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1.
Bone Joint J ; 102-B(1): 55-63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888375

RESUMO

AIMS: The aim of this study was to describe implant and patient-reported outcome in patients with a unilateral transfemoral amputation (TFA) treated with a bone-anchored, transcutaneous prosthesis. METHODS: In this cohort study, all patients with a unilateral TFA treated with the Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) implant system in Sahlgrenska University Hospital, Gothenburg, Sweden, between January 1999 and December 2017 were included. The cohort comprised 111 patients (78 male (70%)), with a mean age 45 years (17 to 70). The main reason for amputation was trauma in 75 (68%) and tumours in 23 (21%). Patients answered the Questionnaire for Persons with Transfemoral Amputation (Q-TFA) before treatment and at two, five, seven, ten, and 15 years' follow-up. A prosthetic activity grade was assigned to each patient at each timepoint. All mechanical complications, defined as fracture, bending, or wear to any part of the implant system resulting in removal or change, were recorded. RESULTS: The Q-TFA scores at two, five, seven, and ten years showed significantly more prosthetic use, better mobility, fewer problems, and an improved global situation, compared with baseline. The survival rate of the osseointegrated implant part (the fixture) was 89% and 72% after seven and 15 years, respectively. A total of 61 patients (55%) had mechanical complications (mean 3.3 (SD 5.76)), resulting in exchange of the percutaneous implant parts. There was a positive relationship between a higher activity grade and the number of mechanical complications. CONCLUSION: Compared with before treatment, the patient-reported outcome was significantly better and remained so over time. Although osseointegration and the ability to transfer loads over a 15-year period have been demonstrated, a large number of mechanical failures in the external implant parts were found. Since these were related to higher activity, restrictions in activity and improvements to the mechanical properties of the implant system are required. Cite this article: Bone Joint J 2020;102-B(1):55-63.


Assuntos
Amputação/métodos , Prótese Ancorada no Osso , Fêmur/cirurgia , Adolescente , Adulto , Idoso , Amputação/instrumentação , Amputados/psicologia , Membros Artificiais , Feminino , Neoplasias Femorais/cirurgia , Fêmur/lesões , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Osseointegração/fisiologia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Falha de Prótese , Adulto Jovem
2.
Anticancer Res ; 39(12): 6807-6811, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810946

RESUMO

BACKGROUND/AIM: Controversy exists between performing limb salvage or amputation to treat osteosarcoma of the upper extremities. Our aim was to review the characteristics associated with limb amputation due to osteosarcoma of the upper extremities. PATIENTS AND METHODS: A descriptive study was performed by querying the National Cancer Database from January 1, 2004 to December 31, 2015. Statistical analysis was performed using chi-squared test and a multivariate logistic regression model. RESULTS: A total of 777 patients diagnosed with osteosarcoma of the upper extremities who underwent surgery met the inclusion criteria. Patients between 61 and 80 years were less likely to undergo limb amputation. Moreover, facilities located in the South Atlantic region, and stage IV of the disease were factors independently positively associated with amputation. CONCLUSION: Patients in facilities located in the South Atlantic region and those with stage IV disease were more likely to undergo amputation.


Assuntos
Amputação/métodos , Neoplasias Ósseas/cirurgia , Salvamento de Membro/métodos , Osteossarcoma/cirurgia , Extremidade Superior/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Osteossarcoma/patologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
3.
Plast Reconstr Surg ; 144(3): 421e-430e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461024

RESUMO

BACKGROUND: Postamputation pain affects a large number of individuals living with major limb loss. Regenerative peripheral nerve interfaces are constructs composed of a transected peripheral nerve implanted into an autologous free muscle graft. The authors have previously shown that regenerative peripheral nerve interfaces can be used to treat symptomatic end neuromas that develop after major limb amputation. In this study, they investigated the potential of prophylactic interfaces to prevent the formation of symptomatic neuromas and mitigate phantom limb pain. METHODS: Patients who underwent limb amputation with and without prophylactic regenerative peripheral nerve interface implantation were identified. A retrospective review was performed to ascertain patient demographics, level of amputation, and postoperative complications. Documentation of symptomatic neuromas and phantom limb pain was noted. RESULTS: Postoperative outcomes were evaluated in a total of 90 patients. Forty-five patients underwent interface implantation at the time of primary amputation, and 45 control patients underwent amputation without interfaces. Six control patients (13.3 percent) developed symptomatic neuromas in the postoperative period compared with zero (0.0 percent) in the prophylactic interface group (p = 0.026). Twenty-three interface patients (51.1 percent) reported phantom limb pain, compared with 41 control patients (91.1 percent; p < 0.0001). CONCLUSIONS: Prophylactic regenerative peripheral nerve interfaces in major limb amputees resulted in a lower incidence of both symptomatic neuromas and phantom limb pain compared with control patients undergoing amputation without regenerative peripheral nerve interfaces, suggesting that prevention of peripheral neuromas following amputation may diminish the central pain mechanisms that lead to phantom limb pain. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Amputação/efeitos adversos , Regeneração Nervosa , Neuroma/epidemiologia , Nervos Periféricos/transplante , Membro Fantasma/prevenção & controle , Adolescente , Adulto , Idoso , Amputação/métodos , Cotos de Amputação/inervação , Estudos de Casos e Controles , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neuroma/etiologia , Nervos Periféricos/fisiologia , Membro Fantasma/epidemiologia , Membro Fantasma/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
J Bone Joint Surg Am ; 101(16): 1470-1478, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436655

RESUMO

BACKGROUND: Severe upper-extremity injuries account for almost one-half of all extremity trauma in recent conflicts in the Global War on Terror. Few long-term outcomes studies address severe combat-related upper-extremity injuries. This study's objective was to describe long-term functional outcomes of amputation compared with those of limb salvage in Global War on Terror veterans who sustained severe upper-extremity injuries. Limb salvage was hypothesized to result in better arm and hand function scores, overall functional status, and quality of life, with similar pain interference. METHODS: This retrospective cohort study utilized data from the Military Extremity Trauma Amputation/Limb Salvage (METALS) study for a subset of 155 individuals who sustained major upper-extremity injuries treated with amputation or limb salvage. Participants were interviewed by telephone 40 months after injury, assessing social support, personal habits, and patient-reported outcome instruments for function, activity, depression, pain, and posttraumatic stress. Outcomes were evaluated for participants with severe upper-extremity injuries and were compared with participants with concomitant severe, lower-extremity injury. The analysis of outcomes comparing limb salvage with amputation was restricted to the 137 participants with a unilateral upper-extremity injury because of the small number of patients with bilateral upper-extremity injuries (n = 18). RESULTS: Overall, participants with upper-extremity injuries reported moderate to high levels of physical and psychosocial disability. Short Musculoskeletal Function Assessment (SMFA) scores were high across domains; 19.4% screened positive for posttraumatic stress disorder (PTSD), and 12.3% were positive for depression. Nonetheless, 63.6% of participants were working, were on active duty, or were attending school, and 38.7% of participants were involved in vigorous recreational activities. No significant differences in outcomes were observed between patients who underwent limb salvage and those who underwent amputation. CONCLUSIONS: Severe, combat-related upper-extremity injuries result in diminished self-reported function and psychosocial health. Our results suggest that long-term outcomes are equivalent for those treated with amputation or limb salvage. Addressing or preventing PTSD, depression, chronic pain, and associated health habits may result in less disability burden in this population. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Amputação/métodos , Traumatismos do Braço/cirurgia , Salvamento de Membro/métodos , Militares/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Amputação/psicologia , Traumatismos do Braço/diagnóstico , Traumatismos do Braço/reabilitação , Membros Artificiais , Estudos de Coortes , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Guerra do Iraque 2003-2011 , Salvamento de Membro/psicologia , Masculino , Militares/psicologia , Medidas de Resultados Relatados pelo Paciente , Implantação de Prótese/métodos , Estudos Retrospectivos , Medição de Risco , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Plast Reconstr Surg ; 144(2): 218e-229e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348345

RESUMO

BACKGROUND: Traditional approaches to amputation are not capable of reproducing the dynamic muscle relationships that are essential for proprioceptive sensation and joint control. In this study, the authors present two caprine models of the agonist-antagonist myoneural interface (AMI), a surgical approach designed to improve bidirectional neural control of a bionic limb. The key advancement of the AMI is the surgical coaptation of natively innervated agonist-antagonist muscle pairs within the residual limb. METHODS: One AMI was surgically created in the hindlimb of each of two African Pygmy goats at the time of primary transtibial amputation. Each animal was also implanted with muscle electrodes and sonomicrometer crystals to enable measurement of muscle activation and muscle state, respectively. Coupled agonist-antagonist excursion in the agonist-antagonist myoneural interface muscles was measured longitudinally for each animal. Fibrosis in the residual limb was evaluated grossly in each animal as part of a planned terminal procedure. RESULTS: Electromyographic and muscle state measurements showed coupled agonist-antagonist motion within the AMI in the presence of both neural activation and artificial muscle stimulation. Gross observation of the residual limb during a planned terminal procedure revealed a thin fibrotic encapsulation of the AMI constructs, which was not sufficient to preclude coupled muscle excursion. CONCLUSIONS: These findings highlight the AMI's potential to provide coupled motion of distal agonist-antagonist muscle pairs preserved during below- or above-knee amputation at nearly human scale. Guided by these findings, it is the authors' expectation that further development of the AMI architecture will improve neural control of advanced limb prostheses through incorporation of physiologically relevant muscle-tendon proprioception.


Assuntos
Amputação/métodos , Eletromiografia/métodos , Propriocepção , Desenho de Prótese , Implantação de Prótese/métodos , Animais , Membros Artificiais , Modelos Animais de Doenças , Eletrodos Implantados , Feminino , Fêmur/cirurgia , Cabras , Masculino , Músculo Esquelético/inervação , Tíbia/cirurgia
6.
J Surg Oncol ; 120(3): 348-358, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31197851

RESUMO

BACKGROUND: We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. METHODS: Our TMR cohort was compared to a cross-sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient-Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. RESULTS: Thirty-one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow-up (mean follow-up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159-10.55; P = .015), 5.896 (95%CI 0.492-11.30; P = .033), and 7.435 (95%CI 1.797-13.07; P = .011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528-10.42; P = .031), 6.195 (95%CI 0.705-11.69; P = .028), and 6.816 (95%CI 1.438-12.2; P = .014), respectively. Fifty-six percent took opioids before amputation compared to 22% at 1 year postoperatively. CONCLUSIONS: Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee-centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.


Assuntos
Cotos de Amputação/inervação , Amputação/métodos , Amputação/reabilitação , Músculo Esquelético/inervação , Neoplasias/cirurgia , Transferência de Nervo/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/reabilitação , Neoplasias Ósseas/cirurgia , Estudos de Coortes , Continuidade da Assistência ao Paciente , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/reabilitação , Osteossarcoma/reabilitação , Osteossarcoma/cirurgia , Equipe de Assistência ao Paciente , Membro Fantasma/prevenção & controle , Sarcoma/reabilitação , Sarcoma/cirurgia , Adulto Jovem
7.
Ann Vasc Surg ; 60: 468-473, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200050

RESUMO

OBJECTIVE: To reevaluate the benefits of a Gritti-Stokes amputation (GSA), as an alternative to the traditional above-knee amputation (AKA), in patients who are nonambulatory or not a candidate for a below-knee amputation (BKA). TECHNIQUE: A fish-mouth incision is fashioned below the tibial tuberosity into the popliteal crease, resulting in an anterior soft tissue flap and smaller posterior soft tissue flap. Thus the incision line will be on the posterior thigh, instead of the end of the stump. The patellar tendon is detached from the anterior tibial tuberosity, then the dissection is carried proximally behind the patellar tendon and the adjoining tendons of the vastus medialis and vastus lateralis, until the patella can be flipped over to expose the posterior patellar surface and joint capsule. The patellar's posterior surface is shaved down flat to medulla bone, with an electric small-toothed bone saw and large bur. The femur is then cleared circumferentially at its base. The foot is then placed at 90°, creating a 45-degree angle between the femur and the tibia, and the femur is then transected with a Gigli saw near the base or just above the base, depending on the size of the patellar surface area. This creates a 45-degree angle to the femur posteriorly, which allows the shaved patella to be secured to the end of the femur, with less chance of shifting. The fascia is then circumferentially closed around the patella and femur. Then, the remnant patellar tendon is sutured to the tendons of the posterior compartment. The dermis and skin are then closed in the standard tension-free manner using 2-0 interrupted vicryl sutures, followed by interrupted 2-0 nylon vertical mattress sutures. The dressing consisted of a single layer of ADAPTIC Non-Adhering Dressing to allow drainage, gauze fluffs, 6-inch kerlix, and finally a 6-inch ACE wrap was applied. The dressings are left intact for 2-3 days and then replaced daily thereafter. METHODS: A retrospective chart review was performed to identify patients who had undergone a GSA from January 2016 to September 2017 by a single surgeon. Estimated blood loss (EBL), operative time, and perioperative and postoperative complications were assessed. RESULTS: A total of 16 GSAs were performed on 15 patients by a single surgeon between January 7, 2016 and September 19, 2017. In our series, intraoperative outcomes were notable for an average EBL of 114 mL, lower than the traditional AKA (average EBL: 300-500 mL) with comparable operative times as short as 90 min (skin incision to dressing). No transfusions were required in the GSA group (postop days: 1-4) compared with traditional AKA group which required an average of 2.1 units. Postoperative outcomes showed low complication rates. Postoperative complications were limited to 2 cases of a stump infection, which were treated with local wound care and subsequently healed completely. One patient died from septic shock secondary to pneumonia unrelated to the GSA surgery. CONCLUSIONS: A reevaluation of the GSA in the nonambulatory patient population is warranted in the United States as an alternative to the traditional AKA whenever possible. Our experience with a small series of GSA's has yielded promising advantages including potential for decreased blood loss and fewer complications in the postoperative period when compared with the standard AKA. Retained muscle attachments facilitate increased limb function and allow use of slide joint prosthetics, which are gaining popularity for ambulatory patients. The thickened skin and subcutaneous tissues overlying the patella, and the posterior incision have the potential benefit of protection against trauma and osteomyelitis seen with traditional AKA, in which case the open ended medullary bone is deep to the incision. We believe that for these same reasons the GSA should be considered in the nonambulatory patient as well.


Assuntos
Amputação/métodos , Extremidade Inferior/cirurgia , Limitação da Mobilidade , Adulto , Idoso , Amputação/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Retalhos Cirúrgicos , Fatores de Tempo , Resultado do Tratamento , Cicatrização
9.
Medicine (Baltimore) ; 98(18): e15406, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045795

RESUMO

BACKGROUND: Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime, triggering bleeding, and ischemia. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. METHODS: To summarize the current evidence of diagnosis and treatment for traumatic vascular injury of limbs, for saving limbs and lives, and put forward some new insights, we comprehensively consulted literatures and analyzed progress in injury diagnosis and wound treatment, summarized the advanced treatments now available, especially in wartime, and explored the principal factors in play in an effort to optimize clinical outcomes. RESULTS: Extremity vascular trauma poses several difficult dilemmas in diagnosis and treatment. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. Any delay in treatment may lead to loss of limbs or death. The development of diagnose and treat vascular injury of extremities are the clinical significance to the tip of military medicine, such as the use of fast, cheap, low invasive diagnostic methods, repairing severe vascular injury as soon as possible, using related technologies actively (fasciotomy, etc). CONCLUSION: We point out the frontier of the diagnosis and treatment of traumatic vascular injury, also with a new model of wartime injury treatment in American (forward surgical teams and combat support hospitals), French military surgeons regarding management of war-related vascular wounds and Chinese military ("3 districts and 7 grades" model). Many issues remain to be resolved by further experience and investigation.


Assuntos
Medicina de Emergência/métodos , Extremidades , Medicina Militar/métodos , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/terapia , Amputação/métodos , Índice Tornozelo-Braço , Traumatismos por Explosões/diagnóstico , Traumatismos por Explosões/terapia , Prótese Vascular , Descompressão Cirúrgica/métodos , Fasciotomia/métodos , Fraturas Ósseas/terapia , Humanos , Militares , Estudos Retrospectivos , Transplante de Pele/métodos , Fatores de Tempo , Índices de Gravidade do Trauma , Estados Unidos , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/diagnóstico por imagem
10.
Clin Podiatr Med Surg ; 36(3): 483-498, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079612

RESUMO

Amputations distal to the ankle joint are commonly performed in efforts to preserve a limb. Thorough examination of lower extremity biomechanics, patient functional status, and patient goals must be used to help prevent reulceration and further amputation. Once infection is resolved in the acute setting, musculotendon balancing should be considered at the time of amputation closure to maintain functionality of the limb. Patients should be closely followed postoperatively and monitored for biomechanical deformity that needs to be addressed. Careful attention to detail and adherence to surgical principles can help keep patients active and prevent further amputation.


Assuntos
Amputação , Pé/cirurgia , Amputação/métodos , Órtoses do Pé , Humanos , Salvamento de Membro , Osteomielite/cirurgia , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente , Prognóstico , Infecções dos Tecidos Moles/cirurgia , Sobrevivência de Tecidos
11.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31138600

RESUMO

Cryofibrinogenaemia is a rare haematological disorder characterised by cold temperature-induced precipitation of plasma proteins causing small-vessel occlusive vascular disorder with a hallmark of skin ulceration. It remains an underdiagnosed entity because of a lack of diagnostic criteria. Cryoglobulinaemia vasculitis is a small-vessel vasculitis involving the skin, the joints, the peripheral nerve system and the kidneys. Its association with cryofibrinogenaemia causes more severe phenotype with poor prognosis. We describe the case of a 59-year-old woman presenting with cold-induced extensive bilateral foot gangrene due to coexisting cryofibrinogenaemia and cryoglobulinaemic vasculitis that required bilateral amputation and rituximab perfusions as maintenance therapy.


Assuntos
Crioglobulinemia/diagnóstico , Pé/irrigação sanguínea , Gangrena/etiologia , Amputação/métodos , Antirreumáticos/uso terapêutico , Crioglobulinemia/complicações , Crioglobulinemia/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Pé/patologia , Gangrena/patologia , Gangrena/cirurgia , Humanos , Pessoa de Meia-Idade , Doenças Raras , Rituximab/administração & dosagem , Rituximab/uso terapêutico , Resultado do Tratamento , Vasculite/complicações
12.
Plast Reconstr Surg ; 143(6): 1688-1701, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136485

RESUMO

BACKGROUND: Upper limb loss is a devastating condition with dramatic physical, psychological, financial, and social consequences. Improvements in the fields of prosthetics and vascularized composite allotransplantation have opened exciting new frontiers for treatment and rehabilitation following upper limb loss. Each modality offers a unique set of advantages and limitations with regard to the restoration of hand function following amputation. METHODS: Presented in this article is a discussion outlining the complex considerations and decisions encountered when determining patient appropriateness for either prosthetic rehabilitation or vascularized composite allotransplantation following upper limb loss. In this review, the authors examine how psychosocial factors, nature of injury, rehabilitation course, functional outcomes, and risks and benefits may affect overall patient selection for either rehabilitative approach. RESULTS: This review summarizes the current state of the literature. Advancements in both prosthetic and biological strategies demonstrate promise with regard to facilitating rehabilitation following upper limb loss. However, there remains a dearth of research directly comparing outcomes in prosthetic rehabilitation to that following upper extremity transplantation. CONCLUSIONS: Few studies have performed a direct comparison between patients undergoing vascularized composite allotransplantation and those undergoing prosthetic rehabilitation. Upper extremity transplantation and prosthetic reconstruction should not be viewed as competing options, but rather as two treatment modalities with different risk-to-benefit profiles and indications.


Assuntos
Amputação/reabilitação , Amputados/reabilitação , Membros Artificiais , Qualidade de Vida , Extremidade Superior/cirurgia , Alotransplante de Tecidos Compostos Vascularizados/métodos , Amputação/métodos , Amputados/psicologia , Tomada de Decisões , Feminino , Seguimentos , Humanos , Masculino , Seleção de Pacientes , Ajuste de Prótese , Medição de Risco , Resultado do Tratamento
13.
Acta Orthop Belg ; 85(1): 21-34, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31023196

RESUMO

Landmine blast injuries are high velocity shattering injuries that produce ghastly and gory wounds, presenting a dilemma to the treating surgeon, especially when the literature on this subject is limited. The aim of the present study is to enlist various surgical procedures that can be explored to treat such complex injuries. 60 cases having varied degrees of involvement of the lower limb from mine blasts were managed. Surgical treatment was tailored to the individual requirement depending on the extent and severity of injury. Serial surgical wound debridement was an integral part of all these procedures. Limb length preservation was possible in 70% cases. A combination of surgical approaches and procedures from fixation to different types of amputations can be employed for treating mine blast injuries to maximise residual limb function.


Assuntos
Amputação/métodos , Traumatismos por Explosões/cirurgia , Desbridamento , Extremidade Inferior/cirurgia , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retalhos Cirúrgicos , Adulto Jovem
14.
Prehosp Disaster Med ; 34(3): 330-334, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31025618

RESUMO

It has become clear that disaster relief needs to transition from good intentions or a charity-based approach to a professional, outcome-oriented response. The practice of medicine in disaster and conflict is a profession practiced in environments where lack of resources, chaos, and unpredictability are the norm rather than the exception. With this consideration in mind, the World Health Organization (WHO; Geneva, Switzerland) and its partners set out to improve the disaster response systems. The resulting Emergency Medical Team (EMT) classification system requires that teams planning on engaging in disaster response follow common standards for the delivery of care in resource-constraint environments. In order to clarify these standards, the WHO EMT Secretariat collaborated with the International Committee of the Red Cross (ICRC; Geneva, Switzerland) and leading experts from other stakeholder non-governmental organizations (NGOs) to produce a guide to the management of limb injuries in disaster and conflict.The resulting text is a free and open-access resource to provide guidance for national and international EMTs caring for patients in disasters and conflicts. The content is a result of expert consensus, literature review, and an iterative process designed to encourage debate and resolution of existing open questions within the field of disaster and conflict medical response.The end result of this process is a text providing guidance to providers seeking to deliver safe, effective care within the EMT framework that is now part of the EMT training and verification system and is being distributed to ICRC teams deploying to the field.This work seeks to encourage professionalization of the field of disaster and conflict response, and to contribute to the existing EMT framework, in order to provide for better care for future victims of disaster and conflict.Jensen G, Bar-On E, Wiedler JT, Hautz SC, Veen H, Kay AR, Norton I, Gosselin RA, von Schreeb J. Improving management of limb injuries in disasters and conflicts. Prehosp Disaster Med. 2019;34(3):330-334.


Assuntos
Traumatismos do Braço/terapia , Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Socorristas/estatística & dados numéricos , Traumatismos da Perna/terapia , Melhoria de Qualidade , Amputação/métodos , Traumatismos do Braço/diagnóstico , Conflito de Interesses , Desastres , Guias como Assunto , Humanos , Escala de Gravidade do Ferimento , Cooperação Internacional , Traumatismos da Perna/diagnóstico , Medição de Risco , Organização Mundial da Saúde
15.
J Rehabil Med ; 51(5): 369-375, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-30964543

RESUMO

OBJECTIVE: To examine how factors associated with infection, organ failure, poor wound healing, or indices of chronic vascular disease are associated with unplanned transfers and functional gains in a population of dysvascular amputees during inpatient rehabilitation. DESIGN: Cross-sectional. SETTING: Inpatient rehabilitation unit at an academic medical centre. PATIENTS: A total of 118 patients with new, dysvascular, lower-extremity, amputation participating in inpatient rehabilitation. METHODS: Logistic regression and indices of change (minimal detectable change; MDC90), standardized response mean and effect size were used to examine the risks of unplanned transfer and functional change. MAIN OUTCOME MEASUREMENTS: Rate of unplanned transfers from rehabilitation, and Functional Independence Measure (FIM). RESULTS: Out of the total of 118 patients 19 had unplanned transfers due to medical complications. Age, creatinine, haemoglobin, white blood cell count, haemodialysis, wound vacuum device use, intravenous antibiotic use, or previous amputations were not independently associated with unplanned transfers, motor FIM change or efficiency. The MDC90 for motor FIM was 17.84, with 21.2% of patients exceeding this value; standardized response mean and effect size were large (1.03 and 1.39, respectively). CONCLUSION: This study suggests that the presence of comorbidities in a population of dysvascular amputees participating in inpatient rehabilitation did not increase the risk of unplanned transfers or affect FIM gains.


Assuntos
Amputação/métodos , Comorbidade/tendências , Alta do Paciente/tendências , Estudos Transversais , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Acta Orthop Traumatol Turc ; 53(3): 221-225, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30967301

RESUMO

OBJECTIVE: The aim of the study was to assess mutual associations of body image perception, compliance with the prosthesis and cognitive performance in transfemoral amputees. METHODS: Fourty transfemoral amputee (30 male and 10 female), who had a traumatic and unilateral amputation were included in this study. The mean age of the patients at the time of study was 37 ± 9.9 and the mean age at amputation was 12.6 ± 9.4 years. Patients's body image perception and compliance with the prosthesis paramaters were evaluated with Amputee Body Image Scale (ABIS) and Trinity Amputation and Prosthesis Experience Scales (TAPES). MoCA (The Montreal Cognitive Assessment) has been used to determine the cognitive ability of the participant. All tests has been administered by dual task method during ambulation. Patients who had neurologic or cognitive deficit were excluded from the study. RESULTS: There was a statistically significant relationship between an individual's body image perception and cognitive performance. Body image perception was significantly and negatively correlated with the MoCA score (r = -0.514, p < 0.001). There was a statistically significant positive correlation between psychosocial adjustment, prosthesis satisfaction and MoCA scores (r = 0.550, p < 0.001). CONCLUSIONS: Body image satisfaction, psychosocial adjustment, lack of activity restriction, and satisfaction with prosthesis are positively associated with cognitive performance of transfemoral amputees. Before beginning the amputee rehabilitation programs, we recommend to include not only physical functions, but also consider body image and cognitive functions as assessment parameters. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.


Assuntos
Amputação , Membros Artificiais/psicologia , Imagem Corporal/psicologia , Cognição , Ajustamento Emocional/fisiologia , Fêmur/cirurgia , Cooperação do Paciente , Adulto , Amputação/métodos , Amputação/psicologia , Amputação/reabilitação , Amputados/psicologia , Amputados/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Autoimagem , Ajustamento Social , Caminhada
17.
Int J Low Extrem Wounds ; 18(2): 200-207, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30968713

RESUMO

Diabetic foot gangrene with lower extremity ischemia can preclude amputation. However, wound treatment principles based on the Wagner classification system are lacking. We proposed the STAGE principle for the surgical management of diabetic foot wounds. The STAGE principle guides surgical intervention during the wound treatment of diabetic foot ulcers and emphasizes that "based on anatomical layers, the management focuses on blood supply and includes layer-by-layer incision to the infected area, maintenance of effective wound drainage, and step-by-step treatment of the wound." We applied the STAGE principle for the treatment of 7 patients with an ankle brachial index <0.5 and Wagner grade 4 diabetic foot gangrene. The average ankle brachial index was 0.42 (0.32-0.48; SD = 0.06), and male patients smoked an average of 1.28 packs/day (0.4-2; SD = 0.63). The average wound duration was 45.86 days (14-63 days; SD = 18.46). The average wound healing time was 8.86 months (5-13 months; SD = 2.36). The follow-up time was 37.71 months (3-84 months; SD = 25.04; median = 36 months). Patient 1 received endovascular interventional therapy twice for the lower extremity artery, and the wound healed. After 3 months of follow-up, the patient exhibited recurrence. After the third application of endovascular interventional therapy for the lower extremity artery, the blood supply was improved, and the wound healed after 1 month. In summary, the treatment of 7 cases of diabetic foot gangrene with severe lower extremity ischemia using the STAGE principle resulted in remarkable efficacy.


Assuntos
Amputação/métodos , Pé Diabético/cirurgia , Procedimentos Endovasculares/métodos , Gangrena/cirurgia , Isquemia/cirurgia , Guias de Prática Clínica como Assunto , Cicatrização/fisiologia , Idoso , China , Estudos de Coortes , Desbridamento/métodos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Pé Diabético/diagnóstico , Pé/cirurgia , Gangrena/diagnóstico , Humanos , Isquemia/fisiopatologia , Perna (Membro)/cirurgia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Dedos do Pé/cirurgia , Resultado do Tratamento
18.
Plast Reconstr Surg ; 143(4): 758e-768e, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30921125

RESUMO

BACKGROUND: Successful limb replantation must be based not only on the viability of the amputated part but also on satisfactory long-term functional recovery. Once the vascular, skeletal, and soft-tissue problems have been taken care of, nerve recovery becomes the ultimate limiting factor. Unfortunately, nerve regeneration after limb replantation is impaired by several consequences. The authors tested the hypothesis that bone marrow mesenchymal stem cells could improve nerve regeneration outcomes in an experimental model of limb replantation. METHODS: Twenty rats underwent replantation after total hindlimb amputation. Animals were subdivided into two groups: a replanted but nontreated control group and a replanted and bone marrow mesenchymal stem cell-transplanted group. Three months after surgery, nerve regeneration was assessed using functional, electrophysiologic, histomorphologic, and immunohistochemical analyses. RESULTS: Bone marrow mesenchymal stem cell-treated animals showed significantly better sciatic functional index levels and higher compound muscle action potential amplitudes in comparison with the controls. Histomorphometric analysis revealed that the number of regenerating axons was approximately two-fold greater in the treated nerves. In addition, the mean g-ratio of these axons was within the optimal range. Immunohistochemical assessment revealed that expression of S-100 and myelin basic protein in the treated nerves was significantly higher than in controls. Correspondingly, the expression levels of anti-protein gene product 9.5 and vesicular acetylcholine transporter in motor endplates were also significantly higher. Finally, muscles in the bone marrow mesenchymal stem cell-transplanted group showed significantly larger average fiber areas. CONCLUSION: The authors' findings demonstrate that it is possible to improve the degree of nerve regeneration after limb replantation by bone marrow mesenchymal stem cell transplantation.


Assuntos
Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/fisiologia , Regeneração Nervosa/fisiologia , Reimplante/métodos , Amputação/métodos , Animais , Contagem de Células , Diferenciação Celular/fisiologia , Sobrevivência Celular/fisiologia , Células Cultivadas , Membro Posterior/inervação , Membro Posterior/cirurgia , Masculino , Músculo Esquelético/fisiologia , Ratos Wistar , Coleta de Tecidos e Órgãos/métodos , Caminhada/fisiologia
19.
Int J Low Extrem Wounds ; 18(2): 112-113, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30919710

RESUMO

The excess risk of amputation in the diabetic population is well documented. However, approximately half of all amputations in England are in people that do not have diabetes - the remainder being mainly peripheral arterial disease. Whilst the prevalence of foot ulcers in the population without diabetes is significantly lower than their diabetic counterparts, the actual number of people with ulcers, and, therefore, the burden on services, is, the same. In addition to this inequality, the prevalence of amputation is greater in men than women and in the North of England compared with the South. We suggest that whilst diabetes is an important inequality to continue addressing, it is not the only one.


Assuntos
Amputação/estatística & dados numéricos , Pé Diabético/cirurgia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Doença Arterial Periférica/cirurgia , Adulto , Fatores Etários , Amputação/métodos , Pé Diabético/diagnóstico , Inglaterra , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Prevalência , Medição de Risco , Fatores Sexuais
20.
BMJ Case Rep ; 12(3)2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30872341

RESUMO

Peripheral artery pseudoaneurysm is rare in upper extremities compared with lower extremities. Early diagnosis and prompt management are two cornerstones of successful outcomes in these cases. Delay can lead to limb and life-threatening complications. We present a case of compartment syndrome of upper limb as a sequel to pseudoaneurysm of brachial artery for which we had to do shoulder disarticulation. The patient recovered uneventfully.


Assuntos
Falso Aneurisma/patologia , Artéria Braquial/patologia , Síndromes Compartimentais/etiologia , Fraturas do Úmero/complicações , Idoso , Amputação/métodos , Artéria Braquial/diagnóstico por imagem , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/cirurgia , Diagnóstico Precoce , Humanos , Masculino , Doenças Raras , Resultado do Tratamento
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