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Journal of Vascular Surgery Cases and... Dec 2022Tools that quantify tissue perfusion of the foot are deficient, contributing to the uncertainty in predicting ulcer healing potential. This pilot study aims to quantify...
OBJECTIVE
Tools that quantify tissue perfusion of the foot are deficient, contributing to the uncertainty in predicting ulcer healing potential. This pilot study aims to quantify peri-wound foot perfusion at various tissue depths using a novel application of pseudo-continuous arterial spin labeling magnetic resonance imaging.
METHODS
Ten diabetic patients with neuropathic wounds and 20 healthy volunteers without wounds were recruited. Wounds were graded according to the Wound, Ischemia, Foot Infection (WIfI) system. All subjects underwent a noncontrasted ASL MRI of the foot for perfusion measurements. For healthy volunteers, perfusion was compared at rest and during sustained toe flexion between four regions: lateral plantar, medial plantar, lateral calcaneal, and medial calcaneal. Evaluations of diabetic volunteers compared perfusion between four zones: wound, near border, far border, and remote. Remote zone perfusion in diabetics was compared with perfusion in the plantar foot of healthy volunteers.
RESULTS
There were 11 wounds, which were located over the metatarsal heads in five, the stump of a transmetatarsal amputation in three, the heel in two, and the mid foot in one. The median WIfI stage was 2. One patient had a WIfI ischemia grade of 1; the remaining patients' grades were 0. The mean ankle-brachial index was 1.0 ± 0.3. There were two patients with a WIfI foot infection grade of 1; the remaining patients' grades were 0. In healthy volunteers, plantar foot perfusion with sustained toe flexion was 43.9 ± 1.7 mL/100g/min and significantly higher than perfusion at rest (27.3 ± 2.7 mL/100g/min; < .001). In diabetic patients, perfusion at the wound, near border, far border, and remote regions was 96.1 ± 10.7, 92.7 ± 9.4, 73.4 ± 8.2, and 62.8 ± 2.7 mL/100g/min. Although this perfusion pattern persisted throughout the depth of the wound, perfusion decreased with tissue depth. In the near border, perfusion at 20% of the wound depth was 124.0 ± 35.6 mL/100g/min and 69.9 ± 10.1 mL/100g/min at 100% ( = .006). Lastly, remote perfusion in diabetics was 2.3 times the plantar perfusion in healthy volunteers (27.3 ± 2.7 mL/100g/min; < .001).
CONCLUSIONS
The pattern of resting tissue perfusion around nonischemic diabetic foot ulcers was successfully quantified with arterial spin labeling magnetic resonance imaging. Diabetic patients with wounds were hyperemic compared with healthy volunteers. There was a 1.5-fold increase in peri-wound tissue perfusion relative to the rest of the foot. This study is the first step in developing a tool to assess the perfusion deficit in ischemic wounds.
PubMed: 36510629
DOI: 10.1016/j.jvscit.2022.09.015 -
Cureus Nov 2022A traumatic neuroma occurs at the injury site of a peripheral nerve; however, albeit rarely, this variant of a neuroma can involve a nerve that has not experienced...
A traumatic neuroma occurs at the injury site of a peripheral nerve; however, albeit rarely, this variant of a neuroma can involve a nerve that has not experienced penetrating trauma. A lower extremity amputation stump is the most common location of a traumatic neuroma. Traumatic neuromas may be symptomatic; tumor-associated pain can be severe and significantly affect the patient's quality of life. Several hypotheses have been postulated for the pathogenesis of neuroma-related pain, including alpha-smooth muscle actin, neural fiber structural changes, nerve growth factor, and/or sensitization of the affected nerve. In addition to prevention, non-surgical treatment (such as chemical interventions, cryotherapy, neuromodulation, pharmacologic agents, and physiotherapy) and surgical interventions (such as direct nerve repair at the time of injury or ligation of the nerve proximal to the neuroma and various potential methods to minimize subsequent irritation of the distal free end of the proximal nerve) have been used to manage neuroma-associated pain. A traumatic neuroma of the nose is rare. Indeed, it has only been described in three individuals: two women (including the Caucasian woman in this report and a Turkish woman) and one man. The benign tumor was extremely painful in both women; however, the man's lesion was non-tender. Prior trauma to the nasal site included either a laceration or elective surgery; however, the reported woman did not experience any penetrating trauma to her nose. The diagnosis was established following an excisional (for the man), incisional (for the Turkish woman), or punch (for the Caucasian woman) biopsy. Follow-up was provided for two of the patients. The man's neuroma had been completely excised, and he never developed tumor-associated tenderness. However, the pain persisted after the biopsy healed for the reported woman whose neuroma was not entirely removed. The explosive and markedly severe character of the reported patient's lesion-related tenderness prompted us to propose an acronym for this uncommon yet exquisitely painful variant of a neuroma: tender nasal traumatic (TNT) neuroma.
PubMed: 36465207
DOI: 10.7759/cureus.30957 -
Indian Journal of Anaesthesia Oct 2022Many pain syndromes such as chronic phantom limb pain (PLP) and stump pain (SP), involving nociceptive and neuropathic pain, develop after amputation. Recent literature...
BACKGROUND AND AIMS
Many pain syndromes such as chronic phantom limb pain (PLP) and stump pain (SP), involving nociceptive and neuropathic pain, develop after amputation. Recent literature suggests that the use of regional blocks reduces repeated stimulation of transected nerve roots and thus prevents central sensitisation. This randomised, double-blind study was conducted to evaluate the effect of pre-emptive ultrasound-guided single-shot lateral sciatic nerve block on the occurrence of chronic pain at six months after traumatic below-knee amputation.
METHODS
Thirty patients undergoing traumatic lower limb amputation under general anaesthesia were randomised into two groups: Group B received sciatic nerve block pre-emptively using ultrasound with 20 ml of 0.75% ropivacaine, whereas group C received 20 ml of normal saline. Follow-up of patients was done till six months post-amputation. The primary objective was to assess the occurrence of chronic pain at six months. Pain at 15 days and one month after surgery, post-operative morphine consumption and post-operative nausea and vomiting (PONV) were the secondary outcomes assessed.
RESULTS
The occurrence of PLP at six months was comparable in the two groups, group B (46.7%) and C (66.7%). None of the patients developed SP at six months. Median intensities of phantom pain were 1.0 (range, 1-2.0) versus 1.0 (range, 1-2.0) ( = 0.36), and median intensities of SP 2 (range, 2-3.0) versus 3 (range, 2-3.0) ( = 0.39) at 1 month.
CONCLUSION
Pre-emptive sciatic nerve block did not decrease the occurrence or severity of chronic pain after traumatic below-knee amputation.
PubMed: 36425919
DOI: 10.4103/ija.ija_796_21 -
International Journal of Burns and... 2022Clostridium species are known to be the primary causative organism of gas gangrene. Non-clostridial gas gangrene (NCGG) is another rare necrotizing entity often...
BACKGROUND
Clostridium species are known to be the primary causative organism of gas gangrene. Non-clostridial gas gangrene (NCGG) is another rare necrotizing entity often associated with an underlying disease, particularly diabetes mellitus, and has a high mortality rate.
CASE REPORT
A 16-year-old, immunocompetent male was referred to us after four days, following a roadside accident, with a degloving injury over the thigh and knee along with fractures around the knee. Although clinico-radiologically suspicious of gas gangrene, the initial smear report was negative for any Gram-positive bacilli. On the same day, he underwent aggressive debridement with an external fixator spanning the knee to salvage the limb. On post-operative day one, due to deteriorating general clinical condition and a strong clinical suspicion of gas gangrene, he underwent above-knee amputation (open stump) after discussion with microbiologists and physicians.
RESULTS
Polymicrobial non-clostridial infection was seen in culture reports taken serially at different stages of management. The latest follow-up showed a healed amputation stump following split skin grafting.
CONCLUSION
Although rare, polymicrobial infections can present as non-clostridial gas gangrene even in an immunocompetent patient. A high index of clinical suspicion with a multi-disciplinary approach helps in early decision-making to avoid a devastating outcome.
PubMed: 36420102
DOI: No ID Found -
Cureus Sep 2022Amputation is more common in men than women, a lot of studies suggest this. It is the complete or partial removal of an extremity through a surgical process and is said...
Amputation is more common in men than women, a lot of studies suggest this. It is the complete or partial removal of an extremity through a surgical process and is said to be a life-saving procedure performed in various critical conditions. The main objective of amputating a limb or any part at a level is that it should be carried out in a way that will give a stump of optimum length to facilitate the prosthetic fitting at later stages. After amputation, the patients are usually trained with prostheses so that they can carry on with functional activities without any restrictions. One of the disorders seen in infants and children is congenital talipes equinovarus (CTEV). It is characterized by plantarflexion at the ankle joint, inversion at the subtalar joint, and adduction at the forefoot. There are various factors and causes associated with CTEV. The treatment should be done as early as possible, if delayed, it can lead to deformities in the joint. Here is a case of a 12-year-old male, who, a neglected case of bilateral clubfoot, now underwent wedge tarsectomy surgery for the left foot and below knee amputation of the right leg due to the formation of infectious gangrene. Post-surgery, the patient was referred to the physiotherapy department for further treatment and rehabilitation.
PubMed: 36321048
DOI: 10.7759/cureus.29724 -
Journal of Pain Research 2022Phantom limb pain (PLP) is a common condition that occurs following both upper and lower limb amputation. First recognized and described in 1551 by Ambroise Pare,... (Review)
Review
Phantom limb pain (PLP) is a common condition that occurs following both upper and lower limb amputation. First recognized and described in 1551 by Ambroise Pare, research into its underlying pathology and effective treatments remains a very active and growing field. To date, however, there is little consensus regarding the optimal management of phantom limb pain. With few large well-designed clinical trials of which to make treatment recommendations, as well as significant heterogeneity in clinical response to available treatments, the management of PLP remains challenging. Below we summarize the current state of knowledge in the field, as well as propose an algorithm for the approach to the treatment of PLP.
PubMed: 36320223
DOI: 10.2147/JPR.S355278 -
Medicina (Kaunas, Lithuania) Oct 2022Amputation at the level of the distal phalanx is a common hand injury and is normally treated with replantation. However, if the level of injury is distal or the vessels...
Amputation at the level of the distal phalanx is a common hand injury and is normally treated with replantation. However, if the level of injury is distal or the vessels of the stump have been crushed by injury, replantation cannot be a viable option. The aim of this study is to evaluate the functional and aesthetic outcomes of the "hybrid abdominal flap", which consists of a random-pattern abdominal skin flap and an autologous bone graft. A retrospective analysis was performed on fingertip amputation patients from March 2019 to April 2021. The patients were managed by either hybrid abdominal flaps (HAFs) or homodigital neurovascular island flaps (HNIFs). The functional and aesthetic outcomes were assessed three months after the operations. In this study, a total of 20 fingers were treated with either HAFs or HNIFs. There was a significant difference in the range of motion (ROM) and the scar quality between the two groups. All of the flaps survived without flap necrosis, and non-union of the bone was not observed. The patients were satisfied with the appearance and function of their fingers, including the ROM and sensory aspects. Our novel HAF is a functionally and aesthetically valid option for fingertip amputations with crushed stumps.
Topics: Humans; Amputation, Traumatic; Finger Injuries; Retrospective Studies; Surgical Flaps; Fingers; Amputation, Surgical
PubMed: 36295643
DOI: 10.3390/medicina58101483 -
Acta Medica Portuguesa May 2022Lower limb lymphorrhea is a condition with a considerable impact on the quality of life. It is usually associated with inguinal lymph node dissection and vascular...
Lower limb lymphorrhea is a condition with a considerable impact on the quality of life. It is usually associated with inguinal lymph node dissection and vascular procedures with femoral exposure. In this case report, we describe a patient who underwent a below-knee amputation and two years later developed lymphorrhea from the stump, preventing adaptation to the prosthesis. Lymphoscintigraphy showed a delayed lymphatic progression. After failure of conservative treatment, she underwent lymphaticovenular anastomosis with a successful outcome. Drainage cessation suggests that lymphaticovenular anastomosis may be an effective treatment for patients with lymphorrhea from and amputation stump, although further studies are required to determine long-term efficacy.
Topics: Female; Humans; Lymphedema; Amputation Stumps; Microsurgery; Quality of Life; Anastomosis, Surgical
PubMed: 36279892
DOI: 10.20344/amp.13470 -
Cureus Sep 2022Several studies have investigated the anatomical adaptations in amputation stumps. In this study, we present a case report of a patient who underwent an above-the-knee...
Several studies have investigated the anatomical adaptations in amputation stumps. In this study, we present a case report of a patient who underwent an above-the-knee amputation and, over the course of time, the length of the residual bone spontaneously shortened. The patient had undergone a total hip replacement in the same leg, and the cement mantle of the hip replacement, which could be seen within the medullary canal in the early postoperative X-rays, protruded due to bone resorption one year after the amputation Although changes in bone microarchitecture in amputation stumps are well established, this is the first report of macroscopic changes in its actual length.
PubMed: 36258997
DOI: 10.7759/cureus.29222 -
Plastic and Reconstructive Surgery.... Sep 2022Finger amputations are one of the most common traumas of daily life. Regularization of the digital stump is the most widely used option in the literature today. The aim...
UNLABELLED
Finger amputations are one of the most common traumas of daily life. Regularization of the digital stump is the most widely used option in the literature today. The aim of this study was to evaluate a valid functional and aesthetic alternative to amputation.
METHODS
We retrospectively investigated our prospective database' selecting the patients who underwent trimmed great toe flap reconstruction for the amputation of a digit from September 2019 to November 2021. All the operations were performed by the first author (L.T.) in the Reconstructive Microsurgery Service of the University Department of Hand Surgery and Rehabilitation of MultiMedica Group.
RESULTS
No flap required anastomosis revision or had major complications. The length of the amputated finger was maintained, with a high functional and aesthetic result achieved.
CONCLUSIONS
The trimmed great toe flap has proven to be a viable alternative to finger amputation in the reconstruction of thumb and long finger defects, leading to high aesthetic results. The morbidity of the donor site is reduced compared with the classic great toe flap, allowing a direct closure in most cases.
PubMed: 36203737
DOI: 10.1097/GOX.0000000000004540