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Scientific Reports Aug 2019Different species respond differently to severe injury, such as limb loss. In species that regenerate, limb loss is met with complete restoration of the limbs' form and...
Different species respond differently to severe injury, such as limb loss. In species that regenerate, limb loss is met with complete restoration of the limbs' form and function, whereas in mammals the amputated limb's stump heals and scars. In in vitro studies, electrical stimulation (EStim) has been shown to promote cell migration, and osteo- and chondrogenesis. In in vivo studies, after limb amputation, EStim causes significant new bone, cartilage and vessel growth. Here, in a rat model, the stumps of amputated rat limbs were exposed to EStim, and we measured extracellular matrix (ECM) deposition, macrophage distribution, cell proliferation and gene expression changes at early (3 and 7 days) and later stages (28 days). We found that EStim caused differences in ECM deposition, with less condensed collagen fibrils, and modified macrophage response by changing M1 to M2 macrophage ratio. The number of proliferating cells was increased in EStim treated stumps 7 days after amputation, and transcriptome data strongly supported our histological findings, with activated gene pathways known to play key roles in embryonic development and regeneration. In conclusion, our findings support the hypothesis that EStim shifts injury response from healing/scarring towards regeneration. A better understanding of if and how EStim controls these changes, could lead to strategies that replace scarring with regeneration.
Topics: Amputation, Surgical; Amputation Stumps; Animals; Cell Proliferation; Cicatrix; Disease Models, Animal; Electric Stimulation Therapy; Gene Expression Regulation; Humans; Male; Neovascularization, Physiologic; Rats; Treatment Outcome; Wound Healing
PubMed: 31391536
DOI: 10.1038/s41598-019-47389-w -
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 -
Journal of Clinical and Diagnostic... Dec 2015Amputation of the extremity is a big challenge to mankind. Revision rate of primary amputations stands high despite of maximum care at tertiary care centres. The purpose...
INRTODUCTION
Amputation of the extremity is a big challenge to mankind. Revision rate of primary amputations stands high despite of maximum care at tertiary care centres. The purpose of this study was to establish cause for the revision, identify preventable cause and to assess outcome of revision amputation surgery.
MATERIALS AND METHODS
We performed a retrospective study on lower limb revision amputations in Department of Physical Medicine and Rehabilitation and Department of Orthopaedic Surgery, King George Medical University between Jan 2012 to Jan 2015. All patients of any age group and gender admitted for revision amputation were included in the study population.
RESULTS
A total of 32 patients who required revision amputation of lower limbs was included in the study, out of these 62.50 % were male and 37.50 % were female. Age of the patients ranged from 5 to 72 years with mean of 42 years. Most common level of initial amputation was below knee (56.25 %) followed by above knee amputation (31.25%). Most common indication for initial amputation was trauma (43.75%) followed by infection, vascular diseases, malignancy and leprosy. Poor stump formation was found to be most common indication for revision amputation (37.50%) followed by infection (25%), recurrent ulceration (18.75%), stitch abscess (6.25%), neuroma (6.25%), and necrosis (6.25%). All patients were treated successfully.
CONCLUSION
Revision amputation increases morbidity. Poor stump formation at the time of initial amputation and infection are the most common indication for revision surgery. These are the preventable causes and every effort should be made to alleviate these as well as other preventable causes.
PubMed: 26813957
DOI: 10.7860/JCDR/2015/16385.6886 -
British Medical Journal May 1969
Topics: Amputation Stumps; Calcinosis; Humans; Male; Middle Aged; Pressure; Prostheses and Implants
PubMed: 5780468
DOI: 10.1136/bmj.2.5652.314-e -
Wiadomosci Lekarskie (Warsaw, Poland :... 2021The aim: To study the role and place of bone grafting in the formation of bone stump after amputation.
OBJECTIVE
The aim: To study the role and place of bone grafting in the formation of bone stump after amputation.
PATIENTS AND METHODS
Materials and methods: 3 series of experiments were carried out on 44 rabbits with amputation of the thigh in the middle third and stump grafting using osteoplastic hermetic closure of the canal with a thin cortical plate (series I), closure of the canal with a spongy bone (series II), and loose closure of the canal with a cortical graft located at the entrance to the canal at an angle of 30° (ІІІ series). Observation period: 1, 3, 6 months. Histological examination method with vascular filling with 10% mascara-gelatin mixture.
RESULTS
Results: In series I, in the majority of observations, a stump of a cylindrical shape with a bone locking plate of an osteon-beam structure and normalization of intraosseous microcirculation was formed. A slight displacement of the graft caused a violation of microcirculation. In series II, organotypic stumps were formed in all observations. In series III, incomplete closure of the bone marrow cavity led to sharp microcirculatory disorders and the course of the reparative process with pathological bone remodeling.
CONCLUSION
Conclusions: The parameters of the favorable course of the reparative process and the formation of the organotypic bone stump are the safety of its cylindrical shape, the presence of a compact bone structure, normalization of intraosseous microcirculation.
Topics: Amputation, Surgical; Amputation Stumps; Animals; Filing; Microcirculation; Rabbits; Thigh
PubMed: 33813442
DOI: No ID Found -
GMS Ophthalmology Cases 2020To report a case of unintentional retina artery amputation during macular peeling. Observational case report A 73-year-old female underwent surgery to treat...
To report a case of unintentional retina artery amputation during macular peeling. Observational case report A 73-year-old female underwent surgery to treat epiretinal membrane (ERM) associated with severe staphyloma in her left eye. While the ERM/posterior hyaloid membrane visually enhanced with triamcinolone (TA) was peeled, a movement of the forceps unintentionally involved the inferior temporal branch artery near the inner edge of the staphyloma. The artery was avulsed and amputated. Oozing from the retinal cleft that had once enfolded the artery and microscopic bleeding from the amputation stump were observed. The vitreous hemorrhage obscured a view of the fundus more than 4 weeks after the surgery. After 8 weeks, postoperative visual acuity was improved; however, the superior nasal visual field was lost, and the patient was aware of the broken vessel as a floater in her vision. Macular peeling is technically challenging, so meticulous attention must be paid to avoid any damage on vessels. The retina tissue was stretched in a staphyloma and vessels were bulged into the vitreous space especially at the inner edge of the staphyloma. High levels of TA dye here buried the texture of the retina. Excessive TA should be removed prior to macular peeling.
PubMed: 32269911
DOI: 10.3205/oc000140 -
Surgical revision for stump problems after traumatic above-ankle amputations of the lower extremity.BMC Musculoskeletal Disorders Mar 2015Stump problems (SPs) secondary to traumatic lower limb amputation had a crucial influence on amputees' ability to return to living and work. The purpose of this study...
BACKGROUND
Stump problems (SPs) secondary to traumatic lower limb amputation had a crucial influence on amputees' ability to return to living and work. The purpose of this study was to investigate the surgical management strategies of the SPs after above-ankle amputation of the lower limb secondary to trauma.
METHOD
A cohort of clinical cases, who were troubled by SPs after above-ankle amputation following trauma, had undergone revision surgery of the stump and was analyzed retrospectively. Various factors were noted like sex, unilateral or bilateral, amputation type, and causes of trauma. Different SPs like excess soft tissue (where a considerable amount of soft tissue interposed between the rigid elements which hindered the fitting of a prosthesis), scar, ulcers, neuromas, and bone spurs were taken as dependent variables. The relationship between factors and SPs was analyzed.
RESULTS
A total of 80 stumps were treated surgically. The frequency of excess soft tissue in above-knee amputation cases was higher than that in below-knee amputation (p = 0.007). Bone spur occurred more frequently in the unilateral amputation than in bilateral ones (p = 0.018). There was a significant difference in the ADL scores between admission and discharge (p = 0.000).
CONCLUSION
Stump problems secondary to traumatic lower limb amputation had crucial influence on amputees' ability to return to living and work, appropriate evaluation and timely surgical revision showed excellent results.
Topics: Adolescent; Amputation Stumps; Amputation, Traumatic; Child; Female; Humans; Lower Extremity; Male; Postoperative Complications; Recovery of Function; Reoperation; Retrospective Studies; Return to Work; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 25887565
DOI: 10.1186/s12891-015-0508-3 -
European Journal of Physical and... Jun 2022Current prosthetic sockets often provide limited anatomical fit, especially in patients with residual limb volume changes and fluctuations.
BACKGROUND
Current prosthetic sockets often provide limited anatomical fit, especially in patients with residual limb volume changes and fluctuations.
AIM
To address these issues, Ottobock has developed the Varos Socket, a modular socket that can be adjusted by the user. The aim of this study was to evaluate the potential benefits and acceptance of a newly designed patient-adjustable socket in transfemoral amputees in early phase of prosthetic rehabilitation.
DESIGN
A prospective A-B-A pilot study was conducted.
SETTING
The setting of the study was an Orthopedic Rehabilitation Clinic.
POPULATION
Ten patients with unilateral transfemoral amputation and recent amputation.
METHODS
All patients underwent a standard rehabilitation program with physical therapy. The outcome measures included the Comprehensive Lower-limb Amputee Socket Survey (CLASS), Score Comfort Scale (SCS), a Socket Fit Scale, frequency of falls and stumbles, perceived pain, and satisfaction.
RESULTS
The total CLASS score and three sub-scores (i.e., stability, suspension, comfort) were significantly higher with Varos socket. Significantly improved comfort and quality of socket fit were observed as measured by the Socket-Comfort-Scale and Socket-Fit-Scale and a trend towards reduced residual limb pain. 87.5% of the patients reported higher satisfaction than with the standard socket.
CONCLUSIONS
The results suggest that the Varos socket improved comfort, stability, suspension, appearance, pain, and satisfaction in transfemoral amputees during the early rehabilitation program. A larger study and a longer observation period are warranted to confirm the results of this study.
CLINICAL REHABILITATION IMPACT
Quick and easy socket fitting as well as instant adjustability by the patient bear substantial potential to improve and accelerate the rehabilitation process in the early phase after amputation.
Topics: Amputation, Surgical; Amputation Stumps; Amputees; Artificial Limbs; Humans; Pain; Pilot Projects; Prospective Studies; Prosthesis Design
PubMed: 35148042
DOI: 10.23736/S1973-9087.22.07020-4 -
Journal of Orthopaedic Surgery and... Mar 2011Treatment of severe lower extremity trauma, diabetic complications, infections, dysvascular limbs, neoplasia, developmental pathology, or other conditions often involves...
Treatment of severe lower extremity trauma, diabetic complications, infections, dysvascular limbs, neoplasia, developmental pathology, or other conditions often involves amputation of the involved extremity. However, techniques of lower extremity amputation have largely remained stagnant over decades. This article reports a reproducible technique for transtibial osteomyoplastic amputation.
Topics: Amputation, Surgical; Amputation Stumps; Fibula; Humans; Regional Blood Flow; Surgical Flaps; Tibia; Weight-Bearing
PubMed: 21385373
DOI: 10.1186/1749-799X-6-13 -
Stem Cell Research & Therapy Jul 2019The diabetic foot ulcer (DFU) is one of the most prevalent complications of diabetes mellitus and often develops severe effects that can lead to amputation. A... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The diabetic foot ulcer (DFU) is one of the most prevalent complications of diabetes mellitus and often develops severe effects that can lead to amputation. A non-healing "minor" amputation often precedes a major amputation resulting in a negative impact on the function and quality of life of the patients. Stem cell-based therapies have emerged as a promising option to improve healing, and the adipose tissue is an abundant and easy to access source. The injection of autologous micro-fragmented adipose tissue at the amputation stump of a diabetic population undergoing a lower limb minor amputation was evaluated and compared with the standard care.
METHODS
In this randomized controlled trial with two arms (parallel assignment) and no masking, 114 patients undergoing a lower limb minor amputation were randomized to standard of care or to micro-fragmented adipose tissue injection prepared using a minimal manipulation technique (Lipogems®) in a closed system. Clinical outcomes were determined monthly up to 6 months. Primary endpoint of the study was the evaluation of the healing rate and time after the minor amputation. Secondary endpoints included the assessment of safety, feasibility, technical success, relapse rate, skin tropism, and intensity of pain.
RESULTS
At 6 months, 80% of the micro-fragmented adipose tissue-treated feet healed and 20% failed as compared with the control group where 46% healed and 54% failed (p = 0.0064). No treatment-related adverse events nor relapses were documented, and technical success was achieved in all cases. The skin tropism was improved in the treatment group, and the pain scale did not differ between the two groups.
CONCLUSION
The results of this randomized controlled trial suggest that the local injection of autologous micro-fragmented adipose tissue is a safe and valid therapeutic option able to improve healing rate following minor amputations of irreversible DFU. The technique overcomes several stem cell therapy-related criticisms and its potential in wound care should be better evaluated and the therapeutic indications could be expanded.
TRIAL REGISTRATION
ClinicalTrials.gov number: NCT03276312. Date of registration: September 8, 2017 (retrospectively registered).
Topics: Adipose Tissue; Aged; Aged, 80 and over; Amputation, Surgical; Diabetic Foot; Female; Humans; Male; Middle Aged; Transplantation, Autologous; Treatment Outcome
PubMed: 31358046
DOI: 10.1186/s13287-019-1328-4