies for foot at risk and diabetic foot are mainly preventive. Studies describing demographic data, clinical and impacting factors continue to be, however, scarce. Our objective was to determine the epidemiological presentation of diabetic foot and understand whether there were easily assessable variables capable of predicting the development of diabetic foot. This was a retrospective study of 496 patients with established foot at risk or diabetic foot, who were evaluated based on age, gender, type and duration of diabetes, foot at risk classification, and the presence of deformities, ulceration, and amputation. The presence of deformities, ulceration, and amputation was recorded in 45.9, 25.3, and 12.9 % of patients, respectively. As for diabetic foot classification, the great majority of our cohort had diabetic neuropathy (92.9 %). Approximately 30 % had neuro-ischemic disease and only 7.1 % had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy. Foot classification was as a significant predictor for the presence of ulcer (p = 0.009; OR = 3.2; 95 % CI = 1.18-7.3). Only male gender was a significant predictor for ulceration (p diabetic foot (p diabetic foot were male gender and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease adds significantly to the risk for amputation among patients with the diabetic foot syndrome. Men, presenting combined risk factors, should be a group receiving special attention and in the foot clinic, due to their potentially worse evolution.

  9. Revisiting risks associated with mortality following initial transtibial or transfemoral amputation

    Directory of Open Access Journals (Sweden)

    Barbara E. Bates, MD, MBA

    2013-01-01

    Full Text Available This study’s objective was to determine how treatment-, environmental-, and facility-level characteristics contribute to postdischarge mortality prediction. The study included 4,153 Veterans who underwent lower-limb amputation in Department of Veterans Affairs facilities during fiscal years 2003 and 2004. Veterans were followed 1 yr postamputation. A Cox regression identified characteristics associated with mortality risk after hospital discharge following amputation. Older age, higher amputation level, and more comorbidities increased mortality likelihood. Patients who had inpatient procedures for pulmonary and renal problems had higher hazards of postdischarge death than those who did not (hazard ratio [HR] = 2.10, 95% confidence interval [CI] = 1.16–3.77, and HR = 2.22, 95% CI = 1.80–2.74, respectively. Patients who had central nervous system procedures had higher hazards of death early postdischarge (HR = 2.23, 95% CI = 1.60–3.11 at 0 d, but this association became insignificant by 180 d. Patients in a surgical intensive care unit (ICU, medical ICU, or medical bed section at the time of discharge were more likely to die than patients on a surgical bed section. Patients hospitalized in the Midwest were less likely to die early after discharge than patients in the Mountain Pacific region, but this regional effect became insignificant by 90 d. Adding treatment-, environmental-, and facility-level characteristics contributed additional information to a mortality risk model.

  10. Cardiovascular risk factors among males with war-related bilateral lower limb amputation.

    Science.gov (United States)

    Shahriar, S H; Masumi, M; Edjtehadi, F; Soroush, M R; Soveid, M; Mousavi, B

    2009-10-01

    This study was conducted to determine the cardiovascular risk factors among 327 Iranian males with bilateral lower limb amputation.The average age at the time of amputation and at the time of the study was 20.6 (SD = 5.4) and 42 years (SD = 6.3), respectively. Below both knees was the most common level of amputation (37.6%). About 95.4% had at least one modifiable risk factor. Prevalence of risk factors included: hyperglycemia 13.1%, systolic hypertension 18.9%, diastolic hypertension 25.6%, abdominal obesity 82.5%, high total cholesterol 36.7%, low HDL 25.9%, high LDL 24.7%, high triglycerides 32.1%, and smoking 31.8%. The most common risk factor was abdominal obesity. Prevalence of coronary artery disease was similar to the general Iranian population but prevalence of risk factors was higher significantly. The majority of the cases seem to be susceptible to cardiovascular disease in near future. Some strategies are needed as a primary prevention to reduce the risk of cardiovascular disease.

  11. Complete fifth ray amputation with peroneal tendon transfer--a staged surgical protocol.

    Science.gov (United States)

    Boffeli, Troy J; Abben, Kyle W

    2012-01-01

    Nonhealing neuropathic ulcers overlying the fifth metatarsal are frequently associated with cavus foot structure and are often complicated by osteomyelitis. Partial fifth ray amputation for metatarsal phalangeal joint ulceration and osteomyelitis is a time-proven procedure. Recurrent wounds and persistent osteomyelitis at the amputation stump or fifth metatarsal base create significant challenges in a cavus foot with neuropathy. Long-term success with removal of the entire fifth ray is largely dependent on preventing infection of the cuboid and maintaining peroneal tendon function. The described technique demonstrates our surgical principles and technical pearls in performing a staged complete fifth ray amputation with initial antibiotic bead placement and delayed peroneal tendon transfer. The peroneus longus tendon transfer has the advantage of preserving the eversion force to counterbalance the posterior tibial tendon and allowing the first ray to elevate, thereby alleviating some of the sagittal plane deformity associated with a cavus foot structure. The surgical tips and pearls are accompanied by procedure indications and incision planning options. To our knowledge, this is the first report of a staged protocol involving complete fifth ray resection, initial antibiotic bead placement, and delayed peroneus longus tendon transfer. PMID:22621858

  12. Global trends in incidence of lower limb amputation: a review of the literature

    Directory of Open Access Journals (Sweden)

    L. Godlwana

    2008-02-01

    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. Unani treatment and leech therapy saved the diabetic foot of a patient from amputation.

    Science.gov (United States)

    Zaidi, S M Arif

    2016-04-01

    Every 30 seconds, a lower limb amputation is carried out due to diabetes throughout the world. The mortality rate due to diabetic foot gangrene is just next to that of cancer. As tissue death cannot be reversed, surgical removal of the affected tissue (debridement) or amputation of the limb is the only treatment option left when gangrene has advanced. The present case study illustrates an option to treat poorly healing diabetic wounds with Unani medicine (blood purifier and deobstruent) besides hirudotherapy. The study was performed on a 60-year-old woman suffering from diabetic foot (on the left) grade 5 and facing the prospect of imminent amputation. The patient was having severe pain (80 mm on a 100 mm visual analogue scale) in the gangrenous foot and foul-smelling with necrosed areas. Wound dressing was done with unripe papaya as it has a very good role in clearing necrotising area and hirudotherapy was also used in poorly healing wounds. The pain score decreased to 0-10 mm on a 100 mm visual analogue scale within 20 days and no further pain relieving medication was required. Over a time interval of nearly 3·5 months, necrotic areas disappeared and the wound was completely healed. PMID:24809835

  14. 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.

  15. Simultaneous toe-to-hand transfer and lower extremity amputations for severe upper and lower limb defects: the use of spare parts.

    Science.gov (United States)

    Chang, J; Jones, N F

    2002-06-01

    From 1995 to 2000, five microvascular toe-to-hand transfers were performed in three children who were simultaneously undergoing lower extremity amputations. Their ages at time of transfer ranged from 4 to 10 years and the types of lower extremity amputation included toe amputation, foot amputation and through-knee amputation. The resulting toe-to-hand transfers included three great toe-to-thumb transfers and one combined great and second toe-to-hand transfer. The toe-to-hand transfers were all successful and all the lower extremity amputations healed without complications. In all cases, improved hand function and lower extremity function was noted by the families. These unique cases represent the ultimate use of spare parts in congenital hand surgery.

  16. Association of lower extremity arterial calcification with amputation and mortality in patients with symptomatic peripheral artery disease.

    Directory of Open Access Journals (Sweden)

    Chi-Lun Huang

    Full Text Available OBJECTIVE: The clinical implication of the coronary artery calcium score (CS is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes. METHODS AND RESULTS: Eighty-two patients with symptomatic peripheral artery disease (age 61.0±12.4 years were followed for 21±11 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03. During the follow-up period (21±11 months, 29 (35% patients underwent amputation, and 24 (29% patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88-fold (95% confidence interval [CI] 1.18-12.72, p = 0.03 and a 5.16-fold (95% CI 1.13-21.61, p = 0.04 higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment. CONCLUSION: Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and all-cause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.

  17. Demographics of Lower Limb Amputations in the Pakistan Military: A Single Center, Three-Year Prospective Survey

    Science.gov (United States)

    Ayaz, Saeed B; Mansoor, Sahibzada N; Qureshi, Ali R; Fahim, Muhammad

    2016-01-01

    Introduction  The Pakistan military has been actively engaged in the war against terror for more than a decade. Many officers and soldiers have lost their limbs in this war. But the data on traumatic lower limb amputations in Pakistan is sparse. The aim of this study is to prospectively document the epidemiological profile of lower limb military amputees presenting at the largest rehabilitation centre of Pakistan over a three-year period. Materials & methods  A prospective three-year survey was conducted at the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Pakistan. One hundred twenty-three consecutive patients with lower limb amputations were enrolled in the survey. The demographic data, etiology, associated injuries, complications profile, and type of prosthesis provided were documented. The data analysis was done using the statistical analysis tool SPSS V 20 (IBM®,NY, USA).  Results  All patients were male. Most had traumatic amputation (119), were between 20–40 years (106), with unilateral amputation (115). Mine blast injury was the leading cause in 73 (59.3%) and most (58.5%) were fitted with modular prosthesis. Transtibial amputation was the commonest level (65), followed by transfemoral (30). The time of surgical amputation was not documented in 87% of the patients. Half of the patients (54%) had associated injuries. Seventy-nine patients had at least one complication with phantom pain being the commonest in 25% cases. Conclusions  This is the largest prospective demographic survey of lower limb amputees in Pakistan military to date. Scores of soldiers and civilians in Pakistan have suffered lower limb amputation. The availability of demographic data can improve the trauma and rehabilitation services for better understanding and management of such cases. There is a need to conduct large scale community-based epidemiological surveys to direct future policies and develop amputee rehabilitation services in the public sector. PMID:27186448

  18. Demographics of Lower Limb Amputations in the Pakistan Military: A Single Center, Three-Year Prospective Survey.

    Science.gov (United States)

    Rathore, Farooq A; Ayaz, Saeed B; Mansoor, Sahibzada N; Qureshi, Ali R; Fahim, Muhammad

    2016-01-01

    INTRODUCTION : The Pakistan military has been actively engaged in the war against terror for more than a decade. Many officers and soldiers have lost their limbs in this war. But the data on traumatic lower limb amputations in Pakistan is sparse. The aim of this study is to prospectively document the epidemiological profile of lower limb military amputees presenting at the largest rehabilitation centre of Pakistan over a three-year period. MATERIALS & METHODS : A prospective three-year survey was conducted at the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Pakistan. One hundred twenty-three consecutive patients with lower limb amputations were enrolled in the survey. The demographic data, etiology, associated injuries, complications profile, and type of prosthesis provided were documented. The data analysis was done using the statistical analysis tool SPSS V 20 (IBM®,NY, USA). RESULTS : All patients were male. Most had traumatic amputation (119), were between 20-40 years (106), with unilateral amputation (115). Mine blast injury was the leading cause in 73 (59.3%) and most (58.5%) were fitted with modular prosthesis. Transtibial amputation was the commonest level (65), followed by transfemoral (30). The time of surgical amputation was not documented in 87% of the patients. Half of the patients (54%) had associated injuries. Seventy-nine patients had at least one complication with phantom pain being the commonest in 25% cases. CONCLUSIONS : This is the largest prospective demographic survey of lower limb amputees in Pakistan military to date. Scores of soldiers and civilians in Pakistan have suffered lower limb amputation. The availability of demographic data can improve the trauma and rehabilitation services for better understanding and management of such cases. There is a need to conduct large scale community-based epidemiological surveys to direct future policies and develop amputee rehabilitation services in the public sector. PMID:27186448

  19. L'influence de l' "eye movement desensitization and reprocessing" sur la douleur fantôme des patients amputés

    OpenAIRE

    Grand, Kevin; Bonny, Marion; Portuesi, Vito

    2015-01-01

    Introduction : Les douleurs fantômes sont présentes chez 70 à 90 % des sujets suite à une amputation. Ces douleurs influencent négativement le quotidien des amputés. Il existe de nombreux traitements, mais aucun ne fait l’unanimité. Problématique : L’incidence des amputations est exponentielle à l’augmentation du nombre de personnes présentant une atteinte vasculaire. Différents changements s’effectuent lors d’une amputation, notamment au niveau du système nerveux qui engendre fréquemment des...

  20. Temporal Trends and Geographic Variation of Lower Extremity Amputation in Patients with Peripheral Artery Disease: Results from U.S. Medicare 2000–2008

    Science.gov (United States)

    Jones, W. Schuyler; Patel, Manesh R.; Dai, David; Subherwal, Sumeet; Stafford, Judith; Calhoun, Sarah; Peterson, Eric D.

    2014-01-01

    Objectives We sought to characterize temporal trends, patient-specific factors and geographic variation associated with amputation in patients with lower extremity peripheral artery disease (LE PAD) during the study period. Background Amputation represents the end stage failure for those with LE PAD and little is known about the rates and geographic variation in use of LE amputation. Methods Using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000 to December 31, 2008, we examined national patterns of LE amputation among patients 65 years or older with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors. Results Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation declined from 7,258 per 100,000 PAD patients to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI, 0.95-0.95, p<0.001). Conclusions From 2000 to 2008, LE amputation rates decreased significantly among PAD patients. There however remains significant patient and geographic variation in amputation rates across the United States. PMID:23103040

  1. Prosthetic programme after above-knee amputation in children with sarcomata.

    Science.gov (United States)

    Cole, W G; Klein, R W; van Lith, M; Jarvis, R

    1982-01-01

    A programme for early mobilisation using a temporary prosthesis was evaluated in 17 children who had had an amputation above the knee for sarcomata. The temporary prosthesis had a performed adjustable polypropylene quadrilateral socket which was able to accommodate changes in the size of the stump during the first few months after amputation. The adjustable sockets were assembled onto wooden knee-shank-foot units or onto modular components covered with foam. The wooden units were better for routine use as more adjustment was possible between the socket and the knee and because they were more durable in active children. Prosthetic fitting usually took one hour and was carried out 10 days after the amputation to coincide with the start of the chemotherapy programme. The prosthesis was cosmetically acceptable, easy to use and provided a simple and economical way of rehabilitating the amputees and restoring their morale. After two to three months a new prosthesis with a laminated socket suspended by a waistband was supplied. The skin tolerated the closer fit of this socket and the small fluctuations in the size of the stump that occurred with each course of chemotherapy were easily accommodated by varying the thickness of the stump sock. A self-suspending laminated socket was provided after completion of the chemotherapy. The permanent sockets were assembled onto wooden components but the girls usually preferred the modular system covered with foam. The chemotherapy and rehabilitation programmes were successfully co-ordinated so that the children spent as little time as possible away from their normal activities.

  2. The modified Pirogoff's amputation in treating diabetic foot infections: surgical technique and case series

    Directory of Open Access Journals (Sweden)

    Aziz Nather

    2014-04-01

    Full Text Available Background: This paper describes the surgical technique of a modified Pirogoff's amputation performed by the senior author and reports the results of this operation in a single surgeon case series for patients with diabetic foot infections. Methods: Six patients with diabetic foot infections were operated on by the National University Hospital (NUH diabetic foot team in Singapore between November 2011 and January 2012. All patients underwent a modified Pirogoff's amputation for diabetic foot infections. Inclusion criteria included the presence of a palpable posterior tibial pulse, ankle brachial index (ABI of more than 0.7, and distal infections not extending proximally beyond the midfoot level. Clinical parameters such as presence of pulses and ABI were recorded. Preoperative blood tests performed included a glycated hemoglobin level, hemoglobin, total white blood cell count, C-reactive protein, erythrocyte sedimentation rate, albumin, and creatinine levels. All patients were subjected to 14 sessions of hyperbaric oxygen therapy postoperatively and were followed up for a minimum of 10 months. Results: All six patients had good wound healing. Tibio-calcaneal arthrodesis of the stump was achieved in all cases by 6 months postoperatively. All patients were able to walk with the prosthesis. Conclusions: The modified Pirogoff's amputation has been found to show good results in carefully selected patients with diabetic foot infections. The selection criteria included a palpable posterior tibial pulse, distal infections not extending proximally beyond the midfoot level, ABI of more than 0.7, hemoglobin level of more than 10 g/dL, and serum albumin level of more than 30 g/L.

  3. Reconstruction of Chopart's Amputation Stump Using Artificial Dermis Combined with Free Anterolateral Thigh Flap.

    Science.gov (United States)

    Shimizu, Mari; Matsumine, Hajime; Takeuchi, Masaki

    2015-11-01

    A 63-year-old man dropped a metal chunk onto his left foot during his work and suffered a crush injury of the left forefoot. He underwent Chopart's amputation followed by stump coverage with sole skin at the orthopedic department on the same day. He was referred to our department for reconstruction because of poor vascularization and subsequent necrosis of tissue at the stump. After the necrotic tissue was debrided, exposure of the talus bone was noted. An artificial dermis was then applied to the stump wound, followed by local negative pressure wound therapy. After 3 weeks, the generation of a strong dermis-like tissue was observed at the site of artificial dermis grafting. We then performed flow-through free anterolateral thigh flap grafting to reconstruct the stump wound. This procedure involved suturing of the peroneal muscle group and tibialis anterior muscle, which were cut off during Chopart's amputation, and suturing the soft tissue surrounding the calcaneus firmly to the fascia lata of the anterolateral thigh flap, followed by suturing of the flap to the skin defect of the left foot. There were neither postoperative complications, such as skin ulcer and equinus/varus deformity, nor need for secondary repair of the grafted flap, so the patient was able to smoothly enter a rehabilitation program including gait training. The current reconstruction technique for the tissue defect following Chopart's amputation, consisting of artificial dermis grafting, negative pressure wound therapy, and flow-through free anterolateral thigh flap grafting, enabled safe and smooth gait rehabilitation with a forefoot prosthesis. PMID:26893983

  4. Chopart prosthesis and semirigid foot orthosis in traumatic forefoot amputation. Comparative gait analysis.

    Science.gov (United States)

    Hirsch, G; McBride, M E; Murray, D D; Sanderson, D J; Dukes, I; Menard, M R

    1996-01-01

    Gait was analyzed in seven otherwise healthy males at least 11 mo after they had recovered from a traumatic unilateral transmetatarsal amputation incurred during the course of their usual occupation. All seven were fitted with a semirigid foot orthosis. Four were also fitted with a Chopart prosthesis. Gait was evaluated with forceplate measurements of ground reaction force during free walking, by clinical observation of such ambulation on videotape, and by the subjective impression of the men as obtained by a questionnaire. In all men, with unmodified footwear, with the orthosis, and with the prosthesis, the forceplate data showed an abnormal pattern characterized by reduced stance duration and deficient forward propulsion on the amputated side. The abnormality and asymmetry of ground-reaction forces were less with greater preserved stump length and for a given stump length were with the above-ankle concept (Chopart) prosthesis than with the below-ankle concept. These features were recognized during the clinical analysis of all footwear, but there was an extra irregularity of weight progression noted with the fixed ankle of the Chopart prosthesis. The questionnaire reported stump problems to be the principal difficulty, and the follow-up revealed persistent attempts at surgical management including consideration of amputation at a higher level. It was concluded that the patient and the surgeons are likely to choose preservation of limb length over considerations of function during acute care and that the prosthetic concept best suited to deal with the resulting stump should emphasize unloading the distal part of the stump and smoothing out the impulsive force peak on the stump in late stance to minimize pain and to enhance ambulation capacity.

  5. [Device to assess in-socket pressure distribution for partial foot amputation].

    Science.gov (United States)

    Alvarez-Camacho, Michelín; Urrusti, José Luis; Acero, María Del Carmen; Galván Duque-Gastélum, Carlos; Rodríguez-Reyes, Gerardo; Mendoza-Cruz, Felipe

    2014-07-01

    A device for dynamic acquisition and distribution analysis of in-socket pressure for patients with partial foot amputation is presented in this work. By using the developed system, we measured and generated pressure distribution graphs, obtained maximal pressure, and calculated pressure-time integral (PTI) of three subjects with partial foot amputation and of a group of Healthy subjects (Hs) (n = 10). Average maximal pressure in the healthy group was 19.4 ± 4.11 PSI, while for the three amputated patients, this was 27.8 ± 1.38, 17.6 ± 1.15, 29.10 ± 3.9 PSI, respectively. Maximal pressure-time integral for healthy subjects was 11.56 ± 2.83 PSI*s, and for study subjects was 19.54 ± 1.9, 12.35 ± 1.48, and 13.17 ± 1.31 PSI*s, respectively. The results of the control group agree with those previously reported in the literature. The pressure distribution pattern showed clear differences between study subjects and those of the control group; these graphs allowed us to identify the pressure in regions-of-interest that could be critical, such as surgical scars. The system presented in this work will aid to assess the effectiveness with which prosthetic systems distribute load, given that the formation of ulcers is highly linked to the pressure exercised at the point of contact; in addition, these results will help to investigate the comfort perception of the prosthesis, a factor directly influenced by the stump's pressure distribution.

  6. Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations

    OpenAIRE

    Amanda Lezanski Gujda; Bingham, Jonathan L.; Logemann, Nicholas F

    2015-01-01

    Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hy...

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

    Directory of Open Access Journals (Sweden)

    Anand Bosmia

    2014-07-01

    Full Text Available Abstract: 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 selfamputation or to have the severed portion of the injured finger reattached.

  8. Controlled environment treatment (CET) for patients with below-knee amputations.

    Science.gov (United States)

    Kegel, B

    1976-12-01

    This paper describes a new approach to early postsurgical wound management of the patient with a below-knee amputation. The method involves using the Controlled Environment Treatment (CET) machine, which wasdeveloped in England. A brief explanation of the components of the machine and its capabilities are listed. Ambient pressure, temperature, sterility, and humidity are easily controllable; advantages and disadvantages of this device over immediate post-operative plaster and conventional dressings as they relate both to wound environment and to physical therapy are mentioned. The early postsurgical therapy program used at Prosthetics Research Study is outlined.

  9. Intra-articular synovial sarcoma treated with a transfemoral amputation: a case report and review of the literature.

    Science.gov (United States)

    Gresswell, Steven D; Corsini, Anthony A; Balsamo, Luke H; Miles, Edward F

    2013-08-01

    A case of monophasic intra-articular synovial sarcoma in the right knee of a 39-year-old active duty serviceman treated with a transfemoral amputation is presented. The patient was evaluated for right knee pain and fullness. After further workup, the patient underwent computed tomography guided biopsy, with the tissue specimen consistent with intra-articular synovial sarcoma. The patient elected for a transfemoral amputation rather than limb or joint-sparing surgery. The gross specimen measured 3.5 × 3.0 × 1.7 cm in the posteromedial knee. No metastatic lesions were seen on positron emission tomography-computed tomography. Chemotherapy and radiation therapy have not been utilized. The transfemoral amputation adds to the uniqueness of this report and is discussed with a review of the multimodality treatment toward intra-articular synovial sarcoma in prior published literature.

  10. Dynamic stability of superior vs. inferior body segments in individuals with transtibial amputation walking in destabilizing environments.

    Science.gov (United States)

    Beurskens, Rainer; Wilken, Jason M; Dingwell, Jonathan B

    2014-09-22

    Interestingly, young and highly active people with lower limb amputation appear to maintain a similar trunk and upper body stability during walking as able-bodied individuals. Understanding the mechanisms underlying how this stability is achieved after lower-leg amputation is important to improve training regimens for improving walking function in these patients. This study quantified how superior (i.e., head, trunk, and pelvis) and inferior (i.e., thigh, shank, and feet) segments of the body respond to continuous visual or mechanical perturbations during walking. Nine persons with transtibial amputation (TTA) and 12 able-bodied controls (AB) walked on a 2 m × 3 m treadmill in a Computer Assisted Rehabilitation Environment (CAREN). Subjects were perturbed by continuous pseudo-random mediolateral movements of either the treadmill platform or the visual scene. TTA maintained a similar local and orbital stability in their superior body segments as AB throughout both perturbation types. However, for their inferior body segments, TTA subjects exhibited greater dynamic instability during perturbed walking. In TTA subjects, these increases in instability were even more pronounced in their prosthetic limb compared to their intact leg. These findings demonstrate that persons with unilateral lower leg amputation maintain upper body stability in spite of increased dynamic instability in their impaired lower leg. Thus, transtibial amputation does significantly impair sensorimotor function, leading to substantially altered dynamic movements of their lower limb segments. However, otherwise relatively healthy patients with unilateral transtibial amputation appear to retain sufficient remaining sensorimotor function in their proximal and contralateral limbs to adequately compensate for their impairment.

  11. 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.

  12. Four-fold increase in foot ulcers in type 2 diabetic subjects without an increase in major amputations by a multidisciplinary setting

    DEFF Research Database (Denmark)

    Hedetoft, Christoffer; Rasmussen, Anne; Fabrin, Jesper;

    2008-01-01

    AIMS: We observed a large increase in type 2 diabetic subjects with foot ulcers in our diabetic outpatient foot clinic and wanted to identify the amputations rate and individuals at risk of amputations by comparing those who had had a regular control in the multidisciplinary foot clinic prior to ...

  13. The Use of the 6-Min Walk Test as a Proxy for the Assessment of Energy Expenditure during Gait in Individuals with Lower-Limb Amputation

    Science.gov (United States)

    Kark, Laurena; McIntosh, Andrew S.B; Simmons, Annea

    2011-01-01

    The objective of this study was to determine, and compare, the utility of the 6-min walk test (6 MWT) and self-selected walking speed over 15 m as proxies for the assessment of energy expenditure during gait in individuals with lower-limb amputation. Patients with unilateral, transfemoral amputation (n = 6) and patients with unilateral,…

  14. 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.

  15. Immunocalization of telomerase in cells of lizard tail after amputation suggests cell activation for tail regeneration.

    Science.gov (United States)

    Alibardi, L

    2016-02-01

    Tail amputation (autotomy) in most lizards elicits a remarkable regenerative response leading to a new although simplified tail. No information on the trigger mechanism following wounding is known but cells from the stump initiate to proliferate and form a regenerative blastema. The present study shows that telomerases are mainly activated in the nuclei of various connective and muscle satellite cells of the stump, and in other tissues, probably responding to the wound signals. Western blotting detection also indicates that telomerase positive bands increases in the regenerating blastema in comparison to the normal tail. Light and ultrastructural immunocytochemistry localization of telomerase shows that 4-14 days post-amputation in lizards immunopositive nuclei of sparse cells located among the wounded tissues are accumulating into the forming blastema. These cells mainly include fibroblasts and fat cells of the connective tissue and satellite cells of muscles. Also some immature basophilic and polychromatophilic erytroblasts, lymphoblasts and myelocytes present within the Bone Marrow of the vertebrae show telomerase localization in their nuclei, but their contribution to the formation of the regenerative blastema remains undetermined. The study proposes that one of the initial mechanisms triggering cell proliferation for the formation of the blastema in lizards involve gene activation for the production of telomerase that stimulates the following signaling pathways for cell division and migration.

  16. 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.

  17. 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.

  18. 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.

  19. Registering a methodology for imaging and analysis of residual-limb shape after transtibial amputation

    Directory of Open Access Journals (Sweden)

    Alexander S. Dickinson, PhD

    2016-03-01

    Full Text Available Successful prosthetic rehabilitation following lower-limb amputation depends upon a safe and comfortable socket-residual limb interface. Current practice predominantly uses a subjective, iterative process to establish socket shape, often requiring several visits to a prosthetist. This study proposes an objective methodology for residual-limb shape scanning and analysis by high-resolution, automated measurements. A 3-D printed "analog" residuum was scanned with three surface digitizers on 10 occasions. Accuracy was measured by the scan-height error between repeat analog scans and the computer-aided design (CAD geometry and the scan versus CAD volume. Subsequently, 20 male residuum casts from ambulatory individuals with transtibial amputation were scanned by two observers, and 10 were repeat-scanned by one observer. The shape files were aligned spatially, and geometric measurements were extracted. Repeatability was evaluated by intraclass correlation, Bland-Altman analysis of scan volumes, and pairwise root-mean-square error ranges of scan area and width profiles. Submillimeter accuracy was achieved when scanning the analog shape using white light and laser scanning technologies. Scanning male residuum casts was highly repeatable within and between observers. The analysis methodology technique provides clinical researchers and prosthetists the capability to establish their own quantitative, objective, multipatient datasets. This could provide an evidence base for training, long-term follow-up, and interpatient outcome comparison, for decision support in socket design.

  20. Transcutaneous oxygen pressure. An effective measure for prosthesis fitting on below-knee amputations.

    Science.gov (United States)

    Casillas, J M; Michel, C; Aurelle, B; Becker, F; Marcer, I; Schultz, S; Didier, J P

    1993-02-01

    After amputation for arterial occlusive disease of the lower limbs, healing and local adaptation to a prosthesis depend on the oxygen ratio in the tissue. Transcutaneous oxygen tension (TcPO2) is a noninvasive microcirculatory exploration. Forty six below-knee stumps were selected without any prosthetic problem excepting vascular, with a follow-up mean duration of 23 months. They were classified into different prosthetic categories. The first was the worst because it required further amputation on the thigh and the fourth the best, which displayed complete adaptation to a socket contact. These groups were related to their TcPO2 values on the anterior and exterior face of the stumps in both reclined and seated positions. It seems that it is impossible to achieve healing when the TcPO2 value is lower than 15 mm Hg in lying position. However, healing is possible above 20 mm Hg but socket contact is not possible when TcPO2 values are under 40 mm Hg. When TcPO2 values are above 40 mm Hg, a good prosthesis fitting is possible when no problems are encountered other than vascular ones.

  1. 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. PMID:20707997

  2. Reconstruction of Punitive Ear Amputations in Uganda: A Unique Surgical Burden of Disease.

    Science.gov (United States)

    Dusseldorp, Joseph; Hodges, Andrew; Patel, Anup; Marchac, Alexandre; Firmin, Françoise

    2015-06-01

    Over the course of 12 months, a plastic surgical team from Paris, France, undertook 2 intensive ear reconstruction missions with plastic surgeons from the CoRSU Rehabilitation Hospital in Uganda. A cohort of over 30 adult women was assessed having been subjected to ear amputations by members of the Lords Resistance Army in Northern Uganda in the 1990s. The patients were identified, mobilized, and transferred to Kampala for surgery by a charitable arm of the Watoto Church, known as Living Hope. The surgical team performed 15 ear reconstruction cases during the first 1-week mission and 16 ear reconstruction cases during the second 1-week mission. All cases were reconstructed successfully using the 2-stage autologous auricular reconstruction method advocated by the senior author (FF). Local skin was used to cover the costal cartilage framework in the first stage without need for temporo-parietal fascial flaps. Technical challenges included the older age of patients and ossified costal cartilage, high prevalence of HIV positivity, bilateral amputation, and difficulty of surgical follow-up. The main modifications to standard practice were routine pre-op testing of the costal cartilage, pre-op viral load and CD4 count screening in HIV-positive patients, simultaneous bilateral first-stage ear reconstruction, prolonged hospital stay, and implementation of routine surgical counting procedures. PMID:26080156

  3. Regeneration of soft tissues is promoted by MMP1 treatment after digit amputation in mice.

    Directory of Open Access Journals (Sweden)

    Xiaodong Mu

    Full Text Available The ratio of matrix metalloproteinases (MMPs to the tissue inhibitors of metalloproteinases (TIMPs in wounded tissues strictly control the protease activity of MMPs, and therefore regulate the progress of wound closure, tissue regeneration and scar formation. Some amphibians (i.e. axolotl/newt demonstrate complete regeneration of missing or wounded digits and even limbs; MMPs play a critical role during amphibian regeneration. Conversely, mammalian wound healing re-establishes tissue integrity, but at the expense of scar tissue formation. The differences between amphibian regeneration and mammalian wound healing can be attributed to the greater ratio of MMPs to TIMPs in amphibian tissue. Previous studies have demonstrated the ability of MMP1 to effectively promote skeletal muscle regeneration by favoring extracellular matrix (ECM remodeling to enhance cell proliferation and migration. In this study, MMP1 was administered to the digits amputated at the mid-second phalanx of adult mice to observe its effect on digit regeneration. Results indicated that the regeneration of soft tissue and the rate of wound closure were significantly improved by MMP1 administration, but the elongation of the skeletal tissue was insignificantly affected. During digit regeneration, more mutipotent progenitor cells, capillary vasculature and neuromuscular-related tissues were observed in MMP1 treated tissues; moreover, there was less fibrotic tissue formed in treated digits. In summary, MMP1 was found to be effective in promoting wound healing in amputated digits of adult mice.

  4. [Pain syndromes following amputation. Analysis of 100 affected patients with chronic stump and phantom pain].

    Science.gov (United States)

    Wörz, R; Wörz, E

    1990-02-10

    One hundred amputees (m = 95, f = 5) with a pain syndrome were analysed. In 80 patients post-amputation pain of the lower, in 20 of the upper, extremities presented. Thirty-two patients suffered bouts of pain, 68 constant pain of various types. The most commonly cited type of pain in the patients with intermittent pain was lancinating, in the case of constant pain a burning sensation. In some patients pain occurred immediately after the loss of the limb, in others not until several years, or even decades, later. Forty per cent of our patients indicated that the incidence and intensity of the pain increased with time. Neurological, orthopedic and internistic causes of stump or phantom pain have been described. In 72% of the patients with constant pain and in 34% of those suffering from bouts of pain, an algogenic psychosyndrome had developed. Complications and late sequelae of amputations are of considerable significance for the development and intensity of stump and phantom pain.

  5. 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.

  6. Antihypertensive drug therapy and the risk of lower extremity amputations in pharmacologically treated type 2 diabetes patients

    NARCIS (Netherlands)

    Erkens, JA; Klungel, OH; Stolk, RP; Spoelstra, JA; Grobbee, DE; Leufkens, HGM

    2004-01-01

    Purpose The objective of this study was to determine the association between different antihypertensive drug therapies and lower extremity amputations (LEAs) in type 2 diabetes patients. Methods Data were obtained from the PHARMO Record Linkage System comprising pharmacy records and data on hospital

  7. Motivation, effort and life circumstances as predictors of foot ulcers and amputations in people with Type 2 diabetes mellitus

    DEFF Research Database (Denmark)

    Bruun, Christine; Guassora, Ann Dorrit; Nielsen, Anni Brit Sternhagen;

    2014-01-01

    Abstract AIM: To investigate the predictive value of both patients' motivation and effort in their management of Type 2 diabetes and their life circumstances for the development of foot ulcers and amputations. METHODS: This study was based on the Diabetes Care in General Practice study and Danish...

  8. 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

    2014-01-01

    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 nor

  9. Langtidsbehandling med spinal cord-stimulation hos en patient med kronisk regionalt smertesyndrom type 1 og fantomsmerter efter amputation

    DEFF Research Database (Denmark)

    Enggaard, Thomas P.; 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 wel...

  10. 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.

    2014-01-01

    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 decr

  11. 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

  12. Curcumin upregulates S100 expression and improves regeneration of the sciatic nerve following its complete amputation in mice

    Institute of Scientific and Technical Information of China (English)

    Guo-min Liu; Kun Xu; Juan Li; Yun-gang Luo

    2016-01-01

    The repair of peripheral nerve injury after complete amputation is dififcult, and even with anastomosis, the rapid recovery of nerve function remains challenging. Curcumin, extracted from plants of the genus Curcuma, has been shown to have anti-oxidant and anti-inlfammatory properties and to improve sciatic nerve crush injury in rats. Here, we determined whether curcumin had neuroprotective effects following com-plete peripheral nerve amputation injury. BALB/c mice underwent complete sciatic nerve amputation, followed by an immediate epineurium anastomosis. Mice were intragastrically administered curcumin at doses of 40 (high), 20 (moderate), and 10 mg/kg/d (low) for 1 week. We found that myelin in the mice of the high-and moderate-dose curcumin groups appeared with regular shape, uniform thickness, clear boundary, and little hyperplasia surrounding the myelin. High and moderate doses of curcumin markedly improved both action potential amplitude of the sciatic nerves and the conduction velocity of the corresponding motor neurons, and upregulated mRNA and protein ex-pression of S100, a marker for Schwann cell proliferation, in L4–6 spinal cord segments. These results suggest that curcumin is effective in promoting the repair of complete sciatic nerve amputation injury and that the underlying mechanism may be associated with upregulation of S100 expression.

  13. Curcumin upregulates S100 expression and improves regeneration of the sciatic nerve following its complete amputation in mice.

    Science.gov (United States)

    Liu, Guo-Min; Xu, Kun; Li, Juan; Luo, Yun-Gang

    2016-08-01

    The repair of peripheral nerve injury after complete amputation is difficult, and even with anastomosis, the rapid recovery of nerve function remains challenging. Curcumin, extracted from plants of the genus Curcuma, has been shown to have anti-oxidant and anti-inflammatory properties and to improve sciatic nerve crush injury in rats. Here, we determined whether curcumin had neuroprotective effects following complete peripheral nerve amputation injury. BALB/c mice underwent complete sciatic nerve amputation, followed by an immediate epineurium anastomosis. Mice were intragastrically administered curcumin at doses of 40 (high), 20 (moderate), and 10 mg/kg/d (low) for 1 week. We found that myelin in the mice of the high- and moderate-dose curcumin groups appeared with regular shape, uniform thickness, clear boundary, and little hyperplasia surrounding the myelin. High and moderate doses of curcumin markedly improved both action potential amplitude of the sciatic nerves and the conduction velocity of the corresponding motor neurons, and upregulated mRNA and protein expression of S100, a marker for Schwann cell proliferation, in L4-6 spinal cord segments. These results suggest that curcumin is effective in promoting the repair of complete sciatic nerve amputation injury and that the underlying mechanism may be associated with upregulation of S100 expression. PMID:27651779

  14. 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

  15. Donovanosis with auto-amputation of penis in a HIV-2 infected person

    Directory of Open Access Journals (Sweden)

    Chandra Gupta T

    2008-01-01

    Full Text Available Donovanosis is a slowly progressive, granulomatous ulcerative disease , caused by Klebsiella (Calymmatobacterium granulomatis. The disease is known to persist for years together, leading to complications. A male patient aged 30 years with underlying HIV-2 infection presented to the department of STD with painful ulceration over the genital region of 5 months duration, with absence of penis. Tissue smear from the ulcer and histopathological examination revealed large histiocytes with intracellular Donovan bodies (Pund cell. A final diagnosis of donovanosis with auto-amputation of penis with HIV-2 infection was made. The old conventional medicines, viz. streptomycin, doxycycline and amoxycillin, were effective. Though HIV-2 infections are milder than HIV-1 infections in all aspects, donovanosis in this HIV-2 infected case presented with complications. However, since the CD4 count was 748 cells/cmm, the severity is attributed to the long standing nature and negligence by the patient, and not to possible immunodeficiency.

  16. 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....

  17. 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.

  18. Prostheses, pain and sequelae of amputation, as seen by the amputee.

    Science.gov (United States)

    Chadderton, H C

    1978-04-01

    Results of a survey of 19 organizations belonging to World Veterans Federation indicate that major complains of amputees include; poor fitting, poor dissemination of knowledge to doctors and amputees regarding new prostheses, lack of opportunity for "input" from amputees at research level and inadequate measures to deal with phantom and stump pain. Suggested improvements by amputees; decrease in weight of prostheses, reduction in maintenance for swing and stance-phase control units development of recreational prostheses, more frequent checks through use of X-ray and film techniques, particularly during the "break-in" of a new appliance. Older veterans showed increasing concern in regard to development of consequential disabilities arising from amputation; premature arthritic changes in spine and remaining limb, circulatory problems and gastro-intestinal problems due to ingestion of drugs to control pain.

  19. USE OF LOPINAVIR/RITONAVIR ASSOCIATED WITH ERGOTAMINE RESULTING IN FOOT AMPUTATION: BRIEF COMMUNICATION

    Directory of Open Access Journals (Sweden)

    Fernando Raphael de Almeida Ferry

    2014-06-01

    Full Text Available A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 mcg, and atropine sulfate 12.5 mcg. Afterwards she was prescribed one capsule of Ormigrein every 30 minutes for a total of six capsules a day. The patient took the medication as prescribed but developed a pain in her left ankle three days later, which evolved to the need for amputation.

  20. Use of lopinavir/ritonavir associated with ergotamine resulting in foot amputation: brief communication.

    Science.gov (United States)

    Ferry, Fernando Raphael de Almeida; Da Silva, Guilherme Almeida Rosa; Motta, Rogerio Neves; Carvalho, Ricardo de Souza; De Sá, Carlos Alberto Morais

    2014-01-01

    A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 mcg, and atropine sulfate 12.5 mcg. Afterwards she was prescribed one capsule of Ormigrein every 30 minutes for a total of six capsules a day. The patient took the medication as prescribed but developed a pain in her left ankle three days later, which evolved to the need for amputation. PMID:24879006

  1. High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes.

    Science.gov (United States)

    Örneholm, Hedvig; Apelqvist, Jan; Larsson, Jan; Eneroth, Magnus

    2015-01-01

    Diabetic foot ulcer is an important entity which in many cases is the first serious complication in diabetes. Although a plantar forefoot location is common, there are few studies on larger cohorts and in such studies there is often a combination of various types of ulcer and ulcer locations. The purpose of this study is to discern the outcome of plantar forefoot ulcers and their specific characteristics in a large cohort. All patients (n = 770), presenting with a plantar forefoot ulcer at a multidisciplinary diabetes foot clinic from January 1, 1983 to December 31, 2012 were considered for the study. Seven hundred one patients (median age 67 [22-95]) fulfilled the inclusion criteria and were followed according to a preset protocol until final outcome (healing or death). Severe peripheral vascular disease was present in 26% of the patients and 14% had evidence of deep infection upon arrival at the foot clinic. Fifty-five percent (385/701) of the patients healed without foot surgery, 25% (173/701) healed after major debridement, 9% (60/701) healed after minor or major amputation and 12% (83/701) died unhealed. Median healing time was 17 weeks. An ulcer classified as Wagner grade 1 or 2 at inclusion and independent living were factors associated with a higher healing rate. Seventy-nine percent of 701 patients with diabetes and a plantar forefoot ulcer treated at a multidisciplinary diabetes foot clinic healed without amputation. For one third some form of foot surgery was needed to achieve healing.

  2. 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

    Introduction 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. Aim To construct a grounded theory (GT) explaining patients’ behavior shortly after having a leg amputated as a result of vascular disease. Method 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. Results 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. Conclusion The theory of “Pendulating” offers a tool to understand the amputated patients’ behavior and underlying concerns and to recognize where they are in the

  3. Pendulating—A grounded theory explaining patients’ behavior shortly after having a leg amputated due to vascular disease

    Directory of Open Access Journals (Sweden)

    Ulla Riis Madsen

    2016-09-01

    Full Text Available Introduction: 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. Aim: To construct a grounded theory (GT explaining patients’ behavior shortly after having a leg amputated as a result of vascular disease. Method: 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. Results: 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. Conclusion: The theory of “Pendulating” offers a tool to understand the amputated patients’ behavior and underlying concerns and to recognize

  4. Amputations and foot ulcers in patients newly diagnosed with Type 2 diabetes mellitus and observed for 19 years. The role of age, gender and co-morbidity

    DEFF Research Database (Denmark)

    Bruun, C; Siersma, V.; Guassora, A.D.;

    2013-01-01

    To determine the prevalence of foot ulcers and the incidence of amputations in patients with Type 2 diabetes observed for 19 years after diagnosis. We investigated the role of gender, age and co-morbidities....

  5. Post-amputation pain is associated with the recall of an impaired body representation in dreams-results from a nation-wide survey on limb amputees.

    Science.gov (United States)

    Bekrater-Bodmann, Robin; Schredl, Michael; Diers, Martin; Reinhard, Iris; Foell, Jens; Trojan, Jörg; Fuchs, Xaver; Flor, Herta

    2015-01-01

    The experience of post-amputation pain such as phantom limb pain (PLP) and residual limb pain (RLP), is a common consequence of limb amputation, and its presence has negative effects on a person's well-being. The continuity hypothesis of dreams suggests that the presence of such aversive experiences in the waking state should be reflected in dream content, with the recalled body representation reflecting a cognitive proxy of negative impact. In the present study, we epidemiologically assessed the presence of post-amputation pain and other amputation-related information as well as recalled body representation in dreams in a sample of 3,234 unilateral limb amputees. Data on the site and time of amputation, residual limb length, prosthesis use, lifetime prevalence of mental disorders, presence of post-amputation pain, and presence of non-painful phantom phenomena were included in logistic regression analyses using recalled body representation in dreams (impaired, intact, no memory) as dependent variable. The effects of age, sex, and frequency of dream recall were controlled for. About 22% of the subjects indicated that they were not able to remember their body representation in dreams, another 24% of the amputees recalled themselves as always intact, and only a minority of less than 3% recalled themselves as always impaired. Almost 35% of the amputees dreamed of themselves in a mixed fashion. We found that lower-limb amputation as well as the presence of PLP and RLP was positively associated with the recall of an impaired body representation in dreams. The presence of non-painful phantom phenomena, however, had no influence. These results complement previous findings and indicate complex interactions of physical body appearance and mental body representation, probably modulated by distress in the waking state. The findings are discussed against the background of alterations in cognitive processes after amputation and hypotheses suggesting an innate body model.

  6. Management of diabetic foot disease and amputation in the Irish health system: a qualitative study of patients' attitudes and experiences with health services.

    LENUS (Irish Health Repository)

    Delea, Sarah

    2015-07-01

    Diabetes is an increasingly prevalent chronic illness that places a huge burden on the individual, the health system and society. Patients with active foot disease and lower limb amputations due to diabetes have a significant amount of interaction with the health care services. The purpose of this study was to explore the attitudes and experiences of foot care services in Ireland among people with diabetes and active foot disease or lower limb amputations.

  7. A prospective study of the importance of life goal characteristics and goal adjustment capacities in longer term psychosocial adjustment to lower limb amputation

    OpenAIRE

    Coffey, Laura; Gallagher, Pamela; Desmond, Deirdre

    2014-01-01

    Objective: To explore the life goal characteristics and goal adjustment capacities of persons with lower limb amputation on admission to rehabilitation, and to examine their efficacy as predictors of psychosocial outcomes 6 months post-discharge. Design: Prospective, descriptive. Setting: Two specialist inpatient rehabilitation facilities in Ireland. Subjects: A consecutive sample of 64 patients with lower limb amputation. Main measures: On admission to rehabilitation, life goal c...

  8. The persistence of gender and racial disparities in vascular lower extremity amputation: an examination of HCUP-NIS data (2002-2011).

    Science.gov (United States)

    Lefebvre, Kristin M; Chevan, Julia

    2015-02-01

    The purpose of this study was to examine trends in racial and gender disparities in the severity of lower extremity amputation among individuals with peripheral artery disease (PAD) over the period of a decade (2002-2011). This is a longitudinal secondary analysis of data from the Healthcare Utilization Project Nationwide Inpatient Survey (HCUP-NIS) for the years 2002-2011. Level of amputation was determined from ICD-9-CM procedure and coded as either transfemoral (TF) or transtibial (TT). The main predictors were gender and race; covariates including age, race, income, insurance status and presence of vascular disease were incorporated as control variables in regression analysis. A total 121,587 cases of non-traumatic dysvascular amputations were identified. Female gender (odds ratio (OR) 1.35; 95% confidence interval (CI) 1.32, 1.39) and black race (OR 1.17; 95% CI 1.12, 1.23) are both significantly associated with increased odds for receiving TF amputation with no change in these odds over the decade of study. Other covariates with significant associations with TF amputation level include increased age (OR 1.03; 95% CI 0.99, 1.09), low income (OR 1.21; 95% CI 1.15, 1.27), Medicaid insurance (OR 1.36; 95% CI 1.29, 1.44), Medicare insurance (OR 1.27; 95% CI 1.21, 1.32), and cerebrovascular disease (OR 2.12; 95% CI 2.03, 2.23). In conclusion, although overall rates of amputation have decreased, disparities in level of amputation related to female gender and black race have not significantly changed over time. Higher-level amputation has significant consequences from a quality-of-life, medical and economic perspective.

  9. The persistence of gender and racial disparities in vascular lower extremity amputation: an examination of HCUP-NIS data (2002-2011).

    Science.gov (United States)

    Lefebvre, Kristin M; Chevan, Julia

    2015-02-01

    The purpose of this study was to examine trends in racial and gender disparities in the severity of lower extremity amputation among individuals with peripheral artery disease (PAD) over the period of a decade (2002-2011). This is a longitudinal secondary analysis of data from the Healthcare Utilization Project Nationwide Inpatient Survey (HCUP-NIS) for the years 2002-2011. Level of amputation was determined from ICD-9-CM procedure and coded as either transfemoral (TF) or transtibial (TT). The main predictors were gender and race; covariates including age, race, income, insurance status and presence of vascular disease were incorporated as control variables in regression analysis. A total 121,587 cases of non-traumatic dysvascular amputations were identified. Female gender (odds ratio (OR) 1.35; 95% confidence interval (CI) 1.32, 1.39) and black race (OR 1.17; 95% CI 1.12, 1.23) are both significantly associated with increased odds for receiving TF amputation with no change in these odds over the decade of study. Other covariates with significant associations with TF amputation level include increased age (OR 1.03; 95% CI 0.99, 1.09), low income (OR 1.21; 95% CI 1.15, 1.27), Medicaid insurance (OR 1.36; 95% CI 1.29, 1.44), Medicare insurance (OR 1.27; 95% CI 1.21, 1.32), and cerebrovascular disease (OR 2.12; 95% CI 2.03, 2.23). In conclusion, although overall rates of amputation have decreased, disparities in level of amputation related to female gender and black race have not significantly changed over time. Higher-level amputation has significant consequences from a quality-of-life, medical and economic perspective. PMID:25659653

  10. Traction avulsion amputation of the major upper limb: a proposed new classification, guidelines for acute management, and strategies for secondary reconstruction.

    Science.gov (United States)

    Chuang, D C; Lai, J B; Cheng, S L; Jain, V; Lin, C H; Chen, H C

    2001-11-01

    Major replantation of a traction avulsion amputation is undertaken with the goal of not only the reestablishment of circulation, but also functional outcome. This type of amputation is characterized by different levels of soft-tissue divisions involving crushing, traction, and avulsion injuries to various structures. Between 1985 and 1998, 27 cases were referred for secondary reconstruction following amputation of the upper extremity involving both arm and forearm. Replantation was performed by at least 12 qualified plastic surgeons using different approaches and management, resulting in different outcomes. Initial replantation management significantly affects the later reconstruction. For comparing studies and prognostic implications, the authors propose a new classification according to the level of injury to muscles and innervated nerves: type I, amputation at or close to the musculotendinous aponeurosis with muscles remaining essentially intact; type II, amputation within the muscle bellies but with the proximal muscles still innervated; type III, amputation involving the motor nerve or neuromuscular junction, thereby causing total loss of muscle function; and type IV, amputation through the joint; i.e., disarticulation of the elbow or shoulder joint. Some patients required further reconstruction for functional restoration after replantation, but some did not. Through this retrospective study based on the proposed classification system, prospective guidelines for the management of different types of traction avulsion amputation are provided, including the value of replantation, length of bone shortening, primary or delayed muscle or nerve repair, necessity of fasciotomy, timing for using free tissue transfer for wound coverage, and the role of functioning free muscle transplantation for late reconstruction. The final functional outcome can also be anticipated prospectively through this classification system.

  11. An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation

    DEFF Research Database (Denmark)

    Kristensen, Morten T; Holm, Gitte; Krasheninnikoff, Michael;

    2016-01-01

    was compared with historical and concurrent national controls in Denmark. Results - The 30-day and 1-year mortality rates were 16% and 37%, respectively, in the intervention group, as compared to 35% and 59% in the historical control group treated in the same orthopedic ward. Cox proportional harzards models...... adjusted for age, sex, residential and health status, the disease that caused the amputation, and the index amputation level showed that 30-day and 1-year mortality risk was reduced by 52% (HR =0.48, 95% CI: 0.25-0.91) and by 46% (HR =0.54, 95% CI: 0.35-0.86), respectively, in the intervention group....... The risk of death was increased for patients living in a nursing home, for patients with a bilateral LEA, and for patients with low health status. Interpretation - With similarly frail patient groups and instituting an enhanced program for patients after LEA, the risks of death by 30 days and by 1 year...

  12. Is the desire for amputation related to disturbed emotion processing? A multiple case study analysis in BIID

    OpenAIRE

    Bottini, G.; Brugger, P; Sedda, A.

    2015-01-01

    Body integrity identity disorder (BIID) is characterized by the overwhelming desire to amputate one or more healthy limbs or to be paraplegic. Recently, a neurological explanation of this condition has been proposed, in part on the basis of findings that the insular cortex might present structural anomalies in these individuals. While these studies focused on body representation, much less is known about emotional processing. Importantly, emotional impairments have been found in psychiatric d...

  13. Feasibility of the Nintendo WiiFit™ for improving walking in individuals with a lower limb amputation

    Directory of Open Access Journals (Sweden)

    Bita Imam

    2013-08-01

    Full Text Available Objectives: To evaluate the feasibility of the Nintendo WiiFit™ as an adjunct to usual therapy in individuals with a lower limb amputation. Methods: The study was a Multiple Baseline (AB Single Subject Research Design. Subjects were ≥19 years old, had their first unilateral transtibial or transfemoral amputation  ≤12 months ago, and were participating in prosthetic training. WiiFit training was provided for 30 min, 5 times a week, for a minimum of 2 and a maximum of 6 weeks in addition to usual therapy. Feasibility indicators were safety, post-intervention fatigue and pain levels, adherence, and subject’s acceptability of the program as measured by the Short Feedback Questionnaire–modified (SFQ-M. The primary clinical outcome was walking capacity assessed by the 2 Minute Walk Test (2MWT. The secondary clinical outcomes were the Short Physical Performance Battery, L-test, and Activities-Specific Balance Confidence. Results: Subjects (4 transtibial; 2 transfemoral had a median age of 48.5 years (range = 45–59 years. No adverse events associated with the intervention occurred. Median pain and fatigue levels were 1.3 (range = 0.5–3.5 and 3.1 (range = 1.4–4.1, respectively. Median adherence was 80%. Subjects found the WiiFit enjoyable and acceptable (median SFQ-M = 35. Five subjects showed statistical improvement on the 2MWT and four on the secondary outcomes (p < 0.05. Conclusion: The WiiFit intervention was found to be feasible in individuals with unilateral lower limb amputation. This research provides the foundation for future clinical research investigating the use of the WiiFit as a viable adjunctive therapy to improve outcomes in individuals with unilateral lower limb amputation who are participating in prosthetic training.

  14. Adjustment to amputation and psychological distress: an examination of the intervening role of posttraumatic stress and posttraumatic growth

    OpenAIRE

    Mac Conaill, Susan

    2013-01-01

    Successful adjustment to amputation can be quantified in a number of ways. Physical measures such as prosthesis use, mobility indices, and activities of daily living have traditionally been suggested as outcome measures in the literature. More recently, the importance of psychological outcomes is gaining attention. This study was based in a regional prosthetic, orthotic, and limb-absence rehabilitation unit. It was developed in order to provide an overview of a range of issues affecting pa...

  15. Amputation in emergency situations: indications, techniques and Médecins Sans Frontières France's experience in Haiti

    OpenAIRE

    Herard, Patrick; Boillot, François

    2012-01-01

    PURPOSE: The decision to amputate is always difficult but becomes even harder in emergency situations, which usually present extra complicating factors. MSF EXPERIENCE: These include human factors (related to both the surgeon and the patient); poor or nonexistent medical facilities, especially in war conditions or resource-poor countries; and cultural and religious considerations. Médecins Sans Frontières (MSF) has developed a quick medical and logistical response that relies on surgical prot...

  16. 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 < 0.001). The physical function SF-36 scores were also improved (p < 0.001). Superficial infection was the most frequent complication, occurring 41 times in 28 patients (rate of infection 54.9%). Most were treated effectively with oral antibiotics. The implant was removed in four patients because of loosening (three aseptic, one infection). Osseointegrated percutaneous implants constitute a novel form of treatment for patients with TFA. The high cumulative survival rate at two years (92%) combined with enhanced prosthetic use and mobility, fewer problems and improved quality of life, supports the 'revolutionary change' that patients with TFA have reported following treatment with osseointegrated percutaneous prostheses.

  17. Transfemoral unilateral computerized analysis of march in amputated individuals with endoskeletal and exoskeletal prothesis

    Directory of Open Access Journals (Sweden)

    Claudia Patricia Pinzón✝,

    2003-12-01

    Full Text Available Title: Computerized Gait Analysis in UnilateralTrans-Femoral Amputees with Endo-Skeleticand Exo-Skeletic Prosthesis. Case Study.The purpose of this study is to perform a computerized gait analysis in subjects with unilateraltrans-femoral amputation with endo-skeleticand exo-skeletic prosthesis. Method: Theparticipants were two soldiers of The ColombianNational Army, with trans-femoral (AK unilateralamputation, because of traumatic cause, age(25+/-10 years. The Software Ariel PerformanceAnalysis System (APAS was employed forthe movement analysis. Information onkinematics, parameters and decisive of the gait,tilt of pelvis, length of step, the length long stride,the broad of step, the march of cadense, the indexof energy, consumption and the percentage ofthe periods of duration of the gait cycle was obtained. Results: The heady data werecompared among if and with a normal gait. Theresults are present in a comparative board.Conclusions: The use of this technology in theintervention physical therapy with amputatedpeople, throws exact data in all the variables of thestudy, what can improve the boarding of thesepeople in the prosthetic and to provide them thegait pattern’s reeducation the nearest thing to thenormal thing.

  18. Epidural electrocorticography of phantom hand movement following long-term upper-limb amputation

    Directory of Open Access Journals (Sweden)

    Alireza eGharabaghi

    2014-05-01

    Full Text Available Introduction: Prostheses for upper-limb amputees are currently controlled by either myoelectric or peripheral neural signals. Performance and dexterity of these devices is still limited, particularly when it comes to controlling hand function. Movement-related brain activity might serve as a complementary bio-signal for motor control of hand prosthesis. Methods: We introduced a methodology to implant a cortical interface without direct exposure of the brain surface in an upper-limb amputee. This bi-directional interface enabled us to explore the cortical physiology following long-term transhumeral amputation. In addition, we investigated neurofeedback of electrocorticographic brain activity related to the patient’s motor imagery to open his missing hand, i.e. phantom hand movement, for real-time control of a virtual hand prosthesis.Results: Both event-related brain potentials and cortical stimulation revealed mutually overlapping cortical representations of the phantom hand. Phantom hand movements could be robustly classified and the patient required only three training sessions to gain reliable control of the virtual hand prosthesis in an online closed-loop paradigm that discriminated between hand opening and rest. Conclusion: Epidural implants may constitute a powerful and safe alternative communication pathway between the brain and external devices for upper-limb amputees, thereby facilitating the integrated use of different signal sources for more intuitive and specific control of multi-functional devices in clinical use.

  19. Toe clearance when walking in people with unilateral transtibial amputation: Effects of passive hydraulic ankle

    Directory of Open Access Journals (Sweden)

    Louise Johnson, PhD

    2014-06-01

    Full Text Available Most clinically available prosthetic feet have a rigid attachment or incorporate an “ankle” device allowing elastic articulation during stance, with the foot returning to a “neutral” position at toe-off. We investigated whether using a foot with a hydraulically controlled articulating ankle that allows the foot to be relatively dorsiflexed at toe-off and throughout swing would increase minimum toe clearance (MTC. Twenty-one people with unilateral transtibial amputation completed overground walking trials using their habitual prosthetic foot with rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment (hyA-F. MTC and other kinematic variables were assessed across multiple trials. When using the hyA-F, mean MTC increased on both limbs (p = 0.03. On the prosthetic limb this was partly due to the device being in its fully dorsiflexed position at toe-off, which reduced the “toes down” foot angle throughout swing (p = 0.01. Walking speed also increased when using the hyA-F (p = 0.001 and was associated with greater swing-limb hip flexion on the prosthetic side (p = 0.04, which may have contributed to the increase in mean MTC. Variability in MTC increased on the prosthetic side when using the hyA-F (p = 0.03, but this did not increase risk of tripping.

  20. Phantom limb perception interferes with motor imagery after unilateral upper-limb amputation.

    Science.gov (United States)

    Lyu, Yuanyuan; Guo, Xiaoli; Bekrater-Bodmann, Robin; Flor, Herta; Tong, Shanbao

    2016-01-01

    A potential contributor to impaired motor imagery in amputees is an alteration of the body schema as a result of the presence of a phantom limb. However, the nature of the relationship between motor imagery and phantom experiences remains unknown. In this study, the influence of phantom limb perception on motor imagery was investigated using a hand mental rotation task by means of behavioral and electrophysiological measures. Compared with healthy controls, significantly prolonged response time for both the intact and missing hand were observed specifically in amputees who perceived a phantom limb during the task but not in amputees without phantom limb perception. Event-related desynchronization of EEG in the beta band (beta-ERD) in central and parietal areas showed an angular disparity specifically in amputees with phantom limb perception, with its source localized in the right inferior parietal lobule. The response time as well as the beta-ERD values were significantly positively correlated with phantom vividness. Our results suggest that phantom limb perception during the task is an important interferential factor for motor imagery after amputation and the interference might be related to a change of the body representation resulting from an unnatural posture of the phantom limb. PMID:26879749

  1. Impact of rehabilitation programs on dependency and functional performance of patients with major lower limb amputations

    Science.gov (United States)

    AlSofyani, Mohammad A.; AlHarthi, Abdulaziz S.; Farahat, Fayssal M.; Abuznadah, Wesam T.

    2016-01-01

    Objectives: To determine pattern and impact of physical rehabilitation on dependency and functional performance of patients. Methods: This retrospective chart review was carried out between July and August 2012 at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data were collected using demographic, clinical, and dependency assessment checklists. Results: Patients who underwent major lower limb amputations between January 2007 and April 2012 (n=121) were included in the study. There were 84 (69.4%) male and 37 (30.6%) female patients with a mean ± standard deviation of 63.3±17.4 years old. Diabetes mellitus was the most frequent cause in 63.6% of patients. Only one-third of the amputees (32.2%) have records of completion of their rehabilitation programs, although 20.7% of them completed the <50% of the scheduled rehabilitation sessions, 17.2% attended between 50% and 80%, and the remaining 62.1% attended more than 80% of the scheduled sessions. Muscle power scores in each side of the upper and lower limbs were significantly better following rehabilitation (p<0.0001). Basic functions of mobility and transfer have also significantly improved (p<0.05). Conclusions: Overall dependency and functional performance were significantly better following implementation of the physical rehabilitation programs. A multidisciplinary team approach is mandatory to improve compliance of patients toward the rehabilitation programs. PMID:27652362

  2. Rehabilitation for Translumbar Amputation (review)%经腰椎离断术后的康复

    Institute of Scientific and Technical Information of China (English)

    杨平; 曹学军

    2011-01-01

    经腰椎离断术又名半体切除,是指经某一腰椎将骨盆、盆腔内容物、双下肢及外生殖器全部切除.手术使患者失去了直立能力,通过医生、护士、假肢技师、物理治疗师、心理治疗师、职业康复和社会康复工作者等多学科合作,对患者进行术后综合康复,可以恢复人体外形,重建直立活动能力、生活自理能力、社会交往及职业劳动能力.本文主要从术后综合康复方面进行综述.%Translumbar amputation, also known as hemicorporectomy, is a life-saying procedure for patients with a life-threatening diagnosis but with a normal life expectancy. In the surgical procedure, the pelvis, pelvic contents, lower extremities and external genitalia are removed following transection of the lumbar spine. The operation makes the patient lose the ability of being upright.With the interdisciplinary cooperation of doctors, nurses, prosthetists, psychologists, vocational rehabilitation workers and social rehabilitation workers, the patient can realize most of independent activities of daily living through rehabilitation. The rehabilitation associated with the procedure is reviewed.

  3. Long-term activity in and among persons with transfemoral amputation

    Directory of Open Access Journals (Sweden)

    Elizabeth G. Halsne, CPO

    2013-07-01

    Full Text Available Although physical limitations associated with transfemoral amputation (TFA have been studied in laboratory settings, little is known about habitual activity within free-living environments. A retrospective analysis of 12 mo of step activity data was performed to quantify activity levels, variations, and patterns in 17 adults with unilateral TFA. Yearly, seasonal, and monthly average daily step counts and coefficients of variation (CoVs were examined to characterize mobility. Analysis by Medicare Functional Classification Level (MFCL was performed to explore relationships between clinical classification and performance. Subjects averaged 1,540 prosthetic steps/day, and activity generally increased with MFCL. Activity between MFCL-2 and -3 subjects was not significantly different, suggesting that ability to engage in habitual physical activity may be similar for these groups. Relative variation (CoV was 0.65 across subjects but was lower for those with higher activity levels. No significant differences in CoV by group were detected. Marked seasonal and monthly patterns in activity were identified. Warmer seasons and months generally promoted higher activity, but peak temperatures and humidity depressed activity. Results suggest that persons with TFA are greatly limited in regards to activity. Further, large variations within and between subjects may challenge the interpretation of step activity gathered over short periods of time.

  4. Long-term activity in and among persons with transfemoral amputation.

    Science.gov (United States)

    Halsne, Elizabeth G; Waddingham, Matthew G; Hafner, Brian J

    2013-01-01

    Although physical limitations associated with transfemoral amputation (TFA) have been studied in laboratory settings, little is known about habitual activity within free-living environments. A retrospective analysis of 12 mo of step activity data was performed to quantify activity levels, variations, and patterns in 17 adults with unilateral TFA. Yearly, seasonal, and monthly average daily step counts and coefficients of variation (CoVs) were examined to characterize mobility. Analysis by Medicare Functional Classification Level (MFCL) was performed to explore relationships between clinical classification and performance. Subjects averaged 1,540 prosthetic steps/day, and activity generally increased with MFCL. Activity between MFCL-2 and -3 subjects was not significantly different, suggesting that ability to engage in habitual physical activity may be similar for these groups. Relative variation (CoV) was 0.65 across subjects but was lower for those with higher activity levels. No significant differences in CoV by group were detected. Marked seasonal and monthly patterns in activity were identified. Warmer seasons and months generally promoted higher activity, but peak temperatures and humidity depressed activity. Results suggest that persons with TFA are greatly limited in regards to activity. Further, large variations within and between subjects may challenge the interpretation of step activity gathered over short periods of time.

  5. Functional and structural regeneration in the axolotl heart (Ambystoma mexicanum) after partial ventricular amputation.

    Science.gov (United States)

    Cano-Martínez, Agustina; Vargas-González, Alvaro; Guarner-Lans, Verónica; Prado-Zayago, Esteban; León-Oleda, Martha; Nieto-Lima, Betzabé

    2010-01-01

    "In the present study we evaluated the effect of partial ventricular amputation (PVA) in the heart of the adult urodele amphibian (Ambystoma mexicanum) in vivo on spontaneous heart contractile activity recorded in vitro in association to the structural recovery at one, five, 30 and 90 days after injury. One day after PVA, ventricular-tension (VT) (16 ± 3%), atrium-tension (AT) (46 ± 4%) and heart rate (HR) (58+10%) resulted lower in comparison to control hearts. On days five, 30 and 90 after damage, values achieved a 61 ± 5, 93 ± 3, and 98 ± 5% (VT), 60 ± 4, 96 ± 3 and 99 ± 5% (AT) and 74 ± 5, 84 ± 10 and 95 ± 10% (HR) of the control values, respectively. Associated to contractile activity recovery we corroborated a gradual tissue restoration by cardiomyocyte proliferation. Our results represent the first quantitative evidence about the recovery of heart of A. mexicanum restores its functional capacity concomitantly to the structural recovery of the myocardium by proliferation of cardiomyocytes after PVA. These properties make the heart of A. mexicanum a potential model to study the mechanisms underlying heart regeneration in adult vertebrates in vivo.

  6. Spatiotemporal Parameters of 100-m Sprint in Different Levels of Sprinters with Unilateral Transtibial Amputation

    Science.gov (United States)

    Hobara, Hiroaki; Hashizume, Satoru; Kobayashi, Yoshiyuki; Mochmaru, Masaaki

    2016-01-01

    The aim of this study was to investigate differences of the spatiotemporal parameters in a 100-m sprint among elite, sub-elite, and non-elite sprinters with a unilateral transtibial amputation. Using publicly available Internet broadcasts, we analyzed 125, 19, and 33 records from 30 elite, 12 sub-elite, and 22 non-elite sprinters, respectively. For each sprinter’s run, the average velocity, step frequency, and step length were calculated using the number of steps in conjunction with the official race time. Average velocity was greatest in elite sprinters (8.71±0.32 m/s), followed by the sub-elite (8.09±0.06 m/s) and non-elite groups (7.72±0.27 m/s). Although there was a significant difference in average step frequency between the three groups, the effect size was small and the relative difference among the three groups was 3.1%. Statistical analysis also revealed that the average step length was longest in elite sprinters, followed by the sub-elite and non-elite groups. These results suggest that the differences in sprint performance between the three groups is mainly due to the average step length rather than step frequency. PMID:27701443

  7. Behavioral outcomes following below-knee amputation in the coordination between balance and leg movement.

    Science.gov (United States)

    Mouchnino, L; Mille, M-L; Martin, N; Baroni, G; Cincera, M; Bardot, A; Delarque, A; Massion, J; Pedotti, A

    2006-08-01

    Lateral leg movement is accompanied by opposite movements of the supporting leg and trunk segments. This kinematic synergy shifts the center of mass (CM) towards the supporting foot and stabilizes its final position, while the leg movement is being performed. The aim of the present study was to provide insight in the behavioral substitution process responsible for the performance of this kinematic synergy. The kinematic synergy was assessed by the principal component analysis (PCA) applied to both hip joints and supporting ankle joint. Patients after unilateral below-knee amputation and control subjects were asked to perform a lateral leg raising. The first principal component (PC(1)) accounted for more than 99% of the total angular variance for all subjects (amputees and controls). PC(1) thus well represents the possibility to describe this complex multi-joint movement as a one degree of freedom movement with fixed ratios between joint angular time course. In control subjects, the time covariation between joints changes holds during all phases of the leg movement (postural phase, ascending and braking phases). In amputees, PC(1) score decreased during the ascending phase of the movement (i.e. when the body weight transfer is completed, while the movement is initiated). We conclude that a feedback mechanism is involved and discuss the hypothesis that this inter-joint coordination in amputees results from a failure in the pre-setting of the inter-joint coupling.

  8. Elective amputation and bionic substitution restore functional hand use after critical soft tissue injuries

    Science.gov (United States)

    Aszmann, Oskar C.; Vujaklija, Ivan; Roche, Aidan D.; Salminger, Stefan; Herceg, Malvina; Sturma, Agnes; Hruby, Laura A.; Pittermann, Anna; Hofer, Christian; Amsuess, Sebastian; Farina, Dario

    2016-01-01

    Critical soft tissue injuries may lead to a non-functional and insensate limb. In these cases standard reconstructive techniques will not suffice to provide a useful outcome, and solutions outside the biological arena must be considered and offered to these patients. We propose a concept which, after all reconstructive options have been exhausted, involves an elective amputation along with a bionic substitution, implementing an actuated prosthetic hand via a structured tech-neuro-rehabilitation program. Here, three patients are presented in whom this concept has been successfully applied after mutilating hand injuries. Clinical tests conducted before, during and after the procedure, evaluating both functional and psychometric parameters, document the benefits of this approach. Additionally, in one of the patients, we show the possibility of implementing a highly functional and natural control of an advanced prosthesis providing both proportional and simultaneous movements of the wrist and hand for completing tasks of daily living with substantially less compensatory movements compared to the traditional systems. It is concluded that the proposed procedure is a viable solution for re-gaining highly functional hand use following critical soft tissue injuries when existing surgical measures fail. Our results are clinically applicable and can be extended to institutions with similar resources. PMID:27721419

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

    International Nuclear Information System (INIS)

    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 mmHg, 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. The difference in failure rate is highly significant (P<0.01). Four out of 30 diabetic patients required reamputation as against 10 out of 30 non-diabetics (0.05< P<0.10) The average SPP was higher in the diabetic group: 57 mmHg (range 18-93 mmHg) compared with 34 mmHg (range 8-68 mmHg) in the non-diabetic group (P<0.001). The postoperative SPP measured on the stumps was on average 8 mmHg higher than the preoperative SPP (P<0.001). The increase took place mainly in stumps with an SPP above 20 mmHg explaining why the preoperative SPP values related so 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. (author)

  10. Gait biomechanics of individuals with transtibial amputation: effect of suspension system.

    Directory of Open Access Journals (Sweden)

    Arezoo Eshraghi

    Full Text Available Prosthetic suspension system is an important component of lower limb prostheses. Suspension efficiency can be best evaluated during one of the vital activities of daily living, i.e. walking. A new magnetic prosthetic suspension system has been developed, but its effects on gait biomechanics have not been studied. This study aimed to explore the effect of suspension type on kinetic and kinematic gait parameters during level walking with the new suspension system as well as two other commonly used systems (the Seal-In and pin/lock. Thirteen persons with transtibial amputation participated in this study. A Vicon motion system (six cameras, two force platforms was utilized to obtain gait kinetic and kinematic variables, as well as pistoning within the prosthetic socket. The gait deviation index was also calculated based on the kinematic data. The findings indicated significant difference in the pistoning values among the three suspension systems. The Seal-In system resulted in the least pistoning compared with the other two systems. Several kinetic and kinematic variables were also affected by the suspension type. The ground reaction force data showed that lower load was applied to the limb joints with the magnetic suspension system compared with the pin/lock suspension. The gait deviation index showed significant deviation from the normal with all the systems, but the systems did not differ significantly. Main significant effects of the suspension type were seen in the GRF (vertical and fore-aft, knee and ankle angles. The new magnetic suspension system showed comparable effects in the remaining kinetic and kinematic gait parameters to the other studied systems. This study may have implications on the selection of suspension systems for transtibial prostheses. Trial registration: Iranian Registry of Clinical Trials IRCT2013061813706N1.

  11. Asymmetrical loading demands associated with vertical jump landings in people with unilateral transtibial amputation

    Directory of Open Access Journals (Sweden)

    Marlene Schoeman, PhD

    2014-02-01

    Full Text Available Loading symmetry during vertical jump landings between a person with amputation’s intact and prosthetic limbs was assessed to determine the role of each limb in controlling the downward momentum of the center of mass during landing. Six participants with unilateral transtibial amputation (TTA and ten nondisabled participants completed 10 maximal vertical jumps, of which the highest jump was analyzed. Contralateral symmetry was assessed through the Symmetry Index (SI, while symmetry at the group level was assessed through a Mann-Whitney U test. Participants with TTA performed quasi-unilateral landings onto the intact limbs, resulting from either the incapability of the prosthetic ankle to plantar flex or increased residual-limb knee and hip flexion. In the loading phase, the participants with TTA displayed reduced prosthetic-side peak vertical forces (p = 0.04 along with reduced prosthetic-side ankle range of motion (p < 0.001, extensor moments (p = 0.03, and negative work generated (p = 0.00. Individual asymmetries were evident in the peak vertical force magnitudes (SI = 51%–140%, duration from touchdown to peak vertical force (SI = 52%–157%, ankle joint angles at touchdown (SI = 100%–538%, ranges of motion (SI = 147%–200%, knee (SI = 66%–179% and hip (SI = 87%–132% extensor moments, and work done at the ankle (SI = 155%–199% and hip (SI = 83%–204%. High peak forces (25.25 +/– 4.89 N·kg−1 intact limb and 14.61 +/– 8.28 N·kg−1 prosthetic limb from significantly lower (p < 0.001 landing heights than the nondisabled participants indicate a potential injury risk associated with landing for people with TTA.

  12. Development of Transvaginal Uterus Amputation Device for Laparoscopic Hysterectomies in Gynecologic Surgeries

    Directory of Open Access Journals (Sweden)

    Serkan DİKİCİ

    2015-01-01

    Full Text Available Hysterectomy, that is removal of uterus, is one of the most common major operations in gynecologic surgeries. Laparoscopy technique is preferred in hysterectomy because of its advantages such as lower intra-operative blood loss, decreased surrounding tissue/organ damage, less operating time, lower postoperative infection and frequency of fever, shorter duration of hospitalization and post-operative returning time to normal activity. During total laparoscopic hysterectomy, first uterine vessels and ligaments are cauterized respectively, and then cervicovaginal connections are cauterized and coagulated to remove uterus completely. Uterine manipulators are used during laparoscopy to maximize the endoscopic vision of surgeons by moving related organs. However, conventional uterine manipulators have important drawbacks particularly to move uterus in three dimensions and to show cervicovaginal landmark during laparoscopic circular cauterization and amputation of the uterine cervix. A new transvaginal uterine manipulator may overcome these two important drawbacks of these currently available devices. For this reason, a3D scanned technique was used to get uterus sizes and computer aided design software is used in designing of the new manipulator and then 3D printer was used in prototyping. Special light emitting diodes (LEDs were mounted on the cervical cap of the manipulator to guide light beams from inside of cervicovaginal tissue to abdominal cavity to facilitate the visualization of tissue landmarks. Moreover, performances of different caps and LED systems will be evaluated. Furthermore, after integration of self-cutting and self-suturing mechanisms into our system, final prototype will be produced by using titanium which is biologically and mechanically appropriate. Therefore, aim of this study was to design and produce a new uterine manipulator with three dimensional movements, LED illumination, self-cutting and self-suturing systems to facilitate

  13. Biomechanics of the human walk-to-run gait transition in persons with unilateral transtibial amputation.

    Science.gov (United States)

    Giest, Tracy N; Chang, Young-Hui

    2016-06-14

    Propulsive force production (indicative of intrinsic force-length-velocity characteristics of the plantar flexor muscles) has been shown to be a major determinant of the human walk-to-run transition. The purpose of this work was to determine the gait transition speed of persons with unilateral transtibial amputation donning a passive-elastic prosthesis and assess whether a mechanical limit of their intact side plantar flexor muscles is a major determinant of their walk-to-run transition. We determined each individual׳s gait transition speed (GTS) via an incremental protocol and assessed kinetics and kinematics during walking at speeds 50%, 60%, 70%, 80%, 90%, 100%, 120%, and 130% of that gait transition speed (100%:GTS). Unilateral transtibial amputees transitioned between gaits at significantly slower absolute speeds than matched able-bodied controls (1.73±0.13 and 2.09±0.05m/s respectively, p120%: 0.23±0.05BW, p<0.05). In contrast, amputee subjects' intact side generated significantly higher peak anterior-posterior propulsive forces while walking at speeds above their preferred gait transition speed (100%: 0.28±0.04<110%: 0.30±0.04BW, p<0.05). Changes in propulsive force production were found to be a function of changes in absolute speed, rather than relative to the walk-to-run transition speed. Therefore, the walk-to-run transition in unilateral transtibial amputees is not likely dictated by propulsive force production or the force-length-velocity characteristics of the intact side plantar flexor muscles. PMID:27087677

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

    Directory of Open Access Journals (Sweden)

    Jun Yao

    2015-01-01

    Full Text Available 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 the newly re-innervated muscles. Correspondingly, recent study results have shown that motor representations for the missing limb move closer to their original locations following TR. Besides regaining motor control signals, TR also restores the sensation in the re-innervated skin areas. We therefore hypothesize that TR causes analogous cortical sensory remapping that may return closer to their original locations. In order to test this hypothesis, cortical activity in response to sensory-level electrical stimulation in different parts of the arm was studied longitudinally in one amputated individual before and up to 2 years after TR. Our results showed that 1 before TR, the cortical response to sensory electrical stimulation in the residual limb showed a diffuse bilateral pattern without a clear focus in either the time or spatial domain; and 2 2 years after TR, the sensory map of the reinnervated median nerve reorganized, showing predominant activity over the contralateral S1 hand area as well as moderate activity over the ipsilateral S1. Therefore, this work provides new evidence for long-term sensory cortical plasticity in the human brain after TR.

  15. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb.

    Science.gov (United States)

    Raffin, Estelle; Richard, Nathalie; Giraux, Pascal; Reilly, Karen T

    2016-04-15

    A substantial body of evidence documents massive reorganization of primary sensory and motor cortices following hand amputation, the extent of which is correlated with phantom limb pain. Many therapies for phantom limb pain are based upon the idea that plastic changes after amputation are maladaptive and attempt to normalize representations of cortical areas adjacent to the hand area. Recent data suggest, however, that higher levels of phantom pain are associated with stronger local activity and more structural integrity in the missing hand area rather than with reorganization of neighbouring body parts. While these models appear to be mutually exclusive they could co-exist, and one reason for the apparent discrepancy between them might be that no single study has examined the organisation of lip, elbow, and hand movements in the same participants. In this study we thoroughly examined the 3D anatomy of the central sulcus and BOLD responses during movements of the hand, elbow, and lips using MRI techniques in 11 upper-limb amputees and 17 healthy control subjects. We observed different reorganizational patterns for all three body parts as the former hand area showed few signs of reorganization, but the lip and elbow representations reorganized and shifted towards the hand area. We also found that poorer voluntary control and higher levels of pain in the phantom limb were powerful drivers of the lip and elbow topological changes. In addition to providing further support for the maladaptative plasticity model, we demonstrate for the first time that motor capacities of the phantom limb correlate with post-amputation reorganization, and that this reorganization is not limited to the face and hand representations but also includes the proximal upper-limb.

  16. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb.

    Science.gov (United States)

    Raffin, Estelle; Richard, Nathalie; Giraux, Pascal; Reilly, Karen T

    2016-04-15

    A substantial body of evidence documents massive reorganization of primary sensory and motor cortices following hand amputation, the extent of which is correlated with phantom limb pain. Many therapies for phantom limb pain are based upon the idea that plastic changes after amputation are maladaptive and attempt to normalize representations of cortical areas adjacent to the hand area. Recent data suggest, however, that higher levels of phantom pain are associated with stronger local activity and more structural integrity in the missing hand area rather than with reorganization of neighbouring body parts. While these models appear to be mutually exclusive they could co-exist, and one reason for the apparent discrepancy between them might be that no single study has examined the organisation of lip, elbow, and hand movements in the same participants. In this study we thoroughly examined the 3D anatomy of the central sulcus and BOLD responses during movements of the hand, elbow, and lips using MRI techniques in 11 upper-limb amputees and 17 healthy control subjects. We observed different reorganizational patterns for all three body parts as the former hand area showed few signs of reorganization, but the lip and elbow representations reorganized and shifted towards the hand area. We also found that poorer voluntary control and higher levels of pain in the phantom limb were powerful drivers of the lip and elbow topological changes. In addition to providing further support for the maladaptative plasticity model, we demonstrate for the first time that motor capacities of the phantom limb correlate with post-amputation reorganization, and that this reorganization is not limited to the face and hand representations but also includes the proximal upper-limb. PMID:26854561

  17. Incidental detection of a pseudoaneurysm at an amputation stump in a Tc-99m HMPAO labeled leukocyte scan

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Myung Hee; Jeong, Hwan Jeong; Lim, Seok Tae [Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2007-08-15

    A 20-year-old man underwent a Tc-99m HMPAO labeled leukocyte scan for the evaluation of an infection at the stump of an AK amputation, which was conducted due to an open communicated fracture of the left lower leg. Blood-flow and blood-pool images demonstrated a pseudoaneurysm with a focus of intense activity medial to the stump, and centered within a large photopenic defect by surrounding hematoma. Delayed image obtained at 3 hours post-injection showed persistent intense and slight increased activity. Contrast angiography confirmed the presence of a pseudoaneurysm arising from a branch of the left superficial femoral artery.

  18. Penis auto-amputation and chasm of the lower abdominal wall due to advanced penile carcinoma: a case report

    OpenAIRE

    Baltogiannis Dimitrios; Zotos Konstantinos; Tsambalas Stavros; Giannakis Dimitrios; Sofikitis Nikolaos

    2011-01-01

    Abstract Introduction Penile cancer is uncommon. When penile cancer is left untreated, at an advanced stage it can have tragic consequences for the patient. Case presentation Our case report does not concern a new manifestation of penile cancer, but an interesting presentation with clinical significance that emphasizes the need to diagnose and treat penile cancer early. It is an unusual case of a neglected penile cancer in a 57-year-old Greek man that led to auto-amputation of the penis and a...

  19. Number of test trials needed for performance stability and interrater reliability of the one leg stand test in patients with a major non-traumatic lower limb amputation

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Nielsen, Anni Østergaard; Madsen Topp, Ulla;

    2014-01-01

    Balance is beneficial for daily functioning of patients with a lower limb amputation and sometimes assessed by the one-leg stand test (OLST). The aims of the study were to examine (1) the number of trials needed to achieve performance stability, (2) the interrater reliability of the OLST in patie......Balance is beneficial for daily functioning of patients with a lower limb amputation and sometimes assessed by the one-leg stand test (OLST). The aims of the study were to examine (1) the number of trials needed to achieve performance stability, (2) the interrater reliability of the OLST...... in patients with a major non-traumatic lower limb amputation, and (3) to provide a test procedure....

  20. Risk factors of amputation in patients with diabetic foot ulcer%糖尿病足患者截肢的相关危险因素

    Institute of Scientific and Technical Information of China (English)

    肖婷; 许樟荣

    2010-01-01

    Diabetic foot is one of the serious complications of diabetes mellitus and the main cause of non-traumatic amputation. Neuropathy,ischemia,infection,malnutrition,smoking and other factors are associated with the diabetic amputation. To control these risk factors can reduce the prevalence of diabetic foot ulcers and diabetic amputation.%糖尿病足足糖尿病的严重并发症之一,是非创伤件截肢的主要原因.神经病变、缺血、感染、营养不良、吸烟等多种因素与糖尿病足溃疡截肢有关.控制上述危险因素,可以降低糖尿病足溃疡的发病率和截肢率.

  1. Health-Related Quality of Life Predicts Major Amputation and Death, but Not Healing, in People With Diabetes Presenting With Foot Ulcers

    DEFF Research Database (Denmark)

    Siersma, V.; Thorsen, H.; Holstein, P.E.;

    2014-01-01

    ObjectiveLow health-related quality of life (HRQoL) has been consistently reported to be associated with poor prognosis for a variety of health outcomes in various settings. We aimed to evaluate whether HRQoL in patients presenting with new diabetic foot ulcers has prognostic significance for ulcer...... healing, major amputation and death.Research design and methodsWe followed 1088 patients with new diabetic foot ulcers presenting for treatment at one of the 14 centers in 10 European countries participating in the Eurodiale study, prospectively until healing (76.9%), major amputation (4.6%) or death (6...

  2. A Simple Technique for the Positioning of a Patient with an above Knee Amputation for an Ipsilateral Extracapsular Hip Fracture Fixation

    Directory of Open Access Journals (Sweden)

    N. Davarinos

    2013-01-01

    Full Text Available The positioning of the patient on the fracture table is critical to the successful reduction and operative fixation of hip fractures which are fixed using the dynamic hip screw system (DHS. There is a standard setup which is commonly used with relative ease. Yet the positioning of patients with amputations either above or below knee of the affected side can pose a significant challenge. We describe a novel positioning technique used on a 51-year old patient with a right above knee amputation who sustained an intertrochanteric extracapsular hip fracture.

  3. Effect of amputation level on the stress transferred to the femur by an artificial limb directly attached to the bone.

    Science.gov (United States)

    Newcombe, L; Dewar, M; Blunn, G W; Fromme, P

    2013-12-01

    Attachment of an artificial limb directly to the skeleton has a number of potential benefits and the technique has been implemented for several amputation sites. In this paper the transfer of stress from an external, transfemoral prosthesis to the femur during normal walking activity is investigated. The stress distribution in the femur and at the implant-bone interface is calculated using finite element analysis for the 3D geometry and inhomogeneous, anisotropic material properties obtained from a CT scan of a healthy femur. Attachment of the prosthetic leg at three different levels of amputation is considered. Stress concentrations are found at the distal end of the bone and adjacent to the implant tip and stress shielding is observed adjacent to the implant. It is found that the stress distribution in the femur distal to the epiphysis, where the femur geometry is close to cylindrical, can be predicted from a cylindrical finite element model, using the correct choice of bone diameter as measured from a radiograph. Proximal to the lesser trochanter the stress decreases as the femur geometry diverges significantly from a cylinder. The stress concentration at the distal, resected end of the bone is removed when a collared implant is employed. These findings form the basis for appropriate settings of an external fail-safe device to protect the bone from excessive stress in the event of an undue load. PMID:23953406

  4. Paul Wittgenstein's right arm and his phantom: the saga of a famous concert pianist and his amputation.

    Science.gov (United States)

    Boller, François; Bogousslavsky, Julien

    2015-01-01

    Reports of postamputation pain and problems linked to phantom limbs have increased in recent years, particularly in relation to war-related amputations. These problems are still poorly understood and are considered rather mysterious, and they are difficult to treat. In addition, they may shed light on brain physiology and neuropsychology. Functional neuroimaging techniques now enable us to better understand their pathophysiology and to consider new rehabilitation techniques. Several artists have suffered from postamputation complications and this has influenced not only their personal life but also their artistic work. Paul Wittgenstein (1887-1961), a pianist whose right arm was amputated during the First World War, became a famous left-handed concert performer. His case provides insight into Post-World War I musical and political history. More specifically, the impact on the artistic life of this pianist illustrates various postamputation complications, such as phantom limb, stump pain, and especially moving phantom. The phantom movements of his right hand helped him develop the dexterity of his left hand. Wittgenstein played piano works that were written especially for him (the most famous being Ravel's Concerto for the Left Hand) and composed some of his own. Additionally, several famous composers had previously written for the left hand.

  5. Breathing-controlled electrical stimulation could modify the affective component of neuropathic pain after amputation: a case report

    Directory of Open Access Journals (Sweden)

    Melton DH

    2012-04-01

    Full Text Available Sheng Li1,2, Danielle H Melton1, Jeffrey C Berliner11Department of Physical Medicine and Rehabilitation, University of Texas Medical School – Houston, Houston, TX; 2UTHealth Motor Recovery Laboratory, Institute for Rehabilitation and Research, Memorial Hermann Hospital, Houston, TX, USAAbstract: In this case, a 31-year-old male suffered phantom neuropathic pain for more than 3 years after an above-the-knee amputation. His shooting phantom pain disappeared after the first session of breathing-controlled electrical stimulation, and reappeared or was triggered 28 days after an experimental error during which he received sustained electrical stimulation. In other words, painful shooting stimuli may not have been “cured” but forgotten and retriggered by a fearful event due to the experimental error. Therefore, this accidental finding provides a unique opportunity to understand sensory and affective components of neuropathic pain, and a novel intervention could modify the affective component of it.Keywords: neuropathic pain, amputation, electrical stimulation, voluntary breathing

  6. Maggot therapy in "lower-extremity hospice" wound care: fewer amputations and more antibiotic-free days.

    Science.gov (United States)

    Armstrong, David G; Salas, Precious; Short, Brian; Martin, Billy R; Kimbriel, Heather R; Nixon, Brent P; Boulton, Andrew J M

    2005-01-01

    We sought to assess, in a case-control model, the potential efficacy of maggot debridement therapy in 60 nonambulatory patients (mean +/- SD age, 72.2 +/- 6.8 years) with neuroischemic diabetic foot wounds (University of Texas grade C or D wounds below the malleoli) and peripheral vascular disease. Twenty-seven of these patients (45%) healed during 6 months of review. There was no significant difference in the proportion of patients healing in the maggot debridement therapy versus control group (57% versus 33%). Of patients who healed, time to healing was significantly shorter in the maggot therapy than in the control group (18.5 +/- 4.8 versus 22.4 +/- 4.4 weeks). Approximately one in five patients (22%) underwent a high-level (above-the-foot) amputation. Patients in the control group were three times as likely to undergo amputation (33% versus 10%). Although there was no significant difference in infection prevalence in patients undergoing maggot therapy versus controls (80% versus 60%), there were significantly more antibiotic-free days during follow-up in patients who received maggot therapy (126.8 +/- 30.3 versus 81.9 +/- 42.1 days). Maggot debridement therapy reduces short-term morbidity in nonambulatory patients with diabetic foot wounds.

  7. Effect of amputation level on the stress transferred to the femur by an artificial limb directly attached to the bone.

    Science.gov (United States)

    Newcombe, L; Dewar, M; Blunn, G W; Fromme, P

    2013-12-01

    Attachment of an artificial limb directly to the skeleton has a number of potential benefits and the technique has been implemented for several amputation sites. In this paper the transfer of stress from an external, transfemoral prosthesis to the femur during normal walking activity is investigated. The stress distribution in the femur and at the implant-bone interface is calculated using finite element analysis for the 3D geometry and inhomogeneous, anisotropic material properties obtained from a CT scan of a healthy femur. Attachment of the prosthetic leg at three different levels of amputation is considered. Stress concentrations are found at the distal end of the bone and adjacent to the implant tip and stress shielding is observed adjacent to the implant. It is found that the stress distribution in the femur distal to the epiphysis, where the femur geometry is close to cylindrical, can be predicted from a cylindrical finite element model, using the correct choice of bone diameter as measured from a radiograph. Proximal to the lesser trochanter the stress decreases as the femur geometry diverges significantly from a cylinder. The stress concentration at the distal, resected end of the bone is removed when a collared implant is employed. These findings form the basis for appropriate settings of an external fail-safe device to protect the bone from excessive stress in the event of an undue load.

  8. Physical activity and lower-back pain in persons with traumatic transfemoral amputation: A national cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Hemakumar Devan, MPhty

    2013-01-01

    Full Text Available Lower-back pain (LBP is a common secondary condition following lower-limb amputation. The purpose of this study was to investigate LBP prevalence and the relationship between LBP and physical activity (PA levels in a national sample of persons with traumatic transfemoral amputation (TFA. Questionnaires were mailed to a random sample of people with traumatic TFA (n = 322 from the New Zealand Artificial Limb Board national database. Of the participants who completed the survey (55% response rate, 64.1% reported LBP and 39.1% reported restricted PA due to LBP. There was no relationship between the PA levels of persons with and without LBP (chi-square = 2.11, p > 0.05. There was an equal distribution of persons with LBP in low, medium, and high PA subgroups. However, persons who reported restricted PA due to LBP had lower PA scores than persons with LBP and no restricted PA (chi-square = 11.56, p < 0.05. Based on our results, LBP is prevalent in the traumatic TFA population. PA levels are not influenced by the presence or absence of LBP. However, future studies investigating LBP coping strategies and using objective PA outcome measures might further elucidate the relationship between PA and LBP in this population.

  9. Topographic maps of human motor cortex in normal and pathological conditions: mirror movements, amputations and spinal cord injuries.

    Science.gov (United States)

    Cohen, L G; Bandinelli, S; Topka, H R; Fuhr, P; Roth, B J; Hallett, M

    1991-01-01

    We studied motor evoked potentials to transcranial magnetic stimulation in patients with unilateral upper limb amputations, complete T10-T12 spinal cord transection, and congenital mirror movements and in controls. Different muscles in the trunk and upper and lower extremities were evaluated at rest. In controls, muscles could be activated with stimulation of regions several centimeters wide. These areas overlapped extensively when muscles studied were from the same limb and shifted positions abruptly when muscles were from different limbs. Distal muscles were easier to activate than proximal muscles and normally evidenced exclusively a contralateral representation. Congenital defects in motor control in patients with mirror movements resulted in marked derangement of the map of outputs of distal hand muscles with enlarged and ipsilateral representations. Peripheral lesions, either acquired (amputations) or congenital (congenital absence of a limb), resulted in plastic reorganization of motor outputs targeting muscles immediately proximal to the stump. Central nervous system lesions (i.e., spinal cord injury producing paraplegia) also resulted in enlargement of the map of outputs targeting muscles proximal to the lesion. These results indicate that magnetic stimulation is a useful non-invasive tool for exploring plastic changes in human motor pathways following different types of injury.

  10. 足部恶性软组织肿瘤患者的特殊类型截肢二例报告%Special types of amputation in patients with foot malignant soft tissue tumors:2 cases report

    Institute of Scientific and Technical Information of China (English)

    杨接来; 张智长; 潘垚; 杨庆诚

    2015-01-01

    Objective To report 2 cases of special types of amputation in patients with foot malignant soft tissue tumors.Methods From January 2008 to December 2012, 2 cases of special types of amputation in patients with foot malignant soft tissue tumors were conducted. Case 1 of rhabdomyosarcoma in the right forefoot was performed with Chopart amputation. Case 2 of squamous cell carcinoma of the right plantar was performed with Syme amputation.Results Two surgeries went successfully. Case 1 was followed up for 23 months. Case 2 was followed up for 22 months. No recurrence occurred after the surgery. Patients could walk well by prosthesis, with good recovery of lower limb functions and no significant adverse complications.Conclusions In the premise of extensive tumor resection, Chopart and Syme amputation are good options in the treatment of foot malignant soft tissue tumors, which can preserve the limb length and functions to the greatest degree and further improve the life quality of patients.

  11. Sexual functioning and sexual well-being in people with a limb amputation : a cross-sectional study in the Netherlands

    NARCIS (Netherlands)

    Verschuren, Jesse E A; Geertzen, Jan H.; Enzlin, Paul; Dijkstra, Pieter U; Dekker, Rienk

    2015-01-01

    PURPOSE: This study aimed to: (a) investigate whether, and if so which, sexual problems are present in people with a limb amputation; (b) analyze how they experience their sexuality; and (c) investigate whether sexuality was discussed with them during their rehabilitation process. METHOD: In total,

  12. Sexual functioning and sexual well-being in people with a limb amputation : a cross-sectional study in the Netherlands

    NARCIS (Netherlands)

    Verschuren, Jesse E. A.; Geertzen, Jan H.; Enzlin, Paul; Dijkstra, Pieter U.; Dekker, Rienk

    2016-01-01

    Purpose: This study aimed to: (a) investigate whether, and if so which, sexual problems are present in people with a limb amputation; (b) analyze how they experience their sexuality; and (c) investigate whether sexuality was discussed with them during their rehabilitation process. Method: In total,

  13. How Depressive Levels Are Related to the Adults' Experiences of Lower-Limb Amputation: A Mixed Methods Pilot Study

    Science.gov (United States)

    Senra, Hugo

    2013-01-01

    The current pilot study aims to explore whether different adults' experiences of lower-limb amputation could be associated with different levels of depression. To achieve these study objectives, a convergent parallel mixed methods design was used in a convenience sample of 42 adult amputees (mean age of 61 years; SD = 13.5). All of them had…

  14. Influence of advanced prosthetic knee joints on perceived performance and everyday life activity level of low-functional persons with a transfemoral amputation or knee disarticulation

    NARCIS (Netherlands)

    Theeven, P.J.; Hemmen, B.; Geers, R.P.; Smeets, R.J.P.; Brink, P.R.; Seelen, H.A.

    2012-01-01

    OBJECTIVE: To assess the effects of two types of microprocessor-controlled prosthetic knee joints (MPKs) on perceived performance and everyday life activity level. DESIGN: Randomized cross-over trial. SUBJECTS: Thirty persons with a unilateral above-knee amputation or knee disarticulation classified

  15. The Effectiveness of Inpatient Rehabilitation in the Acute Postoperative Phase of Care After Transtibial or Transfemoral Amputation: Study of an Integrated Health Care Delivery System

    OpenAIRE

    Stineman, Margaret G.; Kwong, Pui L.; Kurichi, Jibby E.; Prvu-Bettger, Janet A.; Vogel, W. Bruce; Maislin, Greg; Bates, Barbara E.; Reker, Dean M.

    2008-01-01

    Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system. Arch Phys Med Rehabil 2008;89:1863-72.

  16. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case–control study

    Directory of Open Access Journals (Sweden)

    Tjokorda Gde Dalem Pemayun

    2015-12-01

    Full Text Available Background: Diabetic foot ulcers (DFU may cause significant morbidity and lower extremity amputation (LEA due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and to quantify the risk factors of subsequent amputation in hospitalized DFU patients. Methods: We performed a hospital-based, case–control study of 47 DFU patients with LEA and 47 control DFU patients without LEA. The control subjects were matched to cases in respect to age (±5 years, sex, and nutritional status, with ratio of 1:1. This study was conducted in Dr. Kariadi General Hospital Semarang between January 2012 and December 2014. Patients’ demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs and 95% confidence intervals (CIs by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21. Results: There were 47 case–control pairs, all of which were diagnosed with type 2 diabetes mellitus. Seven potential independent variables show a promise of influence, the latter being defined as p≤0.15 upon univariate analysis. Multivariable logistic regression identified levels of HbA1c ≥8% (OR 20.47, 95% CI 3.12–134.31; p=0.002, presence of peripheral arterial disease (PAD (OR 12.97, 95% CI 3.44–48.88; p<0.001, hypertriglyceridemia (OR 5.58, 95% CI 1.74–17.91; p=0.004, and hypertension (OR 3.67, 95% CI 1.14–11.79; p=0.028 as the independent risk factors associated with subsequent LEA in DFU. Conclusions: Several risk factors for LEA were identified. We found that HbA1c ≥8%, PAD, hypertriglyceridemia, and hypertension have been recognized as the predictors of LEA in this study

  17. A quantitative evaluation of gross versus histologic neuroma formation in a rabbit forelimb amputation model: potential implications for the operative treatment and study of neuromas

    Directory of Open Access Journals (Sweden)

    Kuiken Todd A

    2011-10-01

    Full Text Available Abstract Background Surgical treatment of neuromas involves excision of neuromas proximally to the level of grossly "normal" fascicles; however, proximal changes at the axonal level may have both functional and therapeutic implications with regard to amputated nerves. In order to better understand the retrograde "zone of injury" that occurs after nerve transection, we investigated the gross and histologic changes in transected nerves using a rabbit forelimb amputation model. Methods Four New Zealand White rabbits underwent a forelimb amputation with transection and preservation of the median, radial, and ulnar nerves. After 8 weeks, serial sections of the amputated nerves were then obtained in a distal-to-proximal direction toward the brachial plexus. Quantitative histomorphometric analysis was performed on all nerve specimens. Results All nerves demonstrated statistically significant increases in nerve cross-sectional area between treatment and control limbs at the distal nerve end, but these differences were not observed 10 mm more proximal to the neuroma bulb. At the axonal level, an increased number of myelinated fibers were seen at the distal end of all amputated nerves. The number of myelinated fibers progressively decreased in proximal sections, normalizing at 15 mm proximally, or the level of the brachial plexus. The cross-sectional area of myelinated fibers was significantly decreased in all sections of the treatment nerves, indicating that atrophic axonal changes proceed proximally at least to the level of the brachial plexus. Conclusions Morphologic changes at the axonal level extend beyond the region of gross neuroma formation in a distal-to-proximal fashion after nerve transection. This discrepancy between gross and histologic neuromas signifies the need for improved standardization among neuroma models, while also providing a fresh perspective on how we should view neuromas during peripheral nerve surgery.

  18. Secondary Knee Osteoarthritis due to Neurofibromatosis Type 1 Treated with above the Knee Amputation: A Case Report

    Directory of Open Access Journals (Sweden)

    Jay Patel

    2013-01-01

    Full Text Available Background. Neurofibromatosis Type 1 (NF-1 has a variety of associated orthopaedic manifestations that have been previously reported. We report a case of severe, grade 4 knee osteoarthritis (OA with recurrent subluxation and joint laxity due to multiple extra-articular neurofibromas ultimately treated with Above the Knee Amputation (AKA. Case Description. A 39-year-old man presented with multiple neurofibromas and lymphedema leading to degenerative changes of the knee. Conservative treatment failed due to the severity of the knee degeneration and patient discomfort. Likewise, arthroplasty was not possible due to poor bone quality and joint instability. Therefore, AKA was selected to relieve symptoms and provide functional improvement. six months after the procedure the patient has increased functional capacity for ambulation and activities of daily living, as well as significant decrease in pain and discomfort. Clinical Relevance. Extra-articular neurofibromas causing severe secondary OA in relatively young patients can be functionally improved with AKA and prosthetic device use.

  19. Penis auto-amputation and chasm of the lower abdominal wall due to advanced penile carcinoma: a case report

    Directory of Open Access Journals (Sweden)

    Baltogiannis Dimitrios

    2011-12-01

    Full Text Available Abstract Introduction Penile cancer is uncommon. When penile cancer is left untreated, at an advanced stage it can have tragic consequences for the patient. Case presentation Our case report does not concern a new manifestation of penile cancer, but an interesting presentation with clinical significance that emphasizes the need to diagnose and treat penile cancer early. It is an unusual case of a neglected penile cancer in a 57-year-old Greek man that led to auto-amputation of the penis and a large chasm in the lower abdominal wall. The clinical staging was T4N3M0 and our patient was treated with a bilateral cutaneous ureterostomy, chemotherapy and radiotherapy. Our patient died 18 months after his first admission in our clinic. Conclusions Emphasis must be placed on early diagnosis and treatment of penile cancer, so further development of the disease can be prevented.

  20. 糖尿病足截肢的相关危险因素分析%Analysis of the Related Risk Factors of Diabetic Foot Amputation

    Institute of Scientific and Technical Information of China (English)

    陈茂胜

    2013-01-01

    [目的]探讨糖尿病足截肢的相关危险因素,以降低糖尿病足的截肢率。[方法]回顾性分析2006年3月至2012年3月在本院接受治疗的121例糖尿病足患者的临床资料,比较截肢(截肢组)与未截肢(未截肢组)患者的临床资料及生化指标。[结果]两组患者年龄、病程、吸烟史、高血压史、空腹血糖(FBG)及糖化血红蛋白(HbAlc)水平方面比较差异有显著性(P <0.05),但在性别、血脂及糖尿病肾病(DN)的发生率比较无显著差异(P >0.05);糖尿病足截肢率与糖尿病足分级程度、下肢动脉病变程度及周围神经损伤程度呈正相关。[结论]患者病程、年龄、吸烟、血压、血糖、下肢血管病变程度、神经病变程度及糖尿病足程度均为糖尿病足截肢的高危因素,临床可根据患者情况,采取积极措施,减少截肢率,提高患者生活质量。%[Objective]To explore the related risk factors of diabetic foot amputation in order to reduce the amputation rate of diabetic foot.[Methods]Clinical data of 121 patients with diabetic foot who were treated in our hospital from March 2006 to March 2012 were analyzed retrospectively.Clinical data and biochemical inde-xes were compared between amputation group and non-amputation group.[Results]There were significant differences in the age,the course of disease,smoking history,hypertension history,fasting blood glucose (FBG)and glycosylated hemoglobin(HbAlc)level between two groups(P 0.05). The amputation rate of diabetic foot amputation rate had positive correlation with the grade of diabetic foot, the degree of lower limb artery lesion and peripheral nerve injury.[Conclusion]The patients'course of dis-ease,age,smoking,blood pressure,blood sugar,the degree of lower extremity vascular lesion,neuropathy and diabetic foot were high-risk factors of diabetic foot amputation.According to patients'condition in clinical practice

  1. Impact of deteriorated calcium-phosphate homeostasis on amputation-free survival after endovascular revascularization in patients with critical limb ischemia on hemodialysis.

    Science.gov (United States)

    Hioki, Hirofumi; Miyashita, Yusuke; Shiraki, Tatsuya; Iida, Osamu; Uematsu, Masaaki; Miura, Takashi; Ebisawa, Souichirou; Ikeda, Uichi

    2016-04-01

    Patients on hemodialysis (HD) have abnormalities of calcium-phosphate (CaP) homeostasis and high CaP product contributes to atherosclerosis pathogenesis and adverse events. Patients on HD with critical limb ischemia (CLI) are at risk for major amputation and death because of advanced systemic atherosclerotic disease. The aim of this study was to evaluate the relationship between CaP product and amputation-free survival (AFS) in CLI after endovascular treatment (EVT). We retrospectively analyzed 221 CLI patients on HD. In Kaplan-Meier analysis, AFS was significantly lower in patients with CaP product ⩾ 55 mg(2)/dL(2) compared to those with CaP product EVT in CLI patients on HD, and can serve for their risk stratification. PMID:26681436

  2. Effect of Roy’s Adaptation Model-Guided Education on Coping Strategies of the Veterans with Lower Extremities Amputation: A Double-Blind Randomized Controlled Clinical Trial

    Science.gov (United States)

    Farsi, Zahra; Azarmi, Somayeh

    2016-01-01

    Background: Any defect in the extremities of the body can affect different life aspects. The purpose of this study was to investigate the effect of Roy’s adaptation model-guided education on coping strategies of the veterans with lower extremities amputation. Methods: In a double-blind randomized controlled clinical trial, 60 veterans with lower extremities amputation referring to Kowsar Orthotics and Prosthetics Center of Veterans Clinic in Tehran, Iran were recruited using convenience method and randomly assigned to intervention and control groups in 2013-2014. Lazarus and Folkman coping strategies questionnaire was used to collect the data. After completing the questionnaires in both groups, maladaptive behaviours were determined in the intervention group and an education program based on Roy’s adaptation model was implemented. After 2 months, both groups completed the questionnaires again. Data were analyzed using SPSS software. Results: Independent T-test showed that the score of the dimensions of coping strategies did not have a statistically significant difference between the intervention and control groups in the pre-intervention stage (P>0.05). This test showed a statistically significant difference between the two groups in the post-intervention stage in terms of the scores of different dimensions of coping strategies (P>0.05), except in dimensions of social support seeking and positive appraisal (P>0.05). Conclusion: The findings of this research indicated that the Roy’s adaptation model-guided education improved the majority of coping strategies in veterans with lower extremities amputation. It is recommended that further interventions based on Roy’s adaptation model should be performed to improve the coping of the veterans with lower extremities amputation. Trial Registration Number: IRCT2014081118763N1 PMID:27218110

  3. Auto-amputation of penis due to carcinoma: Still a threat in the era of modern medicine: Report of two cases

    OpenAIRE

    Bastab Ghosh; Ramanitharan Manikandan; Dorairajan, Lalgudi N.; Santosh Kumar

    2013-01-01

    Incidence of penile carcinoma is decreasing worldwide. Nevertheless, the incidence of penile cancer is still significant in various tropical countries, and it often presents in advanced stage. We report two unique cases of penile auto-amputation due to advanced cancer and review relevant literature. Both the patients presented with ulcerative lesion replacing penile base following automatic sloughing of the whole penis and voiding dysfunction. In addition, the first patient had metastatic ing...

  4. 高压氧在断指再植术后的临床应用%Clinical Application of Hyperbaric Oxygen Therapy after Replantation of Amputated Finger

    Institute of Scientific and Technical Information of China (English)

    韩扬; 谢荭

    2011-01-01

    Postoperative management of replantation of amputated finger is of vital importance. Active and reasonable hyperbaric oxygen therapy can promote microcirculation rebuild and functional recovery after operation, shorten the rehabilitation time, further reduce the risk of amputated finger deactivation by increasing the oxygen pressure, oxygen concentration in amputated finger and operative region rapidly, improve hypoxia state of tissue effectively, reduce capillary permeability and lessen swelling. Hyperbaric oxygen therapy can be applied as one of the routine therapeutic measures after replantation operation of amputated finger,especially in multi-finger replantation and multi-segment one-finger replantation,where hyperbaric oxygen therapy should be used more actively.%断指再植的术后处理至关重要.积极、合理的高压氧治疗能通过迅速提高断指及手术区域的氧分压、氧含量,有效改善组织缺氧状态和降低毛细血管通透性从而减轻伤指肿胀等机制,促进断指术后的微循环重建和功能恢复,缩短康复时程,进一步降低断指失活风险.高压氧治疗应作为断指再植手术后的常规治疗措施之一.尤其是多指离断再植及一指多段离断再植高压氧治疗应更加积极地予以应用.

  5. Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy.

    Science.gov (United States)

    Dellon, A Lee; Muse, Vickie L; Nickerson, D Scott; Akre, Thomas; Anderson, Sharon R; Barrett, Steve L; Biddinger, Kent R; Bregman, Peter J; Bullard, Bryan P; Dauphinee, Damien M; DeJesus, James M; DeJesus, Ramon A; Ducic, Ivica; Dunkerly, Jeffery; Galina, Michael R; Hung, Virginia; Ichtertz, Dolf R; Kutka, Michael F; Jacoby, Richard P; Johnson, J Barry; Mader, David W; Maloney, Christopher T; Mancuso, Peter J; Martin, R Craig; Martin, Rick F; McDowel, Brian A; Rizzo, Vito J; Rose, Michael; Rosson, Gedge D; Shafiroff, Bruce B; Steck, Jerome K; Stolarski, Raymond G; Swier, Patrick; Wellens-Bruschayt, Tatiana A; Wilke, Bronwyn; Williams, Eric H; Wood, Michael A; Wood, William A; Younes, Michael P; Yuksel, Fuat

    2012-05-01

    This is the first multicenter prospective study of outcomes of tibial neurolysis in diabetics with neuropathy and chronic compression of the tibial nerve in the tarsal tunnels. A total of 38 surgeons enrolled 628 patients using the same technique for diagnosis of compression, neurolysis of four medial ankle tunnels, and objective outcomes: ulceration, amputation, and hospitalization for foot infection. Contralateral limb tibial neurolysis occurred in 211 patients for a total of 839 operated limbs. Kaplan-Meier proportional hazards were used for analysis. New ulcerations occurred in 2 (0.2%) of 782 patients with no previous ulceration history, recurrent ulcerations in 2 (3.8%) of 57 patients with a previous ulcer history, and amputations in 1 (0.2%) of 839 at risk limbs. Admission to the hospital for foot infections was 0.6%. In patients with diabetic neuropathy and chronic tibial nerve compression, neurolysis can result in prevention of ulceration and amputation, and decrease in hospitalization for foot infection. PMID:22411624

  6. Oxygen supplementation facilitating successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease following trans-tibial amputation: a case report

    Directory of Open Access Journals (Sweden)

    Sharma Sat

    2010-12-01

    Full Text Available Abstract Introduction Dysvascular amputations are increasingly performed in patients with underlying cardiac and pulmonary disorders. A limb prosthesis is rarely offered to patients with severe chronic obstructive pulmonary disease because of their inability to achieve the high energy expenditure required for prosthetic ambulation. We describe a case of successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease with the aid of oxygen supplementation. Case presentation A 67-year-old aboriginal woman with severe chronic obstructive pulmonary disease and hypercapnic respiratory failure underwent right trans-tibial (below the knee amputation for severe foot gangrene. An aggressive rehabilitation program of conditioning exercises and gait training utilizing oxygen therapy was initiated. She was custom-fitted with a right trans-tibial prosthesis. A rehabilitation program improved her strength, endurance and stump contracture, and she was able to walk for short distances with the prosthesis. The motion analysis studies showed a cadence of 73.5 steps per minute, a velocity of 0.29 meters per second and no difference in right and left step time and step length. Conclusion This case report illustrates that patients with significant severe chronic obstructive pulmonary disease can be successfully fitted with limb prostheses and undergo rehabilitation using supplemental oxygen along with optimization of their underlying comorbidities. Despite the paucity of published information in this area, prosthesis fitting and rehabilitation should be considered in patients who have undergone amputation and have severe chronic obstructive disease.

  7. Is the desire for amputation related to disturbed emotion processing? A multiple case study analysis in BIID.

    Science.gov (United States)

    Bottini, Gabriella; Brugger, Peter; Sedda, Anna

    2015-01-01

    Body integrity identity disorder (BIID) is characterized by the overwhelming desire to amputate one or more healthy limbs or to be paraplegic. Recently, a neurological explanation of this condition has been proposed, in part on the basis of findings that the insular cortex might present structural anomalies in these individuals. While these studies focused on body representation, much less is known about emotional processing. Importantly, emotional impairments have been found in psychiatric disorders, and a psychiatric etiology is still a valid alternative to purely neurological accounts of BIID. In this study, we explored, by means of a computerized experiment, facial emotion recognition and emotional responses to disgusting images in seven individuals with BIID, taking into account their clinical features and investigating in detail disgust processing, strongly linked to insular functioning. We demonstrate that BIID is not characterized by a general emotional impairment; rather, there is a selectively reduced disgust response to violations of the body envelope. Taken together, our results support the need to explore this condition under an interdisciplinary perspective, taking into account also emotional connotations and the social modulation of body representation. PMID:24679146

  8. Factors Affecting Length of Hospital Stay and Mortality in Infected Diabetic Foot Ulcers Undergoing Surgical Drainage without Major Amputation.

    Science.gov (United States)

    Kim, Tae Gyun; Moon, Sang Young; Park, Moon Seok; Kwon, Soon-Sun; Jung, Ki Jin; Lee, Taeseung; Kim, Baek Kyu; Yoon, Chan; Lee, Kyoung Min

    2016-01-01

    This study aimed to investigate factors affecting length of hospital stay and mortality of a specific group of patients with infected diabetic foot ulcer who underwent surgical drainage without major amputation, which is frequently encountered by orthopedic surgeons. Data on length of hospital stay, mortality, demographics, and other medical information were collected for 79 consecutive patients (60 men, 19 women; mean age, 66.1 [SD, 12.3] yr) with infected diabetic foot ulcer who underwent surgical drainage while retaining the heel between October 2003 and May 2013. Multiple linear regression analysis was performed to determine factors affecting length of hospital stay, while multiple Cox regression analysis was conducted to assess factors contributing to mortality. Erythrocyte sedimentation rate (ESR, P=0.034), glycated hemoglobin (HbA1c) level (P=0.021), body mass index (BMI, P=0.001), and major vascular disease (cerebrovascular accident or coronary artery disease, P=0.004) were significant factors affecting length of hospital stay, whereas age (P=0.005) and serum blood urea nitrogen (BUN) level (P=0.024) were significant factors contributing to mortality. In conclusion, as prognostic factors, the length of hospital stay was affected by the severity of inflammation, the recent control of blood glucose level, BMI, and major vascular disease, whereas patient mortality was affected by age and renal function in patients with infected diabetic foot ulcer undergoing surgical drainage and antibiotic treatment.

  9. The Effect of Prosthetic Ankle Units on Roll-Over Shape Characteristics During Walking in Persons with Bilateral Transtibial Amputations

    Science.gov (United States)

    Gard, Steven A.; Su, Po-Fu; Lipschutz, Robert D.; Hansen, Andrew H.

    2015-01-01

    Some important functions of walking are adversely affected or eliminated in prosthesis users due to reduced or absent ankle motion. The purpose of this retrospective data analysis was to determine the effect of prosthetic ankle units on the characteristics of the ankle-foot roll-over shape in persons with bilateral transtibial amputations. Seventeen subjects were fitted with Endolite Multiflex Ankles to provide ankle plantar/dorsiflexion during the stance phase of gait. Two quantitative gait analyses were performed as subjects walked with (1) Seattle Lightfoot II feet (baseline condition) and (2) with the prosthetic ankle units added. Roll-over shape radii and effective foot length ratio were calculated and compared for the two prosthetic configurations. When subjects walked with the ankle units, ankle motion increased (p<0.001), peak ankle plantarflexion moment during stance decreased slightly, and ankle-foot roll-over shape radii were significantly less (p<0.001) compared to the baseline condition. The effective foot length ratio of the roll-over shape was found to increase with walking speed (p<0.001), but it was not significantly affected by the prosthetic ankle units (p=0.066). Prosthetists and manufacturers are encouraged to consider the effect of combining prosthetic components on the overall characteristics of the prosthesis and the functions they impart to the user. PMID:22234709

  10. Prosthetic interventions for people with transtibial amputation: Systematic review and metaanalysis of high-quality prospective literature and systematic reviews

    Directory of Open Access Journals (Sweden)

    M. Jason Highsmith, PhD, DPT, CP, FAAOP

    2016-03-01

    Full Text Available Considering transtibial amputation (TTA rehabilitation costs and complexity, high-quality literature should inform clinical practice. Systematic reviews (SRs suggest this is not the case. This article's purpose was to review the highest-quality evidence available to guide clinical practice for TTA regarding five prosthetic intervention areas. Six databases were searched for high-quality SRs and prospective clinical trials (randomized clinical trials [RCTs]. Reviewers screened, sorted, rated (i.e., methodologic quality, bias risk, and extracted article data. Meta-analyses were conducted when possible. Thirty-one references were included (25 RCTs and 6 SRs. Five topical areas emerged (alignment, feet and ankles, interface, postoperative care, pylons. Twenty-three evidence statements were supported by level 2 evidence and eight by level 1 evidence. All RCTs reported randomization and reasonable data presentation. Concealed allocation and blinding were not widely used. Mean attrition was 11%. SRs included no meta-analyses. Functional level was poorly reported. Grouping feet and ankle components by functional classification enabled meta-analyses, though variance was considerable given the small sample sizes. Prosthetic interventions are generally safe for TTAs. High-quality literature enabled formulation of evidence statements to support select clinical practice areas, though quantity was lacking. Thus, numerous topics related to TTA care lack rigorous evidence. Although blinding in prosthetic research requires increased funding and effort, it could greatly improve the methodologic quality of prosthetic research.

  11. Parametric analysis using the finite element method to investigate prosthetic interface stresses for persons with trans-tibial amputation.

    Science.gov (United States)

    Silver-Thorn, M B; Childress, D S

    1996-07-01

    A finite element (FE) model of the below-knee residual limb and prosthetic socket was created to investigate the effects of parameter variations on the interface stress distribution during static stance. This model was based upon geometric approximations of anthropometric residual limb geometry. The model was not specific to an individual with amputation, but could be scaled to approximate the limb of a particular subject. Parametric analyses were conducted to investigate the effects of prosthetic socket design and residual limb geometry on the residual limb/prosthetic socket interface stresses. Behavioral trends were illustrated via sensitivity analysis. The results of the parametric analyses indicate that the residual limb/prosthetic socket interface stresses are affected by variations in both prosthetic design and residual limb geometry. Specifically, the analyses indicate: 1) the residual limb/prosthetic liner interface pressures are relatively insensitive to the socket stiffness; 2) the stiffness of the prosthetic liner influences the interface stress distribution for both the unrectified and patellar-tendon-bearing (PTB) rectified models-the external load state appears to influence the interface pressure distribution, while the prosthetic socket rectification appears to influence the interface shear stress distribution; 3) the interface pressures are very sensitive to the prosthetic rectification; 4) the shape and relative bulk of soft tissue may significantly influence the interface pressure distribution; 5) the interface pressure distribution is also influenced by the residual limb length; and 6) the stiffness/compliance of the residual limb soft tissues may significantly alter the interface pressure distribution.

  12. Blunt abdominal trauma with handlebar injury: A rare cause of traumatic amputation of the appendix associated with acute appendicitis

    Directory of Open Access Journals (Sweden)

    Amanda Jensen

    2016-04-01

    Full Text Available We describe traumatic appendicitis in a 7-year-old boy who presented after sustaining blunt abdominal trauma to his right lower abdomen secondary to bicycle handlebar injury. With diffuse abdominal pain following injury, he was admitted for observation. Computed axial tomography (CT obtained at an outside hospital demonstrated moderate stranding of the abdomen in the right lower quadrant. The CT was non-contrasted and therefore significant appendiceal distention could not be confirmed. However, there was a calcified structure in the right pelvis with trace amount of free fluid. Patient was observed with conservative management and over the course of 15 h his abdominal pain continued to intensify. With his worsening symptoms, we elected to take him for diagnostic laparoscopy. In the operating room we found an inflamed traumatically amputated appendix with the mesoappendix intact. We therefore proceeded with laparoscopic appendectomy. Pathology demonstrated acute appendicitis with fecalith. It was unclear as to whether the patient's appendicitis and perforation were secondary to fecalith obstruction, his blunt abdominal trauma or if they concurrently caused his appendicitis. Acute appendicitis is a common acute surgical condition in the pediatric population and continues to be a rare and unique cause of operative intervention in the trauma population.

  13. Muscle activity during stance phase of walking: Comparison of males with transfemoral amputation with osseointegrated fixations to nondisabled male volunteers

    Directory of Open Access Journals (Sweden)

    Annette Pantall, DO(UK, PhD

    2013-07-01

    Full Text Available A recent development in prosthetics is the osseointegrated fixation (OF, with improvements in comfort, fatigue, hip movement, and ease of prosthetic attachment reported. However, little information is available regarding muscle function. This study reports on selected gait parameters of the residual limb during the stance phase of level overground walking, focusing on muscle activity. Five males with transfemoral amputation (TFA with OFs were recruited. Ground reaction force (GRF, lower-limb kinematics, and surface electromyography (sEMG from residual-limb muscles were recorded. sEMG data were also collected from a group of 10 nondisabled male subjects. Interstance variability of gait parameters was assessed by coefficient of multiple correlations. Repeatability of GRF and hip kinematics was high, whereas repeatability of the sEMG was low for four of the five individuals with TFA. Interstance variability of the sEMG for gluteus medius (GMED was significantly greater in the group with TFA. The main difference in sEMG between the groups was the phase, with GMED and adductor magnus displaying greater differences than their counterparts in the nondisabled group. Results demonstrate that muscles in the residual limb retain aspects of their previous functional pattern.

  14. Longitudinal gait analysis of a person with a transfemoral amputation using three different prosthetic knee/foot pairs.

    Science.gov (United States)

    Barr, J Bradley; Wutzke, Clinton J; Threlkeld, A Joseph

    2012-07-01

    Using gait analysis, we documented kinetic and temporospatial changes over a 7-year period in a single healthy individual with a transfemoral amputation walking with three different knees and matched foot components. The knee/foot pairs in chronological order were Four Bar Endolite knee/Endolite Dynamic Response foot; Ossur Total Knee 2000/Pathfinder I foot; and C-Leg knee/IC40 C-walk foot. The design of the suspension and socket were unchanged across the three prostheses. We found an increase in the braking component of A-P ground reaction force on the intact limb while using the C-Leg compared to the other two prosthetic fabrications. There was progressive change across the three component combinations, which included increased step length, increased walking velocity, and decreased double limb support time. The subject ranked the C-Leg system as the most stable. The final gait pattern with the C-Leg was faster, less cautious, and more stable than with the other prosthetic components.

  15. Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: reliability of kinetic data.

    Science.gov (United States)

    Vertriest, Sofie; Coorevits, Pascal; Hagberg, Kerstin; Brånemark, Rickard; Häggström, Eva; Vanderstraeten, Guy; Frossard, Laurent

    2015-05-01

    This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an osseointegrated implant to stimulate the bone remodeling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalization. Eleven unilateral TFAs fitted with an OPRA implant performed five trials in four loading conditions. The forces and moments on the three axes of the implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values ( %SEMs ). The ICCs of all variables were above 0.9 and the %SEM values ranged between 0 and 87%. This study showed a high between-participants' variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.

  16. Muscle activity during stance phase of walking: comparison of males with transfemoral amputation with osseointegrated fixations to nondisabled male volunteers.

    Science.gov (United States)

    Pantall, Annette; Ewins, David

    2013-01-01

    A recent development in prosthetics is the osseointegrated fixation (OF), with improvements in comfort, fatigue, hip movement, and ease of prosthetic attachment reported. However, little information is available regarding muscle function. This study reports on selected gait parameters of the residual limb during the stance phase of level overground walking, focusing on muscle activity. Five males with transfemoral amputation (TFA) with OFs were recruited. Ground reaction force (GRF), lower-limb kinematics, and surface electromyography (sEMG) from residual-limb muscles were recorded. sEMG data were also collected from a group of 10 nondisabled male subjects. Interstance variability of gait parameters was assessed by coefficient of multiple correlations. Repeatability of GRF and hip kinematics was high, whereas repeatability of the sEMG was low for four of the five individuals with TFA. Interstance variability of the sEMG for gluteus medius (GMED) was significantly greater in the group with TFA. The main difference in sEMG between the groups was the phase, with GMED and adductor magnus displaying greater differences than their counterparts in the nondisabled group. Results demonstrate that muscles in the residual limb retain aspects of their previous functional pattern.

  17. Comparative study of different treatment options of grade III and IV diabetic foot ulcers to reduce the incidence of amputations

    Directory of Open Access Journals (Sweden)

    Poras Chaudhary

    2013-02-01

    Full Text Available This study aims to compare the efficacy of antiseptic dressings, hyperbaric oxygen therapy, and recombinant human platelet derived growth factor (rhPDGF for two reasons: i to reduce the incidence of lower limb amputations in diabetic foot ulcer; ii to limit the duration of stay in the hospital. A prospective randomized trial was conducted on 60 patients with stage III and IV diabetic foot ulcers (International Association of Enterostomal Therapy classification and patients were divided randomly in three different therapy groups - antiseptics, hyperbaric oxygen therapy, recombinant platelet derived growth factor, with 20 patients in each group. Patients were managed initially on inpatient and then on outpatient basis till the ulcer healed completely. Results among three groups were compared using unpaired T test and the level of significance was set at P<0.05 using ANOVA. This study compares the efficacy of hyperbaric oxygen therapy, antiseptic dressings, and rhPDGF in grade III and IV diabetic foot ulcers. P value (0.0348 was significant for complete wound contraction while p value healing time (0.6534 and ulcer size (0.0593 in the groups was not significant. PDGF is safe, effective and easy to apply. Results are comparable with hyperbaric oxygen (HBO therapy and cost of treatment is lower than other therapies. Diabetic foot ulcer management requires multidisciplinary and aggressive approach. PDGF should be recommended for all grade III and IV diabetic foot ulcer at least 8 weeks old. HBO is equally good an option but has limitations and side effects.

  18. Can external lateral stabilization reduce the energy cost of walking in persons with a lower limb amputation?

    Science.gov (United States)

    IJmker, T; Noten, S; Lamoth, C J; Beek, P J; van der Woude, L H V; Houdijk, H

    2014-09-01

    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 decrease in energy cost, with concomitant decreases in mean and variability of step width. Using a similar set-up, we expected larger decreases for LLA than able-bodied controls. Fifteen transtibial amputees (TT), 12 transfemoral amputees (TF), and 15 able-bodied controls (CO) walked with and without external lateral stabilization provided via spring like cords attached to the waist. Effects of this manipulation on energy cost, step parameters, and pelvic motion were evaluated between groups. TT (-5%) and CO (-3%) showed on average a small reduction in energy cost when walking with stabilization, whereas TF exhibited an increase in energy cost (+6.5%) The difference in the effect of stabilization was only significant between TT and TF. Step width, step width variability, and medio-lateral pelvic displacement decreased significantly with stabilization in all groups, especially in TT. Contrary to expectations, external lateral stabilization did not result in a larger decrease in the energy cost of walking for LLA compared to able-bodied controls, suggesting that balance control is not a major factor in the increased cost of walking in LLA. Alternatively, the increased energy cost with stabilization for TF suggests that restraining (medio-lateral) pelvic motion impeded necessary movement adaptations in LLA, and thus negated the postulated beneficial effects of stabilization on the energy cost of walking. PMID:25108643

  19. Comparison of walking overground and in a Computer Assisted Rehabilitation Environment (CAREN in individuals with and without transtibial amputation

    Directory of Open Access Journals (Sweden)

    Gates Deanna H

    2012-11-01

    Full Text Available Abstract Background Due to increased interest in treadmill gait training, recent research has focused on the similarities and differences between treadmill and overground walking. Most of these studies have tested healthy, young subjects rather than impaired populations that might benefit from such training. These studies also do not include optic flow, which may change how the individuals integrate sensory information when walking on a treadmill. This study compared overground walking to treadmill walking in a computer assisted virtual reality environment (CAREN in individuals with and without transtibial amputations (TTA. Methods Seven individuals with traumatic TTA and 27 unimpaired controls participated. Subjects walked overground and on a treadmill in a CAREN at a normalized speed. The CAREN applied optic flow at the same speed that the subject walked. Temporal-spatial parameters, full body kinematics, and kinematic variability were collected during all trials. Results Both subject groups decreased step time and control subjects decreased step length when walking in the CAREN. Differences in lower extremity kinematics were small (○ and did not exceed the minimal detectable change values for these measures. Control subjects exhibited decreased transverse and frontal plane range of motion of the pelvis and trunk when walking in the CAREN, while patients with TTA did not. Both groups exhibited increased step width variability during treadmill walking in the CAREN, but only minor changes in kinematic variability. Conclusions The results of this study suggest that treadmill training in a virtual environment should be similar enough to overground that changes should carry over. Caution should be made when comparing step width variability and step time results from studies utilizing a treadmill to those overground.

  20. V.A. Cooperative Study on antiplatelet agents in diabetic patients after amputation for gangrene: III. Definitions and review of design and baseline characteristics.

    Science.gov (United States)

    Colwell, J A; Bingham, S F; Abraira, C; Anderson, J W; Kwaan, H C

    1985-01-01

    This report summarizes the major design features, methods, and baseline characteristics of patients enrolled in a Veterans Administration Cooperative Study. In eleven V.A. centers, 231 male diabetic patients who had either a recent amputation for gangrene (N = 207) or active gangrene (N = 24) were randomly assigned to a group which received aspirin (325 mg t.i.d.) plus dipyridamole (75 mg t.i.d.) (N = 110) or two placeboes t.i.d. (N = 121). Major end point were vascular death and amputation of the opposite extremity for gangrene. Forty-one percent of the 563 patients screened were enrolled during a 39 month period. Enrollment errors were found in 8.7%. Historically, the two groups were well matched regarding the following variables: age, duration of diabetes, insulin therapy, previous oral agent therapy, hypertension, myocardial infarction, congestive heart failure, renal disease, sensory neuropathy, and smoking. The drug therapy group had an increased frequency of a history of cerebrovascular disease (19% vs 7%, p = 0.01). The groups were well matched regarding amputation site, obesity, extent of lower extremity vascular disease, retinopathy, and neuropathy upon examination. Their baseline fasting values of glucose, cholesterol, triglycerides, and creatinine were also comparable. We conclude that this study should provide definitive data on the efficacy of these antiplatelet agents in preventing further vascular disease in this patient group. It should also provide new prospective data on the natural history of vascular disease, and the association of vascular risk factors with subsequent vascular events in this patient population.

  1. Determinants of Quality of Life in the Caregivers of Iranian War Survivors with Bilateral Lower-Limb Amputation after More than Two Decades

    OpenAIRE

    Zohreh Ganjparvar; Batool Mousavi; Mehdi Masumi; Mohammadreza Soroush; Ali Montazeri

    2016-01-01

    Background: Providing care to a disable relative at home exposes the caregiver to a potentially higher risk of physical and mental problems. We measured health-related quality of life (HRQOL) and its determinants among the caregivers of the Iranian survivors of the Iran-Iraq war (1980–1988) with bilateral lower-limb amputation. Methods: Data were collected from 464 individuals comprising war-related bilateral lower-limb amputees (n=232) and their caregivers (n=232) in January 2015 in Shira...

  2. Timing of access to secondary healthcare services for diabetes management and lower extremity amputation in people with diabetes: a protocol of a case-control study.

    LENUS (Irish Health Repository)

    Buckley, Claire M

    2013-09-03

    Lower extremity amputation (LEA) is a complication of diabetes and a marker of the quality of diabetes care. Clinical and sociodemographic determinants of LEA in people with diabetes are well known. However, the role of service-related factors has been less well explored. Early referral to secondary healthcare is assumed to prevent the occurrence of LEA. The objective of this study is to investigate a possible association between the timing of patient access to secondary healthcare services for diabetes management, as a key marker of service-related factors, and LEA in patients with diabetes.

  3. Amputation versus functional reconstruction in the management of complex hind foot injuries caused by land-mine explosions: a long-term retrospective comparison.

    Science.gov (United States)

    Demiralp, Bahtiyar; Ege, Tolga; Kose, Ozkan; Yurttas, Yuksel; Basbozkurt, Mustafa

    2014-05-01

    The purpose of this study is to compare the long-term clinical outcomes of patients who were treated with either hind foot reconstruction or amputation in complex hind foot injuries accompanied with bone and soft tissue loss due to land-mine explosions. Between 1994 and 2004, all patients with hind foot complex injuries due to land-mine explosion, who were operated in our clinic, were enrolled to the study. All patients were evaluated with Short-Form 36 (SF-36), Foot and Ankle Disability Index (FADI) and Body Image Quality of Life Inventory (BIQLI) after a mean of 15.1 ± 2.2 (range 9-19) years of follow-up. Demographic characteristics, number of operations, necessity of psychiatric treatment and all complications were compared between groups. There were a total of 42 patients [21 in reconstruction group (Gr I) and 21 in amputation group (Gr II)]. The mean age at the time of final follow-up was 38.4 ± 3.04 years in Gr I and 38.2 ± 4.24 years in Gr II (p = 0.732). The mean follow-up duration was 15.7 ± 2.07 years in Gr I and 14.57 ± 2.29 years in Gr II (p = 0.081). The number of operations was significantly higher in Gr I (8.66 ± 10.2 times vs. 4.42 ± 7.7 times, respectively, p = 0.001). The mean FADI score at the final follow-up was 64.3 ± 18.1 in Gr I. In amputation group, more patients needed psychotherapy due to major depression (12 patients vs. 4 patients, p = 0.012). Major complications in Gr I were musculocutaneous flap atrophy in calcaneal region (n = 8 patients), limited ankle motion (n = 11) and painful osteophytes on plantar region (n = 6). In Gr II, stump problems were dominating (pain and tenderness n = 10, ulcer n = 2, allergic skin lesions n = 7, painful neuroma n = 10, bony spur n = 5, paresthesia n = 1, excessive sweating n = 12). At the final visit, although SF-36 scores were similar between groups (p = 0.182), extremity reconstruction group had significantly higher BIQLI scores than the amputation group (p = 0.016). If the dorsalis pedis is

  4. Physical performance and self-report outcomes associated with use of passive, adaptive, and active prosthetic knees in persons with unilateral, transfemoral amputation: Randomized crossover trial

    Directory of Open Access Journals (Sweden)

    Brian J. Hafner, PhD

    2015-09-01

    Full Text Available Prosthetic knees are a vital component in an artificial limb. Contemporary knees include passive (mechanical, adaptive (computerized, or active (motorized control systems and have the potential to mitigate amputation-related functional impairments and activity limitations. A 14 mo randomized crossover trial was conducted. Participants (n = 12, mean age = 58 yr were tested under three conditions: passive control (existing knee, adaptive control (Ossur Rheo Knee II, and active control (Ossur Power Knee II. Training and acclimation time were provided to participants in the adaptive and active knees. Outcome measures included indoor tests (Timed Up and Go test [TUG], stairs, and ramp, outdoor tests (walking course and perceived exertion, step activity monitor, self-report surveys (mobility, balance confidence, physical function, fatigue, and general health, and fall incidence. Mixed-effects linear regression modeling was used to evaluate data. Compared with passive control, adaptive control significantly improved comfortable TUG time (difference = 0.91 s, p = 0.001 and reported physical function (difference = 1.26 [T-score], p = 0.03. Active control significantly increased comfortable TUG, fast TUG, and ramp times (difference = 3.02, 2.66, and 0.96 s, respectively, all p < 0.03 and increased balance confidence (difference = 3.77, p = 0.003 compared with passive control. Findings suggest that adaptive knee control may enhance function compared with passive control but that active control can restrict mobility in middle-age or older users with transfemoral amputation.

  5. Temporal adaptations in generic and population-specific quality of life and falls efficacy in men with recent lower-limb amputations

    Directory of Open Access Journals (Sweden)

    Cleveland T. Barnett, PhD

    2013-05-01

    Full Text Available This study examined the longitudinal changes in generic health-related quality of life (QOL, prosthesis-related QOL, falls efficacy, and walking speed in men with lower-limb amputations up to 6 months following discharge from rehabilitation. Seven male unilateral transtibial amputees completed the Medical Outcomes Study 36-Item Short Form Health Survey, the Prosthesis Evaluation Questionnaire, and the Modified Falls Efficacy Scale at 1, 3, and 6 months postdischarge from rehabilitation. Walking speed was also recorded to objectively assess participants’ mobility. Health-related QOL measures displayed increases, resulting in large effect sizes though not reaching statistical significance. Prosthesis-related QOL measures indicated that scales relating to the participants’ prostheses improved and the support of significant others was the most positively scored variable. Walking speed increased by 0.12 m/s, although it was not significantly related to indices of QOL or falls efficacy. Falls efficacy did not improve significantly during the study period, although it was strongly related to QOL (p < 0.05. These results provide a novel insight into how QOL and falls efficacy develop in people with lower-limb amputations, alongside changes in mobility, after discharge from rehabilitation. Further improvements in physical health following discharge may be required to elicit subsequent increases in overall QOL and concurrent improvements in falls efficacy.

  6. 电击伤截肢患者临床护理体会%Nursing care of patients with amputation caused by electrical injury

    Institute of Scientific and Technical Information of China (English)

    黄爱好; 林宝玉; 罗显利

    2011-01-01

    Objective To explore the nursing care for patients with amputation caused by electrical injury. Methods The data on 12 amputee patients were retrospectively reviewed. Holistic nursing was performed on all the patients. Effective care measures were made and incidence of complications was prevented promptly. Results 11 patients were cured, and one patient developed arterial bleeding but received timely management. Conclusions Effective holistic nursing, close observation of changes in disease severity, and prevention and timely treatment of complications are the key to the accleration of rehabilitation of patients with amputation caused by electrical injury.%目的 探讨对电击伤截肢患者的护理.方法 本组通过对12例患者进行回顾性回忆,采用护理程序的方式对患者整体的护理,及时采取有效的护理措施和预防并发症的发生.结果 11例患者治愈出院,有1例患者出现动脉出血达到及时处理.结论 实施有效的整体护理以及严密观察病情变化,预防并及时处理并发症,全面、有效的护理是促进电击伤患者康复的关键.

  7. 心理护理对截肢患者的影响%Influence of Psychological Nursing on Patients Undergoing Amputation

    Institute of Scientific and Technical Information of China (English)

    吕明英; 赵小林

    2015-01-01

    Objective To investigate the ef ects of psychological care on the prognosis of patients with amputation. Methods In recent years,our hospital admit ed 13 cases of psychological care of patients with dif erent causes of amputation experience.Results Early psychological nursing intervention,has important significance for the rehabilitation of amputees. Conclusion Patients with bet er psychological care can accept the status quo, with positive at itude towards life, restore social functions.%目的:探讨心理护理对截肢患者预后的影响。方法总结我院近年来收治的13例不同原因截肢的患者心理护理经验。结果早期进行心理护理干预,对截肢患者的康复具有重要意义。结论心理护理能使患者更好的接受现状,以积极向上的态度对待生活,恢复社会功能。

  8. Comparison between microprocessor-controlled ankle/foot and conventional prosthetic feet during stair negotiation in people with unilateral transtibial amputation

    Directory of Open Access Journals (Sweden)

    Adam A. Finnieston, CPO, LPO

    2013-10-01

    Full Text Available Contrary to stance-phase dorsiflexion of conventional prosthetic feet, the microprocessor-controlled Proprio foot permits swing-phase dorsiflexion on stairs. The purpose of this study was to compare Symmetry in External Work (SEW between a microprocessor-controlled foot and conventional prosthetic feet in two groups with unilateral transtibial amputation (Medicare Functional Classification Levels K-Level-2 and K-Level-3 during stair ascent and descent. Ten subjects were evaluated while wearing three conventional prosthetic feet—solid ankle cushion heel (SACH, stationary attachment flexible endoskeleton (SAFE, and Talux-and the Proprio foot using a study socket and were given a 10- to 14-day accommodation period with each foot. Ground reaction forces were collected using F-scan sensors during stair ascent and descent. The SEW between the intact and amputated limbs was calculated for each foot. During stair ascent, the Proprio foot resulted in a higher interlimb symmetry than conventional prosthetic feet, with significant differences between the Proprio and SACH/SAFE feet. The swing-phase dorsiflexion appeared to promote greater interlimb symmetry because it facilitated forward motion of the body, resulting in a heel-to-toe center of pressure trajectory. During stair descent, all feet had low symmetry without significant differences between feet. The movement strategy used when descending stairs, which is to roll over the edge of a step, had a greater influence on symmetry than the dorsiflexion features of prosthetic fee

  9. Comparison between microprocessor-controlled ankle/foot and conventional prosthetic feet during stair negotiation in people with unilateral transtibial amputation.

    Science.gov (United States)

    Agrawal, Vibhor; Gailey, Robert S; Gaunaurd, Ignacio A; O'Toole, Christopher; Finnieston, Adam A

    2013-01-01

    Contrary to stance-phase dorsiflexion of conventional prosthetic feet, the microprocessor-controlled Proprio foot permits swing-phase dorsiflexion on stairs. The purpose of this study was to compare Symmetry in External Work (SEW) between a microprocessor-controlled foot and conventional prosthetic feet in two groups with unilateral transtibial amputation (Medicare Functional Classification Levels K-Level-2 and K-Level-3) during stair ascent and descent. Ten subjects were evaluated while wearing three conventional prosthetic feet- solid ankle cushion heel (SACH), stationary attachment flexible endoskeleton (SAFE), and Talux-and the Proprio foot using a study socket and were given a 10- to 14-day accommodation period with each foot. Ground reaction forces were collected using F-scan sensors during stair ascent and descent. The SEW between the intact and amputated limbs was calculated for each foot. During stair ascent, the Proprio foot resulted in a higher interlimb symmetry than conventional prosthetic feet, with significant differences between the Pro prio and SACH/SAFE feet. The swing-phase dorsiflexion appeared to promote greater interlimb symmetry because it facilitated forward motion of the body, resulting in a heel-to-toe center of pressure trajectory. During stair descent, all feet had low symmetry without significant differences between feet. The movement strategy used when descending stairs, which is to roll over the edge of a step, had a greater influence on symmetry than the dorsiflexion features of prosthetic feet.

  10. Clinical study on Tangshukang liquid on diabetic foot amputation rate%唐舒康液对糖尿病足截肢率的影响

    Institute of Scientific and Technical Information of China (English)

    吕志强

    2010-01-01

    Objective To investigate the effects of Tangshukang liquid on the rate of diabetic foot amputation.Methods 80 patients with diabetic foot were divided into two groups (40 ones in each group) by single-blind method. On the basis of conventional treatment of controlling blood glucose, preventing infection, improving microcirculation and carrying out partial debridement for both groups, the treatment group was applied Tangshukang liquid (homemade) externally, and the control group was applied gauze of mixture liquid (gentamiycin+654-2+insulin) externally. Both groups were treated with 4 therapeutic courses (30 days equal one therapeutic course). Therapeutic effects were observed after the treatment. Results Amputation rate of diabetic foot was significantly reduced in the treatment group, especially the patients with wet gangrene.Conclusion Tangshukang Liquid can significantly reduce the amputation rate of diabetic foot and has good effect on diabetic foot with wet gangrene.%目的 观察唐舒康液对糖尿病足截肢率的影响.方法 将80例糖尿病足患者采用单盲法按随机数字表法随机分为两组各40例,在控制血糖、抗感染、改善微循环、局部清创处理的基础上,治疗组外敷中药(浸泡纱条)唐舒康液(自制),对照组外用混合液纱布(庆大霉素+654-2+胰岛素),两组患者均于每日早、晚各换药1次,治疗30 d为1个疗程,4个疗程后观察疗效.结果 治疗组总有效率为95.0%,对照组为80.0%,两组总有效率比较,差异有统计学意义(U=2.362,P<0.05).结论 唐舒康液可降低糖尿病足的截肢率,对湿性坏疽效果更佳.

  11. Auto-amputation of penis due to carcinoma: Still a threat in the era of modern medicine: Report of two cases

    Directory of Open Access Journals (Sweden)

    Bastab Ghosh

    2013-01-01

    Full Text Available Incidence of penile carcinoma is decreasing worldwide. Nevertheless, the incidence of penile cancer is still significant in various tropical countries, and it often presents in advanced stage. We report two unique cases of penile auto-amputation due to advanced cancer and review relevant literature. Both the patients presented with ulcerative lesion replacing penile base following automatic sloughing of the whole penis and voiding dysfunction. In addition, the first patient had metastatic inguinal lymph nodes. Supra-pubic urinary diversion was the initial management in both the patients. The first patient was treated with combined chemo-radiation, but he succumbed to death following two cycles of chemotherapy. The second patient was successfully treated with total penectomy and perineal urethrostomy. He recovered well but was lost to follow-up.

  12. Restoring motor control and sensory feedback in people with upper extremity amputations using arrays of 96 microelectrodes implanted in the median and ulnar nerves

    Science.gov (United States)

    Davis, T. S.; Wark, H. A. C.; Hutchinson, D. T.; Warren, D. J.; O'Neill, K.; Scheinblum, T.; Clark, G. A.; Normann, R. A.; Greger, B.

    2016-06-01

    Objective. An important goal of neuroprosthetic research is to establish bidirectional communication between the user and new prosthetic limbs that are capable of controlling >20 different movements. One strategy for achieving this goal is to interface the prosthetic limb directly with efferent and afferent fibres in the peripheral nervous system using an array of intrafascicular microelectrodes. This approach would provide access to a large number of independent neural pathways for controlling high degree-of-freedom prosthetic limbs, as well as evoking multiple-complex sensory percepts. Approach. Utah Slanted Electrode Arrays (USEAs, 96 recording/stimulating electrodes) were implanted for 30 days into the median (Subject 1-M, 31 years post-amputation) or ulnar (Subject 2-U, 1.5 years post-amputation) nerves of two amputees. Neural activity was recorded during intended movements of the subject’s phantom fingers and a linear Kalman filter was used to decode the neural data. Microelectrode stimulation of varying amplitudes and frequencies was delivered via single or multiple electrodes to investigate the number, size and quality of sensory percepts that could be evoked. Device performance over time was assessed by measuring: electrode impedances, signal-to-noise ratios (SNRs), stimulation thresholds, number and stability of evoked percepts. Main results. The subjects were able to proportionally, control individual fingers of a virtual robotic hand, with 13 different movements decoded offline (r = 0.48) and two movements decoded online. Electrical stimulation across one USEA evoked >80 sensory percepts. Varying the stimulation parameters modulated percept quality. Devices remained intrafascicularly implanted for the duration of the study with no significant changes in the SNRs or percept thresholds. Significance. This study demonstrated that an array of 96 microelectrodes can be implanted into the human peripheral nervous system for up to 1 month durations. Such an

  13. The Risk Factors Related to Lower Extremity Amputations in Patients Suffered from Severe Diabetic Foot Infections%糖尿病足感染截肢(趾)相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    刘倩; 王鹏华; 张达; 杨蔚; 孙茜; 褚月颉; 李代清

    2013-01-01

    Objective To analyze risk factors of lower extremity amputations in patients with severe infective diabetic foot ulcers. Methods The total of 1 076 patients with diabetic foot ulcers was included in this study. All patients with severe diabetic foot infections were selected (PEDIS grade 3-4) by PEDIS infection classification,and divided into three groups including non-amputation group (group A,n=48),healing after minor amputations (group B,n =162) and administered amputations above ankle-level (group C,n=70). The biochemical indicators and SAD score were measured and compared in groups of patients. The multiple Logistic regression analysis was used to observe the factors affect small amputation (toe) and amputation. Results The multivariate analysis showed that platelet count,serum uric acid and the degree of peripheral vascular diseases (SAD score) were independent predictors of minor amputations in the patients with severe infections. Besides the above factors,the plasma fibrinogen and the depth of ulcer (scored by SAD) were the factors related to the risk of major amputation. Conclusion It was found that the platelet count,serum uric acid,plasma fibrinogen,the Charlson score,the degree of peripheral vascular diseases and the depth of ulcer can predict the amputation-risk in diabetic foot patients with severe infections.%目的 研究除感染因素外影响感染程度的糖尿病足溃疡患者行大(小)截肢(趾)的因素.方法 选取PEDIS感染分级3~4级的糖尿病足病已愈合的患者1 076例,分未手术愈合组(A组,48例)、小截肢(趾)愈合组(B组,162例)、大截肢愈合组(C组,70例).测量并比较各组患者生化指标和SAD评分,采用多因素Logistic回归分析影响小截肢(趾)和大截肢的因素.结果 患者的血小板水平、血尿酸水平与SAD评分中的动脉病变是其行小截肢(趾)手术的影响因素.而患者的血小板水平、血尿酸水平、血浆纤维蛋白原水平、Charlson评分和患

  14. Epistemologia sobre amputações e desbridamentos de membros inferiores realizados no Hospital Universitário de Maringá Epistemology of lower limb amputations and debridements at Hospital Universitário de Maringá

    Directory of Open Access Journals (Sweden)

    Amélia Cristina Seidel

    2008-12-01

    Full Text Available CONTEXTO: Não há estatísticas precisas sobre o número de amputações realizadas anualmente, mas é conhecido o comprometimento da qualidade de vida desses indivíduos e a necessidade de uma equipe multiprofissional para sua reabilitação. OBJETIVO: Analisar todas as amputações de membros inferiores realizadas pelo Serviço de Angiologia e Cirurgia Vascular do Hospital Universitário Regional de Maringá entre 2000 e 2006. MÉTODOS: Estudo descritivo e retrospectivo a partir dos prontuários de pacientes submetidos a amputação ou desbridamento cirúrgico de membros inferiores por trauma ou doença vascular. RESULTADOS: Ocorreram 116 procedimentos, sendo 84,5% amputações e 15% desbridamentos cirúrgicos, em 111 pacientes, sendo 78 homens e 33 mulheres, cuja média das idades foi de 63,4 anos (4 a 100 anos, sendo os principais fatores etiológicos: doenças vasculares (92,8% e trauma (7,2%. As comorbidades e fatores de risco mais prevalentes foram: hipertensão arterial sistêmica (66%, diabetes melito (60%, tabaco (28% e arritmia cardíaca (0,9%. Quanto à escolaridade, se observou que 52,2% dos pacientes cursaram apenas o ensino fundamental, 6,5% fizeram o ensino médio, completo ou incompleto, e 41,3% eram analfabetos. A percentagem de pacientes submetidos à amputação primária foi de 94,9%, e secundárias, 5,1%. No entanto, houve diminuição progressiva do coeficiente desses procedimentos a cada ano. CONCLUSÕES: Este trabalho permite inferir que a incidência de amputação de membros inferiores foi maior no sexo masculino e teve como principal causa a doença aterosclerótica, mas apresentou uma redução progressiva.BACKGROUND: There are no precise data on the number of amputations performed every year. However, the decrease in quality of life of patients submitted to amputation is well-known, as is the need to involve a multidisciplinary team in the rehabilitation of these individuals. OBJECTIVE: To analyze all lower limb

  15. 下肢创伤性截肢后残端问题的影响因素及其手术治疗%Surgical strategies for stump problems following trauma-related amputation of lower extremity

    Institute of Scientific and Technical Information of China (English)

    刘克敏; 王安庆; 唐涛; 赵利; 崔寿昌

    2010-01-01

    目的 探讨下肢创伤性截肢后残端问题的影响因素及其手术治疗.方法 1992年11月至2008年8月共收治72例(80侧)下肢踝关节以上创伤性截肢后因残端问题而进行手术治疗的患者,其中男47例,女25例;年龄9~60岁,平均(28.8±12.4)岁.小腿截肢48侧,大腿截肢32侧.从受伤截肢到因残端问题接受手术治疗的时间平均为32.7个月.对患者残端问题进行评价,将性别、单双侧截肢、截肢部位(大腿与小腿)、致伤原因作为因素,截肢到首次残端修整术时间、软组织多余臃肿、皮肤明显瘢痕、皮肤溃疡、神经瘤、骨刺作为水平,统计分析每一因素与各水平间的关系.通过ADL评分评价手术后的效果.结果 14侧行胫腓骨融合术,12侧残端修整术≥2次,双侧截肢者13例21侧(8例双侧残端同时修整),再截肢5侧.80侧残端问题中有53侧(66.3%)原始截肢时未行残端肌肉固定成形术,瘢痕多者42侧(52.5%),神经瘤38侧(47.5%),软组织过多臃肿皱褶24侧(30.0%),皮肤溃疡14侧(17.5%).原始截肢到首次残端修整术的时间小腿截肢比大腿截肢长,差异存统计学意义(P=0.030);大腿截肢软组织臃肿多于小腿截肢,差异有统计学意义(P=0.007);单侧截肢患者骨刺发生率高于舣侧截肢患者,差异有统计学意义(P=0.018).41例患者入院时ADL评分平均为(85.31±7.24)分,出院时为(95.40±3.92)分,差异有统计学意义(t=-11.536,P=0.000).结论 单双侧截肢、截肢部位是影响下肢创伤性截肢后残端问题的重要因素.选择适当的患者进行残端修整术及胫腓骨融合术可获得良好疗效.%Objective To investigate the surgical management strategies for stump problems fol-lowing trauma-related amputation of lower limb. Methods From November 1992 to August 2008, 72 consecutive patients, who had been troubled by stump problems after above-the-ankle amputation due to trauma, underwent revision surgery of the stump. They were

  16. Clinical analysis of diabetic foot and the epidemiology of diabetic foot amputation%糖尿病足流行病学及糖尿病足截肢的临床分析

    Institute of Scientific and Technical Information of China (English)

    彭小兵

    2015-01-01

    Objective Discussion for diabetic foot (DF) patients were analyzed epidemiological situation and amputation.Methods Our hospital in October 2012 -2014 October diabetes, diabetic foot and DF patients require amputation. The clinical data of all patients were analyzed retrospectively. Statistics clinical diabetic foot amputation rate, and analyze the reasons for amputees after the completion, resulting in clinical death.Results Clinical manifestations of diabetic foot in a higher amputation rate.For patients with diabetic foot amputation, after the completion of their cases with surgical wound healing in patients with amputation, as well as whether the patient showed a partial case of infection in the presence of a close relationship. Patients with diabetic foot main cause of death for patients appeared in the case of multiple organ failure. The deadline for the 10 patients, 1 patient clinical death, the remaining patients in the healing section showed significant differences in the extent (P<0.05).Conclusion For patients with diabetic foot disease, more common in the elderly population. For amputees, after its complete amputation surgery ensure good blood supply, which can effectively ensure the effective healing of surgical incisions. For diabetic foot amputation patients before surgery, after surgery, the patient needs to make the necessary comprehensive treatment, the patient's body organ function effectively guarantee all normal, you can effectively deal with stress situations for surgery, reduce postoperative mortality.%目的:探讨针对糖尿病足(DF)患者,对其流行病学以及截肢的情况进行分析。方法选取该院2012年10月—2014年10月糖尿病患者、糖尿病足患者以及需要截肢的DF患者。对所有患者的临床资料进行回顾性分析。统计糖尿病足患者临床截肢率,并分析患者完成截肢后,导致患者临床死亡的原因。结果糖尿病足患者于临床表现出较高的截肢率。针对糖尿

  17. 糖尿病足流行病学及糖尿病足截肢的临床分析%Clinical analysis of diabetic foot and the epidemiology of diabetic foot amputation

    Institute of Scientific and Technical Information of China (English)

    彭小兵

    2015-01-01

    Objective Discussion for diabetic foot (DF) patients were analyzed epidemiological situation and amputation.Methods Our hospital in October 2012 -2014 October diabetes, diabetic foot and DF patients require amputation. The clinical data of all patients were analyzed retrospectively. Statistics clinical diabetic foot amputation rate, and analyze the reasons for amputees after the completion, resulting in clinical death.Results Clinical manifestations of diabetic foot in a higher amputation rate.For patients with diabetic foot amputation, after the completion of their cases with surgical wound healing in patients with amputation, as well as whether the patient showed a partial case of infection in the presence of a close relationship. Patients with diabetic foot main cause of death for patients appeared in the case of multiple organ failure. The deadline for the 10 patients, 1 patient clinical death, the remaining patients in the healing section showed significant differences in the extent (P<0.05).Conclusion For patients with diabetic foot disease, more common in the elderly population. For amputees, after its complete amputation surgery ensure good blood supply, which can effectively ensure the effective healing of surgical incisions. For diabetic foot amputation patients before surgery, after surgery, the patient needs to make the necessary comprehensive treatment, the patient's body organ function effectively guarantee all normal, you can effectively deal with stress situations for surgery, reduce postoperative mortality.%目的:探讨针对糖尿病足(DF)患者,对其流行病学以及截肢的情况进行分析。方法选取该院2012年10月—2014年10月糖尿病患者、糖尿病足患者以及需要截肢的DF患者。对所有患者的临床资料进行回顾性分析。统计糖尿病足患者临床截肢率,并分析患者完成截肢后,导致患者临床死亡的原因。结果糖尿病足患者于临床表现出较高的截肢率。针对糖尿

  18. Effects of early psychological intervention on Patients with traumatic amputation%创伤截肢患者早期心理干预的效果

    Institute of Scientific and Technical Information of China (English)

    闵恒; 宁资社; 朱丹

    2012-01-01

    Objective To explore effect of early psychological intervention on Patients with traumatic amputation . Methods 76 cases of research object according to the sequence of admission were incorporated into the intervention group and control group, patients in the intervention group in patients on admission, as before the amputation, after the implementation of psychological intervention and daily 30min. In patients at admission, at discharge, and 3 months after discharge to assess its mental state. Results when admission with anxiety depression and the detection rate were 94.3% and 85.6%; After the intervention, the intervention group on discharge from the hospital patients, three months after anxiety, depression levels than that of the control group patients decreased obviously, the difference was statistically significant (P < 0.05). Conclusion early psychological intervention can significantly reduce the trauma of early amputees depression and anxiety level, and improve the overall mental state.%目的:探讨对创伤截肢患者早期心理干预的措施.方法:将76例研究对象按照入院先后顺序分别纳入到对照组和干预组,干预组患者在患者入院时、截肢前、后实施心理干预每日30min.于患者入院时、出院时、出院后3个月评定其心理状态.结果:患者入院时焦虑、抑郁检出率分别为94.3%和85.6%;经干预后,干预组患者出院时、出院后3个月焦虑、抑郁水平均较对照组患者明显下降,差异有统计学意义(P<0.05).结论:早期心理干预可显著降低创伤截肢患者早期的焦虑、抑郁水平,改善其总体心理状况.

  19. Surgical amputation of a digit and vacuum-assisted-closure (V.A.C.) management in a case of osteomyelitis and wound care in an eastern black rhinoceros (Diceros bicornis michaeli).

    Science.gov (United States)

    Harrison, Tara M; Stanley, Bryden J; Sikarskie, James G; Bohart, George; Ames, N Kent; Tomlian, Janice; Marquardt, Mark; Marcum, Annabel; Kiupel, Matti; Sledge, Dodd; Agnew, Dalen

    2011-06-01

    A 14-yr-old female eastern black rhinoceros (Diceros bicornis michaeli) presented with progressive suppurative osteomyelitis in her left hind lateral toe. beta-Hemolytic Streptococcus sp. was isolated. The animal was treated with multiple systemic antibiotics, and topical wound cleansing. Repeated debridements and nail trimmings were performed for 5 mo prior to electing amputation. The toe was surgically amputated under general anesthesia between the first and second phalanges. Analgesia was diffused into the wound topically via a catheter and elastomeric pump. The open amputation site was covered with adherent drapes and a negative-pressure wound therapy device provided vacuum-assisted closure (V.A.C.) for 72 hr. Three months later this animal developed a deep dermal ulcer on the lateral aspect of the right hind limb, at the level of the stifle. Methicillin-resistant Staphylococcus aureus was isolated. The wound was managed by initial daily lavage, followed by 1 mo of V.A.C. therapy, with 72 hr between dressing changes. Clinically, this therapy expedited the formation of healthy granulation tissue and overall healing was accelerated. The animal tolerated the machine and bandage changes well via operant conditioning. The use of negative-pressure wound therapy appeared to shorten time to resolution of slow-healing wounds in black rhinoceros. PMID:22946413

  20. A modified replantation for thumb rotating avulsion amputation%拇指旋转撕脱离断的再植术式改进

    Institute of Scientific and Technical Information of China (English)

    李瑞华; 阚世廉; 高燕新; 王晓刚; 殷中罡

    2012-01-01

    Objective To introduce a modified replantation for thumb rotating avulsion amputation,and to evaluate its short term clinical outcome.Methods From January 2007 to July 2009,7 patients with thumb rotating avulsion amputation underwent replantation,including 6 males and 1 female,aged from 21 to 47 years (average,28.3 years).The amputation level of each thumb was metacarpophalangeal joint.During operation,fusion of metacarpophalangeal joint was performed according to injury degree of soft tissue; interphalangeal joint of the thumb was fixed in 15 degrees of flexion by sewing flexor pollicis longus muscle tendon and extensor pollicis longus muscle tendon to tendon sheath or soft tissue; the superficial vein harvested from ipsilateral forearm was used to bridge the dorsal carpal branch of radial artery and the ulnar palmacollateral artery of the thumb; direct anastomoses of dorsal veins were performed in 6 cases and venous transplantation in 1 case; and bilateral nerves were transferred to the back of the first metacarpal and anastomosed to the superficial branch of the radial nerve.Results All 7 replanted thumbs survived completely.Arterial crisis occurred in 1 case after operation,which was cured after operative and medication treatment.The follow-up period ranged from 3 to 24 months.The appearance and opposition function of replanted thumbs were satisfactory and the sensation of fingertip recovered to S4 in 4 cases and to S3 in 3 cases.The two point discrimination ranged from 8 to 12 mm.Conclusion Because bridging the dorsal carpal branch of radial artery and the ulnar palmar collateral artery of the thumb with a superficial vein harvested from ipsilateral forearm to reconstruct blood supply of the thumb is available and easy to be performed,this modified replantation is an ideal way to repair thumb rotating avulsion amputation.%目的 对拇指旋转撕脱离断再植术进行改良,并评估其近期临床疗效.方法 2007年1月至2009年7月,对

  1. "Doomed to go in company with miserable pain": surgical recognition and treatment of amputation-related pain on the Western Front during World War 1.

    Science.gov (United States)

    Edwards, Dafydd S; Mayhew, Emily R; Rice, Andrew S C

    2014-11-01

    The principal feature of injuries from World War 1 was musculoskeletal trauma and injury to peripheral nerves as a result of damage to the upper and lower limbs caused by gunshot wounds and fragments of artillery munitions. Amputation was used as a treatment in field hospitals to save lives; limb conservation was a secondary consideration. A century later, the principal feature of injuries to soldiers in today's wars in Iraq and Afghanistan is also musculoskeletal trauma and injury to the peripheral nerves caused by improvised explosive devices. Common to both types of injury is postamputation pain. We searched The Lancet's archives in this Series paper to show the efforts of surgeons in World War 1 to understand and treat postamputation pain in its own right both during and immediately after the war. Despite unprecedented patient numbers and levels of civilian medical expertise, little progress was made in providing relief from this type of pain, a grave concern to the surgeons treating these soldiers. Today postamputation pain is understood beyond a surgical context but remains a complex and poorly understood condition with few effective treatments.

  2. Compensatory-step training of healthy, mobile people with unilateral, transfemoral or knee disarticulation amputations: A potential intervention for trip-related falls.

    Science.gov (United States)

    Crenshaw, Jeremy R; Kaufman, Kenton R; Grabiner, Mark D

    2013-07-01

    The purpose of this study was to evaluate the effects of compensatory-step training of healthy, mobile, young-to-middle aged people with unilateral, transfemoral or knee disarticulation amputations. Outcomes of interest included recovery success, reliance on the prosthesis, and the kinematic variables relevant to trip recovery. Over the course of six training sessions, five subjects responded to postural disturbances that necessitated forward compensatory steps to avoid falling. Subjects improved their ability to recover from these postural disturbances without falling or hopping on the non-prosthetic limb. Subjects improved their compensatory stepping response by decreasing trunk flexion and increasing the sagittal plane distance between the body center of mass and the stepping foot. In response to more challenging disturbances, these training-related improvements were not observed for the initial step with the non-prosthetic limb. Regardless of the stepping limb, step length and the change in pelvic height were not responsive to training. This study exhibits the potential benefits of a compensatory-step training program for amputees and informs future improvements to the protocol.

  3. Magnetic resonance imaging and magnetic resonance angiography in severe crush syndrome with consideration of fasciotomy or amputation: a novel diagnostic tool

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ling; FANG Zhi-jia; LIU Fang; FU Ping; TAO Ye; LI Zheng-yan; SONG Bin

    2011-01-01

    Three cases of severe crush syndrome after the Wenchuan earthquake in China are presented. The patients, 2 males and one female ranging in age from 18-45 years were studied via 1.5 T magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). MRI examinations were performed more than twice on two patients within 60 days of the earthquake. All the patients had acute renal failure (ARF) with plasma myoglobin concentrations above 17 000 μg/L The T2-weighted and short time inversion recovery (STIR) sequences revealed high intensity lesions in the affected muscles, and enhanced T1 -weighted images showed enhancement of partial affected muscles. MRA revealed no signs of arterial occlusion, arteriostenosis, or filling defects of main arteries. All patients were managed medically with continuous venous-venous hemofiltration and other supportive care, and none required fasciotomy or amputation. Repeat MR studies showed that the high intensity lesions seen on the T2-weighted and STIR sequences resolved in parallel with improvement of laboratory studies and clinical course.

  4. Perioperative nursing of imb salvage of patients with near limb amputation%濒临截肢损毁伤保肢围术期护理

    Institute of Scientific and Technical Information of China (English)

    孙琳琳; 于吉文

    2015-01-01

    目的:探究濒临截肢损毁伤保肢手术患者术前、术后护理方法。方法选取近几年于本院就诊的保肢手术患者,对其采取心理护理、疼痛护理等各项护理措施,并观察最终护理效果。结果对濒临截肢损毁伤保肢手术患者采取护理措施后,患者的心理状态明显改善,术后恢复较快,未出现任何护理事故。结论濒临截肢损毁伤保肢手术患者不仅应重视身体方面的护理,也应注重精神上的护理,同时注重提升护理技巧、总结护理经验。%Objective To explore nursing methods before and after operation in limb sal-vage patients who were closed to amputation.Methods The patients with limb salvage operation in our hospital in recent years were chosen.And nursing measures such as psychological nursing and pain nursing were taken and nursing results were observed.Results After nursing,the mental sta-tus of patients had improved.Besides,the patients had a good recovery and no nursing accident oc-curred.Conclusion The patients with limb salvage should focus on both body nursing and the mental nursing.It is very important for the nurses to improve nursing skills and summarize nursing experience.

  5. The Effects of 12 Sessions of Mirror Therapy on Postural Control Kinetic Variables of Amputation below the Knee in Terms of the Manipulation of Afferent Information

    Directory of Open Access Journals (Sweden)

    B Batol.mohamadtaghi@yahoo.com

    2016-05-01

    Full Text Available Abstract Background & aim: Mirror therapy is a relatively new intervention which focuses on moving the defective part in front of the mirror. The intervention is proposed to be an important implement to improve stability during rehabilitation program of the amputee. The present study aimed to evaluate the effects of 12 sessions of mirror therapy on postural control kinetic variables of amputees when manipulating sensory information. Methods: In the present quasi-experimental study with pretest-posttest and random group design, 14 below knee amputees (n =7 control and n =7 experimental were enrolled. The experimental group engaged in 12 session of exercise therapy in front of mirror, but the control group just did their daily routine activities without any intervention. To asses postural control, Computerized Dynamic Posturography was used which shows the balance score according to two variables of stability and displacement of the center of gravity while manipulating sensory organization in 6 conditions (absence or presence of vision, presence or manipulation of vestibular and kinesthetic information. For data analysis, multiple analysis of variance (MANOVA with repeated measures and Bonferroni post-hoc test were used. Results: The results indicated that postural control improved in the experimental group compared to the control group in all six sensory manipulation conditions. The balance improvement in the mirror therapy group in the first condition (existence of three senses of vision, vestibular and kinesthetic and second condition (elimination of sight and presence of vestibular and kinesthetic information was higher than other circumstances. Balance scores were worse in condition 6 (manipulation of vestibular and kinesthetic in the control group compared to other sensory conditions. Conclusion: Findings of the research revealed that 12 sessions of mirror therapy can improve balance in people with below knee amputations. Moreover

  6. Rehabilitation of spinal cord injury complicated with amputation%脊髓损伤合并截肢患者的康复效果分析

    Institute of Scientific and Technical Information of China (English)

    王方永; 关骅; 洪毅; 张军卫; 白金柱; 唐和虎; 姜树东; 李想; 吕振; 陈世铮

    2012-01-01

    Objectives: To study the effect of rehabilitation for patients of spinal cord injury with amputation. Methods: Six cases of spinal cord injury with amputation were selected from the patients admitted in China Rehabilitation Research Center from 1991 to 2011. 5 cases had the ASIA grade in A, 1 case in C. 3 cases were right lower limb amputees, 1 case was left lower limb amputee, 1 case was right upper limb amptutee, 1 case was right lower and upper limb amputee. Rehabilitation assessment was performed before treatment plan laid down. After overall condition and range of motion(ROM) improved, SCI cases with lower limb amputees were prescribed to wear prosthetics and orthotics to stand and walk. Cases with upper limb amputees were prescribed to wear functional prosthesis. American Spinal Injury Association(ASIA) scale was used to e-valuate the patients' neurological function and Functional Independence Measure (FIM) was used to evaluate the patients' activity of daily living(ADL). Results: The mean hospitalization time for the cases was 126 days (from 58 to 236 days). After comprehensive treatment including PT, OT, prosthesis, orthosis and intensive exercise for the five paraplegia cases, ASIA scale was not improved (P>0.05), FIM scores improved significantly (the average score was 25.83 for admission and 52.17 for discharge)(P<0.05). Another cervical spinal injury patient was an incomplete injured one, whose sensory and motor function increased by 58 and 14 scores respectively. FIM score of self-care, transfer and mobility increased 9, 14 and 5 scores respectively. Conclusions: Spinal cord injury patients with amputation can improve their self-care ability significantly by substitution of the lost function after equipped with prosthesis and comprehensive rehabilitation.%目的:探讨脊髓损伤合并截肢患者的康复治疗效果.方法:1991年~2011年共收治脊髓损伤合并截肢者6例,ASIA分级A级5例,C级1例;右下肢截肢者3

  7. Décision d'amputation dans la prise en charge initiale d'une luxation ouverte grave de la cheville à propos d'un cas observé à l'Hôpital Laquintinie de Douala suite à un accident par moto-taxi

    Science.gov (United States)

    Tsatedem, Faustin Atemkeng; Tsiagadigui, Jean Gustave; Ndando, Richard Polle; Arabo, Mohamadou Saidou; Bayiha, Alphonse; Kenfack, Bruno

    2012-01-01

    La décision d'amputation pour traumatisme grave de membre n'est pas toujours facile à prendre. Les auteurs rapportent le cas d'un traumatisme ouvert de la cheville gauche avec luxation tibiotalienne complète, référé pour amputation. Il s'agit d'une passagère d'une moto-taxi percutée par une voiture. A l'admission, le pouls tibial postérieur était présent et le score dit MESS (Mangled Extremity Severity Score) côté à 5, ce qui a permis et d'éviter l'amputation. Après débridement et réduction, une broche transplantaire a permis d'immobiliser la cheville et de faire les pansements. L'amputation a été évitée. La cicatrisation dirigée de la peau a été suivie par la kinésithérapie. La mobilité de la cheville autorise une marche avec cannes au quatrième mois post-opératoire. Les auteurs recommandent l'utilisation du MESS dans la décision d'amputation après traumatisme grave de membre. PMID:23396997

  8. Sensación de miembro fantasma y dolor de miembro residual tras 50 años de la amputación Chronic phantom sensation and residual limb pain 50 years after amputation

    Directory of Open Access Journals (Sweden)

    J. Olarra

    2007-08-01

    Full Text Available Introducción El dolor del miembro residual o dolor de muñón es aquel que aparece en la parte todavía existente de la extremidad amputada. Paciente: Presentamos el caso de un paciente varón de 74 años con antecedentes de amputación supracondílea postraumática del miembro inferior izquierdo, que desarrolló dolor de miembro residual y sensación de miembro fantasma 50 años después de la amputación sin una causa que Justificara su aparición. El tratamiento con antidepresivos tricíclicos (amitriptilina, anticonvulsivantes (gabapentina y tramadol permitió un buen control del dolor. Conclusiones: La existencia de una matriz neuronal determinada genéticamente pero modulada durante la vida por los impulsos nerviosos (nociceptivos, crearía una memoria somato-sensorial que sería responsable de la aparición del dolor de miembro fantasma.Background and objective: Residual limb pain or stump pain is defined as pain in the remaining part of an amputated limb. Patient: We present the case of a 74-year-old male patient with a history of posttraumatic transfemoral (above knee amputation of the left lower limb who developed residual limb pain and phantom limb sensation 50 years after amputation without a clear etiology. Treatment with tricyclic antidepressants (amitriptyline, anticonvulsivants (gabapentin and opioids (tramadol, provided a satisfactory control of pain. Conclusions: The existence of a neuromatrix initially determined genetically and later sculpted by sensory inputs (continuous nociceptive stimulation, could create what is known as the somatosensorial memory, responsible for the development of phantom limb pain.

  9. ANESTESIA PARA AMPUTACIÓN SUPRACONDÍLEA EN PACIENTE CON SÍNDROME CORONARIO AGUDO / Anesthesia for supracondylar amputation in patient with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Marilyn Ramírez Méndez

    2012-03-01

    Full Text Available Resumen La insuficiencia arterial periférica es una enfermedad que se asocia a factores de riesgo aterogénico reconocidos, y es más frecuente en personas con hiperlipidemia, diabetes mellitus y hábito de fumar. Se presenta el caso de una mujer de 67 años de edad, con antecedentes de hipertensión arterial, diabetes mellitus e infarto de miocardio antiguo, que ingresa por signos de inflamación aguda del miembro inferior derecho como consecuencia de una insuficiencia arterial periférica. A los 8 días del ingreso presentó un síndrome coronario agudo sin elevación del segmento ST, con fallo de bomba Killip II, y una vez compensada fue anunciada para amputación supracondílea de urgencia, debido a una gangrena isquémica. Se decidió utilizar anestesia espinal subaracnoidea selectiva del miembro inferior derecho, a cual se aplicó sin complicaciones y favoreció el adecuado desarrollo de la cirugía planificada. A las 72 horas la paciente fue egresada de la UCI, sin síntomas cardiovasculares y compensación metabólica. / Abstract Peripheral arterial insufficiency is a disease that is associated with known atherogenic risk factors, and is more common in people with hyperlipidemia, diabetes mellitus and smoking habit. A case of a 67-year-old woman with a history of hypertension, diabetes mellitus and old myocardial infarction is presented. She was admitted for signs of acute inflammation of the right leg due to peripheral arterial insufficiency. 8 days after admission she presented an acute coronary syndrome without ST segment elevation with pump failure (Killip class II, and once compensated she was scheduled for emergency supracondylar amputation due to ischemic gangrene. It was decided to use selective spinal subarachnoid from the right leg, which was applied without complications and favored the proper development of the planned surgery. At 72 hours, the patient was discharged from the ICU, with metabolic compensation and without

  10. Coping with Aging and Amputation

    Science.gov (United States)

    ... lens you will use to view your limb loss and your life. Perhaps you will choose the close-up lens ... that you will need to look at your life and your limb loss in a different way. Are you willing to ...

  11. 2型糖尿病患者糖尿病足截肢危险因素分析%The analysis of risk factors of amputation for diabetic foot in patients with type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    马朋朋; 张春林; 苏峰

    2011-01-01

    Objective To investigate the risk factors of amputation of diabetic foot in patients with type 2 diabetes mellitus (T2DM) and to provide theoretical basis for preventing the amputation of diabetic foot. Methods One hundred and three inpatients with T2DM diabetic foot who were admitted from March 2006 to February 2007 in our hospital were divided into two groups: amputation group and non-amputation group. The clinical data and biochemical indexes were analyzed for both groups. Results There were significant differences in the patients' age,course of disease,smoking,essential hypertension,fasting blood glucose (FBG) ,glycosylated hemoglobin, the extent of pathological changes of artery of lower extremity, the extent of neuropath, the extent of diabetes mellitus combined with perineuropathy, the degree of foot damage between the two groups ( P < 0. 05 or < 0. 01). Conclusion The risk factors of amputation of diabetic foot include high age,long course of diabetes mellitus,the bad control for the levels of FBG and HbAlc, smoking, DM combined with essential hypertension, severe pathological changes of artery of lower extremity .diabetic perineuropathy, severe neuropathy and foot damage.%目的 探讨2型糖尿病患者糖尿病足截肢的危险因素,为临床预防糖尿病足截肢提供理论依据.方法 选择2006年3月至2010年2月的2型糖尿病糖尿病足患者103例分为截肢组和非截肢组,对2组患者的临床资料和生化指标进行分析.结果 2组患者的年龄、糖尿病病程、吸烟、原发性高血压、空腹血糖(FBG)、糖化血红蛋白(HbAlc)、下肢动脉病变的程度、合并糖尿病周围神经病变及神经病变程度、足部损害的程度比较差异均有统计学意义(P <0.05或<0.01).结论 年龄大、糖尿病病程长、FBG及HBA1c水平控制不佳、吸烟、合并原发性高血压、严重下肢动脉病变、合并糖尿病周围神经病变及神经病变级别高和足部损伤是糖尿病足截肢的危险因素.

  12. The Application of Autologous free Bone Plug Technology in Emergency Repair of Amputation Stump Bone Wound%应用自体游离骨塞技术急诊修复截肢残端骨创面

    Institute of Scientific and Technical Information of China (English)

    李贝; 黄瑞良; 区广鹏; 肖军; 刘伟; 杨康胜; 艾合买提江·玉素甫

    2013-01-01

    Objective:Study the efficacy of free bone plug of discarded limbs after amputation in repairing stump bone wound .Meth-ods:From March 2010 to March 2012 , we emergency repaired 6 cases of amputation stump bone wound in autologous free bone plug tech-nology,5 males and 1 female,the age ranged from 21 to 53 years old, average 35 years old.Causes of injuries:5 cases of traffic accident injury, 1 cases of machine strangulation injury .1 case of upper limb amputation , and 4 cases of lower limb amputation .Special examina-tion:1 cases of distal forearm damage;2 cases of thigh supracondylar and intercondylar comminuted fracture , femoral artery nerve de-structive injury and part of the defect;2 cases of the lower leg tibia and fibula comminuted fractures and popliteal artery injury ;1 cases of knee remote defect .After determining the osteotomy plane , retained inner and outer periosteal flap , osteotomy to the bone surface bleed-ing by swing saws ,sanded the edges of the bones . According the debridement amputation bone surface to design the bone plug size , made class cone type bone plug after removing periosteum , the bone plugs bottom of the cortical bone , surrounded by cancellous bone .Its base is trimmed into a slightly curved bone pad according to the cross -section of the stump osteotomy , stuffed stump medullary cavity .used the periosteal flap closure stump marrow cavity after trim the bottom of the bone plug , Soft tissue flaps designed well in advance embedded stump in turn, placed film drainage in the subcutaneous , a large number of cotton pad dressing , plaster cast processing( hard bandage ) . Results:4 patients wounds first class healing and stitches discharged , 2 patients postoperative wound edge effusion whose wound healing after 20-25 days dressing , Followed up for 3-6 months, all stump without sinus formation .1 year after amputation , assembly prosthetic stump skin are good shape , no ulcers and pressure sores .Conclusion:The results were

  13. Maslow理论对骨肿瘤术后截肢患者抑郁状态的影响%Influence of Maslow theory on depression in patients with amputation after bone tumor resection

    Institute of Scientific and Technical Information of China (English)

    胡楠; 王晶; 高兴

    2013-01-01

    目的:探讨Maslow理论干预对骨肿瘤术后截肢患者抑郁状态的影响.方法:选择骨肿瘤术后截肢患者40例作为研究对象,将其随机分为干预组和对照组各20例,干预组应用Maslow心理干预模式护理,对照组采用常规护理方法.于干预后1,30 d采用Zung抑郁自评量表(SDS)和汉密尔顿抑郁量表(HAMD)及自制问卷进行评估.结果:干预组患者干预后30 d SDS,HAMD评分低于对照组(P<0.05),对护理工作满意率高于对照组(P<0.05).结论:应用Maslow理论对骨肿瘤术后截肢患者进行护理,可减轻其心理压力,改善抑郁状态,提高满意度.%Objective:To investigate the improving effect of Maslow theory intervention on the depression improvement of patients with bone cancer after amputation.Methods:40 bone tumor patients after amputation were selected as the study object and randomly divided into intervention group and control group with 20 cases in each group.Maslow nursing intervention of psychological used in intervention group,control group with routine nursing intervention,in first day and 30th day by Zung self - rating depression scale (SDS) and the Hamilton depression scale ( HAMD) and self - made questionnaire were evaluated.Results:The patients in the intervention group after the intervention of the 30 d SDS, HAMD were lower than the control group ( P < 0.05), satisfactory rate was higher than the control group (P<0.05).Conclusion:The application of Maslow theory on bone tumor after amputation patients with nursing,can reduce the psychological pressure, improve depression, increase satisfaction.

  14. 十指与双前臂同时离断再植成功一例及文献复习%A case of successful replantation of simultaneous amputation of 10 fingers and both forearms and the literature review

    Institute of Scientific and Technical Information of China (English)

    张子清; 杨延军; 马立峰; 刘铭波; 王克列; 李木卫

    2016-01-01

    目的 探讨十指与双前臂同时离断再植手术方法和术后功能康复. 方法 2014年9月,应用显微外科技术,对一例十指、双前臂同时离断患者实施断肢、断指再植术.手术分3个再植团队,术中应用顺行再植与逆行再植方法交替,精确的血管、神经吻合,手术历时11h55min,术后2周康复团队介入,物理治疗与作业治疗相结合. 结果 术后再植肢体、手指全植全活.术后随访14个月,腕关节屈、伸活动功能正常,双手浅、深感觉功能恢复良好,拇、手指握、捏及对掌功能部分恢复,两点辨别觉8 ~ 10 mm;按中华医学会手外科学会上肢部分功能评定试用标准为良好. 结论 十指、双前臂同时离断,只要精心组织团队协作、应用娴熟的显微外科技术精细的吻合血管、神经,术后早期功能康复介入,再植肢、指可获得满意的功能恢复.%Objective To investigate the replantation and postoperative rehabilitation methods for simultaneous amputation of 10 fingers and both forearms.Methods A case of replantation for simultaneous amputation of both forearms and 10 fingers was carried out with microsurgery method in September,2014.The replantation involved 3 teams over 11 hours and 55 minutes to consequently conduct alternate anterograde and retrograde replantation and accurate blood vessels,nerve anastomosis and further followed with physical therapy and occupational therapy treatment in 2 weeks of the surgery.Results All the amputated arms and fingers revived after the surgery.After 14 months follow-up,function of wrist flexion and expansion was normal,superficial and deep sensory functions on hands were good,function of thumb and finger grip,pinch and opposition had partially recovered,the two-point discrimination was 8-10 mm,and all of above rated good according to the temporary criteria of the upper limb functionality set forth by Hand Surgery Branch of China Medical Association.Conclusion For the case

  15. 老年糖尿病足感染截肢(趾)的高危因素分析及预防%Risk Factors Analysis and Prevention in Elderly Diabetic Foot Infection Amputation(toe)

    Institute of Scientific and Technical Information of China (English)

    黄璞

    2015-01-01

    目的:分析老年糖尿病患者发生糖尿病足以及糖尿病足感染截肢(趾)的高危因素,总结相关的预防措施。方法:选取我院2011年3月~2013年3月收治的糖尿病足患者共224例。根据患者是否需要进行截肢手术治疗分为截肢组和非截肢组。回顾性分析两组患者的治疗情况。结果:老年糖尿病感染截肢的高危因素包括血小板含量,血尿酸,血浆纤维原蛋白,动脉病变以及周围神经病变等。糖尿病足患者感染最为常见的是大肠埃希菌,其对氨苄青霉素的耐药菌株较少;其次是表皮球菌,对氨苄青霉素和庆大霉素没有产生耐药菌株;而铜绿假单胞菌对于庆大霉素的耐药性较好,药敏性较低;而聚团肠杆菌则对氨苄青霉素和环丙沙星的耐药性较高,亲水假单胞菌则对丁胺卡那和对氨苄青霉素的耐药性较好。结论:通过检测血小板含量,血尿酸,血浆纤维原蛋白,动脉病变以及周围神经病变,能够预测患者糖尿病足的病变感染程度以及相关的危险性。%Objective: This article is to explore for elderly patients with diabetes,diabetes is sufficient cause analysis and amputation in diabetic foot infections(toe) of the risk factors for its occurrence,analyze and summarize relevant preventive factors. Methods:Our hospital from March 2011 to March 2013 were treated 224 cases of diabetic foot.According to whether the patient needs to be divided into amputation amputation surgery group and non-ended group.A retrospective analysis of medical records of two groups of patients.Results:The risk factors for infection in elderly diabetic amputation include platelet levels ,uric acid,plasma protein fibrils ,artery disease and peripheral neuropathy.Diabetic foot infection is the most common ,such as Escherichia coli,less their ampicillin-resistant strains; followed by skin bacteria,ampicillin and gentamicin did not produce resistant

  16. 自残性断指再植患者心理评估及护理干预%Psychological assessment of patients with replantation of self-mutilation amputated finger and nursing intervention

    Institute of Scientific and Technical Information of China (English)

    陈永霞; 刘莉; 赵霞; 李玲; 刘华

    2012-01-01

    目的:探讨自残性断指再植患者心理状态及心理护理干预的方法和效果.方法:将56例自残性断指再植患者随机分为对照组和观察组各28例,对照组给予常规护理,观察组在常规护理的基础上给予心理护理干预.应用症状自评量表(SCL-90)分别在术前及术后10 d进行评估分析.结果:术后10 d观察组SCL-90躯体化症状、人际关系敏感、抑郁、恐惧、焦虑、精神病性因子分值均低于对照组(P<0.05).结论:自残性断指再植患者术前心理症状复杂,实施心理护理干预能有效地缓解躯体化症状,促进患者身心康复,降低手术应激反应及再植指体血管危象的发生,提高患者自残性断指再植的成活率.%Objective: To analyze the psychological assessment of patients with replantation of self - mutilation amputated finger and investigate the method of psychological nursing intervention and its effect. Methods: 56 patients with replantation of self- mutilation amputated finger were randomly divided into an observation group and a control group ( 28 cases in each group ). The patients in the control group received routine nursing care and the patients in the observation group received extra psychological nursing intervention on the basis of the routine nursing care. The Symptom Checklist ( SCL - 90 ) was used to make a psychological assessment of the patients before operation and on 10 days after operation. Results: The somatic symptoms and the factor scores of interpersonal sensitivity, depression, fear, anxiety and psychosis of SCL - 90 on 10 days after operation were lower in the observation group than those of control group ( P <0. 05 ). Conclusion: The preoperative psychological symptoms of the patients with replantation of self - mutilation amputated finger are so complex. The implementation of psychological nursing intervention can effectively relieve somatic symptoms,promote physical and psychological rehabilitation of the

  17. Application of the vacuum sealing drainage in amputation of the patient with critical limb ischemia%负压封闭引流在重症肢端缺血患者截肢术中的应用

    Institute of Scientific and Technical Information of China (English)

    龚凯; 黄道景; 张亚明; 范跃祖

    2012-01-01

    Objective: To assess the clinical effectiveness of application of the vacuum sealing drainage( VSD) in amputation of the patient with critical limb ischemia. Methods: The data of 66 amputated patients with critical limb ischemia gangrene were reviewed retrospectively. Of 35 patients, VSD was applied to treat wound after the limb amputated, the wound was sutured secondarily after 7 days; of 31 patients, the wound closure was performed at the first stage. The wound healing conditions, the complication, the hospital time and cost were evaluated between two groups. Results: In the VSD group,the wound healing rate was 91% ;the wound infection rate was O;the mortality rate was 9% ;the median length of hospital stay was 23. 5 days;the median hospital cost was 14 485 yuan; in the first-stage suturing group, the wound healing rate was 52% ; the wound infection rate was 42% ; the mortality rate was 19% ;the median length of hospital stay was 58. 8 days;the median hospital cost was 32 213 yuan. There was a significant difference between two groups(P <0. 01). Conclusion: Application of the VSD in amputation of the patient with critical limb ischemia plays a positive role in the prevention of wound infection, promoting wound healing,reducing mortality,reducing hospital time and cost,etc,which is recommended to adopted widely.%目的:探讨负压封闭引流(VSD)技术在重症肢端缺血患者截肢术中应用的临床价值.方法:回顾性分析66例重症肢体缺血坏疽截肢术患者的临床资料.35例患者(VSD组)在离断肢体后先应用VSD技术治疗创面,7d后再二期缝合伤口;31例患者(对照组)离断肢体后一期缝合残端伤口.观察两组患者术后伤口愈合情况、并发症、住院时间和治疗费用.结果:VSD组患者伤口愈合率为91%,感染率为0,死亡率为9%,平均住院时间为23.5 d,平均费用为14 485元;对照组患者伤口愈合率52%,感染率42%,死亡率19%,平均住院时间58.8 d,平均费用32 213

  18. Multidisciplinary treatment of diabetic foot ulcer changes patient' s length of stay and amputation rate%糖尿病足综合治疗对患者住院时间及截肢率的影响

    Institute of Scientific and Technical Information of China (English)

    梁俊强; 麦梨芳; 陈黎红; 杨川; 严励

    2012-01-01

    目的 评价糖尿病足专科综合治疗对糖尿病足患者住院时间以及截肢率的影响.方法 回顾性分析2004年至2010年中山大学孙逸仙纪念医院内分泌科收治的361例糖尿病足患者,以2008年为切点将研究对象分为两组,2004-2007年收治的179例作为传统治疗组,2008-2010年收治的182例为综合治疗组,其中,传统治疗组的治疗包括全身代谢紊乱的控制、伤口抗感染及一般换药等,而综合治疗则包括全身状况及足部情况评估、创面的规范处理(包括溃疡清创、合理地运用敷料等)、代谢紊乱纠正、营养神经、抗血小板以及血管重建等,比较两组患者住院相关生化检查结果、住院时间及截肢情况.结果 两组患者人院时在年龄、糖尿病病程、血压、体重指数、腰臀比、空腹血糖、餐后血糖、糖基化血红蛋白以及糖尿病相关并发症发病情况等方面,差异均无统计学意义(P>0.05).传统治疗组平均住院时间为(28.73±24.86)d、综合治疗组为(23.47士17.48)d,两组比较差异有统计学意义(t=2.326,P=0.021);两组的总截肢率分别为18.4%、8.8%(P=0.007),大范围截肢(踝平面以上)率为10.6%、4.9% (P=0.013).结论 糖尿病足综合治疗可以缩短糖尿病足患者的住院时间,降低截肢率,改善患者生活质量,减轻经济负担.%Objective To evaluate the effect of multidlsciplinary treatment on the duration of hospitalization and amputation rate in patients with diabetic foot.Methods Retrospective analysis was made in 361 cases of diabetic foot admitted to Department of Endocrinology,Sun Yat-sen Memorial Hospital from 2004 to 2010.Patients were divided into two groups:179 cases from 2004 to 2007,were regarded as conventional therapy group; 182 cases from 2008 to 2010 served as multidisciplinary therapy group.Traditional therapy included the treatment of systemic metabolism disturbance,wound infection and resistance of general medicine

  19. 马斯洛需要层次论在骨科截肢术护理中的应用%The application of maslow's hierarchy of basic human needs theory in the nursing care of the amputated patients

    Institute of Scientific and Technical Information of China (English)

    盘雪梅

    2009-01-01

    Objective To study the effect of Maslow's hierarchy of basic human needs theory applying in the nursing treatment of amputated patients.MethodsNinety eight cases of amputated patients were selected and randomly divided into the study group and control group each contained 49 cases.General nursing cares were performed according to the Maslow's hierarchy of basic human needs theory in the study group,control group carried out routine ones.The patient's psychological situation,the knowledge grasp,degree of satisfaction were valued of the two groups according to the self-rating depressive scale (SDS) ; self-rating anxiety scale (SAS),table of related knowledge master and table of patients satisfactory degree of nursing care.ResultsThe results of general nursing care performed according to the Maslow's hierarchy of basic human needs theory were satisfied.The occurrence rate of the patients'anxiety and despondent were greatly reduced.The degree of satisfactory and knowledge acquirement were distinctly enhanced.ConclusionGeneral nursing care performed according to the Maslow's hierarchy of basic human needs theory on the amputated patients were helpful to patient's psychological adjustment,satisfied patient's right to be known,and improved the service quality.%目的 探讨马斯洛需要层次论在骨科截肢患者护理中的应用效果.方法 选取98例截肢患者随机分为研究组与对照组,每组各49例.研究组参照马斯洛需要层次论施行整体护理;对照组采用常规护理.采用抑郁自评量表(SDS)及焦虑自评量表(SAS)、相关知识掌握情况表、患者对护理工作的满意度表,评价两组患者抑郁、焦虑发生率情况和基本知识掌握情况及患者的满意度.结果 研究组患者的焦虑、抑郁发生率明显低于对照组(P<0.05),研究组患者对护理工作的满意度和知识掌握程度明显高于对照组(P<0.05).结论 应用马斯洛需要层次论对截肢患者施行整体护理,收到

  20. Comparative Efficacy and Safety of Different Antiplatelet Agents for Prevention of Major Cardiovascular Events and Leg Amputations in Patients with Peripheral Arterial Disease: A Systematic Review and Network Meta-Analysis

    Science.gov (United States)

    Katsanos, Konstantinos; Spiliopoulos, Stavros; Saha, Prakash; Diamantopoulos, Athanasios; Karunanithy, Narayan; Krokidis, Miltiadis; Modarai, Bijan; Karnabatidis, Dimitris

    2015-01-01

    There is a lack of consensus regarding which type of antiplatelet agent should be used in patients with peripheral arterial disease (PAD) and little is known on the advantages and disadvantages of dual antiplatelet therapy. We conducted a systematic review and network meta-analysis of available randomized controlled trials (RCT) comparing different antiplatelet drugs (Aspirin, Ticlopidine, Clopidogrel, Ticagrelor, Cilostazol, Picotamide and Vorapaxar as monotherapies or in combination with aspirin) in PAD patients (PROSPERO public database; CRD42014010299).We collated evidence from previous relevant meta-analyses and searched online databases. Primary efficacy endpoints were: (1) the composite rate of major adverse cardiovascular events (MACE; including vascular deaths, non-fatal myocardial infarction and non-fatal stroke), and (2) the rate of major leg amputations. The primary safety endpoint was the rate of severe bleeding events. Bayesian models were employed for multiple treatment comparisons and risk-stratified hierarchies of comparative efficacy were produced to aid medical decision making. Number-Needed-to-Treat (NNT) and Number-Needed-to-Harm (NNH) are reported in case of significant results. We analyzed 49 RCTs comprising 34,518 patients with 88,358 person-years of follow-up with placebo as reference treatment. Aspirin, Cilostazol, Vorapaxar and Picotamide were ineffective in reducing MACE. A significant MACE reduction was noted with Ticagrelor plus aspirin (RR: 0.67; 95%CrI: 0.46–0.96, NNT = 66), Clopidogrel (RR: 0.72; 95%CrI: 0.58–0.91, NNT = 80), Ticlopidine (RR: 0.75; 95%CrI: 0.58–0.96, NNT = 87), and Clopidogrel plus aspirin (RR: 0.78; 95%CrI: 0.61–0.99, NNT = 98). Dual antiplatelet therapy with Clopidogrel plus aspirin significantly reduced major amputations following leg revascularization (RR: 0.68; 95%CrI: 0.46–0.99 compared to aspirin, NNT = 94). The risk of severe bleeding was significantly higher with Ticlopidine (RR: 5.03; 95%CrI: 1

  1. 腹腔镜二级脾蒂离断法脾切除32例临床分析%Clinical Analysis of Laparoscopic Splenectomy with Amputation of Secondary Structures

    Institute of Scientific and Technical Information of China (English)

    李兴

    2014-01-01

    Objective To investigate the safety and clinical effects.Methods Clinical data of 32 cases of laparoscopic splenectomy with amputation of secondary structures in our hospital implementation were retrospectively analyzed from 2008 to 2013. Including 10 cases of cirhosis of the liver associated with hypersplenism, l5 cases of idiopathic thrombocytopenic purpura (ITP), 3 cases of splenic rupture, 4 cases of splenic benign placeholder. Results Operation of al the 32 cases were successful y completed except 2 cases convemion to open surgery for hemorhoea,The average operation time and blood loss were 225min and 530mL respectively.The postoperative hospital stay was average 9d,The time of postoperative fasting and drainage tube were 2d and 4d respectively,There is no severe complications.Conclusion Mastering surgical indications of splenectomy and laparoscopic operation technique, laparoscopic splenectomy with amputation of secondary structures is safe, and can achieve smal trauma, quick recovery, less complications of minimal y invasive purpose.%目的探讨腹腔镜二级脾蒂离断法脾切除手术安全性及临床效果。方法对2008年~2013年我院实施32例腹腔镜二级脾蒂离断法脾切除术患者的临床资料进行回顾性分析。包括10例肝硬化脾功能亢进,l5例原发性血小板减少性紫癜(ITP),3例脾破裂,4例脾良性占位。结果30例均完成完全腹腔镜二级脾蒂离断法脾切除术,2例中转开腹。30例腹腔镜手术平均手术时间225min,术中平均失血530ml,术后平均禁食2.5d,引流管4d,术后平均住院9d。术后均无并发症发生。结论掌握好脾切除术的手术指征及腹腔镜下的操作技巧,腹腔镜二级脾蒂离断法脾切除是安全的,并且能达到创伤小、恢复快、并发症少的微创目的。

  2. A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial

    Science.gov (United States)

    Imam, Bita; Finlayson, Heather C; Eng, Janice J; Payne, Michael WC; Jarus, Tal; Goldsmith, Charles H; Mitchell, Ian M

    2014-01-01

    Background The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed “Wii.n.Walk”, an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. Objective The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. Methods This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants’ homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks’ duration. The primary outcome measure will be the “Two-Minute Walk Test” to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and

  3. 硫氢化钠防治截肢术后大鼠肾脏损伤的机制%Sodium hydrosulfide for prevention of kidney damage in rats after amputation

    Institute of Scientific and Technical Information of China (English)

    张颖; 刘宁; 任青爱; 张海峰; 谢晓华

    2013-01-01

    目的 探讨截肢术后大鼠肾脏损伤的机制,探索外源性硫化氢(H2S)供体硫氢化钠(NaHS)的应用对肾脏结构和功能的影响,并了解硫化氢在防治肾脏损伤中的作用机制.方法 实验分为两部分.第1部分:将雄性Wistar大鼠按手术时间随机分为正常对照、手术后6h、NaHS干预、炔丙基甘氨酸(PPG)干预组,每组7只.测定血浆H2S、肾组织肾损伤分子-1(KIM-1)、髓过氧化物酶(MPO)、丙二醛(MDA)、一氧化氮、尿素氮、肌酐浓度和肾组织胱硫醚β-裂解酶(CSE)活性、MPO、MDA、KIM-1水平;光镜观察肾组织形态学变化,电镜观察线粒体结构变化.第2部分:将雄性SD大鼠随机分为4组,每组大鼠8只.提取各组肾线粒体后测定呼吸控制率、膜电位及ATP酶活性.结果 截肢后6h大鼠肾脏细胞和线粒体结构出现了损伤性变化,血浆及肾脏KIM-1含量明显增加(P<0.01),而H2S/CSE水平明显下降(P<0.01),NaHS干预后血浆H2S/肾脏CSE水平明显升高(P<0.01),而肾组织损伤减轻,血浆及肾脏KIM-1含量明显降低(P<0.01).与正常对照组相比,手术后大鼠肾脏线粒体呼吸控制率、膜电位及ATP酶活性显著降低(P<0.01),应用NaHS后以上指标出现明显升高,而应用PPG后无明显改善.结论 截肢创伤可导致大鼠肾脏结构和功能的损害,并导致线粒体的损伤,H2S供体NaHS的应用可使线粒体功能明显改善,并进一步减轻肾脏结构和功能的损害,表明H2S作为是一种新的内源性介质,可能通过多条途径作用于线粒体,调节能量代谢途径,参与组织了损伤与修复的一系列病理生理过程.%Objective To explore the mechanism of kidney injury in rats following amputation and the protective effects of sodium hydrosulfide (NaHS) on kidney structure and function.Methods Male Wistar rats were randomly divided into normal control,6 h after operation,NaHS intervention,and propargyl glycine (PPG) intervention groups (n=7

  4. Application of evidence-based nursing for the prevention of vascular crisis after the operation of replantation of amputated finger%循证护理在预防断指再植术后血管危象中的应用

    Institute of Scientific and Technical Information of China (English)

    孟宪玲

    2009-01-01

    Objective To explore the effective intervention method to prevent vascular crisis after the operation of replantation of amputated finger with Application of evidenced based nursing. Methods 84 cases of replantation of amputated finger were randomly divided into two groups: observe group and compare group. Applicating usual nursing in compare group and evidence-based nursing in observe group. Results To search the cause and the effective intervention method of vascular crisis after the operation of replanlafion of ampu-tated finger with evidenced based nursing. Conclusion Applicatia of evidence-based nursing for the prevention of vascular crisis after the operation of replantation of amputated finger, so as to raise the survival rate of replanta-fion of amputated finger and promote the nursing quality.%目的 应用循证护理(EBM)探索断指再植术后血管危象的有效干预方法.方法 将84例断指再植患者随机分为观察组和对照组,各42例.对照组采用常规护理方法,观察组采用循证护理的方法实施血管危象的护理干预.结果 应用循证护理找出断指再植术后血管危象的原因及有效干预方法对断指再植术后的患者进行护理降低了血管危险的发生率.结论 循证护理在预防断指再植术后血管危象中的应用,使护理活动由被动变主动,有效地降低了血管危象的发生,提高了断指再植成活率,促进了护理质量的提高.

  5. Comparação dos fatores de risco para amputações maiores e menores em pacientes diabéticos de um Programa de Saúde da Família Comparison of risk factors for major and minor amputation in diabetic patients included in a Family Health Program

    Directory of Open Access Journals (Sweden)

    Elvira Cancio Assumpção

    2009-06-01

    sequelae, such as lower limb amputation. Peripheral vascular insufficiency is a common early occurrence in these patients. The coexistence of neuropathy, ischemia, and immunodeficiency favors the development of infections in the lower limbs, which if not treated properly can lead to amputation and even death. OBJECTIVE: Compare risk factors for major and minor amputations in diabetic patients in the Family Health Program of the health care facility CAIC Virgem dos Pobres III, in Maceió, state of Alagoas, Brazil. METHODS: We examined 93 patients diagnosed with diabetes, assessing whether or not lower limb amputation was performed. The variables analyzed were: sex, age, type of diabetes, blood pressure, previous amputation (whether major or minor, skin changes, changes in arterial pedal and posterior tibial pulses, deformities, and neuropathy. Variables were classified according to the Wagner and Texas wound classification. RESULTS: All patients were diagnosed with type 2 diabetes. We found that 4.30% of the patients progressed to lower limb amputation. There was no significant variation in hypertension, deformities and neuropathy in relation to the amputee group. However, absence of distal pulses in the lower limb proved to be quite significant in relation to amputation outcome. CONCLUSION: Diabetic patients should receive appropriate outpatient medical care in order to prevent or minimize diabetes-related complications.

  6. 糖尿病足截肢术的围手术期治疗疗效观察%Diabetic Foot Amputation of Perioperative Treatment Curative Effect Ob-servation

    Institute of Scientific and Technical Information of China (English)

    楚日盛; 曾凡营; 王群

    2015-01-01

    目的:分析糖尿病足截肢术围手术期治疗效果。方法选取从2012年8月—2015年8月收治的30例糖尿病足截肢术患者,其中10例女,20例男,年龄为63~85岁,平均为(79.34±10.52)岁;糖尿病病程为5~39年,平均为(16.34±6.33)年;空腹血糖为16.32~5.89mmol/L,平均为(12.34±5.97)mmol/L。均伴有不同程度感染。对患者加强围术期治疗,分析其治疗效果。结果术后1例出现严重心血管并发症,通过抢救,患者病情稳定,该组患者无死亡病例。22例甲级愈合(73.33%),6例乙级愈合(30.00%),2例丙级愈合(6.67%)。结论糖尿病患者常合并各种疾病,糖尿病足属于全身疾病局部表现,不仅要重视手术治疗,还需加强围手术期治疗,提升临床疗效。%Objective To analysis of diabetic foot amputation perioperative treatment effect. Methods From August 2011 to August 2011 were 30 cases of diabetic foot amputation patients, including 10 cases of female, 20 cases were male, age was 63~85 years old, average age (79.34 ±10.52);For 5 years duration of diabetes-39 years, average (16.34±6.33) years; Fast-ing glucose 16.32 tendency tendency for L - 5.89 L, average tendency for L (12.34 ±5.97). With different degree of infec-tion. Strengthen the perioperative treatment for patients, to analyze its therapeutic effect. Results 1 case of severe postoper-ative cardiovascular complications, through the rescue, patients in stable condition, the patients have no deaths. Class a healing in 22 cases (73.33%), 6 cases of serie b healing (30.00%), 2 cases of class c healing (6.67%). Conclusion Patients with diabetes often merge a variety of diseases, diabetic foot belong to the systemic disease, local performance, should not only attach importance to surgery, still need to strengthen the perioperative treatment, improve the clinical curative effect.

  7. Prosthetic installation and training for the bilateral transfemoral amputation caused by Wenchuan earthquake%双侧大腿截肢患者的假肢装配和使用训练

    Institute of Scientific and Technical Information of China (English)

    武继祥; 周贤丽; 刘青山; 汪琴; 尹清; 林永辉; 刘宏亮; 吴宗耀

    2008-01-01

    目的 促进截肢患者早日掌握假肢使用方法 .方法 对3例截肢患者术后进行系统康复干预,同时针对假肢装配,使用方法 进行强化性训练.结果 3例截肢患者残肢创面均全部愈合,残肢端呈圆柱状,残肢肌力为5级,残肢髋关节活动范围正常,装配双侧大腿假肢后均取到满意的似肢使用疗效.结论 通过进行系统康复治疗、假肢装配及假肢使用训练后,双侧人腿截肢患者均能取得满意假肢使用效果,具有较高的独立生活能力,从而促其早日回归家庭及社会.%Obiective To help bilateral transfemoral amputee using prosthetic limb early.Methods Three bilateral transfemoral amputees were treated with physical therapy,stump moulding,kinesiotherapy,and prosthetic rehabilitation and installed with prosthetic limbs.Results The stump ulcer healed.The stump shape were cylinder.The muscle strength of stump reached the 5th grade.The range of motion of hip was normal.Three bilateral transfemoral amputees were installed with prosthetic limbs and trained with prosthetic management.Conclusion After systematic rehabilitation,prosthetic installation and training the individuals with bilateral transfemoral amputation can successfully ambulate and independently live.

  8. La huella perdida: Identificación personal utilizando un dedo parcialmente amputado encontrado en la escena de un robo The "lost fingerprint": Personal identification using a partially amputated finger found at the scene of a robbery

    Directory of Open Access Journals (Sweden)

    M. Subirana

    2005-04-01

    Full Text Available Las huellas dactilares han sido usadas durante siglos para identificar a las personas y tienen un alto valor como evidencia física que permite identificar al autor de un hecho violento. Usualmente, se encuentran en la escena del hecho como impresiones visibles o invisibles que deben ser encontradas, reveladas y fijadas con las adecuadas técnicas policiales. A pesar de que en los últimos años la identificación mediante técnicas de ADN es considerada el paradigma de la investigación criminal, las huellas dactilares continúan siendo un método fácil y barato para la identificación personal. Presentamos la investigación médico forense y policial de una huella dactilar "perdida" durante un robo. El ladrón sufrió una amputación del pulpejo del dedo que fue una prueba fundamental para su identificación posterior. Se revisan los problemas relacionados con las huellas dactilares como una herramienta adecuada para la identificación física.Fingerprints have been used during centuries for identifying people and they have a high value as an identifying evidence of the author of a crime. It is usual to find them at the scene of the crime as invisible or visible traces that must be looked for, developed and fixed with suitable police techniques. Although in the last years, DNA is considered the paramount in criminal investigation, fingerprints continue to be a very easy and inexpensive technique for personal identification. We present the forensic and police investigation of a fingerprint "lost" during a robbery attempt. A thief suffered an amputation of the finger's pulp that was a fundamental proof to identify him. Problems related to fingerprints as a reliable physical identification tool are reviewed.

  9. 糖尿病足截肢患者股神经中小窝蛋白1的表达及意义%Expression and significance of caveolin-1 in femoral nerve of diabetic foot amputation patients

    Institute of Scientific and Technical Information of China (English)

    丁敏; 褚月颉; 徐俊; 章鸣放; 赵凤云; 王鹏华

    2010-01-01

    Objective To investigate the expression and significance of caveolin-1 in femoral nerve of diabetic patients with foot amputation. Methods Forty patients with foot amputation were assigned to 3 groups according to their duration of type 2 diabetes: group A ( <6 years=, group B (6-10 years), and group C ( >10 years). Hematoxylin and eosin (HE) stain and Weil's stain were used to examine the femoral nerve. Silver staining was used to observe the axons and to count the nerve fiber density. The expression of caveolin-1 in Schwann cells of femoral nerve was tested by immunohistochemisty. Results There were evident progressive pathological changes in femoral nerve in the 3 groups. The variance of nerve fiber density in the 3 groups reached statistical significance ( P<0. 05 =, the nerve fiber density showed negative correlation with HbA1C( r =-0. 792, P<0. 01 = and duration ( r=-0.592, P<0. 01 =. The expression of caveolin-1 in Schwann cells of femoral nerve was positive in all the 3 groups and the variance with statistical significance (P<0. 01 ), it was negatively correlated with HbA1C (r=-0. 762, P<0. 01 )and duration (r=-0. 532, P<0. 01 ), and it was positively correlated with nerve fiber density (r=0. 721, P<0.01 ), the partial correlation coefficient of caveolin-1 and HbA1Cwas-0. 505 ( P<0. 01 ).Conclusion In patients with diabetic foot amputation, caveolin-1 may play a role in the development of diabetic peripheral neuropathy and diabetic foot.%目的 探讨糖尿病足截肢患者股神经雪旺氏细胞中小窝蛋白1的表达及意义.方法 40例糖尿病足截肢患者根据2型糖尿病病程分为A(<6年),B(6~10年),C(>10年)3组.HE、Weil氏染色观察股神经病理学改变,银染法进行轴突染色并计数股神经纤维密度.应用免疫组化染色检测雪旺氏细胞中小窝蛋白1的表达.结果 3组股神经均存在明显的病理改变,随着病程延长病变加重.3组间股神经纤维密

  10. Perfil de clientes submetidos a amputações relacionadas ao diabetes mellitus Perfíl del paciente sometido a la amputación relacionada a el diabestes mellitus Profile of patients submitted to amputation related to diabetes mellitus

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    Darlene Mara dos Santos Tavares

    2009-12-01

    socio- demographical characteristics of 141 individuals which were interned in Teaching Hospital of Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil, who were submitted to amputations related to diabetes and compare the number of amputations considering the variables sex, age, co-morbidity, the type of treatment and then associated the number of amputations with the duration of internments and diagnosis. Data were collected from patient health records, totalizing 208 amputations. Major percentage of masculine individuals (58,9%, and a major occurrence of amputation among the elderly (70.2%; the cause: diabetic foot (35.7%; the most of patients (75.0% went through internment at least twice; most frequent co-morbidity: arterial hypertension (74.0%; median in the number of amputations was two. It was not observed any significant difference between the variables of study.

  11. Caracterização dos portadores de diabetes submetidos à amputação de membros inferiores em Londrina, Estado do Paraná = Characterization of diabetic patients submitted to lower limb amputation in Londrina, Paraná State

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    Maira Sayuri Sakay Bortoletto

    2010-07-01

    Full Text Available Trata-se de um estudo descritivo, quantitativo de análise do perfil dos pacientes portadores de Diabetes mellitus que se submeteram, em 2006, à amputação de membros inferiores em um Hospital Universitário público na cidade de Londrina, Estado do Paraná. Os dados foram coletados em prontuários de pacientes, após aprovação pela Comissão deBioética do referido hospital. Os resultados demonstraram que dos 92 pacientes que se submeteram à amputação, 32% eram diabéticos. A idade dos pacientes variou entre 46 e 89 anos, 52% eram do sexo masculino. Verificou-se que 93% dos pacientes eram portadores de neuropatia diabética, 93% eram portadores de úlcera no membro inferior, 52%apresentaram gangrena. Estes pacientes permaneceram hospitalizados em média 14 dias, e o tempo de internação variou de três a 50 dias. Das amputações realizadas, 30% envolviam a coxa, 30% os dedos dos pés, 27,50% o terço superior da perna, 5% a região transmetatársica, 5% a desarticulação do joelho e 2,5% o osso calcâneo. O aumento das amputações torna-se fator preocupante em relação à qualidade de vida destes pacientes considerando o impacto físico e psicológico que a amputação causa para o indivíduo. Além disso, maiores custos governamentais e institucionais serão necessários para assistir à necessidade de saúde desses pacientes. Concluiu-se que a prevenção é a melhor alternativa para diminuir este percentual de amputação e melhorar a qualidade de vida dos diabéticos.This is a descriptive study, quantitative analysis of the profile of patients with diabetes mellitus who in 2006 underwent amputation of limbs at a public university hospital. Data were collected from patient medical records, after approval by the Bioethics Committee of the hospital. The results showed that of the 92 patients who underwent amputation, 32% were diabetic. The patients’ ages ranged between 46 and 89 years, and 52% were male. It was found that 93% of

  12. Assessment of postural stability in patients with a transtibial amputation with various times of prosthesis use [Hodnocení posturální stability pacientů s transtibiální amputací s různou dobou používání protézy

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    Dagmar Kozáková

    2009-09-01

    Full Text Available BACKGROUND: Postural confidence is an initial precondition for all activities within the activity of daily living. Subjects with lower limb amputation have, due to somatosensory loss of information from the lower limb, more difficult conditions for maintaining postural stability in comparison with healthy subjects. Early prosthetic fitting with a prosthesis (with regard to amputation level, health state, financial claims, etc. is crucial for amputee reintegration into daily life. OBJECTIVE: The aim of this study was to assess the selected biomechanical parameters of standing stability in patients with a transtibial lower limb amputation with various times of prosthesis use. The next aim was to assess how the waiting time for the prosthesis fitting influences standing stability in different situations. METHODS: The tested group was made up of 21 patients (the average age was 64.4 ± 9.18 years with a unilateral transtibial amputation. The reason for amputation was in the case of 12 tested patients a vascular disease, in 8 patients trauma and in one it was a tumor. The average length of prosthesis use was 156.4 ± 359.6 days. A right side transtibial amputation had been performed on 10 patients and on the left side in 11 patients. To define the basic parameters of postural stability, two force plates of the Kistler (type 9286AA were used. Stability was tested for 30 seconds in 4 standing positions (natural bipedal stand, bipedal stand with a narrow base, natural bipedal stand with closed eyes and standing on foam. For an influence assessment of the period of prosthesis use on the level of postural stability, correlation analysis was used. The difference between each standing modification was analysed by ANOVA for repeated measurements and LSD post hoc test. RESULTS: In all tested situations, the loading of the sound limb is greater compared to the prosthetic limb in patients with a transtibial amputation (from 17.8% to 22.8%. This is also valid

  13. Variants in genes belonging to the fibroblast growth factor family are associated with lower extremity amputation in non-Hispanic whites: Findings from the chronic renal insufficiency cohort study.

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    Gupta, Jayanta; Mitra, Nandita; Townsend, Raymond R; Fischer, Michael; Schelling, Jeffrey R; Margolis, David J

    2016-07-01

    Diabetes is the major risk factor for nontraumatic lower extremity amputation (LEA). The role of genetic polymorphisms in predisposing diabetics to impaired wound healing leading to LEA has not been sufficiently explored. We investigated the association between a set of genes belonging to the angiogenesis/wound repair pathway with LEA in the Chronic Renal Insufficiency Cohort, a study of adults with chronic kidney disease (CKD) that includes a subgroup with diabetes. This study was performed on 3,772 Chronic Renal Insufficiency Cohort participants who were genotyped on the ITMAT-Broad-CARe array chip. A total of 1,017 single-nucleotide polymorphisms (SNPs) in 22 genes belonging to the angiogenesis/would repair pathway were investigated. LEA was determined from patient self-report. The association between genetic variants and LEA status was examined using logistic regression and additive genetic models after stratifying the cohort by race/ethnicity and diabetic status. Unadjusted analyses as well as analyses adjusted for age, sex, estimated glomerular filtration rate, body mass index, peripheral vascular disease, hemoglobin A1c, and population stratification were performed. In non-Hispanic white participants with diabetes, rs11938826 and rs1960669, both intronic SNPs in the gene basic fibroblast growth factor-2 (FGF2), were significantly associated with LEA in covariate-adjusted analysis (OR: 2.83 (95% CI: 1.73, 4.62); p-value: 0.000034; Bonferroni adjusted p-value: 0.0006) and (OR: 2.61 (95% CI: 1.48, 4.61); p-value: 0.00095; Bonferroni adjusted p-value: 0.02). In the same subgroup, rs10883688, an FGF8 SNP of unknown functional effect, was also associated with LEA (OR: 1.72 (95% Confidence Interval: 1.14, 2.6); p-value: 0.00999; Bonferroni adjusted p-value: 0.04). No statistically significant associations were identified in the other ethnic groups. In conclusion, variant/s in FGF2 and FGF8 may predispose diabetics with CKD to LEA. Dysregulation of the FGF2 gene

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

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    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

    Introducción: las amputaciones de extremidades inferiores disminuyen la calidad de vida de los pacientes con diabetes mellitus (DM). El objetivo de este estudio fue describir el índice de amputaciones de extremidades inferiores (mayores y menores) en sujetos con DM adscritos al Instituto Mexicano del Seguro Social (IMSS), comparando los años 2004 y 2013. Métodos: estudio observacional transversal comparativo. Se evaluaron los registros hospitalarios de amputaciones obtenidos del Sistema de Estadísticas Médicas (DataMart) y del Censo de pacientes con DM obtenido del Sistema de Atención Integral a la Salud. Se calcularon los índices de amputaciones mayores y menores x 100,000 sujetos con DM adscritos a Medicina Familiar. Resultados: durante 2004 y 2013 se observaron 2 334 340 y 3 416 643 pacientes con DM adscritos a Medicina Familiar respectivamente. Los promedios de edad al momento de la amputación fueron similares en el año 2004 y 2013 (61.7 años para las amputaciones menores y 65.6 años para las amputaciones mayores). Los índices de amputaciones mayores fueron de 100.9 y de 111.1 x 100 000 sujetos con DM en 2004 y 2013; mientras que el índice de amputaciones menores de extremidades inferiores fue de 168.8 y de 162.5 x 100 000 sujetos con DM en el durante 2004 y 2013 respectivamente. Conclusiones: el índice de amputaciones de extremidades inferiores en el IMSS es muy alto comparado con lo reportado en países desarrollados. El índice de amputaciones mayores se incrementó para el año 2013, comparado con 2004.

  15. Avaliação funcional de idosos com amputação de membros inferiores atendidos em um hospital universitário Evaluación funcional de ancianos con amputación de los miembros inferiores atendidos en un hospital universitario Functional evaluation of elderly with lower limb amputation followed at a university hospital

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    Maria José D'Elboux Diogo

    2003-02-01

    Full Text Available Foram entrevistados 40 idosos com amputação acima dos maléolos em acompanhamento no ambulatório de Órteses e Próteses do Hospital das Clínicas da Universidade Estadual de Campinas, no período de junho de 1994 a junho de 1999, com objetivo de avaliar o nível de independência, segundo o índice de Barthel, e de identificar relações entre o índice de Barthel e o tipo e nível da amputação, e uso da prótese. Os sujeitos desta pesquisa apresentam elevado grau de independência para as atividades da vida diária, segundo o índice de Barthel. Houve associação significativa somente entre o índice de Barthel e o tipo de amputação, indicando que os idosos com amputação unilateral são mais independentes do que aqueles com amputação bilateral.Fueron entrevistados 40 ancianos con amputación por encima de los maleolos, que estaban en seguimiento ambulatorio en la Unidad de Órtesis y Prótesis del Hospital Clínicas de la Universidad Estatal de Campinas, en el período de junio de 1994 a junio de 1999. El objetivo fue evaluar el nivel de independencia según el Índice de Barthel e identificar las relaciones entre el Índice de Barthel, el nivel de amputación, y el uso de prótesis. Los sujetos de esta investigación presentaron elevado grado de independencia para las actividades de la vida diaria según el Índice de Barthel. El análisis mostró asociación significativa apenas entre el Índice de Barthel y el tipo de amputación, indicando que los ancianos con amputación unilateral son mas independientes que aquellos con amputación bilateral.We studied 40 elderly with lower limb amputation (above the malleolus, who attended a hospital outpatient clinic (Orthoses and Prostheses Unity, University Hospital, State University of Campinas, from June 1994 to June 1999. Our objectives were to evaluate the independence level according to the Barthel's Index and to identify relationships between the mentioned Index and the type and

  16. EFFECTIVENESS OF VACUUM SEALING DRAINAGE COMBINED WITH ANTI-TAKEN SKIN GRAFT FOR PRIMARY CLOSING OF OPEN AMPUTATION WOUND%封闭式负压引流联合反植皮一期闭合开放性创伤截肢创面的临床分析

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    廖前德; 许鉴; 翁晓军; 钟达; 刘志勤; 王成功

    2012-01-01

    面的理想方法之一.%Objective To observe the effectiveness of vacuum sealing drainage (VSD) combined with anti-taken skin graft on open amputation wound by comparing with direct anti-taken skin graft. Methods Between March 2005 and lune 2010, 60 cases of amputation wounds for limbs open fractures were selected by using the random single-blind method. The amputation wounds were treated with VSD combined with anti-taken skin graft (test group, n=30) and direct anti-taken skin graft (control group, n=30). No significant difference was found in age, gender, injury cause, amputation level, defect size, preoperative albumin index, or injury time between 2 groups (P > 0.05). In test group, the redundant stump skin was used to prepare reattached staggered-meshed middle-thickness skin flap by using a drum dermatome dealing after amputation, which was transplanted amputation wounds, and then the skin surface was covered with VSD for continuous negative pressure drainage for 7-10 days. In control group, wounds were covered by anti-taken thickness skin flap directly after amputation, and conventional dress changing was given. Results To observe the survival condition of the skin graft in test group, the VSD device was removed at 8 days after operation. The skin graft survival rate, wound infection rate, reamputation rate, times of dressing change, and the hospitalization days in test group were significantly better than those in control group [ 90.0% vs. 63.3%, 3.3% vs. 20.0%, 0 vs. 13.3%, (2.0 + 0.5) times vs. (8.0 + 1.5) times, and (12.0 ± 2.6) days vs. (18.0 ± 3.2) days, respectively] (P < 0.05). The patients were followed up 1-3 years with an average of 2 years. At last follow-up, the scar area and grading, and two-point discrimination of wound in test group were better than those in control group, showing significant differences (P < 0.05). No obvious swelling occurred at the residual limbs in 2 groups. The 1 imb pain incidence and the residual limb length were better in test group than those in

  17. A dinâmica dependência-autonomia em idosos submetidos à amputação de membros inferiores La dinámica dependencia-autonomía en el anciano con amputación de los miembros inferiores The dependency-autonomy dynamic in elderly submitted to lower limbs amputation

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    Maria José D'Elboux Diogo

    1997-01-01

    Full Text Available O presente trabalho tem como objetivo discutir a dinâmica dependência-autonomia no idoso com amputação de membros inferiores, relacionando esta questão com a realização das atividades da vida diária.Este trabajo tiene como objetivo, discutir la dinámica dependencia-autonomía en el anciano con amputación de los miembros inferiores, relacionando esta cuestión con la realización de las actividades de la vida diaria.The objective this study is to examine the dependency-autonomy dynamic in elderly submitted to lower limbs amputation, relating this question to the activity of daily living (ADL.

  18. 阴茎背神经离断术联合α1受体阻断药治疗早泄的疗效%Clinical observation of treatment of premature ejaculation by dorsal penile nerve amputation surgery combined with a-adrenergic receptor blocker

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    张水文; 徐野; 周国萍; 秦似龙; 李建华; 郭军红

    2012-01-01

    目的 探讨阴茎背神经离断术联合高选择性α1受体阻断药治疗早泄的疗效.方法 对89例早泄患者随机分为3组:单纯药物治疗组、单纯阴茎背神经离断组、联合治疗组,每组给予相应治疗,观察阴道内射精潜伏期的变化.结果 联合治疗组阴道内射精潜伏期(160.4±57.7 s)较单纯药物α1受体阻断药治疗组(64.3±23.2 s)和单纯阴茎背神经离断组(106.5±41.4 s)明显延长(P<0.01).结论 阴茎背神经离断术联合高选择性α1受体阻断药治疗早泄效果明显.%Objective To investigate the efficacy of treating premature ejaculation with a highly selective at - adrenergic receptor blocker in combination with dorsal penile nerve amputation surgery. Methods 89 patients with premature ejaculation were randomly divided into three groups; simple drug treatment group, simple dorsal penile nerve transection group, the combined treatment group. Patients in each group were given appropriate treatment to observe changes in ejaculation latency. Results The ejaculatory latency of combined therapy group was significantly prolonged (P <0. 01) compared with the simple drug treatment group and the dorsal penile nerve transection group. Conclusion Dorsal penile nerve amputation surgery combined with at - adrenergic receptor blocker is an effective treatment of premature ejaculation.

  19. Effect of unilateral incisor tooth amputation on the glucose metabolism in submandibular glands of rats following sympathetic and parasympathetic denervation Efeito da amputação unilateral do incisivo inferior sobre o metabolismo da glicose em glândulas submandibulares de ratos submetidas a desnervação simpática e parassimpática

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    Marinez ALMEIDA-DE-FARIA

    2000-03-01

    Full Text Available The autonomic nervous system is of major importance in the regulation of physiological functions of the salivary glands, including the sialadenotrophic process. It is well known that the secretory function as well as other functions in the salivary glands depend upon the energy produced in the gland. The acini volume density, some enzymes of the glucose metabolism, such as hexokinase, phosphofructokinase, pyruvate kinase, glucose-6-phosphate dehydrogenase and lactate dehydrogenase were evaluated following sympathetic and parasympathetic denervation of submandibular glands of rats, submitted to unilateral incisor amputation, five days after denervation. Sympathectomized glands submitted to amputation showed a reduction in the activity of hexokinase and phosphofructokinase-1, varying from 27.5 to 36.7 % for hexokinase and from 22.8 to 38.4 % for phosphofructokinase-1. Although no variation was observed in the enzymatic activity of parasympathectomized animals, the acini volume density showed a significant decrease.O sistema nervoso autônomo é de grande importância na regulação da fisiologia das glândulas salivares, incluindo o processo sialadenotrófico. Já é bem conhecido o fato de que a função secretora, bem como, outras funções desempenhadas pelas glândulas salivares dependem de energia produzida nas glândulas. A histometria dos ácinos, algumas enzimas do metabolismo de carboidratos como, hexoquinase, fosfofrutoquinase-1, piruvato quinase, glicose-6-fosfato desidrogenase e lactato desidrogenase foram avaliados na glândula submandibular de ratos com desnervação simpática e parassimpática, submetidos a amputação unilateral dos dentes incisivos, cinco dias após a desnervação. Nas glândulas simpatectomizadas submetidas a amputação dos incisivos observou-se uma redução nas atividades da hexoquinase (27,5 - 36,7 % e da fosofofrutoquinase-1 (22,8 - 38,4 %. Embora, nehuma variação foi observado nas atividades enzim

  20. Amputação abdômino-perineal mais colostomia para-vaginal no tratamento do câncer reto-anal Abdomino-perineal amputation plus para-vaginal colostomy in the treatment of reto-anal cancer

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    Alcino Lázaro da Silva

    2009-12-01

    Full Text Available O apresenta uma proposta e as tentativas iniciais para evitar a colostomia abdominal quando esta tem que ser definitiva. Na mulher foi possível a sua execução, desde que se aproveitou o tono da musculatura esfincteral vulvovaginal quando ela pode ser preservada na amputação de reto-ânus. O colo, preparado com as válvulas, desce posteriormente à vagina, por dentro do conjunto esfincteral vulvovaginal. As observações iniciais mostram que esta tentativa poderia ser incrementada para melhores estudos de continência.The Author presents a proposal and lhe initial attempties to avoid the abdominal colostomy when it has to be definitive. In the woman was possible its execution, since it took advantage from the vulvovaginal esfincteral muscle nohen it can be preserved ot the anus-rectum amputation. The colon, prepared wit the valves, descend posteriorily from the vagina, inside the vulvo-vaginal esfincteral group. The initial observations shows that this attempt could be better developed for cotinency etudies.

  1. Avaliação do equilíbrio estático em indivíduos amputados de membros inferiores através da biofotogrametria computadorizada Evaluation of the static balance lower limb amputeers by means of computerized biophotogrammetry

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    MA Baraúna

    2006-01-01

    Full Text Available Contextualização: Para que sejam realizadas atividades funcionais da vida diária é primordial a manutenção do equilíbrio estático, possibilitando posturas, movimentos e respostas adequadas. Objetivos: O presente trabalho teve como finalidade avaliar e comparar, através do teste de Romberg adaptado, as oscilações do equilíbrio estático de amputados protetizados de membros inferiores com indivíduos não amputados. Método: Foram avaliados 33 indivíduos do sexo masculino com idade média de 33,38 anos, divididos em três diferentes grupos. O grupo A foi composto por 12 indivíduos amputados que utilizavam prótese transfemural. O grupo B foi formado por 9 indivíduos amputados transtibiais. O grupo controle C continha 12 indivíduos não amputados. Cada indivíduo foi filmado nos planos frontal e sagital, avaliado quadro a quadro para a seleção de momentos de maiores oscilações. As imagens selecionadas foram quantificadas através da Biofotogrametria Computadorizada, utilizando-se o programa ALCimage 2.1®. Resultados: Os resultados mostraram diferenças significativas entre as oscilações anteriores para o grupo A (transfemural e entre as oscilações para o lado esquerdo, no grupo B. Conclusão: A partir destes resultados, conclui-se que amputados de membros inferiores apresentam uma tendência de oscilação mais significante em direção anterior e para o lado contra-lateral à prótese. Com o avanço da idade, nota-se uma menor tendência à oscilação posterior.Background: To accomplish day-to-day functional activities, it is fundamentally important to maintain static balance, thereby enabling appropriate postures, movements and responses. Objective: The purpose of this study was to evaluate oscillations in static balance among amputees with lower limb prostheses, by means of an adapted Romberg test, and to compare such oscillations with those among individuals without amputations. Method: Thirty-three male individuals of

  2. Attention to the diagnosis and treatment of peripheral artery disease is essential in reducing diabetic foot ulcer and amputation%重视下肢动脉病变的诊治是降低糖尿病截肢率的重要措施

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    许樟荣

    2009-01-01

    Peripheral artery disease(PAD)is one of diabetic macrovascular complications,with characteristics of being more distal.segmental and extensive.The clinical manifestation of PAD is usually not noticed,and thus diagnosis easily missed.However,PAD is a main cause of diabetic foot and amputation,which would be diagnosed relatively easily if due attention is paid to artery pulse,ankle-brachial blood pressure index,and skin temperature.Ultrasound,CT,MR,and digital subtraction angiography(DSA)examinations are quite useful tools in diagnosis of PAD.The treatment of PAD,including medical and surgical intervention,has been developing quickly.Therapy with stem cell transplantation has been tested in some clinics.%下肢动脉疾病(PAD)是常见的糖尿病并发症,具有多节段、更远端、病变更广泛等临床特点.该症起病缓慢而隐匿,临床上尚未受到足够重视,但危害性大,是糖尿病足的重要原因.该症诊断相对容易,触诊、踝肱动脉压指数测定、皮温测定、超声检查、CT或核磁共振都是有效的诊断技术,血管减数造影仍然是诊断的金标准.轻-中度病变采用药物治疗,重症患者需要外科手术治疗.介入治疗如深部球囊扩张术和血管内支架置放和干细胞移植治疗已在国内一些大医院开展并取得了相当疗效.

  3. Coping style, social support and psychological health status about family members of young and middle-aged patients suffering from amputation%中青年截肢患者家属应对方式、社会支持及心理健康状况调查分析

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    陈树环

    2016-01-01

    目的:调查中青年截肢患者家属应对方式、社会支持及心理健康状况,分析中青年截肢患者家属的心理压力及应对方式对其心理健康的影响。方法选取2012年1月—2015年12月在河北省唐山工人医院住院的中青年截肢患者的家属280名为调查对象,每例患者对应1名家属,采用Lazarus的应对方式问卷、社会支持评定量表( SSRS)、汉密尔顿焦虑量表( HAMA)与汉密尔顿抑郁量表( HAMD)调查患者家属的应对方式、社会支持、焦虑以及抑郁程度。结果青年患者家属中分别有97.25%和96.41%的家属担心患者的工作就业问题以及未来的婚姻,明显高于中年患者家属;而98.83%的中年患者家属担心增加子女抚养压力,明显高于青年患者家属;采用消极态度应对的患者家属HAMA与HAMD评分均高于积极应对患者家属;低社会支持患者家属的HAMA和HAMD评分均高于高支持患者家属,差异均有统计学意义( P<0.05)。结论积极的应对方式与高社会支持能够有效缓解中青年截肢患者家属的心理压力,减少焦虑抑郁等负面情绪。%Objective To investigate coping style, social support and psychological health status about family members of young and middle-aged patients suffering from amputation, and to analyze influence of psychological stress and coping style on psychological health.Methods From January 2012 to December 2015, a total of 280 family members of young and middle-aged patients suffering from amputation were enrolled in this study. All the patients had been treated in Tangshan Workers Hospital. Each patient corresponded to one family member. Lazarus′coping style questionnaire, SSRS (social support rating scale), HAMA (Hamilton anxiety scale) and HAMD ( Hamilton depression scale ) were used to investigate the coping style, social support, anxiety degrees and depression degrees. Results Among family members of young patients, 97. 25

  4. Implantação de lente intraocular com uma alça amputada: proposta para o tratamento cirúrgico da subluxação do cristalino Intraocular lens implantation with one loop haptic amputed: a new propose to the subluxation lens surgical treatment

    Directory of Open Access Journals (Sweden)

    Marcelo Ventura

    2010-04-01

    : Intraocular lens implantation with one loop haptic amputed and supported above the endocapsular ring is an option for the congenital lens subluxation surgical treatment, promoting lens centralization and postoperative visual acuity improvement.

  5. Amputation in the perception of those who experience it: a study under the phenomenological La amputación bajo la percepción de quien la vive: un estudio desde la óptica fenomenológica A amputação na percepção de quem a vivencia: um estudo sob a ótica fenomenológica

    Directory of Open Access Journals (Sweden)

    Gislaine Cristina de Oliveira Chini

    2007-04-01

    Full Text Available This study aimed to understand the implications and feelings associated with the experience of amputation. The literature review allowed the knowledge of this phenomenon under several perspectives, besides the appropriation of some ideas of the philosopher Merleau-Ponty about body and perception. After this initial knowledge, interviews were performed with people who underwent amputation, by living in their world and listening to their statements. By sharing these moments, it was possible to understand meanings from the perspective of those who experience it, which led to six thematic categories. In addition to understanding those who underwent amputation in their context and in their essence, some facets of this phenomenon were revealed through the phenomenological referential.Frente a las circunstancias de amputación, sus implicaciones y sentimientos vividos, este estudio fue realizado con la propuesta de comprender este fenómeno. Inicialmente, la revisión de la literatura permitió conocer el tema desde diversos enfoques, además de permitir la adquisición de algunas ideas sobre el pensamiento filosófico de Merleau-Ponty con respecto al cuerpo y la percepción. Posteriormente al obtener conocimiento sobre esta óptica fueron realizadas entrevistas con las personas quienes fueron sometidas a una amputación, para poder introducirnos en su mundo y escuchar sus expresiones. A partir de esos momentos se pudo comprender el significado de quien lo vive; manifestaciones que son descritas por medio de seis categorías temáticas. De esta forma, fue posible mostrar algunas fases del fenómeno de amputación bajo la óptica del referencial fenomenológico, así como, comprender a la persona amputada en toda su magnitud, tal como ella se manifiesta en sí misma en su esencia.Diante da inquietação com a questão da amputação, suas implicações e sentimentos experimentados pela pessoa que a vivencia, realizou-se esse estudo, com a proposta de

  6. 针刺复合星状神经节阻滞治疗外伤性上肢截肢术后幻肢痛效果观察%The effect of combination therapy of nerve block and acupuncture for phantom limb pain by amputation of upper extremity after surgery

    Institute of Scientific and Technical Information of China (English)

    龚琴; 刘莱莉; 罗富荣; 廖荣宗; 高俊青; 陈浩宇

    2014-01-01

    Objective To investigate the effect of combination therapy of nerve block and acupuncture to phantom limb pain of upper extremity after amputation.Methods Eighty patients with phantom limb pain of upper limb were randomly divided into four groups (n=20):20 patients received basic treatment (A group),which included Medications and Psychotherapy,20 patients recieved acupuncture and basic treatment (B group),20 patients recieved nerve block and basic treatment (C group),20 patients recieved nerve block,acupuncture and basic treatment (D group).Scores of VAS,SR-36 and comprehensive comparison of efficacy were used to assess before and after treatment among the four groups.Results visual analogue scales (VAS) scores and SF-36 scores of four groups of patients were significant differences after treatment compared with before treatment (P<0.05).VAS scores decreased after treatment,while SF-36 scores were significantly increased.When compared with A group (52±6),VAS scores of B group (42±8),C group (42±8) and D group (32±6) after treatment decreased significantly,and the differences were statistically significant(P<0.05).Compared with A group(Mental:58±9,Physical:36±5),SF-36 scores of B group(Mental:67±9,Physical:43± 4),C group(Mental:66±6,Physical:43±5) and D group(Mental:77±10,Physical:50±6) after treatment increased significantly,and the differences were statistically significant (P<0.05).When compared with B group and C group,VAS scores of D group decreased significantly after treatment,and SF-36 scores were significantly increased(P<0.05).Comprehensive comparison of efficacy of four groups of patients:After treatment for 5 weeks,compared with A group (70%),there was significant difference in comprehensive comparison of efficacy of B group(85%),C group(85%) and D group(100%) (P<0.05).The results suggest that the treatment effect of B group,C group and D group is better than A group,the treatment effect of D group is best among four groups

  7. Hodnocení variability dynamických parametrů chůze u osob s jednostrannou trans-tibiální amputací The variability assessment of the dynamic gait parameters of persons with unilateral trans-tibial amputation

    Directory of Open Access Journals (Sweden)

    Milan Elfmark

    2006-02-01

    energy increases. The aim of this study was to compare the intra and inter individual variability of the basic dynamic gait parameters of physically active persons with unilateral trans-tibial amputation. A group of 11 males (age 46.1 ± 12.0 years, body weight 82.5 ± 13.9 kg with unilateral trans-tibial amputation was analysed. The basic dynamic parameters (AMTI of the gait of each subject with conventional and dynamic prosthetic foot were measured. The interindividual variability in the group of the evaluated person is higher in comparison with the intraindividual variability. The sizes of the coefficients of reliability are exceeded for measured parameters (time, force, force impulse in anteroposterior and in vertical direction the value 0.976. The extent of these values depends on the individual properties of evaluated person (for example the instability of the knee etc..

  8. Comfort perception assessment in persons with transfemoral amputation

    Directory of Open Access Journals (Sweden)

    Juan Fernando Ramírez-Patiño

    2015-01-01

    Full Text Available Históricamente, el diseño y ajuste de prótesis es un proceso lento de ensayo y error que depende de la experiencia del protesista. Por lo tanto, una definición clara del concepto de confort es importante para diseñar prótesis cómodas y para el conocimiento de los factores que le contribuyen. Sin embargo, actualmente no existen métodos estandarizados para medir adecuadamente el confort cuando se usan prótesis. Este estudio identifica los factores que subyacen en el concepto de confort al usar prótesis. 41personas con amputación transfemoral completaron un cuestionario para evaluar la percepción de confort y analizar la influencia de seis factores. Se encontró un modelo significativo que clasifica correctamente el 84,9 % de los casos, lo que permite predecir si el paciente siente confort durante el uso de la prótesis. Aunque todos los factores fueron significativos, los factores que más influyen en la percepción de confort fueron funcionalidad y dolor.

  9. Gait analysis in lower-limb amputation and prosthetic rehabilitation.

    Science.gov (United States)

    Esquenazi, Alberto

    2014-02-01

    Gait analysis combined with sound clinical judgment plays an important role in elucidating the factors involved in the pathologic prosthetic gait and the selection and effects of available interventions to optimize it. Detailed clinical evaluation of walking contributes to the analysis of the prosthetic gait, but evaluation in the gait laboratory using kinetic and kinematic data is often necessary to quantify and identify the particular contributions of the variables impacting the gait with confidence and assess the results of such intervention. The same approach can be considered when selecting prosthetic components and assessing leg length in this patient population.

  10. Semi-flexible sockets for amputation below the knee.

    Science.gov (United States)

    Symington, D C; Lowe, P J; Mackay, S

    1975-09-01

    A semi-flexible socket fitted to a series of 47 consecutive below-knee amputees is evaluated, and the problems in assessing prosthetic components and appropriate methodology are discussed. The results suggest that this type of socket deserves wider use and further evaluation in active amputees, where comfort, perspiration control or the condition of the skin is interfering with the patient's function.

  11. Temporary prosthetic fitting for below-knee amputation.

    Science.gov (United States)

    Ozyalcin, H; Sesli, E

    1989-08-01

    The problems encountered in fitting and using the permanent below-knee prosthesis in developing countries are the high price of the prosthesis, inadequate fitting and lack of proper rehabilitation. In Turkey, the preferred treatment of the stump post-operatively is by the soft dressing method with bandaging for maturation and shrinkage. Generally, the application of the permanent prosthesis is in the sixth month post-operatively. Since in patellar-tendon-bearing (PTB) sockets, stumps have to withstand high pressures in limited areas, the PTB socket can only tolerate small volume changes in the stump. For this reason bandaging over a long period may be insufficient for adequate stump shrinkage and amputees will need another below-knee prosthesis, which most of them cannot afford after only a few weeks use. In the authors' clinic, 19 amputees were fitted with simple, effective and inexpensive temporary prostheses following either conventional immediate post-operative dressing or the soft dressing method. The temporary prosthesis is worn for two months. It produces fast stump shrinkage, helps maturation and permits ambulatory discharge even in bilateral amputees. For economical reasons, only eight of nineteen patients were fitted with permanent prostheses, all wearing them successfully without the necessity of further rehabilitation.

  12. Modified cup flap for volar oblique fingertip amputations

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    Ahmadli, A.

    2016-02-01

    Full Text Available We describe a modified volar “V-Y cup” flap for volar fingertip defects that do not exceed more than half of the distal phalanx for better aesthetic and functional outcome. In seven cases out of eight, the flap was elevated with a subdermal pedicle, whereas in one case, the flap was elevated as an island on the bilateral neurovascular bundle. The fingertips have been evaluated for sensibility using standard tests, hook nail deformity and patient satisfaction. Seven flaps have survived completely. The flap with skeletonized bilateral digital neurovascular bundle has shown signs of venous insufficiency on the 5 postoperative day with consecutive necrosis. Suturing the distal edges of the flap in a “cupping” fashion provided a normal pulp contour. The modified flap can be used for defects as mentioned above. Subdermally dissected pedicle-based flap is safe and easy to elevate. The aesthetic and functional outcomes have been reported to be satisfactory.

  13. A surgical approach for replantation of complete digital amputations.

    Science.gov (United States)

    Nissenbaum, M

    1980-01-01

    A technique of extending exposure in digital replantation using lateral incisions permits atraumatic exposure of adequate length of digital nerves, arteries, and veins, and excellent exposure for fashioning bone and debridement and repair of tendon. Increase in viability rates, the ability to repair two arteries per digit, the number of veins repaired per digit, and a higher overall arterial patency rate appear to be related to the improved exposure. Operative time was also significantly shorter.

  14. Traumatic Penile Injury: From Circumcision Injury to Penile Amputation

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    Jae Heon Kim

    2014-01-01

    Full Text Available The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue.

  15. 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

    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...... used with an increasing tendency until 2003. The Phantom eye syndrome is frequent among EA patients. Visual hallucinations were described by 42% of the patients. The content were mainly elementary visual hallucinations, with white or colored light as a continuous sharp light or as moving dots. The most...... frequent triggers were darkness, closing of the eyes, fatigue and psychological stress. Fifty-four percent of the patients had visual hallucinations more than once a week. Ten patients were so visually disturbed that it interfered with their daily life. Approximately 23% of all EA experience phantom pain...

  16. Buscando mobilizar-se para a vida apesar da dor ou da amputação Buscando volver a la vida a pesar del dolor o de la amputación Trying to overcome barriers to normal life in dpite of pain or amputation

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    Maria Clara Cassuli Matheus

    2006-03-01

    ás elementos para evaluar clínicamente y así actuar con mayor adecuación en relación a los aspectos psicosociales.AIM: to understand how patients cope with the consequences of the chronic obstructive arterial disease. METHODS: Symbolic Interaction and Grounded Theorie served as theoretical frameworks for this study. Ten individuals with chronic obstructive arterial disease participated in the study. Data were collected through interviews and analyzed with the technique of comparative analysis. RESULTS: Three themes emerged: having life restricted by pain, feeling overwhelmed, and trying to overcome barriers to normal life. The central element subsidizing patients' decisions, feelings, and behaviors, indicated that they are always symbolically and concretely TRYING TO LIVE A NORMAL LIFE IN SPITE OF PAIN OR AMPUTATION. FINAL CONSIDERATIONS: the results of this study may expand nurses' knowledge about patients' experience with chronic obstructive arterial disease. This knowledge will increase nurses' competency to perform a comprehensive psychosocial assessment and intervene appropriately.

  17. Bloqueio isquiático-femoral guiado por ultra-som para revisão de coto de amputação: relato de caso Bloqueo isquiático-femoral guiado por ultrasonido para revisión de muñón de amputación: relato de caso Ultrasound-guided sciatic-femoral block for revision of the amputation stump: case report

    Directory of Open Access Journals (Sweden)

    Pablo Escovedo Helayel

    2008-10-01

    peripheral nerves, independently of the ability of obtaining sensitive or motor stimulation. CASE REPORT: This is the case of a patient who underwent revision of the amputation stump at the knee under ultrasound-guided sciatic-femoral block with 40 mL of 0.5% ropivacaine, promoting complete sensitive blockade and excellent surgical anesthesia. CONCLUSIONS: Ultrasound assistance is capable of amplifying the spectrum of uses of peripheral nerve blocks in surgical interventions on amputated limbs in situations neurostimulation cannot be used.

  18. Bipolar hip hemiarthroplasty in a patient with an above knee amputation: a case report

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    Liebergall Meir

    2009-07-01

    Full Text Available Abstract The treatment of an above knee amputee who has sustained a fracture of femoral neck is a challenge for both the orthopaedic surgeon and the rehabilitation team. We present a case of such a patient and discuss different difficulties in his treatment.

  19. Coronal plane socket stability during gait in persons with transfemoral amputation: Pilot study

    Directory of Open Access Journals (Sweden)

    Stefania Fatone, PhD, BPO(Hons

    2015-01-01

    Full Text Available Little research describes which transfemoral socket design features are important for coronal plane stability, socket comfort, and gait. Our study objectives were to (1 relate socket comfort during gait to a rank order of changes in ischial containment (IC and tissue loading and (2 compare socket comfort during gait when tissue loading and IC were systematically manipulated. Six randomly assigned socket conditions (IC and tissue compression were assessed: (1 IC and high, (2 IC and medium, (3 IC and low, (4 no IC and high, (5 no IC and medium, and (6 no IC and low. For the six subjects in this study, there was a strong negative relationship between comfort and changes in IC and tissue loading (rho = −0.89. With the ischium contained, tissue loading did not influence socket comfort (p = 0.47. With no IC, the socket was equally comfortable with high tissue loading (p = 0.36 but the medium (p = 0.04 and low (p = 0.02 tissue loading conditions decreased comfort significantly. Coronal plane hip moments, lateral trunk lean, step width, and walking speed were invariant to changes in IC and/or tissue loading. Our results suggest that in an IC socket, medial tissue loading mattered little in terms of comfort. Sockets without IC required high tissue loading to be as comfortable as those with IC, while suboptimal tissue loading compromised comfort.

  20. Role of Egr1 in Hippocampal Synaptic Enhancement Induced by Tetanic Stimulation and Amputation

    OpenAIRE

    Wei, Feng; Xu, Zao C.; Qu, Zhican; Milbrandt, Jeffrey; Zhuo, Min

    2000-01-01

    Hippocampal neurons fire spikes when an animal is at a particular location or performs certain behaviors in a particular place, providing a cellular basis for hippocampal involvement in spatial learning and memory. In a natural environment, spatial memory is often associated with potentially dangerous sensory experiences such as noxious or painful stimuli. The central sites for such pain-associated memory or plasticity have not been identified. Here we present evidence that excitatory glutama...

  1. Severe leukocytoclastic vasculitis secondary to the use of a naproxen and requiring amputation: a case report

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    Martin Jeanine

    2010-07-01

    Full Text Available Abstract Introduction Leukocytoclastic vasculitis (also known as hypersensitivity vasculitis and cutaneous necrotizing vasculitis can present with various manifestations, which often delays the diagnosis and treatment. In order to show the importance of the early recognition of leukocytoclastic vasculitis, we present a case which occurred secondary to the use of a common pharmaceutical, naproxen. We were unable to find a case of leukocytoclastic vasculitis secondary to naproxen in the literature. Case presentation We present the case of a 33-year-old African American woman with below the knee and bilateral digital gangrene from hypersensitivity vasculitis secondary to the non-steroidal anti-inflammatory medication naproxen. Conclusion This is an original case report focusing on the rheumatologic management of leukocytoclastic vasculitis. However, other specialties, such as internal medicine, dermatology, infectious disease, general surgery and pathology, can gain valuable information by reviewing this case report. Reporting a case of leukocytoclastic vasculitis secondary to treatment with naproxen will advance our understanding of this disease etiology by adding yet another non-steroidal anti-inflammatory drug to the list of potential causes of leukocytoclastic vasculitis.

  2. Brain-computer interface devices for patients with paralysis and amputation: a meeting report

    Science.gov (United States)

    Bowsher, K.; Civillico, E. F.; Coburn, J.; Collinger, J.; Contreras-Vidal, J. L.; Denison, T.; Donoghue, J.; French, J.; Getzoff, N.; Hochberg, L. R.; Hoffmann, M.; Judy, J.; Kleitman, N.; Knaack, G.; Krauthamer, V.; Ludwig, K.; Moynahan, M.; Pancrazio, J. J.; Peckham, P. H.; Pena, C.; Pinto, V.; Ryan, T.; Saha, D.; Scharen, H.; Shermer, S.; Skodacek, K.; Takmakov, P.; Tyler, D.; Vasudevan, S.; Wachrathit, K.; Weber, D.; Welle, C. G.; Ye, M.

    2016-04-01

    Objective. The Food and Drug Administration’s (FDA) Center for Devices and Radiological Health (CDRH) believes it is important to help stakeholders (e.g., manufacturers, health-care professionals, patients, patient advocates, academia, and other government agencies) navigate the regulatory landscape for medical devices. For innovative devices involving brain-computer interfaces, this is particularly important. Approach. Towards this goal, on 21 November, 2014, CDRH held an open public workshop on its White Oak, MD campus with the aim of fostering an open discussion on the scientific and clinical considerations associated with the development of brain-computer interface (BCI) devices, defined for the purposes of this workshop as neuroprostheses that interface with the central or peripheral nervous system to restore lost motor or sensory capabilities. Main results. This paper summarizes the presentations and discussions from that workshop. Significance. CDRH plans to use this information to develop regulatory considerations that will promote innovation while maintaining appropriate patient protections. FDA plans to build on advances in regulatory science and input provided in this workshop to develop guidance that provides recommendations for premarket submissions for BCI devices. These proceedings will be a resource for the BCI community during the development of medical devices for consumers.

  3. 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,;

    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...

  4. Management of neglected femoral neck fracture in above knee amputated limb: A case report

    Institute of Scientific and Technical Information of China (English)

    Umesh Meena; Ramesh Meena; Balaji S; Sahil Gaba

    2015-01-01

    The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a challenging situation for both the orthopedic surgeon and the rehabilitation team.These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy.We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected.

  5. How do sock ply changes affect residual-limb fluid volume in people with transtibial amputation?

    Directory of Open Access Journals (Sweden)

    Joan E. Sanders, PhD

    2012-04-01

    Full Text Available The purpose of this research was to investigate the influence of sock addition and removal on residual-limb fluid volume in people using prosthetic limbs. We used bioimpedance analysis to measure residual-limb extracellular fluid volume on 28 transtibial amputee subjects during 30 min test sessions. Upon addition of a one-ply polyester sock, residual-limb fluid volume changes ranged from −4.0% to 0.8% (mean −0.9 +/− 1.3% of the initial limb fluid volume. Changes for sock removal ranged from −1.2% to 2.8% (mean 0.5 +/− 0.8%. Subjects who reduced in fluid volume with both addition and removal of a sock and subjects with high positive ratios between the fluid-volume loss upon sock addition and gain upon sock removal (high add/remove [AR] ratios tended to have arterial disease, were obese, and were smokers. Subjects with low positive AR ratios, subjects who increased in fluid volume both with sock addition and removal, and a single subject who increased in fluid volume with sock addition and decreased with sock removal tended to be nonsmokers and either individuals in good health without complications or individuals without arterial problems. Results are relevant for the anticipation of limb volume changes during prosthetic fitting and toward the design of adjustable-socket technologies.

  6. Brain–computer interface devices for patients with paralysis and amputation: a meeting report

    Science.gov (United States)

    Bowsher, K.; Civillico, E. F.; Coburn, J.; Collinger, J.; Contreras-Vidal, J. L.; Denison, T.; Donoghue, J.; French, J.; Getzoff, N.; Hochberg, L. R.; Hoffmann, M.; Judy, J.; Kleitman, N.; Knaack, G.; Krauthamer, V.; Ludwig, K.; Moynahan, M.; Pancrazio, J. J.; Peckham, P. H.; Pena, C.; Pinto, V.; Ryan, T.; Saha, D.; Scharen, H.; Shermer, S.; Skodacek, K.; Takmakov, P.; Tyler, D.; Vasudevan, S.; Wachrathit, K.; Weber, D.; Welle, C. G.; Ye, M.

    2016-04-01

    Objective. The Food and Drug Administration’s (FDA) Center for Devices and Radiological Health (CDRH) believes it is important to help stakeholders (e.g., manufacturers, health-care professionals, patients, patient advocates, academia, and other government agencies) navigate the regulatory landscape for medical devices. For innovative devices involving brain–computer interfaces, this is particularly important. Approach. Towards this goal, on 21 November, 2014, CDRH held an open public workshop on its White Oak, MD campus with the aim of fostering an open discussion on the scientific and clinical considerations associated with the development of brain–computer interface (BCI) devices, defined for the purposes of this workshop as neuroprostheses that interface with the central or peripheral nervous system to restore lost motor or sensory capabilities. Main results. This paper summarizes the presentations and discussions from that workshop. Significance. CDRH plans to use this information to develop regulatory considerations that will promote innovation while maintaining appropriate patient protections. FDA plans to build on advances in regulatory science and input provided in this workshop to develop guidance that provides recommendations for premarket submissions for BCI devices. These proceedings will be a resource for the BCI community during the development of medical devices for consumers.

  7. Monitoring functional capability of individuals with lower limb amputations using mobile phones.

    Directory of Open Access Journals (Sweden)

    Mark V Albert

    Full Text Available To be effective, a prescribed prosthetic device must match the functional requirements and capabilities of each patient. These capabilities are usually assessed by a clinician and reported by the Medicare K-level designation of mobility. However, it is not clear how the K-level designation objectively relates to the use of prostheses outside of a clinical environment. Here, we quantify participant activity using mobile phones and relate activity measured during real world activity to the assigned K-levels. We observe a correlation between K-level and the proportion of moderate to high activity over the course of a week. This relationship suggests that accelerometry-based technologies such as mobile phones can be used to evaluate real world activity for mobility assessment. Quantifying everyday activity promises to improve assessment of real world prosthesis use, leading to a better matching of prostheses to individuals and enabling better evaluations of future prosthetic devices.

  8. 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...

  9. Quantum dot-antibody and amputator conjugates shift fluorescence upon binding bacteria

    International Nuclear Information System (INIS)

    CdSe/ZnS quantum dots (QDs) exhibited fluorescence emission blue shifts when conjugated to antibodies or DNA aptamers that are bound to bacteria. The intensity of the shifted emission peak increased with the number of bound bacteria. Curiously, the emission was consistently shifted to approximately 440-460 nm, which is distinctly different from the major component of the natural fluorescence spectrum of these QDs. This minor emission peak can grow upon conjugation to antibodies or aptamers and subsequent binding to bacterial cell surfaces. We hypothesize that the wavelength shift is due to changes in the chemical environment of the QD conjugates when they encounter the bacterial surface and may be due to physical deformation of the QD that changes the quantum confinement state. Regardless of the mechanism, these remarkable emission wavelength shifts of greater than 140 nm in some cases strongly suggest new applications for QD-receptor conjugates

  10. Anthropogenic Radio-Frequency Electromagnetic Fields Elicit Neuropathic Pain in an Amputation Model

    Science.gov (United States)

    Jones, Erick; Romero-Ortega, Mario

    2016-01-01

    Anecdotal and clinical reports have suggested that radio-frequency electromagnetic fields (RF EMFs) may serve as a trigger for neuropathic pain. However, these reports have been widely disregarded, as the epidemiological effects of electromagnetic fields have not been systematically proven, and are highly controversial. Here, we demonstrate that anthropogenic RF EMFs elicit post-neurotomy pain in a tibial neuroma transposition model. Behavioral assays indicate a persistent and significant pain response to RF EMFs when compared to SHAM surgery groups. Laser thermometry revealed a transient skin temperature increase during stimulation. Furthermore, immunofluorescence revealed an increased expression of temperature sensitive cation channels (TRPV4) in the neuroma bulb, suggesting that RF EMF-induced pain may be due to cytokine-mediated channel dysregulation and hypersensitization, leading to thermal allodynia. Additional behavioral assays were performed using an infrared heating lamp in place of the RF stimulus. While thermally-induced pain responses were observed, the response frequency and progression did not recapitulate the RF EMF effects. In vitro calcium imaging experiments demonstrated that our RF EMF stimulus is sufficient to directly contribute to the depolarization of dissociated sensory neurons. Furthermore, the perfusion of inflammatory cytokine TNF-α resulted in a significantly higher percentage of active sensory neurons during RF EMF stimulation. These results substantiate patient reports of RF EMF-pain, in the case of peripheral nerve injury, while confirming the public and scientific consensus that anthropogenic RF EMFs engender no adverse sensory effects in the general population. PMID:26760033

  11. Management of neglected femoral neck fracture in above knee amputated limb: A case report.

    Science.gov (United States)

    Meena, Umesh; Meena, Ramesh; S, Balaji; Gaba, Sahil

    2015-01-01

    The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a chal- lenging situation for both the orthopedic surgeon and the rehabilitation team. These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy. We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected. PMID:26917032

  12. Bipolar hip hemiarthroplasty in a patient with an above knee amputation: a case report

    OpenAIRE

    Liebergall Meir; Schwartz Isabella; Safran Ori; Hernandez Miguel; Kandel Leonid; Mattan Yoav

    2009-01-01

    Abstract The treatment of an above knee amputee who has sustained a fracture of femoral neck is a challenge for both the orthopaedic surgeon and the rehabilitation team. We present a case of such a patient and discuss different difficulties in his treatment.

  13. Coronal plane socket stability during gait in persons with transfemoral amputation: Pilot study.

    Science.gov (United States)

    Fatone, Stefania; Dillon, Michael; Stine, Rebecca; Tillges, Robert

    2014-01-01

    Little research describes which transfemoral socket design features are important for coronal plane stability, socket comfort, and gait. Our study objectives were to (1) relate socket comfort during gait to a rank order of changes in ischial containment (IC) and tissue loading and (2) compare socket comfort during gait when tissue loading and IC were systematically manipulated. Six randomly assigned socket conditions (IC and tissue compression) were assessed: (1) IC and high, (2) IC and medium, (3) IC and low, (4) no IC and high, (5) no IC and medium, and (6) no IC and low. For the six subjects in this study, there was a strong, negative relationship between comfort and changes in IC and tissue loading (rho = -0.89). With the ischium contained, tissue loading did not influence socket comfort (p = 0.47). With no IC, the socket was equally comfortable with high tissue loading (p = 0.36) but the medium (p = 0.04) and low (p = 0.02) tissue loading conditions decreased comfort significantly. Coronal plane hip moments, lateral trunk lean, step width, and walking speed were invariant to changes in IC and/or tissue loading. Our results suggest that in an IC socket, medial tissue loading mattered little in terms of comfort. Sockets without IC required high tissue loading to be as comfortable as those with IC, while suboptimal tissue loading compromised comfort.

  14. Coronal plane socket stability during gait in persons with transfemoral amputation: Pilot study.

    Science.gov (United States)

    Fatone, Stefania; Dillon, Michael; Stine, Rebecca; Tillges, Robert

    2014-01-01

    Little research describes which transfemoral socket design features are important for coronal plane stability, socket comfort, and gait. Our study objectives were to (1) relate socket comfort during gait to a rank order of changes in ischial containment (IC) and tissue loading and (2) compare socket comfort during gait when tissue loading and IC were systematically manipulated. Six randomly assigned socket conditions (IC and tissue compression) were assessed: (1) IC and high, (2) IC and medium, (3) IC and low, (4) no IC and high, (5) no IC and medium, and (6) no IC and low. For the six subjects in this study, there was a strong, negative relationship between comfort and changes in IC and tissue loading (rho = -0.89). With the ischium contained, tissue loading did not influence socket comfort (p = 0.47). With no IC, the socket was equally comfortable with high tissue loading (p = 0.36) but the medium (p = 0.04) and low (p = 0.02) tissue loading conditions decreased comfort significantly. Coronal plane hip moments, lateral trunk lean, step width, and walking speed were invariant to changes in IC and/or tissue loading. Our results suggest that in an IC socket, medial tissue loading mattered little in terms of comfort. Sockets without IC required high tissue loading to be as comfortable as those with IC, while suboptimal tissue loading compromised comfort. PMID:25629691

  15. Mobility of people with lower limb amputations : scales and questionnaires: a review

    NARCIS (Netherlands)

    Rommers, G.M.; Groothoff, J.W.; Eisma, W.H.

    2001-01-01

    Objective and design: A systematic literature review to compare mobility scales used for lower limb amputees. A literature search was carried out by computerized search of biomedical literature including Medline and Embase. The studies included were published between 1978 and 1998 and including the

  16. Development of prosthetic knee joint technologies for children and youth with above-knee amputations

    NARCIS (Netherlands)

    Andrysek, J.

    2009-01-01

    Mobility and participation in physical activity is of primary importance for children with limb absence or loss. A prosthetic knee joint is an essential facilitator of this, providing controlled articulation to enable sitting, standing, and natural, safe and efficient movements during mobility. Desp

  17. USE OF LOPINAVIR/RITONAVIR ASSOCIATED WITH ERGOTAMINE RESULTING IN FOOT AMPUTATION: BRIEF COMMUNICATION

    OpenAIRE

    Fernando Raphael de Almeida Ferry; Guilherme Almeida Rosa Da Silva; Rogerio Neves Motta; Ricardo de Souza Carvalho; Carlos Alberto Morais De Sá

    2014-01-01

    A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 m...

  18. Completely thoracoscopic pulmonary vein isolation with ganglionic plexus ablation and left atrial appendage amputation for treatment of atrial fibrillation

    NARCIS (Netherlands)

    A. Yilmaz; G.S.C. Geuzebroek; B.P. van Putte; L.V.A. Boersma; U. Sonker; J.M.T. de Bakker; W.J. van Boven

    2010-01-01

    Objective: Percutaneous catheter pulmonary vein isolation (PVI) has been the preferred choice for invasive treatment of symptomatic, drug-refractory lone atrial fibrillation (AF). Incomplete ablation lines, procedure-related morbidity and long-term success remain, however, a problem. A minimally inv

  19. An Overview of the Running Performance of Athletes with Lower-Limb Amputation at the Paralympic Games 2004–2012

    Directory of Open Access Journals (Sweden)

    Hossein Hassani

    2015-06-01

    Full Text Available This paper analyses the performances of lower-limb amputees in the 100, 200 and 400 m running events from the 2004, 2008 and 2012 Paralympic Games. In this paper, four hypotheses are pursued. In the first, it investigates whether the running performance of lower-limb amputees over three consecutive Paralympic Games has changed. In the second, it asks whether a bi-lateral amputee has a competitive advantage over a uni-lateral amputee. In the third, the effect of blade classification has been considered and we attempt to see whether amputees in various classifications have different level of performance. Finally, it is considered whether the final round of competition obtains different levels of performance in comparison to the qualification heats. Based on the outcomes of these investigations, it is proposed that future amputee-based running events should be undertaken with separate and not combined events for the T42, T43 and T44 classifications at the Paralympic Games.

  20. Job satisfaction and health experience of people with a lower-limb amputation in comparison with healthy colleagues

    NARCIS (Netherlands)

    Schoppen, Tanneke; Boonstra, A; Groothoff, JW; de Vries, J; Goeken, LN; Eisma, Willem

    2002-01-01

    Objectives: To describe indicators of job dissatisfaction among amputee employees and to compare job satisfaction and health experience of working amputee employees with that of control subjects. Design: A cross-sectional study, mailed questionnaire. Setting: Patients were recruited by the orthopedi

  1. The psychological rehabilitation nursing of the patients who have ten- finger complete amputation and survived after replantation

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To explore the mental dynamic change of the ten -finger replanted patients, to give psychological rehabilitation guidance, and to improve the survival of the replantation and function recovery. Methods Take psychological investigation with Scl-90 at different periods after operation, judge the exsisting negative psychological factors, and find the countermeasure of solution. Enable the patients to break away from the negative mentations in short period. Results Through the 1 -week, 8 -week and 16 -week Scl - 90 measurements after operation, we found that all the items' score of the three times measurement was higher thanthe usual modellp <0. 05), and fiufuated up and down with mental charadedstics of different phases. The assessment of the replantation of the severed finger was good. Conclusion The psychological state of the patient would affect the survivial and function recovery of the replantation of severed finger directly. 5o the psychological rehabilitation nursing should be performed throughout the disease.

  2. A Patient-Controlled Analgesia Adaptor to Mitigate Postsurgical Pain for Combat Casualties With Multiple Limb Amputation: A Case Series.

    Science.gov (United States)

    Pasquina, Paul F; Isaacson, Brad M; Johnson, Elizabeth; Rhoades, Daniel S; Lindholm, Mark P; Grindle, Garrett G; Cooper, Rory A

    2016-08-01

    The use of explosive armaments during Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn has resulted in a significant number of injured U.S. service members. These weapons often generate substantial extremity trauma requiring multiple surgical procedures to preserve life, limb, and restore function. For those individuals who require multiple surgeries, the use of patient-controlled analgesia (PCA) devices can be an effective way to achieve adequate pain management and promote successful rehabilitation and recovery during inpatient treatment. A subpopulation of patients are unable to independently control a PCA device because of severe multiple limb dysfunction and/or loss. In response to the needs of these patients, our team designed and developed a custom adaptor to assist service members who would otherwise not be able to use a PCA. Patient feedback of the device indicated a positive response, improved independence, and overall satisfaction during inpatient hospitalization. PMID:27483540

  3. The perception of trauma patients from social support in adjustment to lower-limb amputation: A qualitative study

    Directory of Open Access Journals (Sweden)

    Sousan Valizadeh

    2014-01-01

    Conclusion: Given the high number of physical, mental and social problems in trauma patients, identifying and strengthening support sources can be effective in their adaptation with the disease and improvement of the quality of their life.

  4. Bilateral Lower Limb Amputations in a Nigerian Child Following High-Voltage Electrical Burns Injury: A Case Report

    OpenAIRE

    Dim, EM; Amanari, OC; Nottidge, TE; Inyang, UC; Nwashindi, A

    2013-01-01

    Abstract The human body conducts electricity very well. Direct contact with electric current can be lethal. The passage of electric current through the body is capable of producing a wide spectrum of injuries, including serious damage to the heart, brain, skin and muscles. Naked high-voltage electric cables negligently abandoned in residential, commercial and industrial areas are a recipe for disaster. This is a case report of a 5-year girl child who had bilateral lower limb gangrene followin...

  5. Whole again and how to get there. An Anthropological Study of Experience and Identity in Cases of Leg Amputation

    DEFF Research Database (Denmark)

    Østergaard, Elisabeth Bomholt

    2007-01-01

    are relevant. IMPLICATIONS: The ritual perspective can be used in relation to crisis, diseases and handicaps. It inspires us to consider the individual human crisis in a society perspective, and it directs the attention to the characteristics of liminality and to the bodily aspect of reintegration into society...

  6. 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

    This article discusses how the simplification of adaptation can actually empower a translation with a historically and culturally significant function. The study analyses and discusses the fairly unknown first Danish translation of Herman Melville’s classic novel Moby Dick made in 1942. The trans...... on the back cover of the book, but what is a man’s book? The aim of this study is to draw attention to an interesting story of translation strategies for a male readership as well as to provide new insight into verbal adaptations classified as interlingual translation...

  7. Memantine (a N-Methyl-D-aspartate receptor antagonist) in the treatment of neuropathic pain after amputation or surgery: A randomised, double-blinded, crossover study

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Gottrup, Hanne; Kristensen, Anders Due;

    2000-01-01

    (pressure and von Frey hair). A total of 15 patients (12 amputees and three patients with other nerve injuries) completed the study. There was no difference between memantine and placebo on any of the outcome measures. We conclude that memantine at a dosage of 20 mg/d does not reduce spontaneous or evoked...

  8. Lethal lesions and amputation caused by plastic debris and fishing gear on the loggerhead turtle Caretta caretta (Linnaeus, 1758). Three case reports from Terceira Island, Azores (NE Atlantic).

    Science.gov (United States)

    Barreiros, João P; Raykov, Violin S

    2014-09-15

    In this note we report and discuss three cases involving two serious injuries and one death on three specimens of the loggerhead turtle Caretta caretta, found in Terceira Island, Azores (NE Atlantic). Plastic debris and lost/discarded fishing gear caused these accidents. In fact, these types of marine litter are known to cause several accidents all over the world involving many taxa. However, we think that this issue has probably a much wider impact and detected cases such as those reported here are but just a small sample of the whole unknown dimension of this serious marine pollution problem. PMID:25066455

  9. Study of the effect of physical therapy on patients with above knee amputation%运动疗法对大腿截肢患者的疗效探讨

    Institute of Scientific and Technical Information of China (English)

    常冬梅; 纪树荣; 郭辉; 张琦

    2002-01-01

    目的研究运动疗法对大腿截肢患者康复的疗效.方法对50例大腿截肢患者于运动疗法前后利用FIM评测表进行评定.结果大腿截肢患者运动疗法训练后FIM评分与训练前相比有显著性差异( P<0.05).结论运动疗法对大腿截肢患者有确切的康复疗效.

  10. Des voix des aïeules à Sylvie Vartan : paroles et chants de femmes dans l’Afrique contemporaine dans La mémoire amputée de Werewere Liking

    OpenAIRE

    Colombo, Laura

    2011-01-01

    La connivence entre la femme et la parole a toujours été reconnue, et l’écriture féminine paraît également marquée par une grande présence de l’oralité. Dans le roman, le discours prime souvent sur le récit, et l’abondance des dialogues instaure également une interaction avec le lecteur, finalisée à un changement des mentalités. Werewere Liking, artiste polyvalente, enrichit ces mécanismes, et les acquis du féminisme, en les inscrivant dans une tradition multiséculaire. Elle crée des chants-r...

  11. Avaliação isocinética do membro inferior de atleta com amputação transtibial: estudo de caso = Isokinetic assessment of lower limb in an athlete with below-knee amputation: a case study

    Directory of Open Access Journals (Sweden)

    Polidoro, Bruno Seara

    2014-01-01

    Conclusões: É fundamental um período de adaptação no dinamômetro isocinético em atletas com amputação de membro inferior, para familiarização na execução dos movimentos concêntricos e excêntricos. A ausência ou ineficiência dessa adaptação poderá comprometer os dados para a composição de protocolos de tratamento e/ou treinamento do atleta com amputação

  12. Amputação dos membros inferiores na criança: relato e experiência em 21 casos Lower limb amputation in children: report and experience in 21 cases

    OpenAIRE

    William Dias Belangero; Bruno Livani; Alessando Janson Angelini; Michael Davitt

    2001-01-01

    Os autores apresentam os resultados de 21 pacientes, com idade média de 6 anos, submetidos à 26 amputações do membro inferior por malformações congênitas (14), infecções (06) e outras. Discute-se os procedimentos, as complicações, as vantagens e desvantagens de cada nível de amputação. Concluem que a amputação na criança continua sendo uma opção a ser considerada, principalmente por propiciar rápida recuperação funcional e social do paciente.It is reported the experience in 21 patients, avera...

  13. 抽脂结合腓肠神经内侧头离断术在小腿塑形中的应用%Application of liposuction combined with the amputation of sural nerve medial head in calf shaping

    Institute of Scientific and Technical Information of China (English)

    常文超; 孙肇晟; 张敬德

    2013-01-01

    目的:探索抽脂结合腓肠神经内侧头离断在改善小腿外形的临床疗效.方法:通过腘窝皮肤皱襞处取3 ~ 5cm横切口,抽取脂肪结合离断腓肠神经内侧头,使皮下脂肪容积减少和腓肠肌内侧头失神经萎缩,达到小腿塑形的目的.测量并记录小腿周径和外形的变化.结果:本组14例患者行皮下抽脂结合离断腓肠神经内侧支术后,小腿最大周径缩小(3.5±1.5) cm.小腿内径曲线变得平缓.抽脂结合离断腓肠神经内侧头术后,患者休息2~3天后可下床行走,早期有轻度不适,适应2天后症状基本消失.随访半年,站立、行走等日常活动未受影响.结论:抽脂结合离断腓肠神经内侧头术,可缩小小腿容积,改善小腿外形,方法简便、安全,效果明显,同时不影响患者的日常功能活动.%Objective Explore the curative clinical effect about liposuction combined with dividing the caput mediale of the sural nerve to improve the appearance of the crus.Methods Take the 3~5cm transverse incision on the skin folds of popliteal fossa,extract fat combined with dividing the caput mediale of the sural nerve to reach the goal of the reduction of subcutaneous fat and caput mediale of gastrocnemius nerve atrophy.Measure and record changes in circumference and shape of the calf.Result This group of 14 patients who underwent subcutaneous liposuction combined with medial branch away from the sural nerve,postoperative the largest circumference of calf reduces (3.5±1.5)cm.The inside diameter curve of the calf flattens.Patients can walk normally after the rest for 2~3days after surgery,when they underwent liposuction combining with medial branch away from the sural nerve,they will have mild discomfort in the early stage,the symptoms will disappear after 2days.Follow-up for six months,standing,walking and other daily activities were not affected.Conclusion Liposuction and medial branch being away from the sural nerve can cause the reduction of calf's volume and improve the shape of the calf,the method is convenient,safe and effective,at the same time it doesn't affect the patients' daily activities.

  14. Causative analysis on postoperative patients with vascellum articulo after underwent replantation of amputated finger and its countermeasure%断指再植术后血管危象的原因分析及对策

    Institute of Scientific and Technical Information of China (English)

    邵建云

    2005-01-01

    @@ 血管危象是指由于某种原因导致患肢血液循环障碍,进而影响断指动脉血供或静脉回流.断指再植术后,护理人员积极预防、及时发现和正确处理术后血管危象,对于提高断指再植成活率具有重要意义.我院自2003年1月-2004年6月为75例96指断指病人进行再植,术后发生血管危象11指.本文对术后出现血管危象的原因进行回顾性分析,并提出护理对策.

  15. Influence of transfusion speed on formation of vascular articulo patients after replantation of amputated finger%输液时速对断指再植术后血管危象形成的影响

    Institute of Scientific and Technical Information of China (English)

    李丽娟; 陶艳玲; 杨毅华; 陈丽璇; 李健清

    2007-01-01

    [目的]探讨输液时限及输液速度对断指再植术后血管危象形成的影响.[方法]将149例断指再植病人分为实验组75例和对照组74例.对照组按常规方法输液,实验组则在输液速度、输液时限上实施干预,比较两组血管危象的发生率及断指再植成活率.[结果]实验组血管危象发生率明显低于对照组(P<0.05);断指再植成活率明显高于对照组(P<0.05).[结论]在血管危象发生的高危时期(术后1周内)采取24 h持续缓慢匀速滴入液体,有助于减少血管危象的发生.

  16. "5·12"汶川地震伤员截肢时机对预后的影响%A retrospective study on the amputation time and prognosis of the amputees wounded in the"5·12"earthquake

    Institute of Scientific and Technical Information of China (English)

    李效全; 刘佳易; 李自会; 舒为民

    2009-01-01

    目的 探讨地震灾害群体伤事件时,伤员截肢的时机对术后伤员康复的影响.方法 地震伤住院病员中有22例不同部位肢体截肢,按截肢时间分为急诊截肢组18例和延迟截肢组4例,对比分析截肢时机对术后伤口愈合、 感染、二次截肢、术后并发症、特殊感染的影响.结果 两组术后切口感染率比较,差异有显著性意义(P<0.01);并发 症发生率比较,差异有显著性意义(P<0.05);术后感染后二次截肢率比较,差异无显著性意义(P>0.05);特殊感染 发生率比较,差异无显著性意义(P>0.05).结论 地震灾害群体伤事件时,有截肢指征的伤员在入院后12小时内截 肢能有效降低伤员术后伤口感染率及并症发生率,提高医疗救治质量.

  17. Avaliação isocinética do membro inferior de atleta com amputação transtibial: estudo de caso = Isokinetic assessment of lower limb in an athlete with below-knee amputation: a case study

    OpenAIRE

    Polidoro, Bruno Seara

    2014-01-01

    Objetivos: Avaliar os efeitos de um treinamento isocinético no pico de torque e na potência máxima dos músculos flexores e extensores de joelho e quadril em um atleta amputado de membro inferior. Descrição do caso: Avaliou-se um atleta de Triathlon com 27 anos de idade com amputação congênita do terço proximal da tíbia à direita, usuário de prótese de alta performance para corrida. Realizou-se perimetria de ambos os membros inferiores, mensuração do pico de torque e mensuração da potência ...

  18. JRRD Then & Now: Commentary on Troedsson’s 1964 article "Stump arterial circulation and its relationship to the prescription of a prosthesis for the geriatric patient"

    Directory of Open Access Journals (Sweden)

    Joan E. Sanders, PhD

    2013-08-01

    Full Text Available hough the reasons for amputation since 1964 have shifted from primarily disease (93% disease, 5% trauma [1] to a closer balance between disease and trauma (55% disease, 45% trauma [2], a major challenge faced by the amputation surgeon continues to be selection of the appropriate level of amputation.

  19. JRRD Then & Now: Commentary on Troedsson’s 1964 article "Stump arterial circulation and its relationship to the prescription of a prosthesis for the geriatric patient"

    OpenAIRE

    Joan E. Sanders, PhD

    2013-01-01

    hough the reasons for amputation since 1964 have shifted from primarily disease (93% disease, 5% trauma) [1] to a closer balance between disease and trauma (55% disease, 45% trauma) [2], a major challenge faced by the amputation surgeon continues to be selection of the appropriate level of amputation.

  20. Ambulation and independence among Veterans with nontraumatic bilateral lower–limb loss

    Directory of Open Access Journals (Sweden)

    Sherene E. Sharath, MPH

    2015-11-01

    Full Text Available In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17 were bilateral transfemoral amputations (TFAs; bilateral transtibial amputations (TTAs and TFA–TTA accounted for the rest (33% and 25%, respectively. Of the 19 (48% patients who were ambulatory prior to bilateral amputation, only 2 (11% remained ambulatory after the second amputation, while 17 (89% patients lost ambulatory capabilities. Compared with those who were amputation (p = 0.03. All patients with bilateral TFA were nonambulatory. Independence postcontralateral amputation decreased from 88% (35 to 53% (21. When data were available (58%, pre and post Functional Independence Measure scores showed a decrease in 74% of patients, while 22% showed an increase. In conclusion, bilateral lower–limb amputation among dysvascular Veterans is highly associated with a loss of ambulation.

  1. Ambulation and independence among Veterans with nontraumatic bilateral lower-limb loss.

    Science.gov (United States)

    Sharath, Sherene; Henson, Helene; Flynn, Stacy; Pisimisis, George; Kougias, Panos; Barshes, Neal R

    2015-01-01

    In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17) were bilateral transfemoral amputations (TFAs); bilateral transtibial amputations (TTAs) and TFA-TTA accounted for the rest (33% and 25%, respectively). Of the 19 (48%) patients who were ambulatory prior to bilateral amputation, only 2 (11%) remained ambulatory after the second amputation, while 17 (89%) patients lost ambulatory capabilities. Compared with those who were amputation (p = 0.03). All patients with bilateral TFA were nonambulatory. Independence postcontralateral amputation decreased from 88% (35) to 53% (21). When data were available (58%), pre and post Functional Independence Measure scores showed a decrease in 74% of patients, while 22% showed an increase. In conclusion, bilateral lower-limb amputation among dysvascular Veterans is highly associated with a loss of ambulation. PMID:26745753

  2. Phantom pain and phantom sensations in upper limb amputees : an epidemiological study

    NARCIS (Netherlands)

    Kooijman, CM; Dijkstra, PU; Geertzen, JHB; Elzinga, A; van der Schans, CP

    2000-01-01

    Phantom pain in subjects with an amputated limb is a well-known problem. However, estimates of the prevalence of phantom pain differ considerably in the literature. Various factors associated with phantom pain have been described including pain before the amputation, gender, dominance, and time elap

  3. Determining asymmetry of roll-over shapes in prosthetic walking

    NARCIS (Netherlands)

    Curtze, C.; Otten, B.; Hof, A.L.; Postema, K.

    2011-01-01

    How does the inherent asymmetry of the locomotor system in people with lower-limb amputation affect the ankle-foot roll-over shape of prosthetic walking? In a single-case design, we evaluated the walking patterns of six people with lower-limb amputation (3 transtibial and 3 transfemoral) and three m

  4. Beta-blocker use and clinical outcomes after primary vascular surgery

    DEFF Research Database (Denmark)

    Høgh, A.; Lindholt, J.S.; Nielsen, Henrik;

    2013-01-01

    To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.......To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction....

  5. Microsurgically aided upper lip replantation – case report and literature review

    Science.gov (United States)

    Gustafsson, Jonas; Lidén, Mattias; Thorarinsson, Andri

    2016-01-01

    Abstract A case with a patient who suffered an upper lip amputation and a lower lip laceration due to dog bite is presented. The amputated segment was replanted using microsurgical technique. The operative technique and postoperative care is presented, as well as a review of the current literature on the subject. PMID:27713916

  6. [The "diabetic foot" syndrome. An overview].

    Science.gov (United States)

    Chantelau, E

    1999-01-01

    Amputation has been used most frequently to treat the diabetic foot syndrome, occlusive microangiopathy being suspected as the underlying cause. This paradigm is obsolete: most diabetic foot lesions are due to traumatic painless (neuropathic) infections. Evidence is presented for alternative treatment strategies to effectively reduce exorbitant amputation rates in diabetic patients.

  7. THE GAIT OF UNILATERAL TRANSFEMORAL AMPUTEES

    NARCIS (Netherlands)

    BOONSTRA, AM; SCHRAMA, J; FIDLER, [No Value; EISMA, WH

    1994-01-01

    The aim of this study was to describe the gait of persons with a unilateral transfemoral amputation by means of a questionnaire, gait analysis and measurement of energy expenditure, and to find correlations among the variables studied. The study included 29 transfemoral amputees amputated for other

  8. Trans-femoral amputee pilots: criteria for return to the fighter cockpit.

    Science.gov (United States)

    Grossman, Alon; Goldstein, Liav; Heim, Michael; Barenboim, Erez; Dudkiewicz, Israel

    2005-04-01

    Proximal lower limb amputations (trans-femoral) usually leave amputees with significant functional disturbances. This article contains information regarding three pilots with trans-femoral amputations that returned swiftly to continue their aeronautical careers despite their disabilities. Adaptations are needed in the limb prostheses to enable the amputees to access the minimally spaced cockpit.

  9. Phantom limb pain: a case of maladaptive CNS plasticity?

    DEFF Research Database (Denmark)

    Flor, Herta; Nikolajsen, Lone; Jensen, Troels Staehelin

    2006-01-01

    Phantom pain refers to pain in a body part that has been amputated or deafferented. It has often been viewed as a type of mental disorder or has been assumed to stem from pathological alterations in the region of the amputation stump. In the past decade, evidence has accumulated that phantom pain...

  10. The stump and the prosthesis.

    OpenAIRE

    Day, H. J.

    1980-01-01

    In performing amputations the surgeon must bear in mind the biomechanical and other constraints of the prosthesis likely to be fitted and, so far as possible, should fashion the stump accordingly. The various types of prosthesis and their features are discussed in relation to amputations of the lower and upper limbs at all levels.

  11. The effects of rotation and positional change of stump tissues upon morphogenesis of the regenerating axolotl limb

    NARCIS (Netherlands)

    Carlson, Bruce M.

    1972-01-01

    Rotation of a skin cuff 180° around the proximodistal axis of the upper arm in the axolotl results in the formation of multiple regenerates in about 80° of cases after amputation of the limb through the rotated skin. Rotation of the dermis or the flexor and extensor muscles folowed by amputation pro

  12. A Systematic Review

    Directory of Open Access Journals (Sweden)

    Christine Eiser

    1999-01-01

    Full Text Available Purpose. We conducted a systematic search of published literature, to assess (i quality of life (QoL for survivors of a bone tumour compared with the normal population; (ii QoL implications following amputation, successful or failed limb salvage; (iii adaptation of young children to amputation compared with older children or adolescents.

  13. Amputees and sports : a systematic review

    NARCIS (Netherlands)

    Bragaru, M.; Dekker, R.; Geertzen, J.H.B.; Dijkstra, P.U.

    2011-01-01

    Amputation of a limb may have a negative impact on the psychological and physical well-being, mobility and social life of individuals with limb amputations. Participation in sports and/or regular physical activity has a positive effect on the above mentioned areas in able-bodied individuals. Data co

  14. The stump and the prosthesis.

    Science.gov (United States)

    Day, H J

    1980-03-01

    In performing amputations the surgeon must bear in mind the biomechanical and other constraints of the prosthesis likely to be fitted and, so far as possible, should fashion the stump accordingly. The various types of prosthesis and their features are discussed in relation to amputations of the lower and upper limbs at all levels.

  15. Stress Distribution in Implant Retained Finger Prosthesis: A Finite Element Study

    OpenAIRE

    Amornvit, Pokpong; Rokaya, Dinesh; Keawcharoen, Konrawee; Thongpulsawasdi, Nimit

    2013-01-01

    Background: Finger amputation may result from congenital cause, trauma, infection and tumours. The finger amputation may be rehabilitated with dental implant-retained finger prosthesis. The success of implant-retained finger prosthesis is determined by the implant loading. The type of the force is a determining factor in implant loading.

  16. Prospective cohort study on surgical wounds comparing a polyhexanide-containing biocellulose dressing with a dialkyl-carbamoyl-chloride-containing hydrophobic dressing

    DEFF Research Database (Denmark)

    Nielsen, Anna Marie; Andriessen, Anneke

    2012-01-01

    Postsurgery dressing changes in diabetic foot amputation wounds and surgical wounds healing by secondary intention are often conducted in the operating room under general anesthesia. A prospective comparative cohort study was performed in 60 patients (n = 60: n = 30/n = 30) with secondary......-intention surgical wounds (82% had forefoot and/or digit[s] amputations) to compare 2 different dressing types....

  17. Upper-limb thrombo-embolectomy: national cohort study in Denmark

    DEFF Research Database (Denmark)

    Andersen, L V; Mortensen, L S; Lindholt, Jes S.;

    2010-01-01

    We investigated the incidence of thrombo-embolectomy in upper-limb and prognosis with respect to arm amputation, stroke and death.......We investigated the incidence of thrombo-embolectomy in upper-limb and prognosis with respect to arm amputation, stroke and death....

  18. Maslow's hierarchy of needs theory of care in 16 patients with traumatic amputation%马斯洛需要层次理论在16例创伤性截肢患者术后护理中的应用

    Institute of Scientific and Technical Information of China (English)

    宋良云

    2009-01-01

    目的:应用马斯洛需要层次理论护理创伤性截肢患者.方法:对16例创伤性截肢的患者,应用马斯洛需要层次理论进行护理.结果:13例恢复良好,重返工作岗位学习工作,3例因复合伤截瘫.结论:截肢术后患者,针对不同的人格特征,满足其各层次的需要,使其克服困难,珍惜生命,提高生活质量.

  19. 断指再植术后应用脉搏血氧饱和度仪早期发现血管危象的研究%A study on application of pulse blood oxygen saturation meter in early finding of blood vessel articulo in patients after replantation of amputated finger

    Institute of Scientific and Technical Information of China (English)

    孟宪玲; 苗凤珍; 李丽; 任晓凤; 靳彩霞; 董晶

    2006-01-01

    [目的]早期发现血管危象的发生,提高再植指成活率.[方法]将病人分为A组和B组,A组56例76指,于断指再植术后1 d~5 d内应用脉搏血氧饱和度仪监测再植指和对侧相应健指的经皮血氧饱和度(SpO2);B组为30例48指断指再植术后发生血管危象的病人,于危象时立即监测再植指和对侧相应健指的SpO2变化.[结果]A组再植指与健指SpO2变化无统计学意义(P>0.05),而B组再植指与健指SpO2差异有统计学意义(P<0.01).[结论]应用脉搏血氧饱和度仪对再植指进行SpO2监测,能及时发现血管危象,并有助于分析血管危象的类型.

  20. Perfil de clientes submetidos a amputações relacionadas ao diabetes mellitus Perfíl del paciente sometido a la amputación relacionada a el diabestes mellitus Profile of patients submitted to amputation related to diabetes mellitus

    OpenAIRE

    Darlene Mara dos Santos Tavares; Flávia Aparecida Dias; Luciana Rabelo Araújo; Gilberto de Araújo Pereira

    2009-01-01

    Estudo retrospectivo que objetivou descrever as características sócio-demográficas e clínicas de 141 sujeitos, internados no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro, submetidos à amputação relacionada ao diabetes; comparar o número de amputações de acordo com as variáveis sexo, faixa etária, co-morbidades e tipo de tratamento e associar o número de amputações com o tempo de internação e de diagnóstico. Os dados coletados em prontuários totalizaram 208 amputações. Mai...