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The East African Health Research Journal 2023Limb amputation is among the commonly performed surgical procedures known to have a significant impact on health-related quality of life (HRQoL). Nonetheless, factors...
BACKGROUND
Limb amputation is among the commonly performed surgical procedures known to have a significant impact on health-related quality of life (HRQoL). Nonetheless, factors influencing the HRQoL among amputees have not been extensively explored. We therefore conducted a study aiming at determining factors influencing the HRQoL among lower limb amputees.
METHODS
A cross-sectional study was conducted from May 2021 to December 2021 in two specialized hospitals located in Dar es Salaam, Tanzania. A total of 160 participants who exclusively underwent lower limb amputation(s) were recruited. Data was collected using a checklist incorporating the 36-Item Short Form Survey (SF-36) questionnaire. Multivariable linear regression analysis was performed to identify factors influencing the HRQoL.
RESULTS
The mean age of the study participants was 53.8 (±15.44) years; with males constituting 68.7%. The mean duration since amputation was 19.84 (±12.44) months. A relatively poor physical component summary score (PCS), as opposed to the mental component summary score (MCS) of the SF-36 was observed among the participants (42.0 vs. 59.3, respectively). Factors that positively influenced the PCS included achieving a college/university level of education, absence of stump pain, and the use of a prosthetic device or crutches. Conversely, factors that negatively influenced the PCS included increasing age and the absence of associated comorbid conditions. These factors accounted for 34.1% of the variance in the PCS. With reference to the MCS, post-amputation employment, longer durations since amputation, and the use of prostheses or crutches had a positive influence. However, having no associated comorbidity negatively influenced the MCS. These factors explained 26.5% of the variances in the MCS.
CONCLUSION AND RECOMMENDATIONS
The aforementioned factors should be addressed accordingly in order to ensure a holistic approach in the management of lower limb amputees. Moreover, longitudinal studies are recommended to systematically study the change in HRQoL over time and to assess its determinants.
PubMed: 37529490
DOI: 10.24248/eahrj.v7i1.718 -
Cureus Jun 2023We report two cases of shortening of the bone at the stump after amputation. Case 1 was a 57-year-old male with a traumatic transhumeral amputation. The remaining...
We report two cases of shortening of the bone at the stump after amputation. Case 1 was a 57-year-old male with a traumatic transhumeral amputation. The remaining humerus had shortened by 3.5 cm in eight months. Case 2 was a 27-year-old male with a traumatic transtibial amputation. The remaining tibia had shortened by 1.4 cm in 72 months. These two cases had the same cause of amputation, but the amputation site, age, and time course differed. Few studies have examined the bone length of stumps after amputation. The bone length of stumps is generally assumed to not change after amputation. However, the residual bone at the stump can shorten after amputation.
PubMed: 37519481
DOI: 10.7759/cureus.41024 -
Sensors (Basel, Switzerland) Jul 2023The soft tissues of residual limb amputees are subject to large volume fluctuations over the course of a day. Volume fluctuations in residual limbs can lead to local...
The soft tissues of residual limb amputees are subject to large volume fluctuations over the course of a day. Volume fluctuations in residual limbs can lead to local pressure marks, causing discomfort, pain and rejection of prostheses. Existing methods for measuring interface stress encounter several limitations. A major problem is that the measurement instrumentation is applied in the sensitive interface between the prosthesis and residual limb. This paper presents the principle investigation of a non-intrusive technique to evaluate the fit of orthopaedic prosthesis sockets in transfemoral amputees based on experimentally obtained vibrational data. The proposed approach is based on changes in the dynamical behaviour detectable at the outer surface of prostheses; thus, the described interface is not affected. Based on the experimental investigations shown and the derived results, it can be concluded that structural dynamic measurements are a promising non-intrusive technique to evaluate the fit of orthopaedic prosthesis sockets in transfemoral amputee patients. The obtained resonance frequency changes of 2% are a good indicator of successful applicabilityas these changes can be detected without the need for complex measurement devices.
Topics: Humans; Prosthesis Design; Orthopedics; Prosthesis Implantation; Artificial Limbs; Amputees; Amputation Stumps
PubMed: 37514793
DOI: 10.3390/s23146500 -
Cell Regeneration (London, England) Jul 2023Deer antlers are the only known mammalian organ that, once lost, can fully grow back naturally. Hence, the antler offers a unique opportunity to learn how nature has... (Review)
Review
Deer antlers are the only known mammalian organ that, once lost, can fully grow back naturally. Hence, the antler offers a unique opportunity to learn how nature has solved the problem of mammalian epimorphic regeneration (EpR). Comprehensive comparisons amongst different types of EpR reveal that antler renewal is fundamentally different from that in lower vertebrates such as regeneration of the newt limb. Surprisingly, antler renewal is comparable to wound healing over a stump of regeneration-incompetent digit/limb, bone fracture repair, and to a lesser extent to digit tip regeneration in mammals. Common to all these mammalian cases of reaction to the amputation/mechanical trauma is the response of the periosteal cells at the distal end/injury site with formation of a circumferential cartilaginous callus (CCC). Interestingly, whether the CCC can proceed to the next stage to transform to a blastema fully depends on the presence of an interactive partner. The actual form of the partner can vary in different cases with the nail organ in digit tip EpR, the opposing callus in bone fracture repair, and the closely associated enveloping skin in antler regeneration. Due to absence of such an interactive partner, the CCC of a mouse/rat digit/limb stump becomes involuted gradually. Based on these discoveries, we created an interactive partner for the rat digit/limb stump through surgically removal of the interposing layers of loose connective tissue and muscle between the resultant CCC and the enveloping skin after amputation and by forcefully bonding two tissue types tightly together. In so doing partial regeneration of the limb stump occurred. In summary, if EpR in humans is to be realized, then I envisage that it would be more likely in a manner akin to antler regeneration rather to that of lower vertebrates such as newt limbs.
PubMed: 37490254
DOI: 10.1186/s13619-023-00169-4 -
Interventional Radiology... Jul 2023Efficacy of percutaneous deep venous arterialization (pDVA) has been reported for patients with no-option chronic limb-threatening ischemia (CLTI). In the countries...
Efficacy of percutaneous deep venous arterialization (pDVA) has been reported for patients with no-option chronic limb-threatening ischemia (CLTI). In the countries where a manufactured device dedicated for pDVA has not been reimbursed, pDVA using the off-the-shelf technique has alternatively spread. The off-the-shelf techniques for arteriovenous fistula (AVF) creation reported are as follows: AV spear technique, venous arterialization simplified technique (VAST), and a use of penetration guidewire or a reentry device. Technical success rates of the procedures are similar to those using the dedicated device. pDVA could be a last resort for the patients with no-option CLTI, including those suffering from stump ulcer after major limb amputation or those with occluded surgical bypass.
PubMed: 37485486
DOI: 10.22575/interventionalradiology.2022-0025 -
Joint Diseases and Related Surgery May 2023The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of...
OBJECTIVES
The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake.
PATIENTS AND METHODS
Between February 6, 2023 and February 20, 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called 'Earthquake' created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach.
RESULTS
Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection.
CONCLUSION
Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.
Topics: Child; Male; Female; Humans; Adolescent; Young Adult; Adult; Middle Aged; Triage; Tertiary Care Centers; Retrospective Studies; Earthquakes; Fractures, Open; Musculoskeletal Diseases
PubMed: 37462656
DOI: 10.52312/jdrs.2023.1102 -
BMC Sports Science, Medicine &... Jul 2023The main aim of this paper is to present the feasibility of rigorously designed multiple N-of-1 design in prosthetics research. While research of adequate power and high...
BACKGROUND
The main aim of this paper is to present the feasibility of rigorously designed multiple N-of-1 design in prosthetics research. While research of adequate power and high quality is often lacking in rehabilitation, N-of-1 trials can offer a feasible alternative to randomized controlled group trials, both increasing design power at group level and allowing a rigorous, statistically confirmed evaluation of effectiveness at a single patient level. The paper presents a multiple N-of-1 trial protocol, which aim is to evaluate the effectiveness of Unity, a prosthetic add-on suspension system for amputees, on patient-reported comfort during daily activities (main outcome measure), prosthesis wearing time, perception of limb-prosthesis fitting and stump volume and functional walking parameters.
METHODS
Multicenter, randomized, prospective, double-blind multiple N-of-1 trial using an introduction/withdrawal design alternating Unity connected/disconnected phases of randomized length on twenty patients with unilateral transtibial amputation. The primary outcome measure is the Prosthetic Socket Comfort Score (SCS), a validated measure of comfort, administered daily by an phone app designed for the study. Secondary outcomes measures will be collected during the 50 days period of the N-of-1 trial: (1) by the same app, daily for patient-reported limb-prosthesis fitting, stump volume variation, and daily wearing time of the prosthesis; (2) by a pedometer for the number of steps per day; (3) by blind assessors in the rehabilitation center during adjustment visits for functional walking parameter (L-Test, 6-minute walk test), and by the patient for the QUEST, and ABC-S. Effectiveness of the Unity system regarding SCS and daily secondary outcome measures will be tested by randomization test. The secondary outcome measures assessed during visits in the rehabilitation center will be analyzed by Non Overlap of All pairs. An estimate of the effect on the amputee population will be generated by aggregating each individual clinical trial (N-of-1 trial) by Hierarchical Bayesian methods.
DISCUSSION
This study protocol was designed to answer the question "which device is best for THIS patient" and to conclude at a group level on the effectiveness of a new devic, using a Multiple N-of-1 trial, which is promising but underused in prosthetics research so far.
TRIAL REGISTRATION
N° ID-RCB 2020-A01309-30 Clintrial.gov : NCT04804150 - Retrospectively registered March 20th 2021.
PubMed: 37452356
DOI: 10.1186/s13102-023-00694-4 -
EJVES Vascular Forum 2023Functional near infrared spectroscopy (fNIRS) can be used to quantify stump oxygen saturation (SaO) as one of many possible causes of pain following major amputation....
INTRODUCTION
Functional near infrared spectroscopy (fNIRS) can be used to quantify stump oxygen saturation (SaO) as one of many possible causes of pain following major amputation. Although commonly used for cerebral perfusion monitoring during carotid or cardiac surgery, it can also be used to monitor tissue perfusion in the lower limb and predict healing following below knee amputation (BKA). The aim of this study was to measure the SaO trend as there is no validated oxygen threshold to diagnose insufficient flow into the arterial collateral network currently.
REPORT
NIRS was used to measure SaO while performing treadmill exercise. Two BKA patients with chronic stump pain were asked to perform treadmill exercise while using their prosthesis and NIRS optode applied to the posterior stump to monitor SaO. Cases 1 and 2 showed a decline in SaO of 25% and 18%, respectively, while walking on the prosthesis. After superficial femoral artery (SFA) recanalisation and stenting, Case 1 showed improvement by maintaining SaO between 54% and 60% throughout treadmill exercise. In Case 2, perfusion could not be further improved, and the patient underwent through knee amputation.
DISCUSSION
fNIRS detected compressive ischaemia and exercise induced ischaemia as mechanisms of stump pain. Findings provided the multidisciplinary team with objective information, aiding decision making to treat stump pain.
PubMed: 37448526
DOI: 10.1016/j.ejvsvf.2023.05.012 -
Annals of the Royal College of Surgeons... May 2024The aim was to study the effect of incisional negative pressure wound therapy (iNPWT) in wound healing compared with standard sterile gauze dressings after major lower... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
The aim was to study the effect of incisional negative pressure wound therapy (iNPWT) in wound healing compared with standard sterile gauze dressings after major lower extremity amputation in patients with peripheral arterial disease (PAD).
METHODS
This prospective, randomised controlled trial included 50 patients undergoing major lower extremity amputations for PAD. Patients were randomised into iNPWT and standard dressing groups. The patency of blood vessels at the level of the stump was ensured with or without revascularisation. The primary outcome was wound-related complications such as surgical site infection (SSI), wound dehiscence, seroma/haematoma formation or the need for revision amputation. The secondary outcome was the time taken for the eligibility of prosthesis placement.
RESULTS
It was found that only 12% of the patients in the iNPWT group had SSI compared with 36% in the standard dressing group ( = 0.047). Rates of wound dehiscence, seroma/haematoma formation and revision amputation were decreased in the iNPWT group but this was not statistically significant ( > 0.05). There was a significant reduction in the time taken for eligibility of prosthesis placement in the iNPWT group (5.12 ± 1.53 vs 6.8 ± 1.95 weeks, = 0.002).
CONCLUSIONS
iNPWT is effective in reducing the incidence of SSI and the time taken for rehabilitation in patients undergoing major lower limb amputation due to PAD.
Topics: Humans; Negative-Pressure Wound Therapy; Male; Female; Amputation, Surgical; Middle Aged; Prospective Studies; Aged; Lower Extremity; Wound Healing; Peripheral Arterial Disease; Surgical Wound Infection; Treatment Outcome; Bandages
PubMed: 37435705
DOI: 10.1308/rcsann.2023.0011 -
Medicinski Glasnik : Official... Aug 2023Aim To investigate the effect of direct epineural electrical stimulation of the nerve on the nature of reparative processes in the bone stump. Methods Three series of...
Aim To investigate the effect of direct epineural electrical stimulation of the nerve on the nature of reparative processes in the bone stump. Methods Three series of experiments were carried out with amputation of the thigh in the middle third and muscle plasty. In the 1st and 2nd experimental series a perineural catheter was brought to the stump of the sciatic nerve, through which mechanical irritation of the nerve was performed for 20 days daily for 20 minutes. In the 2nd series, an electrode was added to the nerve and epineural electrical stimulation was performed daily for 20 days. Animals of the 3rd series served as control. The observation periods were 1, 3, 6 months. Histological research method with filling vessels with ink-gelatin mixture was applied. Results In the 1st series, there was a sharp distortion of the reparative process, which consisted of a violation of microcirculation, changes in shape, resorption of the cortical diaphyseal plate, fractures, deformations. In most experiments of the 2nd series, organotypic stumps were formed with normalization of microcirculation. In the 3rd series, results of the formation of the stump were better than in the 1st, but worse than in the 2nd series. Conclusions Painful nerve irritation after amputation leads to a significant disturbance of microcirculation and reparative regeneration at the end of the bone stump with the development of pathological restructuring of bone tissue. Electrostimulation of the nerve improves microcirculation and reparative regeneration of the bone tissue.
PubMed: 37421178
DOI: 10.17392/1602-23