-
World Journal of Clinical Cases May 2022In this review intended for medical staff involved in patient rehabilitation, we provided an overview of the basic methods for managing amputation stumps. After the... (Review)
Review
In this review intended for medical staff involved in patient rehabilitation, we provided an overview of the basic methods for managing amputation stumps. After the amputation surgery, it is imperative to optimize the remaining physical abilities of the amputee through rehabilitation processes, including postoperative rehabilitation, desensitization, and continuous application of soft or rigid dressings for pain reduction and shaping of the stump. Depending on the situation, a prosthesis may be worn in the early stage of recovery or an immediate postoperative prosthesis may be applied to promote stump maturation. Subsequently, to maintain the range of motion of the stump and to prevent deformation, the remaining portion of the limb should be positioned to prevent contracture. Continuous exercises should also be performed to improve muscle strength to ensure that the amputee is able to perform activities of daily living, independently. Additionally, clean wound or edema management of the stump is necessary to prevent problems associated with wearing the prosthesis. Our review is expected to contribute to the establishment of basic protocols that will be useful for stump management from the time of completion of amputation surgery to the fitting of a prosthesis to optimize patient recovery.
PubMed: 35665133
DOI: 10.12998/wjcc.v10.i13.3981 -
Der Unfallchirurg Apr 2022Revision amputation, ray amputation and narrowing of the hand can be indicated for pathological alterations of fingers and thumbs due to traumatic, inflammatory or... (Review)
Review
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.
Topics: Amputation, Surgical; Amputation Stumps; Amputation, Traumatic; Fingers; Humans; Plastic Surgery Procedures
PubMed: 35290475
DOI: 10.1007/s00113-022-01154-3 -
Hand Clinics Aug 2021With the development of newer techniques for symptomatic neuroma treatment, such as regenerative peripheral nerve interface and targeted muscle reinnervation,... (Review)
Review
With the development of newer techniques for symptomatic neuroma treatment, such as regenerative peripheral nerve interface and targeted muscle reinnervation, transposition and coverage techniques often have been referred to as "passive techniques." In spite of its negative connotation, these passive techniques yield positive results in a majority of patients treated. The experienced surgeon has more options than ever before in the prevention and management of problematic neuromas. Critical appraisal of the current literature reveals no single, optimal standard of care. Instead, surgeons have a plethora of useful techniques that can be implemented on a case-by-case basis to optimize outcomes.
Topics: Humans; Amputation Stumps; Amputation, Surgical; Neuroma; Peripheral Nerves; Nerve Regeneration; Nerve Transfer
PubMed: 34253307
DOI: 10.1016/j.hcl.2021.04.002 -
Der Orthopade Jan 2021Problems in prosthetic fitting or mobility of amputated patients are often caused primarily by insufficient stump quality. To achieve better rehabilitation results and... (Review)
Review
Problems in prosthetic fitting or mobility of amputated patients are often caused primarily by insufficient stump quality. To achieve better rehabilitation results and a higher quality of life it is mandatory that the physician treating the patient is able to diagnose stump problems and to indicate stump correction surgery. A skilled knowledge of amputation techniques, different levels of amputation, as well as of prosthetic fitting methods is needed. The physician has to have knowledge of the differences between phantom sensation, phantom pain and stump pain, as well as their possible causes. Especially with stump pain caused by stump problems revision surgery has to be considered with the patient. A well-done surgical stump correction should result in a better end-bearing capacity, less pain, improved rehabilitation potential and better life quality. Stump revision surgery should be indicated more often, and this type of surgery should be a standard procedure in every orthopaedic and trauma department.
Topics: Amputation, Surgical; Amputation Stumps; Humans; Phantom Limb; Quality of Life
PubMed: 33284356
DOI: 10.1007/s00132-020-04039-8 -
Annals of Plastic Surgery May 2022Neuromas, neuralgia, and phantom limb pain commonly occur after lower-extremity amputations; however, incidence of these issues is poorly reported and understood....
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.
Topics: Amputation, Surgical; Amputation Stumps; Humans; Lower Extremity; Male; Neuralgia; Neuroma; Phantom Limb; Retrospective Studies
PubMed: 35443269
DOI: 10.1097/SAP.0000000000003009 -
Hand Clinics Aug 2021Targeted muscle reinnervation (TMR) is a surgical procedure, whereby nerves without muscle targets after extremity amputation are transferred to residual stump muscles.... (Review)
Review
Targeted muscle reinnervation (TMR) is a surgical procedure, whereby nerves without muscle targets after extremity amputation are transferred to residual stump muscles. Thereby, the control of prosthesis is improved by increasing the number of independent muscle signals. The authors describe indications for TMR to improve prosthetic control and present standard nerve transfer matrices suitable for transhumeral and glenohumeral amputees. In addition, the perioperative procedure is described, including preoperative testing, surgical approach, and postoperative rehabilitation. Based on recent neurophysiological insights and technological advances, they present an outlook into the future of prosthetic control combining TMR and implantable electromyographic technology.
Topics: Amputation, Surgical; Amputation Stumps; Amputees; Artificial Limbs; Humans; Muscle, Skeletal
PubMed: 34253314
DOI: 10.1016/j.hcl.2021.05.006 -
Der Orthopade Jun 2015
Topics: Amputation, Surgical; Amputation Stumps; Artificial Limbs; Humans; Neural Prostheses; Prosthesis Fitting
PubMed: 25962862
DOI: 10.1007/s00132-015-3118-8 -
Journal of Bioethical Inquiry Mar 2022Despite optimistic reports about the results of amputation for advanced vascular disease, the patient's assessment of advantages and disadvantages is seldom...
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.
Topics: Amputation, Surgical; Amputation Stumps; Amputees; Artificial Limbs; Emotions; Humans
PubMed: 35362927
DOI: 10.1007/s11673-022-10174-y -
Orthopaedics & Traumatology, Surgery &... Feb 2016Amputation of a limb is always perceived as a catastrophe. The principles underlying creation of a stump adapted to modern prosthetic fittings must be fully understood... (Review)
Review
Amputation of a limb is always perceived as a catastrophe. The principles underlying creation of a stump adapted to modern prosthetic fittings must be fully understood and the patient managed by a multidisciplinary team. In paediatric patients, preserving residual limb length is a crucial point that should be assessed according to the expected growth potential. Advances in prosthetic fittings have led to changes in the overall concept of socket design, which seeks to achieve three objectives: to maximise the weight-bearing surface area, to eliminate friction of the skin on the socket, and to eliminate lever-arm effects. The introduction on the market of new materials has contributed substantially to advances in prosthetic fittings. These advances require the use of new criteria for stump quality and optimisation, which exert a considerable influence on prosthesis function. Prosthetic fitting and specific management of psychological and social problems are provided during an inpatient stay in a physical medicine department, by a team of physicians, other healthcare professionals, social workers, and educators. Three-dimensional imaging and gait analysis provide valuable information.
Topics: Amputation, Surgical; Amputation Stumps; Artificial Limbs; Biomechanical Phenomena; Child; Gait; Humans; Imaging, Three-Dimensional; Lower Extremity; Prosthesis Design; Prosthesis Fitting; Weight-Bearing
PubMed: 26797004
DOI: 10.1016/j.otsr.2015.03.020 -
Expert Review of Medical Devices Jan 2022The prosthetic socket is the connecting part between the stump and the prosthesis, which is the important basis for the function of the prosthesis. The current... (Review)
Review
INTRODUCTION
The prosthetic socket is the connecting part between the stump and the prosthesis, which is the important basis for the function of the prosthesis. The current prosthetic socket is difficult in meeting the needs of amputees current, which is the main reason for amputees abandoning their prostheses. This paper reviews the design and use of prosthetic sockets for lower limb.
AREAS COVERED
The contribution of this publication is to review the skin problem, interface stress and volume fluctuations for prosthetic sockets, which are proposed as the key factors affecting the use of prosthetic sockets. Moreover, the lower limb prosthetic sockets are classified into the full-contact and the frame-type sockets according to the different contact type between stump and prosthetic socket, and their advantages and disadvantages are analyzed from different perspectives.
EXPERT OPINION
Aim to design the prosthetic socket with function transfer, suspension stability and comfort of socket, a design concept for prosthetic socket with self-adapt in real-time is proposed. It can be achieved by the smart materials with special mechanical properties.
Topics: Amputation Stumps; Amputees; Artificial Limbs; Humans; Lower Extremity; Prosthesis Design
PubMed: 34932435
DOI: 10.1080/17434440.2022.2020094