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1.
Acta Med Port ; 35(5): 384-387, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-36279892

RESUMO

Lower limb lymphorrhea is a condition with a considerable impact on the quality of life. It is usually associated with inguinal lymph node dissection and vascular procedures with femoral exposure. In this case report, we describe a patient who underwent a below-knee amputation and two years later developed lymphorrhea from the stump, preventing adaptation to the prosthesis. Lymphoscintigraphy showed a delayed lymphatic progression. After failure of conservative treatment, she underwent lymphaticovenular anastomosis with a successful outcome. Drainage cessation suggests that lymphaticovenular anastomosis may be an effective treatment for patients with lymphorrhea from and amputation stump, although further studies are required to determine long-term efficacy.


A linforreia do membro inferior é uma patologia com grande impacto na qualidade de vida. Está geralmente associada a esvaziamentos ganglionares inguinais e a procedimentos vasculares com exposição dos vasos femorais. Apresentamos o caso de uma doente que sofreu uma amputação abaixo do joelho e dois anos depois desenvolveu linforreia a partir do coto de amputação, impedindo a adaptação à prótese. A linfocintigrafia revelou um atraso na progressão linfática. Após falência do tratamento conservador, foi submetida a anastomoses linfático-venosas, com resolução da linforreia. A cessação da drenagem sugere que a realização de anastomoses linfático-venosas poderá ser um tratamento eficaz em doentes com inforreia a partir de um coto de amputação, embora sejam necessários mais estudos para determinar a sua eficácia a longo prazo.


Assuntos
Linfedema , Feminino , Humanos , Linfedema/etiologia , Linfedema/cirurgia , Cotos de Amputação/cirurgia , Microcirurgia/métodos , Qualidade de Vida , Anastomose Cirúrgica
2.
Proc Inst Mech Eng H ; 236(11): 1635-1645, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36177996

RESUMO

Selecting the correct material for each application has always been important. Now, with lattice metamaterials engineers can take advantage of the properties of these metamaterials to best suit a specific application. This paper investigates transtibial lower limb socket stress reduction through the implementation of conformal lattice metamaterials. In this work, a model was obtained with a 3D scanner from a plaster cast taken from a participant with a trans-tibial amputation. Then a 3D socket model was created and two conformal patterns were added to the surface of the socket using nTopology®. Parametric studies to relate the lattice metamaterials constituent elements to their effective structural properties, when such are loaded in-plane and out-of-plane were also included. Pressure test simulations were performed to determine the stresses produced in the sockets. This study concludes with discussion of the results and provides information on how surface conformal patterns can improve socket performance, showing that surface-vertex-centroid patterns increase stiffness and relieve stresses.


Assuntos
Membros Artificiais , Humanos , Desenho de Prótese , Cotos de Amputação , Amputação , Tíbia/cirurgia , Extremidade Inferior
3.
JBJS Case Connect ; 12(2)2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-36099516

RESUMO

CASE: A 7-year-old boy presented with osteosarcoma of the ulna that required a transhumeral amputation. The patient completed neoadjuvant chemotherapy before surgery. To prevent bone overgrowth and improved prosthetic fitting, a modified amputation was performed with acute shortening and distal epiphysis preservation. CONCLUSION: In this modified amputation, bone overgrowth was not seen and repeated surgeries for stump shaping were prevented. The modified technique enabled length for the prosthetic elbow and a wide stump for better fitting. In cases of transhumeral amputation in children, the modified technique should be considered.


Assuntos
Cotos de Amputação , Amputação , Amputação/métodos , Criança , Humanos , Masculino , Reoperação , Extremidade Superior
4.
Clin Biomech (Bristol, Avon) ; 99: 105741, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36041309

RESUMO

BACKGROUND: Step activity monitors provide insight into the amount of physical activity prosthesis users conduct but not how they use their prosthesis. The purpose of this research was to help fill this void by developing and testing a technology to monitor bodily position and type of activity. METHODS: Thin inductive distance sensors were adhered to the insides of sockets of a small group of transtibial prosthesis users, two at proximal locations and two at distal locations. An in-lab structured protocol and a semi-structured out-of-lab protocol were video recorded, and then participants wore the sensing system for up to 7 days. A data processing algorithm was developed to identify sit, seated shift, stand, standing weight-shift, walk, partial doff, and non-use. Sensed distance data from the structured and semi-structured protocols were compared against the video data to characterize accuracy. Bodily positions and activities during take-home testing were tabulated to characterize participants' use of the prosthesis. FINDINGS: Sit and walk detection accuracies were above 95% for all four participants tested. Stand detection accuracy was above 90% for three participants and 62.5% for one participant. The reduced accuracy may have been due to limited stand data from that participant. Step count was not proportional to active use time (sum of stand, walk, and standing weight-shift times). INTERPRETATION: Step count may provide an incomplete picture of prosthesis use. Larger studies should be pursued to investigate how bodily position and type of activity may facilitate clinical decision-making and improve the lives of people with lower limb amputation.


Assuntos
Membros Artificiais , Amputação , Cotos de Amputação , Humanos , Desenho de Prótese , Caminhada
6.
Sensors (Basel) ; 22(14)2022 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-35890905

RESUMO

(1) Background: A sustainable casting system that combines the use of a polystyrene bag, a prosthetic liner and a vacuum system was developed to reduce fabrication time while maintaining comfort for the trans-tibial prosthesis user. (2) Methods: Eight prosthetists (28.7 ± 8.25 years old) fit ten trans-tibial prosthesis wearers (46 ± 12.4 years old) with two types of total surface bearing (TSB) prostheses; a polystyrene bead (PS) prosthesis and a plaster of paris (POP) prosthesis. Duration of casting and combined mean peak pressure was measured at six locations on the residual limb using Force Sensing Resistors (FSR). A pressure uniformity score (%) was determined. Socket Comfort Scale (SCS) was also measured. (3) Results: Duration of casting for the POP method was 64.8 ± 9.53 min and 7.8 ± 2 min for the PS method, (p = 0.006). Pressure uniformity in the POP prosthesis was 79.3 ± 6.54 and 81.7 ± 5.83 in the PS prosthesis (p = 0.027). SCS in both prosthesis types were equivalent. (4) Conclusion: A rapid fit PS prosthesis was developed, with significantly shorter duration than the traditional POP method. Socket pressure uniformity was confirmed and improved in the PS method. Socket comfort was equal between the two prothesis types.


Assuntos
Membros Artificiais , Poliestirenos , Cotos de Amputação , Desenho de Prótese , Tíbia , Caminhada
7.
Proc Inst Mech Eng H ; 236(9): 1349-1356, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35821656

RESUMO

The study was designed to establish a biomechanical assessment platform for the lower limb residuum/socket interface as a function of duration and speed of movement. The approach exploits an interface sensor which measures multi-directional stresses at the interface. The corresponding interface coupling motion was assessed using a 3D motion capture system. A longitudinal study, involving a trans-femoral amputee, was conducted with nine repeated level walking sessions over a 12-month period. The effect of walking speed on interface biomechanics was also assessed. Interface peak pressures and shear stresses in the range of 55-59 kPa and 12-19 kPa were measured, respectively, over all sessions in the 12 months study period at the posterior-proximal location of the residuum. The peak pressure and longitudinal shear values were found to fluctuate approximately 11% and 40% as against its maximum value, respectively, over 12 months. In addition, up to 12° of angular coupling and up to 28 mm of pistoning were recorded over a gait cycle, which was found to change by 29% and 45% respectively over the study period. The variation in walking speed, by altering self-selected cadence, resulted in changes of pressure and shear stresses at mid-stance of the gait cycle. In particular, as compared with self-selected cadence, for fast speed, peak pressure and peak longitudinal shear stress decreased by 5% and 33%, respectively. For slow speed, peak pressure and peak longitudinal shear stress increased by 7% and 17%, respectively. The corresponding angular and pistoning revealed a variation of up to 29% and 45%, respectively. This biomechanical assessment approach shows promise in the quantitative assessment of interface kinematics and kinetics for lower limb prosthetics, the usage of which could assist the clinical assessment of prosthetic socket fit.


Assuntos
Amputados , Membros Artificiais , Cotos de Amputação , Fenômenos Biomecânicos , Marcha , Humanos , Estudos Longitudinais , Extremidade Inferior , Desenho de Prótese
8.
Med Eng Phys ; 105: 103829, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35781389

RESUMO

The role of the above-knee socket is to ensure the load transfer via the coupling of residual limb-prosthesis with minimal discomfort and without damaging the soft tissues. Modelling is a potential tool to predict socket fit prior to manufacture. However, state-of-the-art models only include the femur in soft tissues submitted to static loads neglecting the contribution of the hip joint. The hip joint is particularly challenging to model because it requires to compute the forces of muscles inserting on the residual limb. This work proposes a modelling of the hip joint including the estimation of muscular forces using a combined MusculoSKeletal (MSK)/Finite Element (FE) framework. An experimental-numerical approach was conducted on one femoral amputee subject. This allowed to i) model the hip joint and personalise muscular forces, ii) study the impact of the ischial support, and iii) evaluate the interface pressure. A reduction of the gluteus medius force from the MSK modelling was noticed when considering the ischial support. Interface pressure, predicted between 63 to 71 kPa, agreed with experimental literature data. The contribution of the hip joint is a key element of the modelling approach for the prediction of the socket interface pressure with the residual limb soft tissues.


Assuntos
Cotos de Amputação , Articulação do Quadril , Progressão da Doença , Fêmur , Análise de Elementos Finitos , Humanos , Extremidade Inferior
9.
J Ultrasound Med ; 41(12): 3119-3124, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35633227

RESUMO

Up to 70% of limb amputees develop chronic postamputation neuropathic pain (CPANP) which includes phantom pain and residual limb neuropathic pain due to neuroma formation. CPANP often requires invasive procedures aimed at neuroma ablation. Five amputees received 6 noninvasive magnetic resonance-guided high-intensity-focused ultrasound MRgHIFU treatments ExAblate®, Insightec, Tirat-Carmel, Israel). Although ablative temperature (>65°C) at the neuroma was reached in only 1 patient, pain intensity dropped from 5.7 at baseline to 4.3 and back to 5.6 at 3 and 6 month follow-up. Post-treatment bone necrosis was demonstrated in 1 patient. Although no firm conclusion about the effectiveness of MRgHIFU for CPANP could be drawn, further studies are warranted.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Neuralgia , Neuroma , Humanos , Estudos de Viabilidade , Cotos de Amputação/diagnóstico por imagem , Cotos de Amputação/cirurgia , Neuroma/complicações , Neuroma/diagnóstico por imagem , Neuroma/cirurgia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Neuralgia/diagnóstico por imagem , Neuralgia/cirurgia , Espectroscopia de Ressonância Magnética
10.
J Neuroeng Rehabil ; 19(1): 42, 2022 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501879

RESUMO

BACKGROUND: After amputation, many people become less active, feel lonely and lose independence. Understanding the factors associated with low physical activity levels and participation could contribute to defining key interventions which can support prosthesis users so they can live a more active and socially included lifestyle. This longitudinal observational study aims to assess relationships between physical activity, community participation, prosthetic fit, comfort and user satisfaction using actimetry, 3D scans and questionnaires in a Cambodian cohort of established lower limb prosthesis users. METHODS: Twenty participants (5F:15M, nine transfemoral, eleven transtibial, 24-60 years old and 3-43 years since amputation) were recruited. They completed a questionnaire which included their demographics, community participation, prosthesis satisfaction and comfort at the start of the study, and between three and six months later. Their prosthetic sockets and residual limbs were 3D scanned at the start and end of the study. Accelerometers were embedded under the cosmesis on the shank of the prosthesis, to collect ten weeks of activity data. RESULTS: Participants averaged 4470 steps/day (743-7315 steps/day), and wore their prosthesis for most waking hours, averaging 13.4 h/day (4.5-17.6 h/day). Self-reported measures of activity and hours of wear correlated with these accelerometer data (Spearman's rho rs = 0.59, and rs = 0.71, respectively). Participants who were more active wore their prosthesis for more hours/day (Pearson r = 0.73) and were more satisfied with socket fit (rs = 0.49). A longer residual limb correlated with better community participation (rs = 0.56) and comfort (rs = 0.56). Self-reported community participation did not correlate with a person's activity level (rs = 0.13), or their prosthesis comfort (rs = 0.19), and there was only weak correlation between how important the activity was to an individual, and how often they participated in it (rs = 0.37). A simple 0-10 scale of overall comfort did not provide enough detail to understand the types and severity of discomfort experienced. CONCLUSION: Associations between perceived and measured activity levels correlated with socket satisfaction in this cohort of people with established lower limb amputations. The small sample size means these correlations should be interpreted with caution, but they indicate variables worthy of further study to understand barriers to community engagement and physical activity for prosthesis users in Cambodia, and potentially in other settings.


Assuntos
Membros Artificiais , Adulto , Cotos de Amputação , Asiáticos , Estudos de Coortes , Participação da Comunidade , Humanos , Pessoa de Meia-Idade , Adulto Jovem
11.
Prosthet Orthot Int ; 46(5): 432-436, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35511446

RESUMO

BACKGROUND: Thermal discomfort because of elevated residual limb skin temperatures and/or perspiration within the prosthetic socket is frequently reported among people with amputation. OBJECTIVE: To evaluate the impact of the thermal conductivity characteristics of prosthetic liners on transtibial prosthesis heat dissipation, following postactivity rest. STUDY DESIGN: Time-dependent heat transfer study in solids using finite element analysis. METHODS: A three-dimensional model of the transtibial residual limb was developed by simplifying the geometry to tapered, layered cylinders. Four prosthetic socket liners of varying thermal conductivities were then added to the exterior, and the final surface temperatures of the skin layer were analyzed. RESULTS: Warmer temperatures were observed near regions with greater muscle volume; cooler temperatures were observed at the distal end of the simplified model. The final residual limb skin temperatures for each prosthetic liner were found to be significantly different from one another. Overall, the average final surface temperatures of the skin layer at the end of postactivity rest was 3.85°C ± 0.12°C greater than the initial surface temperatures of skin layer. CONCLUSIONS: None of the prosthetic liners made a significant reduction in residual limb skin temperatures after activity. The results indicate that the focus should be on other material properties of the prosthetic liners or active cooling systems.


Assuntos
Membros Artificiais , Cotos de Amputação , Análise de Elementos Finitos , Humanos , Desenho de Prótese , Tíbia/cirurgia
12.
Med Eng Phys ; 103: 103787, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35500988

RESUMO

The purpose of this research was to pursue an innovative cyclic panel-pull strategy during ambulation to minimize limb fluid volume loss in transtibial prosthesis users. Participants' traditional socket shapes were duplicated, and test sockets prepared with three adjustable motor-driven panels that were controlled by a microprocessor. After donning the prosthesis, participants' liners were fastened to the panels. During a 40 min test session, participants conducted three cycles of sitting (5 min) and walking (8 min). During the 5th and 6th min of each cycle of walking, the panels were cyclically pulled outward in late stance phase, decreasing pressure on the residual limb. Panels were returned to their original position in swing phase. Eight of twelve participants gained more fluid volume while walking when panel-pull was added than when it was removed. When the liner was uncoupled from the panels and panel-pull was executed, eight of twelve participants gained less fluid volume compared to when the liner was fastened to the panels. Panel-pull may facilitate limb fluid volume retention in transtibial prosthesis users. Efforts to simplify the design so that it can be implemented in long-term testing during at-home use should be considered.


Assuntos
Cotos de Amputação , Amputados , Humanos , Desenho de Prótese , Tíbia/cirurgia , Caminhada
13.
Prosthet Orthot Int ; 46(2): 95-107, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35412519

RESUMO

INTRODUCTION: Fit and alignment are observable objectives of the prosthesis rendering process for individuals with lower limb amputation. Nevertheless, there is a dearth of validated measures to directly assess the quality of this clinical procedure. OBJECTIVES: The objectives of this scoping review are to evaluate existing measurement parameters and clinical outcomes used in investigations of transtibial socket fit or prosthetic alignment and to identify gaps in the literature regarding tools for evaluation of prosthetic fitting. STUDY DESIGN: Scoping literature review. METHODS: A comprehensive search was conducted in the following databases: MEDLINE (through PubMed), Embase (through Elsevier), Scopus (through Elsevier), and Engineering Village (through Elsevier), resulting in 6107 studies to be screened. RESULTS: Sixty-three studies were included in the review. When measuring fit, studies most frequently reported on patient-reported comfort (n = 22) and socket size compared with the residual limb volume (n = 9). Alignment was most frequently measured by the prosthetists' judgment and/or use of an alignment jig (n = 34). The measurement parameters used to determine alignment or fit varied greatly among the included studies. CONCLUSION: This review demonstrated that most measures of socket fit rely on a patient's self-report and may vary with biopsychosocial factors unrelated to the socket fitting process. Meanwhile, alignment is determined mostly by the prosthetist's judgment, paired with objective measurements, such as alignment jigs and gait analysis. Efforts to standardize and validate measures of these parameters of prosthetic fitting are vital to improving clinical practice and reporting outcomes.


Assuntos
Membros Artificiais , Amputação , Cotos de Amputação , Análise da Marcha , Humanos , Conforto do Paciente , Desenho de Prótese , Ajuste de Prótese/métodos , Tíbia/cirurgia
14.
Ann Plast Surg ; 88(5): 533-537, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35443269

RESUMO

BACKGROUND: Neuromas, neuralgia, and phantom limb pain commonly occur after lower-extremity amputations; however, incidence of these issues is poorly reported and understood. Present literature is limited to small cohort studies of amputees, and the reported incidence of chronic pain after amputation ranges as widely as 0% to 80%. We sought to objectively investigate the incidence of postamputation pain and nerve-related complications after lower-extremity amputation. METHODS: Patients who underwent lower-extremity amputation between 2007 and 2017 were identified using a national insurance-based claims database. Incidence of reporting of postoperative neuroma, neuralgia, and phantom limb pain were identified. Patient demographics and comorbidities were assessed. Average costs of treatment were determined in the year after lower-extremity amputation. Logistic regression analyses and resulting odds ratios were calculated to determine statistically significant increases in incidence of postamputation nerve-related pain complications in the setting of demographic factors and comorbidities. RESULTS: There were 29,507 lower amputations identified. Postoperative neuralgia occurred in 4.4% of all amputations, neuromas in 0.4%, and phantom limb pain in 10.9%. Nerve-related pain complications were most common in through knee amputations (20.3%) and below knee amputations (16.7%). Male sex, Charlson Comorbidity Index > 3, diabetes mellitus, diabetic neuropathy, diabetic angiopathy, diabetic retinopathy, obesity, peripheral vascular disease, and tobacco abuse were associated with statistically significant increases in incidence of 1-year nerve-related pain or phantom limb pain. CONCLUSIONS: Given the incidence of these complications after operative extremity amputations and associated increased treatment costs, future research regarding their pathophysiology, treatment, and prevention would be beneficial to both patients and providers.


Assuntos
Neuralgia , Neuroma , Membro Fantasma , Amputação/métodos , Cotos de Amputação/cirurgia , Humanos , Extremidade Inferior/cirurgia , Masculino , Neuralgia/etiologia , Neuroma/etiologia , Membro Fantasma/epidemiologia , Membro Fantasma/etiologia , Estudos Retrospectivos
15.
J Bioeth Inq ; 19(1): 21-24, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35362927

RESUMO

Despite optimistic reports about the results of amputation for advanced vascular disease, the patient's assessment of advantages and disadvantages is seldom acknowledged. A detailed social study of 67 amputees has revealed considerable disparity between the patient's views and those of the medical staff. About a third of the patients are forced to retire from active work by the amputation; about three-quarters report a serious decline in their social activities; only about half are really independent with prostheses in the long term; a quarter report severe and intractable symptoms related to their amputation stumps; only about a quarter feel that the amputation was definitely beneficial; and only about one in five feel that the medical staff have provided adequate support during their hospital stay. Amputees face physical and financial disability, isolation, and discomfort. Every effort must be made to explain the implications of amputation honestly and realistically and to ensure continuing patient assessment and support.


Assuntos
Amputados , Membros Artificiais , Amputação , Cotos de Amputação , Emoções , Humanos
16.
J Neural Eng ; 19(2)2022 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-35320789

RESUMO

Objective. Evoked tactile sensation (ETS) elicited by transcutaneous electrical nerve stimulation (TENS) is promising to convey digit-specific sensory information to amputees naturally and non-invasively. Fitting ETS-based sensory feedback to amputees entails customizing coding of multiple sensory information for each stimulation site. This study was to elucidate the consistency of percepts and qualities by TENS at multiple stimulation sites in amputees retaining ETS.Approach. Five transradial amputees with ETS and fourteen able-bodied subjects participated in this study. Surface electrodes with small size (10 mm in diameter) were adopted to fit the restricted projected finger map on the forearm stump of amputees. Effects of stimulus frequency on sensory types were assessed, and the map of perceptual threshold for each sensation was characterized. Sensitivity for vibration and buzz sensations was measured using distinguishable difference in stimulus pulse width. Rapid assessments for modulation ranges of pulse width at fixed amplitude and frequency were developed for coding sensory information. Buzz sensation was demonstrated for location discrimination relating to prosthetic fingers.Main results. Vibration and buzz sensations were consistently evoked at 20 Hz and 50 Hz as dominant sensation types in all amputees and able-bodied subjects. Perceptual thresholds of different sensations followed a similar strength-duration curve relating stimulus amplitude to pulse width. The averaged distinguishable difference in pulse width was 12.84 ± 7.23µs for vibration and 15.21 ± 6.47µs for buzz in able-bodied subjects, and 14.91 ± 10.54µs for vibration and 11.30 ± 3.42µs for buzz in amputees. Buzz coding strategy enabled five amputees to discriminate contact of individual fingers with an overall accuracy of 77.85%.Significance. The consistency in perceptual qualities of dominant sensations can be exploited for coding multi-modality sensory feedback. A fast protocol of sensory coding is possible for fitting ETS-based, non-invasive sensory feedback to amputees.


Assuntos
Amputados , Membros Artificiais , Estimulação Elétrica Nervosa Transcutânea , Cotos de Amputação , Retroalimentação Sensorial/fisiologia , Antebraço/fisiologia , Humanos , Tato/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos
17.
Prosthet Orthot Int ; 46(5): 532-537, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35333813

RESUMO

BACKGROUND: Many people with amputations who live in low-resourced settings struggle to access the workshops where qualified prosthetists provide appropriate care. Novel technologies such as the thermoplastic Confidence Socket are emerging, which could help facilitate easier access to prosthetic services. OBJECTIVES: The objective of this study was to evaluate the satisfaction and the performance of transtibial prosthesis featuring the Confidence Socket. STUDY DESIGN: This is a longitudinal repeated-measures design study. METHODS: A convenience sample of 26 participants who underwent transtibial amputation were fitted with the Confidence Socket. The performance of the socket was evaluated after a follow-up period between 1 month and 6 months using the L test of functional mobility and the amputee mobility predictor. Satisfaction with the prosthesis was measured using the Trinity Amputation and Prosthetic Experience Scales and purposefully designed 7-point Likert scales. RESULTS: Ten of the 26 participants returned for follow-up. Perceived activity restriction and L test times improved significantly at follow-up, but the self-reported satisfaction with the Confidence Socket was lower at follow-up compared with that after fitting. CONCLUSIONS: The Amparo Confidence Socket represents a potentially viable alternative to improve access to appropriate prosthesis in Kenya, but some aspects of users' self-reported satisfaction should be further investigated.


Assuntos
Membros Artificiais , Tíbia , Amputação , Cotos de Amputação , Humanos , Quênia , Projetos Piloto , Desenho de Prótese , Tíbia/cirurgia
18.
Unfallchirurg ; 125(4): 275-281, 2022 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-35290475

RESUMO

Revision amputation, ray amputation and narrowing of the hand can be indicated for pathological alterations of fingers and thumbs due to traumatic, inflammatory or vascular causes but also for functional deficits regarding mobility, sensibility, perfusion, and/or pain. Surgical amputation is considered if reconstructive options are no longer possible, not desired and are no longer meaningful with respect to effort and risks. Patients need to be informed about the expected deficits in function and esthetic appearance due to the amputation in advance. On the other hand, surgical amputations represent a good treatment option, for which the duration of treatment and scope are well estimated. Therefore, they are good options for patients with comorbidities, with concerns about extensive reconstructive surgery and with limited compliance. It is essential to respect anatomical and functional aspects to guarantee favorable surgical results and avoid complications, which might compromise the function of the hand beyond that which is unavoidable. The most frequent complications after creating a stump or ray resection are persistent pain, unstable skin and soft tissue conditions, mobility disorders, disturbing stumps without function, uncontrolled growth of nail remnants and recurrent inflammation.


Assuntos
Amputação Traumática , Procedimentos Cirúrgicos Reconstrutivos , Amputação/métodos , Cotos de Amputação/cirurgia , Amputação Traumática/cirurgia , Dedos/cirurgia , Humanos
19.
Eur J Phys Rehabil Med ; 58(3): 462-469, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35148042

RESUMO

BACKGROUND: Current prosthetic sockets often provide limited anatomical fit, especially in patients with residual limb volume changes and fluctuations. AIM: To address these issues, Ottobock has developed the Varos Socket, a modular socket that can be adjusted by the user. The aim of this study was to evaluate the potential benefits and acceptance of a newly designed patient-adjustable socket in transfemoral amputees in early phase of prosthetic rehabilitation. DESIGN: A prospective A-B-A pilot study was conducted. SETTING: The setting of the study was an Orthopedic Rehabilitation Clinic. POPULATION: Ten patients with unilateral transfemoral amputation and recent amputation. METHODS: All patients underwent a standard rehabilitation program with physical therapy. The outcome measures included the Comprehensive Lower-limb Amputee Socket Survey (CLASS), Score Comfort Scale (SCS), a Socket Fit Scale, frequency of falls and stumbles, perceived pain, and satisfaction. RESULTS: The total CLASS score and three sub-scores (i.e., stability, suspension, comfort) were significantly higher with Varos socket. Significantly improved comfort and quality of socket fit were observed as measured by the Socket-Comfort-Scale and Socket-Fit-Scale and a trend towards reduced residual limb pain. 87.5% of the patients reported higher satisfaction than with the standard socket. CONCLUSIONS: The results suggest that the Varos socket improved comfort, stability, suspension, appearance, pain, and satisfaction in transfemoral amputees during the early rehabilitation program. A larger study and a longer observation period are warranted to confirm the results of this study. CLINICAL REHABILITATION IMPACT: Quick and easy socket fitting as well as instant adjustability by the patient bear substantial potential to improve and accelerate the rehabilitation process in the early phase after amputation.


Assuntos
Amputados , Membros Artificiais , Amputação/reabilitação , Cotos de Amputação , Amputados/reabilitação , Humanos , Dor , Projetos Piloto , Estudos Prospectivos , Desenho de Prótese
20.
Ann Surg ; 276(5): e302-e310, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-35129469

RESUMO

OBJECTIVE: To evaluate the impact of N-acetyl-cysteine (NAC) on amputation stump perfusion and healing in patients with critical limb-threatening ischemia (CLTI). BACKGROUND: Patients with CLTI are at increased risk of poor amputation site healing leading to increased procedure-associated morbidity. METHODS: In a pilot, double-blind, placebo-controlled, randomized controlled trial, patients with CLTI undergoing major elective lower extremity amputation were randomized 1:1 to intravenous NAC (1200 mg twice-daily) or placebo for up to 5 days postoperatively. Primary outcomes were change in stump perfusion at postoperative day 3 (POD3) and POD5, and healing at POD30. Stumps were serially evaluated for wound healing, and tissue perfusion was evaluated using noninvasive laser-assisted fluorescent angiography. RESULTS: Thirty-three patients were randomized to NAC (n = 16) or placebo (n = 17). Thirty-one patients were eligible for intent-to-treat analysis (NAC14; placebo17). Twenty patients (NAC7; placebo13) had amputation stump perfusion defects at POD0 and were considered high-risk for poor healing. Intent-to-treat analysis revealed no significant differences between treatment groups. Subgroup analysis of high-risk patients revealed differences in stump perfusion defect size (NAC-0.53-fold, placebo +0.71-fold; 95% confidence interval -2.11 to-0.35; P < 0.05) and healing (NAC [100%], placebo [46%]; P < 0.01) between study treatments. CONCLUSIONS: Postoperative NAC administration may improve amputation stump perfusion and healing in patients with CLTI and tissue perfusion defects at the time of amputation. Intraoperative laser-assisted fluorescent angiogra-phy may help surgeons identify high-risk patients with stump perfusion defects and provide early adjunctive interventions. Future studies can further explore the therapeutic benefits of NAC in the healing and perfusion of other surgical operative sites in high-risk individuals. TRIAL REGISTRATION: clinicaltrials.gov, Identifier: NCT03253328.


Assuntos
Cotos de Amputação , Doença Arterial Periférica , Acetilcisteína/uso terapêutico , Amputação , Cotos de Amputação/cirurgia , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Extremidade Inferior/cirurgia , Doença Arterial Periférica/cirurgia , Projetos Piloto , Fatores de Risco , Resultado do Tratamento
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