The success of salvage procedures for failing digital replants: A retrospective cohort study.

BACKGROUND: The success of salvage procedures for failing digital replants (FR) is poorly documented. We sought to evaluate the success of salvage procedures for FR and factors contributing to successes and failures of replants. METHODS: Adult patients who presented to our center between January 1, 2000 and December 31, 2015, suffered ≥1 digital amputation(s), and underwent digital replantation were included. Preoperative, perioperative, and postoperative details were recorded. Digits were monitored postoperatively via nursing and physician assessments. The presumed reason for failure, details, and outcomes of salvage attempts were recorded for FR. Length of hospital stay and complications were also recorded. RESULTS: Fifty-two patients and 83 digits were included. Fifty-two digits (63%) were compromised (arterial ischemia in 15 digits; venous congestion in 37 digits) and 48 digits had salvage therapy. Twenty-one FR (44%) were salvaged via operative (1 of 2; 50%), nonoperative (19 of 43; 44%), and combined (1 of 3; 33%) therapies. FR patients were more likely than those with successful replants to receive a blood transfusion (52 vs. 23%; p = .009) with more transfused units (3.45 ± 3.30 vs. 0.86 ± 0.95; p = .001). Length of stay was prolonged for FR patients (9 [range: 2-22] vs. 7 [range: 3-19] days; p = .039). Ultimately, 59% (49 of 83) of replants were successful, where 25% (21 of 83) were successfully salvaged. CONCLUSION: Nonoperative and operative salvage therapies improve the rate of replant survival. We suggest close postoperative monitoring of all replants and active salvage interventions for compromised replants in the postoperative period.

Psychological and Physical Health in Military Amputees During Rehabilitation: Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND: Service members who have experienced combat trauma with resulting amputation are at risk for compromised quality of life postamputation. Monitoring mental and physical health in amputees returning from the war is of paramount importance. This study examined changes in physical and mental health-related quality of life in service members following traumatic unilateral, transtibial amputation (TTA) during a 12-week period of rehabilitation before and after receiving a prosthesis. METHOD: This study is a secondary analysis from a randomized controlled trial (RCT) of military service members starting Military Amputee Rehabilitation Program (MARP) following a traumatic TTA. The study examined change in SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores as two aspects of health-related quality of life. Forty-four injured service members, aged 19 to 46, were recruited into the RCT. Participants were randomized into 12 weeks of MARP plus home neuromuscular electrical stimulation therapy (n = 23) or MARP alone (N = 21) and compared at baseline, 6, and 12 weeks on: SF-36 PCS and MCS scores. Linear mixed models examined time and group differences and their interaction for the MCS and PCS scores. A multivariate mixed model tested whether MCS and PCS scores differed. RESULTS: For the combined rehabilitation cohort, MCS did not differ over 12 weeks (p = 0.27) with scores at week 0 of M = 56.7 (SD = 11.9) and at week 12 of M = 52.7 (SD = 11.4), similar to healthy controls (age = 25-34, M = 51.0, SD = 7.6). Scores did not differ between treatment groups (p = 0.28) with no group by time interaction (p = 0.34). The MCS significantly declined over time (p = 0.05) after adjustment for covariates. PCS improved over 12 weeks (p < 0.0001) in the total rehabilitation group with scores at week 0 of M = 34.0 (SD = 8.1) to M = 41.8 (SD = 8.4) at week 12, significantly lower than healthy controls (age = 25-34, M = 54.1, SD = 6.6). Scores did not differ between treatment groups (p = 0.89), and there was no group by time interaction (p = 0.34). An interaction between the PCS and MCS was observed such that the PCS improved over time, whereas the MCS did not significantly change (p = 0.0005). DISCUSSION: War-injured transtibial amputees are at risk for compromised quality of life during rehabilitation. Self-perceived physical health improved as might be expected from rehabilitation. Self-perceived mental health did not. During rehabilitation, physical healing, psychological adjustment, and lifestyle adaptation are occurring simultaneously. However, more attention may need to be directed toward mental health during rehabilitation.

Valoración de un programa de fisioterapia, actividad física, deporte y psicomotricidad en niños amputados que utilizan prótesis mioeléctricas / Assesment of a physiotherapy programme, physical activity, sports and pyschomotricity for amputee children using myoelectric prosthesis

Después de haber desarrollado un programa intensivo de actividad física, psicomotricidad y deporte adaptado para niños y adolescentes amputados de miembro superior, se valora la eficacia y los logros cualitativos del mismo respecto a la bimanualidad y el uso de prótesis mioeléctricas. El programa fue desarrollado en el formato de campamento de verano, de cinco días de duración, y durante dos ediciones sucesivas. Los resultados han demostrado su eficacia cualitativa y cuantitativa. Se emplaza a la utilización de estos sistemas de reentrenamiento, combinados con otras formas de rehabilitación en España (AU)

After having developed an intensive program of physical and psychomotor activity, and adapted sports for children and adolescents with upper limb amputations, effectiveness and qualitative achievements are recognized, regarding bimanual skills and the use of myoelectric prosthesis. This programme was developed in the frame of six-day «summer camp», in two consecutive editions in Spain. The results have shown qualitative and quantitative efficiency and encourage the use of these training systems in combination with other forms of rehabilitation in Spain (AU)

The role of initial physical activity experiences in promoting posttraumatic growth in Paralympic athletes with an acquired disability.

PURPOSE: To explore Paralympic athletes' lived experiences of becoming physically active after disability, and the role that this may have played in the development of posttraumatic growth. METHODS: Life history interviews were conducted with 7 individuals with an acquired and traumatic disability, who were aiming to take part in the London 2012 Paralympic Games. This was also informed by observation of sport participation. Data were analysed using a holistic content analysis. RESULTS: Three main themes were identified that reflected participants' initial physical activity experiences and which were linked to posttraumatic growth. These were recognizing possibility by acknowledging limitations, responsibility for choice and consequences, and re-establishing and enhancing meaning. CONCLUSIONS: Posttraumatic growth is a process and consequently, part of this process may include experiencing both positive and negative trauma symptoms. Participation in physical activity may assist an individual in achieving posttraumatic growth by facilitating meaning making, providing an environment where risks and responsibilities can be taken, and allowing an individual to understand their limitations and future possibilities. IMPLICATIONS FOR REHABILITATION: While posttraumatic growth is often associated with positive psychological outcomes, it is important to consider that this can occur alongside the experience of negative trauma symptoms. Participation in physical activity may induce both positive and negative responses following trauma. In order to foster posttraumatic growth, physical activity should be meaningful to the activity and allow a sense of control and personal responsibility.

Haptic feedback enhances grip force control of sEMG-controlled prosthetic hands in targeted reinnervation amputees.

In this study, we hypothesized that haptic feedback would enhance grip force control of surface electromyography (sEMG)-controlled prosthetic hands for targeted reinnervation (TR) amputees. A new miniature haptic device, a tactor, that can deliver touch, pressure, shear, and temperature sensation, allows modality-matching haptic feedback. TR surgery that creates sensory regions on the patient's skin that refer to the surface of the missing limb allows somatotopic-matching haptic feedback. This paper evaluates the hypothesis via an sEMG-controlled virtual prosthetic arm operated by TR amputees under diverse haptic feedback conditions. The results indicate that the grip force control is significantly enhanced via the haptic feedback. However, the simultaneous display of two haptic channels (pressure and shear) does not enhance, but instead degrades, grip force control.

Mobilizaçäo precoce da mäo pós-reimplantes ou revascularizaçöes / Early mobilization of the post-replantation hand or revascularizations

A alta frequência de complicaçöes pós-operatórias nos traumatismos das mäos e dedos por aderências cicatriciais, sugerem a aplicaçäo de técnicas de reabilitaçäo precoce, uma vez que a mobilizaçäo da mäo neste período fornece melhor aporte vascular à área lesada, promove melhor qualidade nutricional, mantém as superfícies de deslizamento e evita a täo rotineira aderência tendinosa, que impossibilita a integridade funcional da mäo e dedos comprometidos, além de evitar edemas e outros problemas pós-cirúrgicos. No entanto, há divergências em relaçäo ao início devido, talvez, à insegurança dos cirurgiöes na aplicaçäo da técnica de cinesioterapia pós-operatória imediata após uma cirurgia que normalmente teve muitas horas de duraçäo. Sugere-se neste estudo que a mobilizaçäo pós-reimplante ou revascularizaçäo dos dedos e/ou da mäo seja iniciada após 48 horas, conforme o protocolo utilizado nos 3 casos apresentados neste trabalho, justificando, dessa forma, a integridade funcional e a reabilitaçäo funcional da mäo e dedos traumatizados. Preconizou-se o ínico das atividades diárias a partir do 21§ dia após a cirurgia, sem qualquer incidente traumático em funçäo da precocidade e com integridade funcional da mäo.

Bioenergetic comparison of a new energy-storing foot and SACH foot in traumatic below-knee vascular amputations.

In this study, the metabolic performances of a new energy-storing foot (Proteor) and of the solid-ankle cushion heel (SACH) are compared. Twelve patients with traumatic below-knee amputations (mean age: 50.0 +/- 19.9 years) and 12 patients with vascular below-knee amputations (mean age: 73 +/- 7 years) were studied. Oxygen uptake (VO2) was measured in all the subjects on a walkway at a self-selected velocity; only the subjects with traumatic amputation were tested on a level treadmill (progressive speed: 2.4-4 and 6 km/h), and then in two randomized trials: incline (+5%) and decline walking treadmill test at 4 km/h. Vascular explorations were done in the vascular patients: distal pressure measurements, pulse plethysmography, transcutaneous oxygen tension. Free walking was improved in subjects with traumatic amputation using the energy-storing foot (+6%), with a better bioenergetic efficiency (0.24 +/- 0.4mL/kg.m vs 0.22 +/- 0.04mL/kg.m). However, in subjects with vascular amputation, this foot did not produce an increased free velocity nor an improved energy cost. During the level treadmill test, the traumatic amputee subjects showed a decrease of energy expenditure with the new prosthetic foot, more significant at sufficient speed (4 km/h): 17.00 +/- 3.42 vs 14.67 +/- 2.05 mL/kg/min (p < .05). The same effect is shown during the incline (19.31 +/- 2.80 vs 16.79 +/- 2.32 mL/kg/min-p < .02) and decline walking tests (14.13 +/- 3.64 vs 11.81 +/- 1.54mL/kg/min-p < .02). There is no significant difference in cardiocirculatory effects between the two types of prosthetic foot. Despite a lower velocity, the subjects with vascular amputation exceed 70% of the maximal heart rate, with the cardiocirculatory factor being the main cause of walking restriction. The energy-storing foot should be reserved for active and fast walkers, whereas the SACH foot seems more suitable for elderly patients with amputation with a slow walk.

[Amputation in the growth period]. / Amputationen im Wachstumsalter.

Amputations during childhood and juvenile age differ from those in adults: Osseous over-growth can be expected especially in trans-humeral and trans-tibial stumps,--to be prevented by stump-capping. After loss of a growth-plate transosseous stumps will reduce growth; therefore it is crucial to preserve the distal femoral growth-plate and a weight-bearing knee-disarticulation stump with respect to future prosthetic function and appearance. Besides predominantly traumatic origin of acquired amputations in the growth-period longitudinal deficiencies present at birth have to attract utmost attention when decision-making for surgical conversion--e.g. of a missing tibia to a knee-disarticulation stump or severe fibular deficiency to a weightbearing Symeor modified Pirogoff-/Boyd-stump. The multiple limb-deficient child and adolescent depends on a holistic approach towards therapy provided by specialised centers.

Successful voluntary grasp and release using the cookie crusher myoelectric hand in 2-year-olds.

We examined the ability of two 2-year-old children with limb deficiency to demonstrate grasp and release while using the cable-operated voluntary opening hook-hand and the externally powered single-site myoelectric Cookie Crusher system. The Cookie Crusher circuit is an electronic package that causes the prosthetic hand to open in response to muscle contraction and closes (as if crushing a cookie) when the muscle is relaxed. Both children were consistently good prosthetic wearers, beginning with their initial passive devices and progressing through their cable-operated hooks and hands. However, before they began to use the Cookie Crusher (Subject 1 at 25 months, Subject 2 at 30 months), neither had developed voluntary grasp or release in spite of 3 to 12 months' use of cable-operated voluntary opening prehensors. Both children developed a voluntary grasp and release for the first time within minutes of starting to use the Cookie Crusher. The more adept of the two children, a girl with a traumatic above-elbow amputation, showed prehensile function with the Cookie Crusher during play. The spontaneous use of the Cookie Crusher may be related to the predominance of associated reactions in young children. As children play bimanually, associated movements of the nondominant extremity often occur and, in the case of children with limb deficiencies fitted with Cookie Crusher prehensors, these associated reactions result in successful grasp and release. We will continue to follow the choice of effective control schemes in these children as they mature.

A clinical experience with a hierarchically controlled myoelectric hand prosthesis with vibro-tactile feedback.

UNLABELLED: Improved performance of externally powered myoelectric hands is possible when the direct control of the digit flexion and grip force are given over to an electronic controller which frees the operator to concentrate on other demands. DESIGN: A commercial myoelectric hand was modified to take the new touch and slip sensors and novel control method. SUBJECT: An adult male with a traumatic mid-forearm amputation. OUTCOME MEASURE: The range and ease of use of the prosthetics system. RESULT: The hand was easily and usefully operated in the home and work environment. CONCLUSION: Hierarchical control of a hand is possible using sensory feedback to a sophisticated electronic controller. Such a control method reduces the demands on the user's concentration and enhances the hand's range.