Surgical excision of P3 fragments in 86 declawed cats: case series (2013-2023).

CASE SERIES SUMMARY: This case series describes the clinical findings and surgical intervention of 86 declawed cats; 52 from a shelter or rescue and 34 owned cats. Historical reports from owners and shelter staff included house-soiling, biting behavior, repelling behavior, barbering, lameness, chronic digit infection and nail regrowth. All the cats had fragments of the third phalanx (P3) of varying sizes diagnosed on radiographs. Pathology visible on examination included digital subcutaneous swelling, ecchymosis, malaligned digital pads, ulcerations, exudate, tendon contracture, nail regrowth and callusing. Surgery was pursued in these cases to remove the P3 fragments, relieve tendon contracture and reposition the digital pads with an anchoring suture. Gross findings intraoperatively included fragmented growth of cornified and non-cornified nail tissue, osteophytes on the surface of the second phalanx, deep digital flexor tendon calcification, and both bacterial and sterile exudate. The most common complication 14 days postoperatively was mild (14%) to moderate (1%) lameness. All historical parameters recorded improved in both populations of cats (house-soiling, biting behavior, repelling behavior, barbering, lameness, tendon contracture and chronic digit infection). Postoperatively, 1/47 cats exhibited continued malalignment of two digital pads and there were no reports of long-term postoperative lameness. RELEVANCE AND NOVEL INFORMATION: Two methods of declawing cats are detailed in the veterinary literature, including partial amputation of P3 and disarticulation of the entire P3 bone. The novel information in this report includes historical and clinical signs of declawed cats with P3 fragments, intraoperative gross pathology, surgical intervention and the postoperative follow-up results.

Prospective evaluation of canine partial limb amputation with socket prostheses.

BACKGROUND: Canine prostheses have been commercially available for many years but are still in early stages of research, development, and clinical application. OBJECTIVE: To prospectively investigate mid-term clinical outcomes of partial limb amputation with a socket prosthesis (PLASP) in canine patients via a descriptive prospective clinical case series and to describe a clinical protocol for PLASP. METHODS: Client-owned dogs (n = 12) with distal limb pathology for which total limb amputation was recommended were enrolled. Partial limb amputation was performed and a socket prosthesis was moulded and fitted to the limb. Complications, clinical follow-up, and objective gait analysis (OGA) were recorded for at least 6 months. An online survey was completed by owners after study completion. RESULTS: Ten dogs with thoracic limb pathology and two with pelvic limb pathology were included. The most common site of amputation was mid-radius (n = 5). Eleven of 12 dogs demonstrated quadrupedal gait on OGA with mean per cent body weight distribution (%BWD) of 26% on thoracic limb prostheses and a %BWD of 16% for the one pelvic limb prosthesis that OGA data were available for. Complications included prosthesis suspension difficulties (n = 5), pressure sores (4), bursitis (4), postoperative infection (3), prosthesis aversion (2), dermatitis (1), and owner noncompliance (1). Two owners elected to discontinue prosthesis use. CONCLUSIONS: PLASP allowed restoration of quadrupedal gait patterns in most patients. Owners reported overall positive satisfaction, though a high complication rate was observed. PLASP should be considered in select cases as an alternative to total limb amputation for dogs with distal limb pathology.

[Moschella island flap for coverage of thumb defects]. / Homodigitaler Insellappen nach Moschella zur Defektdeckung am Daumen.

OBJECTIVE: The homodigital island flap according to Moschella is used to cover palmar and radiodorsal soft tissue defects of the thumb. INDICATIONS: Soft tissue reconstruction of the thumb with exposed bone and/or tendon if reconstruction of the soft tissue is required. CONTRAINDICATIONS: Extensive scars in the harvesting area of the flap; vascular occlusions of the radial artery. SURGICAL TECHNIQUE: After Doppler sonographic imaging of the origin of the vessel radially at the thumb, the pivot point is determined. The flap is then cut from ulnar to radial, including the dorsoradial artery of the thumb. Removal of the origin of the vessel from the radial artery in the tabatiére and preparation from proximal to distal to the pivot point of the flap at the junction of the artery with the palmar vessels. If necessary, a part of the skin can remain palmar to the pivot point to improve venous drainage. The donor site of the flap can primarily close defect sizes up to 5â€¯× 4 cm. POSTOPERATIVE MANAGEMENT: Until wound healing, soft cotton dressing should protect the vascular pedicle from pressure; immobilisation on a palmar splint may be helpful. RESULTS: In 9 men, sufficient soft tissue reconstruction of thumb defects could be achieved with the described Moschella flap. Eight patients had additional injuries to the fingers and hand.

Surgical management for isolated macrodactyly in an adult PIK3CA mutant.

Isolated macrodactyly in adults caused by mosaic pattern PIK3CA mutation can result in significant functional impairment and psychological burden. Due to the rarity of this condition there are no clear treatment guidelines, and those few available are focused on paediatric cases. Reports on surgical management of isolated macrodactyly in adults are lacking. We present here the surgical management through partial amputation of enlarged rays of the right hand in an individual affected by low-grade mosaic PIK3CA mutation.

Optimization of the antibiotic management of diabetic foot infections: protocol for two randomized controlled trials.

BACKGROUND: Few studies have addressed the appropriate duration of antibiotic therapy for diabetic foot infections (DFI) with or without amputation. We will perform two randomized clinical trials (RCTs) to reduce the antibiotic use and associated adverse events in DFI. METHODS: We hypothesize that shorter durations of postdebridement systemic antibiotic therapy are noninferior (10% margin, 80% power, alpha 5%) to existing (long) durations and we will perform two unblinded RCTs with a total of 400 DFI episodes (randomization 1:1) from 2019 to 2022. The primary outcome for both RCTs is remission of infection after a minimal follow-up of 2 months. The secondary outcomes for both RCTs are the incidence of adverse events and the overall treatment costs. The first RCT will allocate the total therapeutic amputations in two arms of 50 patients each: 1 versus 3 weeks of antibiotic therapy for residual osteomyelitis (positive microbiological samples of the residual bone stump); or 1 versus 4 days for remaining soft tissue infection. The second RCT will randomize the conservative approach (only surgical debridement without in toto amputation) in two arms with 50 patients each: 10 versus 20 days of antibiotic therapy for soft tissue infections; and 3 versus 6 weeks for osteomyelitis. All participants will have professional wound debridement, adequate off-loading, angiology evaluation, and a concomitant surgical, re-educational, podiatric, internist and infectiology care. During the surgeries, we will collect tissues for BioBanking and future laboratory studies. DISCUSSION: Both parallel RCTs will respond to frequent questions regarding the duration of antibiotic use in the both major subsets of DFIs, to ensure the quality of care, and to avoid unnecessary excesses in terms of surgery and antibiotic use. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04081792. Registered on 4 September 2019.

Experiencias del uso de ortoprótesis de mano impresa en 3D (Cyborg Beast) en adolescentes con amputación congénita de mano y sus cuidadores principales: un estudio de casos / Experiences of the use of 3D printed hand ortoprosthesis (Cyborg Beast) in adolescents with congenital hand amputation and their main caregivers: a study of cases

OBJETIVO: Describir la experiencia del uso de la ortoprótesis de mano impresa en 3D Cyborg Beast, en adolescentes usuarios de Teletón Santiago con amputación congénita de mano y sus cuidadores principales, que participaron en un estudio de casos para evaluar la funcionalidad de la mano proté sica. CASO CLÍNICO: Investigación de estudio de casos de tipo descriptivo, mediante entrevistas semi- estructuradas a cinco adolescentes con amputación congénita de mano y a sus cuidadores principales, las cuales fueron transcritas y analizadas mediante codificación abierta. Los participantes visualizan la ortoprótesis como una oportunidad para ellos asociándola a la normalidad. Asimismo, identificaron características positivas y negativas, enfatizando en estas últimas. Además, describieron efectos positivos y negativos producidos al utilizar la prótesis, destacando que el uso de la prótesis les permite ha blar sobre su condición. Finalmente, se presentan propuestas de mejora para la prótesis, definiéndose que se debe corregir el prototipo y cambiar la edad de la población objetivo. CONCLUSIONES: El estudio se configura como pionero al investigar un tema poco explorado, permitiendo entregar información respecto de la experiencia subjetiva de adolescentes que utilizan una ortoprótesis que actualmente tiene gran importancia mediática. Los participantes del estudio relataron dificultades para usar la ortoprótesis de mano, ya sea por aspectos de materialidad y diseño. La ortoprótesis no cumplió las expectativas de uso y estética.

OBJECTIVE: To describe the experience of using the 3D-printed prosthetic hand Cyborg Beast in ado lescents of Teletón Santiago with congenital hand amputation and their main caregivers who partici pated in a case study to evaluate the functionality of the prosthetic hand. CLINICAL CASE: Qualitative and descriptive research of case studies using semi-structured interviews with five adolescents with congenital hand amputation and their main caregivers. The information was transcribed and ana lyzed through open coding. Participants visualize the prosthesis as an opportunity for them by asso ciating it with normality. They also identify positive and negative characteristics, emphasizing in the latter. In addition, they described positive and negative effects produced when using the prosthesis, highlighting that the use of the prosthesis allows them to talk about their condition. Finally, im provement proposals for the prosthesis are presented, defining that the prototype must be corrected and change the age of the target population. CONCLUSIONS: The study is the first to investigate a little explored topic, allowing to provide information regarding the subjective experience of adolescents who use a prosthesis that currently has great media importance. The study participants reported dif ficulties in using the hand prosthesis, either due to materiality and design aspects. The prosthesis did not meet the expectations of use and esthetic.

Retrospective Multi-Center Analysis of Canine Socket Prostheses for Partial Limbs.

Introduction: Socket prostheses for treatment of distal limb pathology are becoming increasingly prevalent in veterinary medicine, however, limited objective data is available. Objectives of the present study were to retrospectively evaluate owner satisfaction, clinical outcomes, and prognostic factors associated with dogs receiving socket prostheses for partial limbs in a larger patient population. Materials and Methods: Client databases of a single prosthesis provider were reviewed to identify owners whose dogs had received a prosthetic device within the last 10 years. An online survey was developed to evaluate owner-reported outcomes. The survey inquired about anatomy of the residuum, concurrent disease, prosthesis use, rehabilitation, activity, complications, and owner satisfaction. Medical records and radiographs were requested from all participants. Radiographs were used to confirm level of amputation and evaluate for osseous complications. Survey responses were analyzed by assigning author-defined numeric scores defining clinical outcome and owner satisfaction. Results: One-hundred thirty-seven owners were contacted. The response rate was 50/137 (37%); 47 responses were analyzed. Forty-six of 47 owners reported positive satisfaction; 1/47 was displeased. Forty-two of 47 dogs were scored to have acceptable to full function; 5/47 had unacceptable clinical function using the author-defined scoring system. A 62% short-term complication rate and a 19% long-term complication rate were reported. Skin sores were the most common short and long-term complication. There was a significant correlation between both clinical outcome scores and owner satisfaction with days per week spent in the prosthesis. Additionally, clinical outcome scores and owner satisfaction significantly varied between dogs with different durations of prosthesis wear with a trend toward better outcomes associated with longer prosthesis wear. Radiographs were obtained for 23/47 dogs to further define level of defect. The most proximal level of defect was mid-radius for the forelimb and mid-tibia for the hind limb. There was no correlation between level of defect and either owner satisfaction or clinical outcome. Discussion/Conclusion: Results of this survey suggest a high degree of owner satisfaction despite substantial complication rates. Based on preliminary data, further evaluation of socket prostheses as a limb-sparing option for treatment of distal limb pathology should be considered. Prospective clinical trials with objective outcome measures are required to draw firm conclusions.

Adherence to the EAU guidelines on Penile Cancer Treatment: European, multicentre, retrospective study.

PURPOSE: The European Association of Urology (EAU) guidelines for penile cancer (PC) are exclusively based on retrospective studies and have low grades of recommendation. The aim of this study was to assess the adherence to guidelines by investigating the management strategies for primary tumours and inguinal lymph nodes. METHODS: We retrospectively reviewed the clinical charts of 176 PC patients who underwent surgery in eight European centres from 2010 to 2016. The stage and grade were assessed according to the 2009 AJCC-UICC TNM classification system. To assess adherence rates, we compared theoretical and practical adherence to the EAU guidelines. RESULTS: Overall, 176 patients were enrolled. Partial amputation was the most frequent surgical approach (39%). 53.7% of tumours were stage Tis-T1b and the remaining 46.3% were stage T2-T4. Palpable lymph nodes were detected in 30.1% of patients and 45.1% underwent lymphadenectomy (LY). A sizeable group of tumours (43.2%) were N0. For primary treatment, adherence to the EAU guidelines was good (66%). In non-adherent cases, reasons for discrepancy were patient's choice (17%), surgeon's preference (36%), and other causes (47%). For LY, the guideline adherence was 70%, with either patient's or surgeon's choice or other causes accounting for discrepancy in 28, 20, and 52% of non-adherent cases, respectively. CONCLUSION: Adherence to the EAU guidelines for PC was quite high across the eight European centres involved in the study. This notwithstanding, strategies for further improvement should be developed and evenly adopted.

Medial forefoot fillet flap for primary closure of transmetatarsal amputation: A series of four cases.

Amputation of the forefoot is a salvage procedure for several forefoot acute or chronic infection. A good, sensate and durable skin cover is important for quicker and better rehabilitation. The use of filleted flaps (or "spare parts technique") has been published in the past as a creative technique. The purpose of this article is to introduce a reproducible, pre-planned, technique that requires less creativity for the use of the "spare parts". The authors describe a case series of 4 patients with deep infection and osteomyelitis of the forefoot, without involvement of the medial skin that underwent two staged procedure for transmetatarsal amputation with medial forefoot fillet flap. The first procedure was amputation of the 4 lesser metatarsal and the wound was left open. After a few days the second operation was done with amputation of the first metatarsal bone and using the filleted medial skin and subcutaneous tissue for closure of the wound. In conclusion the medial fillet flap is an effective method of covering large wounds after partial, lateral forefoot amputation. This method shortens the healing time of the patient, and in hospital stay. The authors recommend using the staged method when dealing with diabetic patients with partial, central and lateral forefoot deep infection and/or necrosis.

Clinical outcome and complications of thoracic and pelvic limb stump and socket prostheses.

OBJECTIVES: To describe the use, quality of life, compliance, complications, and outcome of animals fitted with stump socket prostheses. METHODS: Medical records of dogs fitted with a stump socket prosthesis were reviewed. Functional outcome, quality of life and complications were retrospectively assessed from an owner questionnaire. RESULTS: Thirteen stump socket prostheses (12 dogs) were fitted for a variety of reasons including trauma, congenital abnormalities, and neoplasia. Eight dogs had a good outcome overall and four a poor outcome. Quality of life (QOL) remained good or excellent in 10/12 dogs. Nine complications were seen in 7/12 dogs, most were manageable; surgical wound complications (n = 2) and pressures sores (n = 4) were the most frequently encountered. One dog suffered multiple complications. Thoracic and pelvic limb stump socket prostheses had a similar complication rate, however all animals with a poor outcome had a thoracic limb stump socket prosthesis; two were small breed dogs (under 10 kg) and two had bilateral thoracic limb abnormalities. CLINICAL SIGNIFICANCE: Stump socket prostheses are feasible and versatile in animals. In correctly selected cases, good to excellent outcomes are possible. However, complications are frequent but often manageable. Further investigations are required into the risk factors for poor outcomes and prospective studies are required to assess changes in biomechanics, function, and QOL before and after fitting of a stump socket prosthesis. Until further evidence is available, careful consideration should be given before fitting bilateral thoracic limb stump socket prostheses or thoracic limb stump socket prostheses to small breed dogs.

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

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.

Productos de apoyo para paciente con amputación transmetacarpiana / Support products for patient with transmetacarpal amputation

Propósito: Analizar propiedades funcionales y antropométricas de los PA, criterios de selección de diseño, procesos de confección y materiales de fabricación, para analizar las ventajas y/o desventajas que proporcionan y el impacto de esto sobre la CV, ya que los PA disponibles en el mercado no siempre se adaptan a requerimientos del individuo. Se demostrará a través de la presentación de un caso clínico con amputación transmetacarpiana izquierda, de 60 años sufrida el 24/11/2012. Metodología y Materiales: Mediciones antropométricas elementos termoplásticos y de descarte. Resultados: A partir del análisis de propiedades y características de los PA se podría establecer la forma en la cual éstos inciden en la CV de las personas en cuanto a confort, seguridad e independencia funcional, y a partir de ello conocer el grado de satisfacción del usuario respecto a su participación ocupacional en las AVD. Conclusiones: Respecto al desarrollo de PA, se están abriendo nuevas posibilidades para la mejora de la CV de la población en general. Si bien el avance tecnológico está orientado a potenciar la autonomía de los usuarios mediante nuevas y variadas estrategias se ha ido intensificando en campos como la rehabilitación y la antropometría, es necesario en más de una ocasión incorporar acciones que permitan al paciente mejorar su economía, funcionalidad, durabilidad y adecuación estética.

Purpose: Analyze SP functional and anthropometric properties, design selection criteria, preparation processes and manufacturing materials, to analyze the advantages and/or disadvantages that they have and their impact on the LQ, since the SP available in the market do not always adapt to the individual’s requirements. It will be demonstrated through the presentation of a clinical case with left transmetacarpal amputation, 60 years old, suffered on 11/24/2012. Methodology and Materials: anthropometric measures, thermoplastic and disposable items. Results: From the analysis of properties and characteristics of the SP it could be established the way in which they affect people’s LQ in terms of comfort, safety and functional independence, and considering this we can determine the degree of the user’s satisfaction regarding occupational participation in DLA. Conclusions: Regarding the SP development, new possibilities are appearing for the improvement of general population LQ. Even though the technological advance oriented to highlight the user’s autonomy through new and various strategies has been intensifying in some other fields like rehabilitation and anthropometry, it is necessary in more than one occasion to incorporate actions that allow the patient to enhance his functionality with economy criteria, functionality, durability and aesthetics as quality standards in design and construction.