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Journal of Pediatric Orthopedics Sep 2020Fibula hemimelia is the most common congenital deficiency of long bones. Primary treatment options include amputation with prosthetic fitting or limb reconstruction. The... (Meta-Analysis)
Meta-Analysis
PURPOSE
Fibula hemimelia is the most common congenital deficiency of long bones. Primary treatment options include amputation with prosthetic fitting or limb reconstruction. The aim of our study was to conduct a systematic review comparing amputation with limb reconstruction for fibula hemimelia.
METHODS
MEDLINE, EMBASE, Web of Science, Elsevier Scopus, and the Cochrane Registry of Clinical Trials were searched from 1951 to 2019 for studies that evaluated amputation versus limb reconstruction for fibula hemimelia. Random effect models were utilized for the meta-analytic comparisons of amputation versus limb reconstruction for patient satisfaction and surgical complications. Descriptive, quantitative, and qualitative data were extracted.
RESULTS
Seven retrospective cohort studies were eligible for the meta-analysis, with a total of 169 fibula hemimelia cases. Amputation resulted in an odds ratio of 6.8 (95% confidence interval: 2.4, 19.2) when compared with limb reconstruction in terms of patient satisfaction. Furthermore, limb reconstruction was found to have an odds ratio of 28 (95% confidence interval: 7.8, 100.3) for complications. The total surgical complication rates in the amputation and limb reconstruction groups were 0.2 and 1.2 complications per limb. The rate of surgical procedures per patient was 1.5 and 4.2 for amputation and limb reconstruction, respectively.
CONCLUSIONS
The cumulative evidence at present indicates better patient satisfaction with less surgical complications and less number of procedures with amputation for fibula hemimelia when compared with limb reconstruction. Absence of uniform protocols make it difficult to compare results accurately.
LEVEL OF EVIDENCE
Level III-therapeutic.
Topics: Amputation, Surgical; Ectromelia; Fibula; Humans; Outcome Assessment, Health Care; Patient Satisfaction; Postoperative Complications; Plastic Surgery Procedures
PubMed: 31972725
DOI: 10.1097/BPO.0000000000001510 -
Annals of Surgery Feb 2021Recent progress in biomechatronics and vascularized composite allotransplantation have occurred in the absence of congruent advancements in the surgical approaches... (Review)
Review
BACKGROUND
Recent progress in biomechatronics and vascularized composite allotransplantation have occurred in the absence of congruent advancements in the surgical approaches generally utilized for limb amputation. Consideration of these advances, as well as of both novel and time-honored reconstructive surgical techniques, argues for a fundamental reframing of the way in which amputation procedures should be performed.
METHODS
We review sentinel developments in external prosthetic limb technology and limb transplantation, in addition to standard and emerging reconstructive surgical techniques relevant to limb modification, and then propose a new paradigm for limb amputation.
RESULTS
An approach to limb amputation based on the availability of native tissues is proposed, with the intent of maximizing limb function, limiting neuropathic pain, restoring limb perception/proprioception and mitigating limb atrophy.
CONCLUSIONS
We propose a reinvention of the manner in which limb amputations are performed, framed in the context of time-tested reconstructive techniques, as well as novel, state-of-the-art surgical procedures. Implementation of the proposed techniques in the acute setting has the potential to elevate advanced limb replacement strategies to a clinical solution that perhaps exceeds what is possible through traditional surgical approaches to limb salvage. We therefore argue that amputation, performed with the intent of optimizing the residuum for interaction with either a bionic or a transplanted limb, should be viewed not as a surgical failure, but as an alternative form of limb reconstruction.
Topics: Amputation, Surgical; Artificial Limbs; Humans; Limb Salvage; Vascularized Composite Allotransplantation
PubMed: 32324689
DOI: 10.1097/SLA.0000000000003895 -
Journal of Plastic, Reconstructive &... Sep 2023Plastic surgeons play a critical role in the management of amputations and are uniquely positioned to improve the lives and functional abilities of patients with limb... (Review)
Review
Plastic surgeons play a critical role in the management of amputations and are uniquely positioned to improve the lives and functional abilities of patients with limb loss. The embodiment of a prosthesis describes how effectively it replaces a missing limb and is an important aspect of patient care. Despite its importance, the current prosthetics literature lacks a formal definition of embodiment, and descriptions are often vague or incomplete. In this narrative review, we assess the current literature on prosthetic embodiment to explore the main mechanisms of embodiment and how each allows a prosthesis to interface with the human body. In doing so, we provide a comprehensive, holistic framework for understanding this concept.
Topics: Humans; Amputation, Surgical; Prosthesis Implantation; Artificial Limbs; Amputees; Surgeons
PubMed: 37418846
DOI: 10.1016/j.bjps.2023.06.041 -
The Journal of Spinal Cord Medicine May 2022: The purpose of this study is to describe a population of individuals with chronic spinal cord injury (SCI), who underwent lower limb amputations, identify indications... (Observational Study)
Observational Study
: The purpose of this study is to describe a population of individuals with chronic spinal cord injury (SCI), who underwent lower limb amputations, identify indications for amputations, medical co-morbidities and summarize resulting complications and functional changes.: Retrospective observational cohort study. SCI Service, Department of Veterans Affairs (VA) Health Care System.: Veterans with SCI of greater than one-year duration who underwent amputation at a VA Medical Center over a 15-year period, using patient registry and electronic health records. Diagnosis and procedure codes were utilized to identify amputations.: Not applicable.: Amputation level, complications, functional status, change in prescribed mobility equipment and mortality.: 52 individuals with SCI received amputation surgery with a mean age of 62.9 years at time of amputation. Thirty-seven (71.2%) had paraplegia, and 34 (65.3%) had motor-complete SCI. Pressure injuries and osteomyelitis were most common indications for amputation. Amputations were primarily (83%) at the transtibial level or more proximal, with the most common amputation level at transfemoral/through-knee (29;55.8%). Postoperative complications occurred in five individuals. Seven of nine individuals who were ambulatory pre-surgery remained ambulatory. Equipment modifications were required in 37 (71%) of individuals. Five-year survival following amputations was 52%, and presence of peripheral vascular disease was significantly associated with mortality (P = 0.006).: Pressure injuries and osteomyelitis were most common etiologies for limb loss. Less than half experienced functional change after amputation; more than half required new or modified mobility equipment. An increase in mortality may reflect overall health deterioration over time.
Topics: Amputation, Surgical; Humans; Lower Extremity; Middle Aged; Osteomyelitis; Retrospective Studies; Spinal Cord Injuries
PubMed: 32808883
DOI: 10.1080/10790268.2020.1800964 -
BMC Musculoskeletal Disorders Jan 2020The purpose of this study was to investigate residual rotation of patients with forearm amputation and the contribution of involved muscle to residual rotation.
BACKGROUND
The purpose of this study was to investigate residual rotation of patients with forearm amputation and the contribution of involved muscle to residual rotation.
METHODS
Testing was performed using five fresh-frozen cadaveric specimens prepared by isolating muscles involved in forearm rotation. Amputation was implemented at 25 cm (wrist disarticulation), 18 cm, or 10 cm from the tip of olecranon. Supination and pronation in the amputation stump were simulated with traction of involved muscle (supinator, biceps brachii, pronator teres, pronator quadratus) using an electric actuator. The degree of rotation was examined at 30°, 60°, 90°, and 120° in flexion of elbow.
RESULTS
Average rotation of 25 cm forearm stump was 148° (SD: 23.1). The rotation was decreased to 117.5° (SD: 26.6) at 18 cm forearm stump. It was further decreased to 63° (SD 31.5) at 10 cm forearm stump. Tendency of disorganized rotation was observed in close proximity of the amputation site to the elbow. Full residual pronation was achieved with traction of each pronator teres and pronator quadratus. Although traction of supinator could implement residual supination, the contribution of biceps brachii ranged from 4 to 88% according to the degree of flexion.
CONCLUSIONS
Close proximity of the amputation site to the elbow decreased the residual rotation significantly compared to residual rotation of wrist disarticulation. The preservation of pronosupination was 80% at 18 cm forearm stump. Although the pronator teres and the pronator quadratus could make a full residual pronation separately, the supinator was essential to a residual supination.
Topics: Aged; Aged, 80 and over; Amputation, Surgical; Cadaver; Female; Forearm; Humans; Male; Middle Aged; Rotation
PubMed: 31954406
DOI: 10.1186/s12891-020-3050-x -
Irish Journal of Medical Science Nov 2020Data on vascular patients following amputation in Ireland is lacking, limiting capability to plan services. This paper seeks to benchmark survival and rehabilitation... (Review)
Review
OBJECTIVES
Data on vascular patients following amputation in Ireland is lacking, limiting capability to plan services. This paper seeks to benchmark survival and rehabilitation outcomes among vascular patients in Ireland following lower extremity amputation (LEA), and compare subgroups of those undergoing transfemoral (TFA) or transtibial amputation (TTA).
METHODS
A review was conducted of all patients who underwent non-traumatic TFA or TTA from 2000 to 2009 in a tertiary vascular surgery centre. Demographics, surgical data, perioperative outcomes, medium-term functional outcomes, and survival were assessed.
RESULTS
One hundred and seventy-two patients (2:1 male: female) underwent 192 non-traumatic LEAs. Median age for TFA was 75 years and TTA 67 (p = 0.002). A percentage of 36.5% had undergone prior attempts at surgical revascularization, 25% had undergone prior distal amputation or debridement. Thirty-three (17%) required stump revision. Twenty-three (13.2%) died in hospital. Median survival for those who died in hospital was 17 days (0-367), versus 17 months (2-106) for those who survived to discharge.
CONCLUSION
LEA for vascular pathology has significant morbidity and mortality, with long in-patient stays and short median survival; there is need to focus on improving quality of life in postoperative pathways.
Topics: Aged; Amputation, Surgical; Female; Humans; Ireland; Lower Extremity; Male; Quality of Life; Retrospective Studies; Tertiary Care Centers
PubMed: 32323085
DOI: 10.1007/s11845-020-02231-5 -
The American Surgeon Oct 2023Trauma is the second most common cause of limb loss in the United States (US), second only to vascular disease. The aim of this study was to evaluate the demographics... (Review)
Review
BACKGROUND
Trauma is the second most common cause of limb loss in the United States (US), second only to vascular disease. The aim of this study was to evaluate the demographics and commercial products associated with traumatic amputations in the United States.
METHODS
The National Electronic Injury Surveillance System (NEISS) database was analyzed from 2012 to 2021 to identify patients presenting to the Emergency Department (ED) with the diagnosis of amputation. Additional variables included patient demographics, body part amputated, commercial products associated with amputation, and ED treatment disposition.
RESULTS
A total of 7323 patients diagnosed with amputation were identified in the NEISS database. Amputations were most frequent in the 0-5 years age group, followed by 51-55 years. More males than females suffered an amputation during the study period (77% vs 22%). Most patients were Caucasian. Fingers were most frequently amputated (91%), followed by toes (5%). Most injuries occurred in the home (56%). The top commercial product behind these traumatic amputations was doors (18%), followed by bench or table saws (14%) and power lawn mowers (6%). Over 70% of patients were able to be treated and released from the ED, while 22% required hospitalization and 5% were transferred to another facility.
DISCUSSION
Traumatic amputations can cause significant injuries. A better understanding of the incidence and mechanisms behind traumatic amputations may help with injury prevention. Pediatric patients had a high incidence of traumatic amputations, which warrants further research and dedication to injury prevention in this vulnerable group.
Topics: Male; Female; Child; Humans; United States; Middle Aged; Amputation, Traumatic; Amputation, Surgical; Emergency Service, Hospital; Databases, Factual; Incidence
PubMed: 37226454
DOI: 10.1177/00031348231177947 -
The Journal of the American Academy of... Jul 2021Pediatric patients may benefit from extremity amputations with potential prosthetic fitting when addressing limb deficiencies, trauma, infection, limb ischemia, or other...
Pediatric patients may benefit from extremity amputations with potential prosthetic fitting when addressing limb deficiencies, trauma, infection, limb ischemia, or other pathologies. The performance of a quality amputation is a fundamental skill to an orthopaedic surgeon, yet avoidance of pitfalls can be elusive in children. The need for surgical precision and sound decision-making is amplified in pediatric amputations, where the skeleton is dynamic and growing, anatomy can be miniscule and (in the case of congenital anomalies) variable. The principles that guide amputation level and technical approach are unique in children. Despite this, descriptions of these procedures as they should be applied to a growing or congenitally deficient skeleton are lacking. Furthermore, surgeons must also understand the unique prosthetic and psychosocial considerations for children. A collaborative approach between the surgeons, rehabilitation physicians, prosthetists, therapists, and families is essential to ensuring optimal results.
Topics: Amputation, Surgical; Artificial Limbs; Child; Humans; Prosthesis Implantation; Surgeons
PubMed: 33878082
DOI: 10.5435/JAAOS-D-20-01283 -
Prosthetics and Orthotics International Apr 2022A patient (the first author) with a preexisting right side transfemoral amputation (20 years before) had osseointegration surgery. She was assigned a physiotherapist...
A patient (the first author) with a preexisting right side transfemoral amputation (20 years before) had osseointegration surgery. She was assigned a physiotherapist (the second author) and began a rehabilitation program. We provide a unique insight into the first 18 months of rehabilitation after insertion of an osseointegration bone anchor from a physiotherapist and patient perspective with the intention of informing practitioners, patients, and potential patients about the experience and identifying potential areas for improvements in the rehabilitation protocol. The experience was tracked by both the patient and the physiotherapist for 18 months post-surgery. The physiotherapist followed a specific protocol with the patient in the first part of the recovery stage. The patient kept records of subjective experiences over the same period. Loading and physiotherapy were completed in line with the protocol for the first 12-week phase including successful fitting of the prosthetic limb on day 12. Physiotherapy and other interventions evolved to meet the patient's needs over the 18-month period. The patient progressed through her rehabilitation, and new data about the patient's experience were gathered. Following the protocol enabled the patient to progress through her rehabilitation. Unforeseen setbacks (abscesses and inflammation/entheseopathies) slowed this process to some extent. Findings from these data can be used to help inform and improve future rehabilitations for patients with osseointegration: patients can be advised about possible setbacks and physiotherapy, and other interventions can be developed to treat should these problems arise.
Topics: Amputation, Surgical; Female; Humans; Osseointegration; Physical Therapy Modalities
PubMed: 35412525
DOI: 10.1097/PXR.0000000000000055 -
American Journal of Surgery May 2022
Topics: Amputation, Surgical; Diabetic Foot; Humans; Incidence; Lower Extremity; Racial Groups; Retrospective Studies
PubMed: 34711409
DOI: 10.1016/j.amjsurg.2021.10.010