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Deutsches Arzteblatt International Oct 2020
Topics: Amputation, Surgical; Humans; Intermittent Claudication; Peripheral Arterial Disease
PubMed: 33357355
DOI: 10.3238/arztebl.2020.0677a -
Annals of Vascular Surgery Sep 2022Major lower limb amputations are associated with considerable disability, low quality of life, and poor rates of returning to work, all of which are often attributed to...
BACKGROUND
Major lower limb amputations are associated with considerable disability, low quality of life, and poor rates of returning to work, all of which are often attributed to the poor level of functional mobility that amputees experience postoperatively. This study aimed to quantify ambulatory outcomes after major lower limb amputation and identify potential prognostic factors for patients most likely to achieve ambulation and prosthesis use, with the hypothesis that variation in outcomes correlates to age, level of amputation, and place of residence at the time of amputation.
METHODS
This retrospective cohort study identified functional outcomes for patients who had lower limb amputations between 2012 and 2020. Patients were identified from the 10th revision of the International Classification of Diseases Australian Modification (ICD-10-AM)-coded state-wide government-maintained hospital administrative data by procedure codes for lower limb amputation. The primary outcomes were ambulation at the time of discharge from acute hospital stay, discharge destination, and prosthesis use. Variables for adjustment included patient age, comorbidity, level of amputation, and place of residence.
RESULTS
Three-hundred and seventeen amputations were performed in 269 patients. Most procedures were transtibial amputations (56.4%) and for ischemic/infective indications (84%). Thirty-seven percent of patients were ambulating independently at the time of discharge and 55.9% demonstrated independent mobility with prosthesis at follow-up. Ambulation at the time of discharge predicted patients who were more likely to return home rather than residential or hospital care (odds ratio [OR] 1.8 95%; confidence interval [CI] 1.0-3.2). Patients with transtibial amputation were more likely to achieve prosthesis use than transfemoral (OR 4.4, 95% CI 2.1-9.5), after adjusting for age, comorbidity, and geographical factors. Mobility and prosthesis use was lowest in patients who were older, had transfemoral amputations, and resided in regional or rural areas.
CONCLUSIONS
The significant outcome disparities identified in this cohort study highlight the need for targeted quality interventions aimed at improving functional outcomes for patients undergoing major amputation for peripheral artery disease.
Topics: Amputation, Surgical; Australia; Cohort Studies; Humans; Lower Extremity; Peripheral Arterial Disease; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 35257926
DOI: 10.1016/j.avsg.2022.02.009 -
Hand Clinics Feb 2021Following a fingertip amputation, if vessels are present and of adequate condition, microsurgical replantation is the preferred technique for management. Composite... (Review)
Review
Following a fingertip amputation, if vessels are present and of adequate condition, microsurgical replantation is the preferred technique for management. Composite grafting has a limited role in the management of fingertip amputations due to its unreliable nature but can be an option when an amputated fingertip is not replantable and the patient desires restoration of fingertip length and aesthetics. When composite grafting is selected as the treatment of choice for a particular patient, there are methods of optimizing the chances of graft revascularization and survival, including early grafting, graft cooling, and a moist wound healing environment.
Topics: Amputation, Surgical; Amputation, Traumatic; Finger Injuries; Fingers; Humans; Replantation
PubMed: 33198917
DOI: 10.1016/j.hcl.2020.09.007 -
Polski Przeglad Chirurgiczny Feb 2022<b>Introduction:</b> Metastases of malignant neoplasms to the hand are very rare and constitute approximately 0.01% of whole distant metastases. They usually...
<b>Introduction:</b> Metastases of malignant neoplasms to the hand are very rare and constitute approximately 0.01% of whole distant metastases. They usually indicate generalized neoplastic disease, although sometimes can be a first manifestation of dissemination. </br></br> <b>Cases reports:</b> The study presents 4 cases of metastatic tumors to the hands in patients with diagnosis of renal (2) and lung cancer (1) and one of unknown point of origin. The lesions were localized in the fingers in two patients and in the wrist in the other two. The patient with wrist involvement received excisional biopsy of the lesion, followed by forearm amputation. Two patients with finger tumors had their affected fingers amputated. The patient with the cyst involving the wrist received local excision of the lesion. Operative wounds healed uneventfully in all patients, but 3 of them eventually died within one year from hand operation.
Topics: Amputation, Surgical; Hand; Humans; Lung Neoplasms
PubMed: 36169589
DOI: 10.5604/01.3001.0015.7341 -
Revista Espanola de Salud Publica Feb 2024Amputations in work accidents are a phenomenon with a high incidence and peculiar characteristics. The few studies about the effects of amputation are referred to large... (Review)
Review
OBJECTIVE
Amputations in work accidents are a phenomenon with a high incidence and peculiar characteristics. The few studies about the effects of amputation are referred to large limbs, and show that, beyond the physical consequences, there are important psychological consequences. The goal of this paper was to show the updated knowledge on the main psychopathological consequences of amputations in work accidents, as well as the variables that can modulate them.
METHODS
A non-systematic bibliographic review was carried out, with varied ad hoc searches for the different variables studied.
RESULTS
Studies have focused mainly on anxiety and depressive symptoms, post-traumatic stress disorder, and phantom limb pain. Modulating variables whose presence improves the prognosis of these persons have been identified, such as adaptation to daily life, physical exercise, coping strategies, resilience and quality of life.
CONCLUSIONS
The different psychological areas reviewed should be considered when attending people who have suffered an amputation in a work accident. Likewise, enhancing the modulating variables whose presence improves the prognosis is an interesting field for professional intervention.
Topics: Humans; Quality of Life; Spain; Amputation, Surgical; Anxiety; Accidents
PubMed: 38421014
DOI: No ID Found -
The Journal of Bone and Joint Surgery.... Aug 2022A cohort of patients with traumatic brachial plexus injuries (BPIs) underwent elective amputation following unsuccessful surgical reconstruction or delayed presentation....
BACKGROUND
A cohort of patients with traumatic brachial plexus injuries (BPIs) underwent elective amputation following unsuccessful surgical reconstruction or delayed presentation. The results of amputation with and without a myoelectric prosthesis (MEP) using nonintuitive controls were compared. We sought to determine the benefits of amputation, and whether fitting with an MEP was feasible and functional.
METHODS
We conducted a retrospective review of patients with BPI who underwent elective upper-extremity amputation at a single institution. Medical records were reviewed for demographics, injury and reconstruction details, amputation characteristics, outcomes, and complications. Prosthesis use and MEP function were assessed. The minimum follow-up for clinical outcomes was 12 months.
RESULTS
Thirty-two patients with BPI and an average follow-up of 53 months underwent elective amputation between June 2000 and June 2020. Among the cases were 18 transhumeral amputations, 12 transradial amputations, and 2 wrist disarticulations. There were 29 pan-plexus injuries, 1 partial C5-sparing pan-plexus injury, 1 lower-trunk with lateral cord injury, and 1 lower-trunk injury. Amputation occurred, on average, at 48.9 months following BPI and 36.5 months following final reconstruction. Ten patients were fitted for an MEP with electromyographic signal control from muscles not normally associated with the intended function (nonintuitive control). Average visual analog scale pain scores decreased post-amputation: from 4.8 pre-amputation to 3.3 for the MEP group and from 5.4 to 4.4 for the non-MEP group. Average scores on the Disabilities of the Arm, Shoulder and Hand questionnaire decreased post-amputation, but not significantly: from 35 to 30 for the MEP group and from 43 to 40 for the non-MEP group. Patients were more likely to be employed following amputation than they were before amputation. No patient expressed regret about undergoing amputation. All patients in the MEP group reported regular use of their prosthesis compared with 29% of patients with a traditional prosthesis. All patients in the MEP group demonstrated functional terminal grasp/release that they considered useful.
CONCLUSIONS
Amputation is an effective treatment for select patients with BPI for whom surgical reconstruction is unsuccessful. Patients who underwent amputation reported decreased mechanical pain, increased employment rates, and a high rate of satisfaction following surgery. In amputees with sufficient nonintuitive electromyographic signals, MEPs allow for terminal grasp/release and are associated with high rates of prosthesis use.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Amputation, Surgical; Amputation, Traumatic; Amputees; Artificial Limbs; Brachial Plexus; Humans; Pain
PubMed: 35976186
DOI: 10.2106/JBJS.21.01261 -
The Canadian Journal of Cardiology Mar 2023
Topics: Humans; Lower Extremity; Retrospective Studies; Amputation, Surgical
PubMed: 36528278
DOI: 10.1016/j.cjca.2022.12.008 -
Rehabilitacion 2022Partial hand and finger amputations are relatively rare but devastating due to the consequences they provoque. In addition, they are more likely than lower limb... (Review)
Review
Partial hand and finger amputations are relatively rare but devastating due to the consequences they provoque. In addition, they are more likely than lower limb amputations in car accidents, work accidents and by certain weapons of war. Men are going to have a much higher risk of traumatic amputation than women, with a rate 6.6 times higher. Fitting can be a complex process and a challenge for professionals. For this reason, it is important to know all the options available on the market that can meet the needs of patients, from cosmetic to myoelectric prostheses. Fitting requires the coordinated activity of a multiassistant clinical work team, the center of the team being the person who has suffered the amputation, who must have all the information possible to be able to actively participate in decision-making.
Topics: Amputation, Surgical; Amputation, Traumatic; Artificial Limbs; Female; Hand; Humans; Male; Upper Extremity
PubMed: 35641345
DOI: 10.1016/j.rh.2022.04.002 -
Journal of Orthopaedic Surgery (Hong... 2020Major lower limb amputation is occasionally required in the management of end-stage pathology where other treatment options have failed. The primary aim of this study...
BACKGROUND
Major lower limb amputation is occasionally required in the management of end-stage pathology where other treatment options have failed. The primary aim of this study was to determine the 30-day and 1-year mortality rates of patients undergoing nontraumatic major lower limb amputation. Secondary aims were to investigate risk factors for poor outcomes, incidence of previous minor amputation, and the rate of subsequent major amputation.
METHODS
All nontraumatic, major lower limb amputations performed at Toowoomba Hospital during an 18-year period were retrospectively reviewed. Mortality data were obtained from the Queensland Registry of Births, Deaths and Marriages. Kaplan-Meier analysis was performed to determine survival after amputation.
RESULTS
A total of 147 patients were included in the study, with 104 undergoing below knee and 43 undergoing above knee amputations. Ten patients identified as having an Aboriginal and Torres Strait Islander background. For all patients, the 30-day mortality was 4.1% and 1-year mortality was 21.1%. For Indigenous patients, 30-day mortality was 10%. Previous minor amputation had occurred in 40 patients. Twenty-nine patients underwent further minor surgery after their initial major amputation, with thirteen requiring subsequent major amputation. Factors that increased mortality risk were the presence of peripheral vascular disease, an American Society of Anesthesiologists score of four and age greater than 65 years.
CONCLUSION
The morbidity and mortality following major lower limb amputation is significant. The findings of this study highlight the importance of preventative measures to minimize the incidence of lower limb amputations in the future.
Topics: Adult; Aged; Aged, 80 and over; Amputation, Surgical; Amputees; Female; Humans; Incidence; Lower Extremity; Male; Middle Aged; Queensland; Registries; Retrospective Studies; Risk Factors; Survival Rate
PubMed: 33054544
DOI: 10.1177/2309499020958477 -
Foot and Ankle Clinics Sep 2022The prevalence of diabetes mellitus, particularly type 2 diabetes, is increasing worldwide. Also, the incidence of both lower limb revascularizations and amputations is... (Review)
Review
The prevalence of diabetes mellitus, particularly type 2 diabetes, is increasing worldwide. Also, the incidence of both lower limb revascularizations and amputations is increasing. We have less transtibial amputations due to improved diabetes care, but also due to modern treatments, vascular surgery, and development of plastic surgery. With well-planned minor amputations, more limbs can be saved. Minor limb-saving amputations are preferred especially to older diabetes patients, because they have a high-risk contralateral amputations. Losing both limbs causes major problems for patients and their life, risk for lifetime ward is high.
Topics: Amputation, Surgical; Diabetes Mellitus, Type 2; Diabetic Foot; Foot; Humans
PubMed: 36096558
DOI: 10.1016/j.fcl.2022.05.003