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Cureus May 2024Major amputation of a lower limb is a traumatic experience that causes physical and psychosocial disabilities. This study set out to ascertain how anxiety and depression...
OBJECTIVE
Major amputation of a lower limb is a traumatic experience that causes physical and psychosocial disabilities. This study set out to ascertain how anxiety and depression symptoms changed during the three months following the amputation.
MATERIALS AND METHODS
A prospective longitudinal observational study was conducted between October 1, 2019, and January 1, 2021, in the Department of Vascular Surgery and the Department of Orthopedic Traumatology of the Ibn Sina Hospital Center in Rabat, Morocco. The study assesses symptoms of anxiety and depression in patients who have undergone a major lower limb amputation over a three-month interval.
RESULTS
In patients who had undergone a major lower limb amputation, the prevalence of anxiety and depression symptoms was very high immediately postoperatively (47.4% and 79.2%, respectively), with a significant decrease in these symptoms. Three months later, anxiety was reported in 24.4% of cases, and depressive symptoms in 65.1% of cases. Age, amputation level, stump pain, phantom limb pain, re-amputation, and emergency amputation were all associated with an increased risk of anxiety and depression. The patient's psychological preparation prior to the amputation, the anesthetic technique used during the procedure, the patient's mobility, and the patient's post-amputation professional status were all protective factors.
CONCLUSION
Our research findings bolster the necessity of promptly evaluating and managing anxiety and depression in the initial three months following major lower limb amputation. Thus, we believe that amputee patients ought to receive a formal psychological evaluation, which could be helpful, particularly for those whose anxiety or depression symptoms did not improve after three months.
PubMed: 38872678
DOI: 10.7759/cureus.60284 -
Injury Epidemiology Jun 2024Hand injuries constitute up to 30% of the total cases treated in emergency departments. Over time, demographic changes, especially an aging population, and shifts in...
INTRODUCTION
Hand injuries constitute up to 30% of the total cases treated in emergency departments. Over time, demographic changes, especially an aging population, and shifts in workplace safety regulations and healthcare policies have significantly impacted the landscape of hand trauma. This study aims to identify and analyze these evolving trends over nearly two decades.
METHODS
In this retrospective, cross-sectional study, we investigated patients who were admitted to the high-volume regional hand trauma center of a university hospital between January 2007 and December 2022. We analyzed trends in patients' demographics and annual alterations of injuries. For the comparative analysis, patients were divided into two groups based on the time of presentation: the early cohort (2007-2014) and the current cohort (2015-2022).
RESULTS
A total of 14,414 patients were admitted to our emergency department within the study period. A significant annual increase in patient age was identified (R = 0.254, p = 0.047). The number of presentations increased annually by an average of 2% (p < 0.001). The incidence of the following hand injuries significantly increased: sprains/strains (+ 70.51%, p = 0.004), superficial lacerations (+ 53.99%, p < 0.001), joint dislocations (+ 51.28%, p < 0.001), fractures (carpal: + 49.25%, p = 0.003; noncarpal: + 39.18%, p < 0.001), deep lacerations (+ 37.16%, p < 0.001) and burns and corrosions (+ 29.45%, p < 0.001). However, rates of amputations decreased significantly (- 22.09%, p = 0.04).
CONCLUSIONS
A consistent and significant annual increase in both the total number of injuries and the average age of patients was identified. An aging population may increase injury rates and comorbidities, stressing healthcare resources. Our study underscores the need to adapt healthcare structures and reimbursement policies, especially for outpatient hand injury care.
PubMed: 38872185
DOI: 10.1186/s40621-024-00510-8 -
JMIR Rehabilitation and Assistive... Jun 2024Lower limb amputation (LLA) impacts physical activity (PA) participation and quality of life (QoL). To minimize the effects of these challenges, LLA survivors need to...
Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study.
BACKGROUND
Lower limb amputation (LLA) impacts physical activity (PA) participation and quality of life (QoL). To minimize the effects of these challenges, LLA survivors need to have opportunities to engage in appropriately tailored rehabilitation throughout their lives. However, in Sri Lanka, where a 3-decade civil war resulted in trauma-related LLA among young male soldiers, access to rehabilitation was limited to the immediate postinjury period. Developing rehabilitation interventions for these veterans requires an understanding of their current health status and rehabilitation perceptions.
OBJECTIVE
This study was conducted to evaluate the QoL and PA participation of veterans with LLA and explore perceptions of factors influencing their PA participation and expectations for a future community-based physical rehabilitation (CBPR) intervention.
METHODS
This mixed methods study combined a comparative cross-sectional quantitative survey with qualitative semistructured interviews in 5 districts of Sri Lanka. QoL and PA participation were assessed among community-reintegrated veterans with LLA (n=85) and compared with a matched able-bodied cohort (control; n=85) using Mann-Whitney U and Chi-square tests. PA was assessed in terms of metabolic equivalent of task (MET) minutes per week and was computed for walking, moderate-intensity, and vigorous-intensity activities. PA was classified as sufficiently active, low, or sedentary. The design of interview questions was guided by the Theoretical Domains Framework and followed a phenomenological approach. Interviews were conducted with 25 veterans and were analyzed thematically, and the perceptions regarding PA participation and CBPR were codified using the Consolidated Framework for Implementation Research (CFIR).
RESULTS
Based on the quantitative survey findings, scores for both physical (P<.001) and psychological (P<.001) well-being and participation in walking (P=.004) and vigorous-intensity activities (P<.001) were significantly lower among veterans than among controls. A "sedentary" classification was made for 43% (34/79) of veterans and 12% (10/82) of controls. Veterans mostly engaged in moderate-intensity PA inside the house (49/79, 62%) and in the yard (30/79, 38%). Qualitative interviews revealed that barriers to PA exist at individual (eg, comorbidity burden), primary care (eg, absence of community rehabilitation services), and policy levels (eg, limited resources) and facilitators exist primarily at societal (eg, inclusive community) and individual levels (eg, preinjury activity baseline and positive attitudes toward exercise). Expectations regarding CBPR included individualized rehabilitation parameters; functional exercises; and involvement of peers, amputee societies, and community health care providers. The nonresponse rate for interviews was 7% (2/27).
CONCLUSIONS
The findings of reduced PA participation, poor QoL, and physical and psychological impairments among relatively young veterans reveal the long-term impacts of living with LLA in the absence of long-term rehabilitation. Policy-level changes need to be implemented along with behavior-change strategies to promote PA participation and minimize physical inactivity-induced health issues. Veterans' perceptions regarding future CBPR programs were positive and centered on holistic, individualized, and peer-led activities.
PubMed: 38869933
DOI: 10.2196/52811 -
Plastic and Reconstructive Surgery.... Jun 2024Patients without proper covering of the bone stump with soft tissues after below-knee amputation have limited opportunities for prosthesis. The resulting high degree of...
Patients without proper covering of the bone stump with soft tissues after below-knee amputation have limited opportunities for prosthesis. The resulting high degree of disability severely restricts their proper functioning in social and professional life. The commonly used significant reduction of the bone length for local coverage limits rehabilitative options to the less comprehensive prosthesis. We aimed to describe a delayed reconstruction with soft tissues of the lower leg stump using free anterolateral thigh flap as an alternative surgical method allowing for optimal prosthesis. A 20-year-old patient was consulted because of right lower leg stump, covered only with a skin graft following posttraumatic amputation. Previously, the patient had ineffective attempts of using a prosthesis. He asked to determine the possibility of recovering the functionality of the lower limb. We performed reconstruction of soft tissues of the stump with a free anterolateral thigh flap. Postoperatively, the patient achieved good coverage of the remaining part of the tibia with a thick layer of soft tissues, allowing the subsequent adequate forming of the stump. Therefore, a fixed prosthesis with the dynamic foot could be implemented. A significant increase in physical activity contributed to a full return to the patient's professional and private life. In conclusion, the free anterolateral thigh flap provides a robust amount of good-quality tissues for supportive function of the lower limb stump. The resulting adaptation of the stump to numerous modern prosthetic devices significantly increases the range of physical activity and contributes to the full return of the patient to their professional and private life.
PubMed: 38868619
DOI: 10.1097/GOX.0000000000005905 -
Annals of Surgical Treatment and... Jun 2024The anatomical distribution, characteristics of lesions, and treatment modalities for peripheral artery disease (PAD) are diverse. Endovascular intervention is popular...
PURPOSE
The anatomical distribution, characteristics of lesions, and treatment modalities for peripheral artery disease (PAD) are diverse. Endovascular intervention is popular for symptomatic PAD, for both intermittent claudication (IC) and chronic limb-threatening ischemia (CLTI). We aimed to investigate the endovascular devices used by comparing patients with PAD referred for endovascular revascularization with IC and CLTI.
METHODS
We identified 736 patients with PAD enrolled in the multicenter PAD registry in South Korea from 2019 to 2022. Of these patients, 636 received endovascular treatment at the time of this study. After excluding missing data, we analyzed 506 patients with IC or CLTI. Patients' characteristics, target lesions, and endovascular device data such as type, length, balloon diameter, and stent, were examined. Procedure outcomes of the aortoiliac, femoropopliteal, and below-the-knee lesions were analyzed.
RESULTS
Patients with CLTI were more likely to have diabetes mellitus, below-the-knee interventions, and multilevel PAD than the IC group. Patients with IC had more aortoiliac artery lesions and underwent atherectomies than the CLTI group (63.3% and 61.1% 39.7% and 40.6%, respectively; P < 0.001). In patients with femoropopliteal lesions, those with CLTI were more revascularized with stents than the patients with IC, without significant differences (35.3% 29.1%, P = 0.161). Compared to the IC group, the CLTI patients showed significantly worse rates of primary patency, amputation, and mortality (P = 0.029, P < 0.001, and P < 0.001, respectively).
CONCLUSION
Among Korean patients with PAD, there is a significant difference in baseline and lesion characteristics, endovascular strategies, and short-term follow-up outcomes among those with IC and CLTI.
PubMed: 38868587
DOI: 10.4174/astr.2024.106.6.344 -
Heliyon Jun 2024To develop a novel and accurate nomogram to predict survival without amputation in patients with acute lower limb ischemia (ALLI) during the first year following...
OBJECTIVES
To develop a novel and accurate nomogram to predict survival without amputation in patients with acute lower limb ischemia (ALLI) during the first year following endovascular therapy.
METHODS
Patients with ALLI who underwent endovascular therapy in our department between January 2012 and September 2020 were screened and included in the research. The included patients were randomly divided into a training and validation cohorts, respectively. Univariate and multivariate analyses were used in the training cohort to identify independent risk factors for amputation-free survival (AFS). A nomogram was then developed according to the identified independent risk factors. The nomogram was then validated in the validation cohort.
RESULTS
415 Chinese patients with 417 affected limbs were included in this study. Among these patients, 311 patients were classified into the training cohort and 104 patients were assigned to the validation cohort. Most patients were men (n = 240) and the average age of patients was 71.43 (standard deviation 8.86) years old. After the univariate and multivariate analyses, advanced age ( < 0.001), history of smoking ( < 0.001), atrial fibrillation ( < 0.001), and insufficient outflow ( = 0.001) were revealed as independent risk factors for AFS during the first year. The nomogram yielded AUROC values of 0.912 (95 % confidence interval [CI]: 0.873-0.950) and 0.889 (95 % CI: 0.812-0.967) in the training and validation cohorts, respectively.
CONCLUSION
Advanced age, history of smoking, atrial fibrillation, and insufficient outflow were independent negative predictors for AFS in ALLI patients treated by endovascular therapy. The novel nomogram offered an accurate prediction of AFS in ALLI patients.
PubMed: 38867944
DOI: 10.1016/j.heliyon.2024.e32110 -
International Journal of Surgery Case... Jul 2024Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma, accounting for less than 0.1 % of tumors. While it predominantly occurs in adults, pediatric cases are...
INTRODUCTION
Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma, accounting for less than 0.1 % of tumors. While it predominantly occurs in adults, pediatric cases are unusual. This case report aims to highlight the diagnostic and therapeutic challenges posed by DFSP in infants due to its rarity and slow-growing nature, emphasizing the importance of early diagnosis and prompt intervention.
CASE PRESENTATION
We report the case of an 8-month-old infant presenting with a progressive finger mass, initially mistakenly diagnosed as a dermatofibroma. Local excision was done, but the tumor recurred after one year. Subsequent re-excision and skin grafting were performed, and histopathology confirmed DFSP. Despite middle finger amputation three weeks later, a new mass emerged on the adjacent ring finger after one year. This tested negative for DFSP. The fibrous mass has persisted for five years without significant changes.
CLINICAL DISCUSSION
DFSP is a rare sarcoma with a higher prevalence in adults. It typically presents as a painless, slow-growing mass and is usually diagnosed by biopsy and immunohistochemistry. Surgical excision with negative margins is the preferred treatment. The rarity and slow-growing nature of DFSP pose challenges in diagnosis and treatment.
CONCLUSION
Early diagnosis and prompt surgical intervention are crucial in managing DFSP, especially given its high recurrence potential. Maintaining a high index of suspicion is essential even in very young children. Aggressive resection with negative margins and diligent post-operative surveillance are key strategies to mitigate metastasis risk and improve prognosis in such challenging cases.
PubMed: 38865945
DOI: 10.1016/j.ijscr.2024.109890 -
Cancer Management and Research 2024Desmoid tumors (DT) are rare, intermediate-grade sarcomas characterized by locally aggressive growths that commonly occur intra-abdominally, in the abdominal wall, or in... (Review)
Review
Desmoid tumors (DT) are rare, intermediate-grade sarcomas characterized by locally aggressive growths that commonly occur intra-abdominally, in the abdominal wall, or in the extremities. Desmoid tumors are 2-3-fold more common in females than males, with most patients aged <40 years at diagnosis. Clinical course of DT is highly variable but rarely fatal, with median overall survival >80% at 20 years. However, patient morbidity and DT symptom burden can be high. DT significantly reduce patient quality of life, imposing substantial physical, emotional, and social burdens. Pain, fatigue, and insomnia are common symptoms; disfigurement, mobility restrictions, and, rarely, the need for amputation may also result. Despite its limited impact on survival, patients with DT may have anxiety and depression levels commensurate with those associated with malignant sarcomas. Thus, DT impose an array of significant, long-term morbidities on a young patient population. In order to evaluate the impact of these morbidities, patient-reported outcome (PRO) tools are used, which assess outcomes of importance to patients that extend beyond traditional oncology endpoints. General or oncology-related PROs can be used; although currently, the only DT-specific, validated PRO measure is the GOunder/Desmoid Tumor Research Foundation DEsmoid Symptom/Impact Scale (GODDESS), consisting of an 11-item DT Symptom Scale (DTSS) and a 17-item DT Impact Scale (DTIS). DTSS and DTIS were secondary endpoints in DeFi, a randomized phase 3 trial of nirogacestat; blinded, pooled data from DeFi were used to validate GODDESS reliability and responsiveness as a PRO measure in DT. Another DT-specific PRO measure, the Desmoid-Type Fibromatosis Quality of Life (DTF-QoL) questionnaire, has been developed but not validated. As novel DT therapies continue to be developed, incorporating DT-specific PRO measures into clinical trials will be key to capturing patient voice, improving outcomes of importance to this unique patient population, and assisting patients and providers in selecting optimal treatment.
PubMed: 38863992
DOI: 10.2147/CMAR.S362694 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jun 2024This controlled experimental study aimed to compare ectopic replantation with other replantation techniques in a rat model of crush amputations. It also assessed the...
BACKGROUND
This controlled experimental study aimed to compare ectopic replantation with other replantation techniques in a rat model of crush amputations. It also assessed the impact of different replantation methods on the viability of amputates.
METHODS
Forty male Wistar albino rats were divided into four groups. Groin flaps served as the amputation model. Group 1 un-derwent guillotine-style amputation followed by orthotopic replantation, Group 2 experienced crush-type amputation and orthotopic replantation, Group 3 had crush-type amputation and orthotopic replantation with a vein graft, and Group 4 underwent crush-type amputation followed by ectopic replantation. Flap viability and perfusion rates were assessed on day 3 using an infrared perfusion as-sessment system. The ratio of viable area to total flap area and thrombus formation in the pedicle vessels were evaluated on day 7.
RESULTS
Infrared evaluations on day 3 post-replantation revealed flap perfusion percentages of 73.5% in Group 1, 11.1% in Group 2, 65% in Group 3, and 64.1% in Group 4. Statistical analysis indicated that Group 1 exhibited the highest perfusion rates, while Group 2 showed the lowest. No differences were observed between Groups 3 and 4. On the seventh day, the average surviving flap areas were found to be 74.6% in Group 1, 2.5% in Group 2, 64.5% in Group 3, and 64% in Group 4. Statistically, Group 1 exhibited the best outcomes, while Group 2 had the poorest, with no differences between Groups 3 and 4. Additionally, thrombus formation was observed in the vessels of two animals in Group 1, nine in Group 2, and three each in Groups 3 and 4. Significant statistical differences were noted among the groups.
CONCLUSION
The results indicate that ectopic replantation and replantation with a vein graft are equally effective. The preferred method for crush-type replantations may depend on the patient's and the amputated limb's conditions. In crush-type amputations, we recommend vein graft repair if the patient's overall condition supports replantation and if crushed segments can be debrided without excessive shortening of the amputated part. If these conditions are not met, temporary ectopic replantation is advised to preserve the amputated limb.
Topics: Animals; Replantation; Rats, Wistar; Male; Rats; Amputation, Traumatic; Crush Injuries; Disease Models, Animal; Surgical Flaps
PubMed: 38863288
DOI: 10.14744/tjtes.2024.39470 -
Scientific Reports Jun 2024The agonist-antagonist myoneural interface (AMI) is an amputation surgery that preserves sensorimotor signaling mechanisms of the central-peripheral nervous systems. Our...
The agonist-antagonist myoneural interface (AMI) is an amputation surgery that preserves sensorimotor signaling mechanisms of the central-peripheral nervous systems. Our first neuroimaging study investigating AMI subjects conducted by Srinivasan et al. (2020) focused on task-based neural signatures, and showed evidence of proprioceptive feedback to the central nervous system. The study of resting state neural activity helps non-invasively characterize the neural patterns that prime task response. In this study on resting state functional magnetic resonance imaging in AMI subjects, we compared functional connectivity in patients with transtibial AMI (n = 12) and traditional (n = 7) amputations (TA). To test our hypothesis that we would find significant neurophysiological differences between AMI and TA subjects, we performed a whole-brain exploratory analysis to identify a seed region; namely, we conducted ANOVA, followed by t-test statistics to locate a seed in the salience network. Then, we implemented a seed-based connectivity analysis to gather cluster-level inferences contrasting our subject groups. We show evidence supporting our hypothesis that the AMI surgery induces functional network reorganization resulting in a neural configuration that significantly differs from the neural configuration after TA surgery. AMI subjects show significantly less coupling with regions functionally dedicated to selecting where to focus attention when it comes to salient stimuli. Our findings provide researchers and clinicians with a critical mechanistic understanding of the effect of AMI amputation on brain networks at rest, which has promising implications for improved neurorehabilitation and prosthetic control.
Topics: Humans; Amputation, Surgical; Magnetic Resonance Imaging; Male; Female; Adult; Middle Aged; Rest; Tibia; Brain; Neurophysiology; Amputees; Brain Mapping
PubMed: 38862558
DOI: 10.1038/s41598-024-63134-4