Amputation Research Articles

Hospitalized upper extremity artery disease patients: treatment and long-term outcomes.

Current knowledge about upper extremity artery disease (UEAD) is scarce. This study aimed to evaluate the prevalence, treatment patterns, and short- and long-term outcomes of patients suffering from UEAD. Retrospective health claims data of patients who were hospitalized with a primary diagnosis of UEAD between 2010 and 2017 were analysed. The data were obtained from 11 legally independent statutory health insurance funds of the 'AOK-Die Gesundheitskasse'. Risk factors, comorbidities, pharmacotherapy, revascularization procedure, and outcome were evaluated with a particular focus on sex-related disparities (median follow-up time: 5.5 years). Among 2437 UEAD patients (43% female, median age of 67 years), 80% were solely atherosclerotic (UEADa), while 20% had concomitant inflammatory/connective tissue diseases (UEADc/i). Cardiovascular risk factors and comorbidities were highly prevalent in both sexes. Coronary, cerebrovascular, and lower extremity artery diseases and organ failure such as chronic kidney and heart failure were more frequent in men compared with women. At index stay, women had higher rate of revascularization than men (37% vs. 27%). The 5 year mortality among the entire population was almost 50%, even higher in men (UEADa: 51% vs. 36% P < .001; UEADc/i: 44% vs. 36%, P < .05). Furthermore, men had higher rates of upper limb amputation compared with women despite equal secondary preventive pharmacotherapy (UEADa: 26% vs. 11%, P < .001; UEADc/i: 30% vs. 18%, P < .01). Upper extremity artery disease patients, irrespective of the underlying disease type, face a poor prognosis with elevated proportion of amputation and mortality. Male sex was linked to increased risk of future cardiovascular and limb events including death. Further investigation is warranted to understand the underlying causes of the sex-related disparities and identify treatment improvements.

Corrosion Characteristics and Flexural Performance of Carbonated Recycled Aggregate Concrete Beams in Corrosive Environments

The influence of the carbonation of recycled coarse aggregates on the durability performance of the recycled aggregate concrete beams is still unclear. In this study, the corrosion characteristics and flexural performance of the carbonated recycled aggregate concrete (C-RAC) beams in corrosive environments were investigated. The results illustrated that the mass loss of the longitudinal tensile steel bars (LTSBs) in the corroded C-RAC beams decreased when the replacement ratio of the carbonated recycled coarse aggregate (CRCA) increased. Compared to the corroded non-carbonated recycled aggregate concrete (NC-RAC) beam, the mass loss of LTSBs in the corroded C-RAC beam was reduced by 37.91% when the CRCA replacement ratio was 100%. The average mass loss of the short limbs of the stirrups on the tensile side of the corroded C-RAC beam was lower than that of the corroded NC-RAC beam. As the CRCA replacement ratio increased, the flexural performance of the corroded C-RAC beams was enhanced. When the CRCA replacement ratio was 100%, the ultimate load and the displacement ductility coefficient of the corroded C-RAC beam increased by 14.04% and 25.82% compared to the corroded NC-RAC beam, respectively. During the service life, the concrete strains of the cross-section at the mid-span of the corroded C-RAC beams satisfied the assumption of plane section. The research results of this study can provide some reference for the durability design and engineering application of C-RAC beams.

PECULIARITIES OF PROVIDING MEDICAL ASSISTANCE TO CIVILIAN VICTIMS OF EXPLOSIVE INJURIES

Introduction. On February 24, 2022, Ukraine faced a stark new reality as war reshaped the lives of its people, including the medical community. In today's world, where wars and conflicts have become an unfortunate part of reality, the management of injuries sustained during combat operations has gained critical importance. Civilians, often unintended victims of conflict, lack the protective measures afforded to military personnel. Treating wounded civilians presents unique challenges, as they frequently suffer from comorbidities that complicate both medical care and rehabilitation. These factors necessitate tailored approaches to diagnosis, treatment, and recovery. The aim of this study was to analyze the injuries caused by blast trauma among the civilian population and to develop an algorithm for the diagnosis and treatment of patients affected by such trauma. Materials and methods. Medical records of 94 inpatients with explosive injuries treated in the surgical departments of the Communal Non-Commercial Institution of the Kharkiv Regional Council “Regional Clinical Hospital” and the Communal Non-Commercial Institution of the Kharkiv City Council “City Clinical Multidisciplinary Hospital No. 25” between 2022 and 2024 were analyzed. Among the patients, 36 (38.3%) were women aged 21 to 87 years, and 58 (61.7%) were men aged 23 to 86 years. Results and Discussion. Soft tissue injuries were observed in all 94 patients admitted to the hospital. Of these, 45 patients (47.9%) sustained soft tissue damage to one or more anatomical regions without involvement of thoracic, abdominal, or pelvic organs. All patients underwent surgical treatment of wound, which included hemorrhage control, removal of visible foreign bodies, and wound debridement. For patients with traumatic limb amputations, surgical treatment included the formation of limb stumps. Patients with bone injuries underwent immobilization of the affected areas. Subsequently, dynamic monitoring of the wounds was conducted to assess healing and detect complications. Internal organ damage was identified in 49 victims (52.1%). All patients with intrapleural complications underwent Bülau drainage of the pleural cavities as the initial intervention. The second stage of care for victims with combined trauma involved laparotomy, during which the extent of the surgical procedure was determined intraoperatively. The third stage focused on wound management. During the primary operation, interventions were limited to wound debridement, hemostasis, and tamponade of wound channels. Subsequent procedures included repeated wound treatments, the primary delayed closure, or the use of vacuum-assisted closure (VAC) systems in cases of extensive soft tissue damage. For such cases, the final step involved autodermoplasty. Conclusions. The experience of managing these victims highlights the importance of a stepwise approach to treating blast injuries, integrating modern surgical and resuscitation techniques. This structured approach has demonstrated its potential to yield favorable outcomes. Despite the severity of injuries and the presence of comorbidities, all patients were discharged in satisfactory condition, underscoring the high efficacy of the proposed treatment strategy.

New Treatment Strategies of Type 1 Diabetes Mellitus

Diabetes mellitus is a serious metabolic disorder characterized by elevated blood glucose levels resulting from either autoimmune destruction of β-cells in the pancreatic islets or insulin resistance. Type 1 diabetes mellitus is currently managed with insulin therapy; however, long-term treatment is often associated with chronic complications such as limb amputation, blindness, and kidney failure. This review explores innovative therapeutic strategies for Type 1 diabetes mellitus based on a comprehensive literature search using PubMed and relevant keywords. The findings highlight several promising approaches, including gene therapy, trans-differentiation, enhancing the self-replication of β-cells, stem cell therapies, immunomodulatory agents, and herbal medicines, all of which show potential for improving disease management and reducing complications.

No penalty for blocking: Preoperative nerve blocks do not prevent motor nerve stimulation during TMR.

The timing of nerve blocks for amputation surgery with immediate targeted muscle reinnervation (TMR) has been disputed. Traditional practices often defer nerve blocks until post-amputation, fearing interference with motor nerve target identification for TMR. Here, we present a case series demonstrating that pre-amputation regional nerve blocks do not prevent the identification of motor nerve targets. Retrospective data from 26 patients undergoing amputation with TMR and pre-operative nerve blocks were analyzed. The results in Tables 1 and 2 showcase successful TMR transfers across various amputation types, with preserved nerve stimulation for TMR despite preoperative regional anesthesia. The findings are supported by existing literature on regional anesthesia's differential blockage mechanism, emphasizing its compatibility with TMR. Moreover, pre-operative nerve blocks have shown efficacy in pain reduction and postoperative complication mitigation, possibly enhancing overall surgical outcomes. This study underscores the feasibility and benefits of integrating pre-amputation nerve blocks with TMR, offering a comprehensive approach to pain management in limb amputation. This technique optimizes both short- and long-term pain control.

Cobalt Chromium or Stainless Steel Balloon-Expandable Bare Metal Stents for Iliac Occlusive Disease?

To compare the performance of a new-generation cobalt-chromium balloon-expandable bare metal stent with a stainless steel platform for the treatment of iliac occlusive disease. Consecutive patients treated for symptomatic iliac occlusive disease between 2014 and 2021 with the cobalt-chromium Dynetic-35 or the stainless steel Dynamic platform were retrospectively evaluated. Outcome measures included technical success, device- or procedure-related death, clinically-driven target lesion revascularization (CD-TLR), primary patency, and major index limb amputation up to 12 months. In total, 222 Cobalt chromium (CC) stents were used in 159 patients (34.6% female; mean age 66.9 ± 9.5 years) for the treatment of 216 lesions, while 234 iliac lesions of 182 patients (34.6% female; mean age 66.3 ± 9.9 years) were treated with 252 stainless steel (SS) stents. The mean lesion length (30.2 ± 12.8 mm vs 28.7 ± 22.5 mm, p=0.36) and the mean calcification grade (2.0 vs 1.9, p=0.07) did not differ significantly between the 2 groups. Patients treated by the CC platform were more frequently on statins (p<0.001), whereas more active smokers and subjects with higher Rutherford class underwent a SS deployment (p<0.001). Technical success was significantly higher in the SS group (100% vs 97.3%; p=0.01). This was due to longitudinal deformation or stent dislocation after passing the Dynetic-35 with endovascular material. After 1 year, no difference was found following CC and SS stent deployment in terms of device- or procedure-related deaths (0.6% vs 1.1%, p=0.99), target limb amputations (1.9% vs 1.6%, p=0.99), primary patency (91.3% vs 93.5%), and CD-TLR (6.5% vs 2.8% p=0.07). Through 1 year, cobalt-chromium and stainless steel balloon-expandable stents are safe and effective in the treatment of iliac occlusive disease. Enhanced attention should be given passing the cobalt-chromium stent with endovascular devices to avoid procedural complications. Stents with a thin-strut structure improve the flexibility and deliverability. The lower profile also increases the applicability lowering the risk of vascular access complications. In this study newer-generation cobalt chromium balloon-expandable stent did not confer advantages over stainless steel bare metal stent. On contrary, the technical success was inferior to stainless steel stents as longitudinal deformation or dislocation of the Dynetic-35 occurred. Therefore, enhanced attention should be given passing a Cobalt chromium stent with wires, catheters or sheaths to avoid stent deformation.

PATHOGENETIC APPROACH TO THE TREATMENT OF WOUNDS AFTER AMPUTATION OF THE FOOT AGAINST THE BACKGROUND OF CHRONIC LIMB-THREATENING ISCHEMIA (CLTI)

SUMMARY. The strategy of treatment of chronic limb-threatening ischemia (CLTI) should be its timely revascularization and prioritization of performing "small" amputations on the foot. The aim – to improve the healing of wounds after amputation of a part of the foot with the help of a biological membrane enriched with growth factors for their subsequent autodermoplasty Material and Methods. 81 patients with IV grade CLTI were under observation according to the Fontaine classification (category 6 according to the Rutherford classification), with open wounds after amputation of a part of the foot due to dry gangrene. The average age of the patients was 56.7±9.3 years, all men. Patients underwent vasoballoon angioplasty of the arteries of the lower extremities. After that, amputation of the foot was performed using various methods. In connection with the shortage of skin flaps of the wound, 41 patients were treated by the open method, according to the traditional method, followed by autodermoplasty. In other patients (40 patients), to stimulate the reparative process, the entire area of the wound surface on the foot was covered with a plasma membrane (PRGF®-Endoret® supernatant), enriched with growth factors. To control the regeneration process, the tyrosine kinase index was calculated at different times of treatment (6-10 and 15 days after amputation). Also, the content of interleukins IL-1β, IL-4, tumor necrosis factor (TNF-α), interferon (IFN-γ) was determined. After that, the intercytokine coefficient (ICC) was calculated. Result. In patients who underwent endovascular angioplasty and PRP therapy before limb amputation and closed the wound with a plasma membrane, ICC decreased below baseline. This can be explained by a significant increase in the level of anti-inflammatory cytokines against the background of a stable amount of pro-inflammatory factors. The reaction of IL-4 and IFN-γ can be regarded as preparation for the transition of the wound process to the proliferation stage, and the decrease in the levels of IL-1β and TNF-α reflects a decrease in the manifestations of the inflammatory reaction in the wound. Conclusions: 1. Wound healing after foot amputation in patients with CLTI depends not only on restoration of blood supply to the limb. The healing process in an acute wound is largely controlled by the spatio-temporal action of growth factors, cytokines, and chemokines. The use of plasma membrane as a biological membrane enriched with growth factors (PRGF)-Endoret can be a new therapeutic strategy to accelerate the healing process of wounds after amputation of the foot on the background of CLTI with the purpose of subsequent autodermoplasty.

TRANSCRANIAL ELECTRIC PULSE THERAPY IN THE TREATMENT OF CHRONIC PAIN SYNDROME

Rationale: chronic pain syndrome in patients with combined mine-explosive injuries, traumatic limb amputations, extensive burns, etc., is currently especially relevant. The presented analysis of modern literature data on electrophysiotherapy of chronic pain in this category of patients.Objective: to study the literature data and conduct a comparative analysis of the currently used methods of transcranial electrophysiotherapy of pain syndrome, which will improve the results of treatment of patients with chronic pain syndrome.Materials and methods: the analysis of articles, reviews, and studies in the modern scientific medical literature on the voiced problem is carried out. The collection of materials was carried out in the electronic libraries of the kirov university, the first sechenov Moscow state medical university, articles from information resources were used: ncbi, pcm; springer; elsevier, embase, web of science and psychinfo, elibrary, etc.Results: a wide variety of transcranial electrophysiotherapy methods used in clinical practice in the treatment of chronic pain syndrome has been revealed in the literature. The methods are systematized based on: the nature of the intervention (invasive, non-invasive), the parameters of the electric current (direct, alternating, continuous or pulsed).Conclusion: methods of noninvasive transcranial electrophysiotherapy may be more effective and preferable for the treatment of chronic pain syndrome compared to other methods for a number of reasons: noninvasiveness, safety, simplicity, pain reduction due to regulation of neuroplasticity, regulation of emotional state.

The conflict between oral health and patient autonomy in dentistry: a scoping review

BackgroundRespect for patient autonomy, the principle that patients are capable to make informed decisions about medical interventions, is fundamental in present-day medicine. However, if a patient’s request is medically not indicated, the practitioner faces an ethical dilemma represented by the conflict of the principles of patient autonomy, beneficence, and maleficence. Adjacent to topics such as medical assistance in dying and healthy limb amputation, this ethical dilemma also manifests in the care of the maxillofacial region (the oral cavity and its surroundings), an area crucial to esthetic appearance, but also to everyday functions including mastication, speech, and facial expression, all of which are related to well-being. Our aim was to explore the manifestations and resolutions of the conflict between oral health and patient autonomy in relevant literature in order to contribute to the discourse of ethical challenges concerning patient autonomy, beneficence, and nonmaleficence.MethodsWe screened all journal articles discussing the researched ethical dilemma obtained from three databases. Two researchers developed a hierarchical coding scheme, where the parent and grandparent codes were designated deductively as: Case (situations involving the researched ethical dilemma), Judgement (decisions made in the ethical dilemma), and Principle (ideas, rules, propositions explaining the judgements); child codes were developed inductively. After coding the sources, we utilized thematic analysis to construct code constellations.ResultsMost themes identified in our sources advocated for the practitioner to choose the alternative that benefits the patient from a medical perspective, although no theme excluded the consideration of patient autonomy. Instances where respect for patient autonomy was encouraged concerned oral preventive care or when the requested intervention was expected to have an insignificant impact on oral health.ConclusionsEthical conflicts concerning patient autonomy, beneficence, and nonmaleficence have a marked presence in oral care. These conflicts arise through the issue of body modification, evident in cosmetic dentistry and requests for tooth extraction. Our sources generally support the argumentation for beneficence, despite the rise of cosmetic procedures in dentistry.

Major limb amputation in ageriatric patient following minor laceration

Major limb amputation in ageriatric patient following minor laceration

Therapeutic role of Differential Target Multiplexed (DTM) spinal cord stimulation in painful diabetic neuropathy. Case report.

Diabetic peripheral polyneuropathy (DPN) is the most common cause for diabetic foot complications, including diabetic ulcers, Charcot arthropathy, and lower limb amputations. Spinal Cord Stimulation (SCS) is a safe and effective treatment used for pain reduction in neuropathic/nociceptive pain conditions; the most common stimulation modalities used for the management of painful diabetic neuropathy were conventional paresthesia-based and high-frequency SCS, which stimulate the A beta fibers in the dorsal column of the spinal cord. Differential Target Multiplexed (DTM) SCS is a novel paresthesia-free stimulation technique targeting the supportive glial cells in the nervous system, modulating glial cells and neurons with a rebalance of their interactions. We report a case of severe painful DPN who had immediate pain relief after DTM-SCS implantation, with constant pain relief during the 12 months follow-up. We also investigated the effect of neurostimulation on diabetes control, evaluating the preoperative and postoperative glucose metrics using Continuous Glucose Monitoring (CGM) and compared neurophysiological examination results of the peripheral lower limbs' nerves.

Relationship of stump length with muscle strength, proprioception, and balance in patients with traumatic unilateral transfemoral amputation.

Many factors affect the rehabilitation of lower limb amputation. One of these factors is the length of the stump. The aim of this study was to assess the relationship of stump length with muscle strength, proprioception, and balance in patients with traumatic unilateral transfemoral amputation. Sixteen patients with traumatic unilateral transfemoral amputation were included in this cross-sectional study. Stump length was determined by measuring the distance from the trochanter major to the tip of the stump. Hip extensor and flexor muscle strength on the amputated side was determined using the computer-assisted isokinetic system. The proprioceptive sensation of the lower extremities was measured at hip flexion with computer-assisted isokinetic system. Balance of the patients was determined using the Berg Balance Scale. There was a statistically significant negative correlation between the stump length and proprioception measurements (r = -0.508, p = 0.044). There was also a statistically significant correlation between Berg Balance Scale and the flexion total work value at 60° angular velocity (r = 0.541, p = 0.03). There was no significant correlation between stump length and other muscle strength, proprioception, and balance parameters. A relationship was found between stump length and proprioception, and balance and hip flexor muscle strength in patients with traumatic unilateral transfemoral amputation. In elective lower limb amputations, the level of amputation should be determined at the most functional level with the longest possible stump.

Principles and biomechanical response of normal gait cycle to measure gait parameters for the alignment of prosthetics limb: A technical report.

The limb amputations caused due to emergent incidents of trauma injuries and vascular diseases currently represent crucial global problems. The patients/amputees with limb amputation who lost the residual limb (knee-ankle foot system) must depend on the prosthetic limb. Prosthetic clinicians and technicians have attempted to develop optimal limb prosthetics that will enhance the ability and functional elements of the patients/users. However, the amputees still do not gain the same level of comfort and functional stability as compared to normal limbs (without amputation). Thus, to provide that comfort and stability, proper construction with accurate positioning and alignment of constructed prosthetic limb is crucial to reconstitute these amputees/patients to do their activities for daily life. The objective of technical report is to provide the brief summary about basic principle and biomechanics regarding gait analysis, construction, and alignment of prosthetic limb during gait cycle. The study also summarized the kinematics and kinetic biomechanical response of prosthetic limbs to assess the biomechanics of limb prosthetics, socket assembly principle, gait parameters, and static and dynamic alignment during walking. The basic principle of positioning and alignment with different flexion and torque moment at hip, knee, and ankle joint has been analyzed.

Prosthesis and health-related factors of mobility in people with nontraumatic unilateral transtibial amputation.

Numerous factors can affect mobility of individuals with lower limb amputation, including prosthesis-dependent, physical and psychological determinants.Objective:This study aimed to investigate the prosthesis and health-related factors of mobility in people with nontraumatic unilateral transtibial amputation.Study Design:Cross-sectional observational study. Individuals with nontraumatic unilateral transtibial amputation who are using a prosthetic leg were included. All participants were asked to fill out the Prosthesis Evaluation Questionnaire, 12-Item Short-Form Health Survey (SF-12), Comprehensive Lower Limb Amputee Socket Survey, and 12-item Prosthetic Limb Users Survey of Mobility. The relationships between the variables of interest and mobility were investigated using correlation coefficient analyses. Multiple regression analysis was run to investigate the impact of a set of predictor variables on mobility. A total of 168 people with lower limb amputation were included. Mobility had a significant association with age, comorbidity, occupation, Prosthesis Evaluation Questionnaire score, physical and mental component scores of SF-12, subscales of the Comprehensive Lower Limb Amputee Socket Survey, educational status, amputation cause, time since amputation, time since using the prosthesis, and socket insert type. In the final model of multiple regression analysis, the Physical Component Summary score of SF-12 showed the strongest predictor of mobility (beta = 0.40, p < 0.001). Nonprosthetic factors play a significant role in mobility of people with nontraumatic unilateral transtibial amputation. Although some predictors, such as age and time since amputation, are immutable, clinicians may still enhance the mobility of this population through the utilization of health-related factors, such as improving their physical activity.

Erratum for the Research Article "Restoration of grasping in an upper limb amputee using the myokinetic prosthesis with implanted magnets" by M. Gherardini et al.

Erratum for the Research Article "Restoration of grasping in an upper limb amputee using the myokinetic prosthesis with implanted magnets" by M. Gherardini et al.

Influence of the COVID-19 pandemic on the amputation rate in Germany in patients with critical limb-threatening ischaemia

Abstract Objectives The COVID-19 pandemic has shown a wide range of direct and indirect influences on the health of the population. This study examines the impact of the COVID-19 pandemic on the amputation rate in Germany in patients with critical limb-threatening ischaemia (CLTI). Methods The epidemiological, pooled, and anonymised data of 476,168 CLTI patients from the Institute for the Hospital Remuneration System (InEK) were analysed for 2019–2023 at the federal level at weekly intervals and compared with epidemiological data for COVID-19 patients from the Robert Koch Institute (RKI) database, divided into the pandemic phases. Results The number of inpatient cases declined by −4.64 % (p&gt;0.05) from 2019 to 2020 and increased significantly by +7.07 % (p=0.001) from 2020 to 2023. The incidence of all lower limb amputations increased from 2019 to 2022 (23.9 vs. 25.7 %, p=0.01) with no significant changes in 2023. Moreover, the incidence of minor amputations increased from 16.9 % in 2019 to a maximum of 18.9 % (p&lt;0.001) in 2022, and then to 18.4 % (p=0.02) in 2023. In the short-term perspective, inpatient cases significantly decreased in phases 1 and 3, with a relevant increase in the subsequent phases. However, the incidence of all amputations, especially minor ones, is constantly increasing. Conclusions The COVID-19 pandemic has significantly indirectly impacted the management of CLTI patients, with a marked increase in the incidence of minor amputations, presumably due to the delayed presentation of patients with small necroses and due to limited access to healthcare.

Traumatic Amputations in Military Personnel: From The Perspective of Forensic Medicine

Aim: Traumatic amputations are devastating injuries that occur suddenly and unexpectedly, resulting in the loss of a body part. This study was aimed at evaluating cases of traumatic amputations from a medico-legal perspective. Material and Method: The forensic reports prepared by the Department of Forensic Medicine, Gülhane Training and Research Hospital (fka; Gülhane Military Medical Academy), between January 1, 2011, and December 31, 2014 were examined retrospectively and the cases who had traumatic amputations analyzed in depth. Results: All of the cases (n=72) were male, and the mean age at the time of the injury was 24.2 (±4.3) years. Almost all the cases (97.2%) were soldiers. It was determined that the most common cause of trauma among all cases was work accident (51.5%), followed by explosion injuries (26.4%). Traumatic amputations were mostly seen in the upper extremity (83.3%), followed by lower the extremity (12.5%) and both upper and lower extremities (4.2%). The most common cause of upper extremity amputations was work accidents, while lower extremity amputations were mostly caused by blast injuries. While 58.3% of the amputations were minor (fingers only), 41.7% were major. It was determined that psychiatric disorders developed in 19.4% of the cases after traumatic amputation. Conclusion: Traumatic amputations are among the issues that need to be carefully examined because they occur especially at the young age group and cause disabilities in the affected people. It is necessary to reduce trauma, which is one of the important causes of amputations, to take precautions by using personal protective equipment, and to not neglect treatment and follow-up. The majority of patients in developing nations, like Türkiye, struggle to receive pre-hospital care, which proves to be a major challenge for trauma care, especially in military cases. It is of great importance that psychiatric follow-up of people is carried out in the early and late periods after amputation and that social support and appropriate treatments are not neglected.

Time to Amputation After Traumatic Digital Injury Does Not Affect Complication Rates: A Retrospective Multi-Institutional Analysis.

Revisionary digital amputations are often performed after partial or full traumatic digital amputation to minimize complications while preserving as much length and functionality as possible. Many surgeons attempt revisionary procedures swiftly after initial injury. The aim of this study was to investigate the effects of time from injury to surgery on rate of complications and reoperation in revisionary traumatic digital amputations. This was a retrospective chart review of all patients undergoing revisionary digital amputation for initial traumatic amputation at a single hospital from January 1, 2007 to December 31, 2021. Demographics, comorbidities, surgical details, complications, and time from injury to surgery were collected. Five-factor modified fragility index scores were also computed for each patient. Primary outcomes of interest included complications and need for additional procedures. Secondary outcomes of interest included development of neuroma, phantom limb, and referral to a long-term pain specialist. A total of 97 patients were identified as meeting all inclusion criteria. The average time to surgery was 14.4 days. Body mass index, comorbidities, and time to surgery were not associated with increased risk of complication. Increasing time to surgery was not significantly associated with increased risk of complications, development of neuroma, phantom limb, or a referral to long-term pain service. The only factors which were significantly associated with reoperation were absence of diabetes and hypertension. Increasing time to surgery after initial injury was not significantly associated with increased risk of complications or reoperation. Surgeons should consider this when assessing urgency of surgery in patients after traumatic digital amputation.

The impact of body mass index on rehabilitation outcomes after lower limb amputation.

To determine the effect of obesity on physical function and clinical outcome measures in patients who received inpatient rehabilitation services for lower extremity amputation. A retrospective review was performed on patients with lower extremity amputation (n = 951). Patients were stratified into five categories adjusted for limb loss mass across different levels of healthy body mass index (BMI), overweight, and obesity. Outcomes included the Inpatient Rehabilitation Facility Patient Assessment Instrument functional scores (GG section), discharge home, length of stay (LOS), therapy time, discharge location, medical complications and acute care readmissions. Deep learning neural networks (DLNNs) were developed to learn the relationships between adjusted BMI and discharge home. The severely obese group (BMI > 40 kg/m2) demonstrated 7%-13% lower toileting hygiene functional scores at discharge compared to the remaining groups (p < .001). The severely obese group also demonstrated 8%-9% lower sit-to-lying and lying-to-sitting bed mobility scores than the other groups (both p < .001). Sit-to-stand scores were 16%-21% worse and toilet transfer scores were 12%-20% worse in the BMI > 40 kg/m2 group than the other groups (all p < .001). Walking 50 ft with two turns was most difficult for the BMI > 40 kg/m2 group, with mean scores 7%-27% lower than the other BMI groups (p = .011). Wheelchair mobility scores for propelling 150 ft were worst for the severely obese group (4.9 points vs. 5.1-5.5 points for all other groups; p = .021). The LOS was longest in the BMI > 40 group and shortest in the BMI < 25 group (15.0 days vs. 13.3 days; p = .032). Logistic regression analysis indicated that BMI > 40 kg/m2 was associated with lower odds risk (OR) of discharge-to-home (OR = 0.504 [0.281-0.904]; p < .022). DLNNs found that adjusted BMI and BMI category were ranked 11th and 12th out of 90 model variables in predicting discharge home. Patients with severe obesity (>40 kg/m2) achieved lower functional independence for several tasks and are less likely to be discharged home despite higher therapy volume than other groups. If a patient is going home, obesity will pose unique demands on the caregivers and resources can be put in place to help reintegrate the patient into life.

Attitudes and opinions of Brazilian veterinarians towards the assessment and management of acute avian pain.

Veterinarians' approaches to the management ofavian pain have been poorly documented despite the rising number of pet birds seen in clinical settings. An online survey was advertised nationwide to recruit Brazilian veterinarians who had treated traumatic and surgical conditions in birds within the previous year. The survey comprised 25 closed or semi-closed questions divided into four sections (demographics, routinely performed medical procedures and pain recognition, drug choices for analgesia and challenges to pain treatment, and attitudes towards pain relief in birds). Survey results are expressed as a percentage of responses and a chi-squared test was used to compare proportions. A total of 370 completed surveys were received. Approximately 72% of respondents worked exclusively in wild/exotic animal practice. Parrots and related species were the most commonly seen birds. The most frequently reported painful conditions were fractures (88.4%), feather plucking (73.0%) and limb amputation (65.1%). Although pain was diagnosed behaviourally by 97.6% of the respondents, 83.5% believed that the presence of an observer inhibited avian pain expression. NSAIDs and opioids, most commonly meloxicam and tramadol, were always provided perioperatively by 66.4% and 42.1% of respondents, respectively. Although nearly all respondents (95.4%) agreed that analgesics improve the quality of recovery after surgery, 80.3% stated that acute pain in birds is frequently undiagnosed in the clinical setting. Selection bias could have overestimated the attitudes concerning avian pain in relation to the wider veterinary population. Practising veterinarians in Brazil revealed a positive attitude towards avian pain management. However, the lack of validated pain assessment methods makes avian pain relief highly challenging.