Amputation Stump Research Articles

Structural and molecular characteristics of weight-bearing volar skin can be reconstituted by micro skin tissue column grafting.

For patients with lower limb amputations, prostheses are immensely helpful for mobility and the ability to perform job-related or recreational activities. However, the skin covering the amputation stump is typically transposed from adjacent areas of the leg and lacks the weight-bearing capacity that is only found in the specialized skin covering the palms and soles (a.k.a. volar skin). As a result, the skin tissue in direct contact with the prosthesis frequently breaks down, leading to the development of painful sores and other complications that limit, and often preclude, the use of prostheses. Transplanting volar skin onto amputation stumps could be a solution to these problems, but traditional skin transplantation techniques cause substantial morbidity at the donor site, such as pain and scarring, which are especially problematic for volar skin given the critical functional importance of the volar skin areas. We previously developed the technology to collect and engraft full-thickness skin tissue while avoiding long-term donor site morbidity, by harvesting the skin in the form of small (~0.5 mm diameter) cores that we termed "micro skin tissue columns" (MSTCs), so that each donor wound is small enough to heal quickly and without clinically appreciable scarring or other long-term abnormalities. The goal of this study was to establish whether a similar approach could be used to confer the structural and molecular characteristics of volar skin ectopically to other skin areas. In a human-to-mouse xenograft model, we show the long-term persistence of various human plantar MSTC-derived cell types in the murine recipient. Then in an autologous porcine model, we harvested MSTCs from the bottom of the foot and transplanted them onto excision wounds on the animals' trunks. The healing processes at both the donor and graft sites were monitored over 8 weeks, and tissue samples were taken to verify volar-specific characteristics by histology and immunohistochemistry. The volar donor sites were well-tolerated, healed rapidly, and showed no signs of scarring or any other long-term defects. The graft sites were able to maintain volar-specific histologic features and expression of characteristics protein markers, up to the 8-week duration of this study. These results suggest that MSTC grafting could be a practical approach to obtain autologous donor volar skin tissue, confer volar skin characteristics ectopically to nonvolar skin areas, improve the load-bearing capacity of amputation stump skin, and ultimately enhance mobility and quality-of-life for lower limb amputees.

Unilateral spinal anesthesia with hypobaric bupivacaine for regularization of the right lower limb amputation stump: a case report with video

Unilateral spinal anesthesia with hypobaric bupivacaine for regularization of the right lower limb amputation stump: a case report with video

Depression as a Prognostic Factor in Lower Extremity Amputation for Diabetic Foot: Insights From a Prospective Study on Wound Healing, Infections, and Early Mortality

This study addresses the challenges faced by diabetic patients undergoing lower extremity amputation due to diabetic foot, particularly focusing on the implications for wound healing and early mortality. The wounds at the amputation stump may necessitate multiple surgical interventions. The aim is to identify prognostic factors associated with these outcomes, shedding light on the complexities surrounding the postamputation phase. A prospective study was conducted on 39 diabetic patients who underwent lower extremity amputation due to diabetic foot between 2021 and 2022. Comprehensive preoperative data, encompassing parameters such as blood count, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, hemoglobin A1c, albumin, protein, transferrin, ferritin levels, age, gender, body mass index, smoking habits, dialysis, revascularization, duration of surgery, and the use of tourniquet during the procedure were meticulously recorded. Additionally, cognitive performance and depression status were assessed preoperatively using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory (BDI), respectively. A follow-up period of 3 months postsurgery allowed for the comparison of patients who developed infections at the amputation stump with those who did not, as well as the distinction between patients who survived and those who succumbed to mortality. The study revealed that the use of a tourniquet during surgery significantly increased the risk of infection (p = .027), and higher BDI scores were associated with increased risks of both infection (AUC = 0.814) and mortality (AUC = 0.769), with cut-off scores of 24.0 and 23.5 predicting these outcomes with high sensitivity and specificity, respectively. Additionally, lower MMSE scores were associated with increased short-term postoperative mortality. There were no statistically significant differences between the groups in parameters such as complete blood count, ESR, CRP, procalcitonin, HbA1c, albumin, total protein, transferrin, ferritin levels, age, gender, BMI, smoking, dialysis, revascularization, and surgery duration. This investigation highlights the significance of considering tourniquet usage during amputation, preoperative depression status, and cognitive function in patients who undergo amputation due to diabetic foot. The use of a tourniquet during surgery is a significant risk factor for infection, and elevated BDI scores are strong predictors of both infection and mortality in patients undergoing amputations. The findings underscore the importance of a multidisciplinary neuropsychiatric evaluation preoperatively to enhance patient care and outcomes.

Fillet flap transfer as alternative to conventional lower limb amputation

The fitting of a prosthesis after lower limb amputation is associated with several challenges. Skeletal stump-prosthesis interfaces and selective nerve transfer can partially overcome these but are also associated with new impairments that emphasize the necessity of innovative approaches. The concept of so-called spare part surgery with the use of fillet flaps could play an important role in this respect. An overview of the classical prosthesis-associated discomforts, advantages and disadvantages of treatment strategies and presentation of alternative surgical concepts. A selective literature search was carried out considering the experiences of the authors and perspectives with respect to the advantages and disadvantages of the surgical treatment options. Furthermore, aclinical case is presented. The transfer of the sole of the foot as afillet flap to the weight-bearing region of the amputation stump offers anumber of benefits, such as creating afully weight-bearing stump, prevention of neuralgia, preserved sensation and conservation of the body image. As long as the calcaneal region is not impaired, this technique can be performed in amputations below as well as above the knee. The question of whether parts of the bone should be included in the transfer must be individually evaluated for each patient. This approach enables optimization of the residual limb stump for the subsequent fitting of a prosthesis for the patient.

Risk factors for 30-day hospital readmission in patients with diabetic foot

IntroductionDiabetic foot (DF) is part of the natural history of diabetes mellitus, ulceration being a severe complication with a prevalence of approximately 6.3 %, which confers a significant economic burden. Hospital readmission in the first thirty (30) days is considered a measure of quality of healthcare and it's been identified that the most preventable causes are the ones that occur in this period. This study seeks to identify the risk factors associated with readmission of patients with DF. MethodsA case-control study was done by performing a secondary analysis of a database. Descriptive statistics were used for all variables of interest, bivariate analysis to identify statistically significant variables, and a logistic regression model for multivariate analysis. Results575 cases were analyzed (113 cases, 462 controls). A 20 % incidence rate of 30-day readmission was identified. Statistically significant differences were found in relation to the institution of attention (Hospital Universitario de la Samaritana: OR 1.9, p value < 0.01, 95 % CI 1.2–3.0; Hospital Universitario San Ignacio: OR 0.5, p value < 0.01, 95 % CI 0.3–0.8) and the reasons for readmission before 30 days, especially due to surgical site infection (SSI) (OR 7.1, p value < 0.01, 95 % CI 4.1–12.4), sepsis (OR 8.4, p value 0.02, 95 % CI 1.2–94.0), dehiscence in amputation stump (OR 16.4, p value < 0.01, 95 % CI 4.2–93.1) and decompensation of other pathologies (OR 3.5, p value < 0.01, 95 % CI 2.1–5.7). ConclusionThe hospital readmission rate before 30 days for our population compares to current literature. Our results were consistent with exacerbation of chronic pathologies, but other relevant variables not mentioned in other studies were the hospital in which patients were taken care of, the presence of SSI, sepsis, and dehiscence of the amputation stump. We consider thoughtful and close screening of patients at risk in an outpatient setting might identify possible readmissions.

Loss of the ability to regenerate body appendages in vertebrates: from side effects of evolutionary innovations to gene loss.

The ability to regenerate large body appendages is an ancestral trait of vertebrates, which varies across different animal groups. While anamniotes (fish and amphibians) commonly possess this ability, it is notably restricted in amniotes (reptiles, birds, and mammals). In this review, we explore the factors contributing to the loss of regenerative capabilities in amniotes. First, we analyse the potential negative impacts on appendage regeneration caused by four evolutionary innovations: advanced immunity, skin keratinization, whole-body endothermy, and increased body size. These innovations emerged as amniotes transitioned to terrestrial habitats and were correlated with a decline in regeneration capability. Second, we examine the role played by the loss of regeneration-related enhancers and genes initiated by these innovations in the fixation of an inability to regenerate body appendages at the genomic level. We propose that following the cessation of regenerative capacity, the loss of highly specific regeneration enhancers could represent an evolutionarily neutral event. Consequently, the loss of such enhancers might promptly follow the suppression of regeneration as a side effect of evolutionary innovations. By contrast, the loss of regeneration-related genes, due to their pleiotropic functions, would only take place if such loss was accompanied by additional evolutionary innovations that compensated for the loss of pleiotropic functions unrelated to regeneration, which would remain even after participation of these genes in regeneration was lost. Through a review of the literature, we provide evidence that, in many cases, the loss in amniotes of genes associated with body appendage regeneration in anamniotes was significantly delayed relative to the time when regenerative capability was lost. We hypothesise that this delay may be attributed to the necessity for evolutionary restructuring of developmental mechanisms to create conditions where the loss of these genes was a beneficial innovation for the organism. Experimental investigation of the downregulation of genes involved in the regeneration of body appendages in anamniotes but absent in amniotes offers a promising avenue to uncover evolutionary innovations that emerged from the loss of these genes. We propose that the vast majority of regeneration-related genes lost in amniotes (about 150 in humans) may be involved in regulating the early stages of limb and tail regeneration in anamniotes. Disruption of this stage, rather than the late stage, may not interfere with the mechanisms of limb and tail bud development during embryogenesis, as these mechanisms share similarities with those operating in the late stage of regeneration. Consequently, the most promising approach to restoring regeneration in humans may involve creating analogs of embryonic limb buds using stem cell-based tissue-engineering methods, followed by their transfer to the amputation stump. Due to the loss of many genes required specifically during the early stage of regeneration, this approach may be more effective than attempting to induce both early and late stages of regeneration directly in the stump itself.

Profunda artery perforator flap—a novel approach to soft tissue reconstruction post lower limb amputation: a case report

The authors report a case with successful resurfacing of a through- knee amputation stump using two ipsilateral profunda artery perforator flaps from the same vascular tree.

The Lacing Dermatotraction Suturing Technique

Introduction: Hailing from a tertiary government-aided center, infected surgical wounds varying from diabetic foot and necrotizing fasciitis to surgical site infection are by far the most common cluster of cases encountered in our practice. Due to an overall lack of patient education on wounds, most of these patients present late, necessitating extensive debridement and tissue loss.&#x0D; Aim and Objective: To describe the lacing dermatotraction technique and to study its application in aiding early secondary closure of infected surgical wounds.&#x0D; Material and Methods: An interventional Study was conducted at VICTORIA Hospital, Bangalore, from February 2020 to October 2021. Fifty-four patients with Infected wounds were debrided until healthy margins were obtained, followed by applying the shoelace tension lacing suture. This consisted of an infant feeding tube running under loops of prolene fixed 1 cm away from the edge of the wound. One end of the IFT is anchored to the skin, and the other is held in position with single throws of no-1 silk suture, which can be loosened at the next sitting for adequate wound exposure, which aids in better debridement. The tension suture is again tightened to attain the maximal possible wound approximation. Thus, constant traction on the skin edges creates progressive closure until secondary closure is achieved.&#x0D; Results: 54 Patients were enrolled, consisting of 8 amputation stump infections, 11 diabetic foot, 14 disarticulations, five bed sore, 12 fasciotomies, three mastectomy flap necrosis, and one traumatic avulsion. There were 38 males and 16 females, with a mean age of 53.4 years. The mean duration of the wound at presentation was 17 days, and they were subjected to an average of 11 days of debridement. Mean wound dimensions - length= 11.02cm, breadth=4.86cm and area = 53.55 cm2. On applying the lacing, the wounds were debrided for an average of 8.85 days with 2.9 tightening. Secondary closure was achieved in 45 (83.33%) patients,.&#x0D; Conclusion: The lacing technique is inexpensive and safe to achieve early secondary closure of infected wounds. It avoids the need for skin grafts, reducing the need for anesthesia, hospital expenditure, and duration of hospital stay of patients.&#x0D;

Investigation of walking speed and plantar pressure after chopart amputation.

In foot amputation, Chopart amputation is considered to have a high risk of deformity, and can result in poor function. We experienced a case in which Chopart amputation combined with tendon transfer and tendon lengthening was performed, and the patient was eventually able to walk independently with a foot prosthesis without experiencing deformity of the foot. We investigated walking speed and plantar pressure after Chopart amputation with and without a foot prosthesis. A 78-year-old man underwent Chopart amputation with tendon transfer and tendon lengthening. As a result, he was able to stand up and walk, both while bearing weight on the heel of the affected foot, but he was unable to push off the ground using that foot. When a foot prosthesis was introduced, the patient's walking speed increased from 0.6 m/s without the prosthesis to 0.8 m/s with the prosthesis, which was an increase of 33%. The plantar pressure at the stump decreased from 129.3 N/cm2 on average without the prosthesis to 51.6 N/cm2 with the prosthesis, which was a 59% decrease. Wearing a foot prosthesis improved the patient's walking speed and decreased plantar pressure at the amputation stump.

Intertrochanteric Fracture Fixation Using a Traction Table in a Patient with Ipsilateral Above-knee Amputation – A Case Report and Review of Reduction Techniques

Introduction: Although commonly encountered in clinical practice and considered among the “bread and butter” cases in trauma and orthopedics, intertrochanteric fractures of the femur in certain scenarios pose a challenge to the orthopedic surgeon. Good reduction and stable fixation are a key for good outcome, and certain anatomical limitations such as amputations make that difficult to achieve. Ipsilateral above-knee amputation is a scenario where positioning of the patient on an orthopedic fracture table and reduction of the fracture becomes challenging. Case Report: An active 59-year-old female with good functional baseline and ipsilateral above-knee amputation presented with an intertrochanteric fracture of the right proximal femur. The fracture was treated operatively and fixed with a dynamic hip screw (DHS). This case report highlights the technique of positioning of the patient and reduction of the fracture on a traction table using skeletal traction though the amputation stump with a Denham pin connected to the traction device. Conclusion: This technique provides a reliable and stable means of reducing the fracture using skeletal traction through the bone itself and will be helpful to any orthopedic surgeon faced with a similar situation. This report also sheds light on current literature regarding different ways of overcoming the challenge of positioning and reducing intertrochanteric/intracapsular neck femur fractures using the orthopedic traction table in patients with ipsilateral limb amputations. Keywords: Intertrochanteric fracture, above-knee amputation, reduction techniques, traction table

Detection of wound healing disorders after major amputations by measurements of the microcirculation: A prospective single-center study.

Although major amputations can often be avoided due to evolving methods of endovascular and surgical revascularizations techniques, in patients with chronic limb-threatening ischemia, it is still necessary in some cases. Aim of this study was the detection of wound healing disorders through intraoperative microcirculation measurements in major limb amputations. In this single-center clinical study, patients with an indication for major amputation were enrolled prospectively. Cause of amputation, patients' comorbidities including cardiovascular risk profile were assessed. Macrocirculation, as well as microcirculation were assessed. Microcirculation measurements were performed by fluorescence angiography with the administration of indocyanine green. A preoperative measurement was obtained at the amputation level, followed by three additional measurements of the amputation stump postoperatively. Wound healing was monitored and correlated with the microcirculatory findings, based on the perfusion parameters ingress and ingress rate, calculated in the indocyanine green fluorescence video sequences of the amputation stumps. Forty-five patients were enrolled, including 19 (42%) below-the-knee amputations and 26 (58%) above-the-knee amputations. When considering the need for revision, a change in the microperfusion parameters was observed postoperatively. The mean value for ingress was significantly lower directly postoperatively in stumps requiring revisions (5 ± 0 A.U. versus 40.5 ± 42.5 A.U., p < 0.001). The mean value of ingress rate behaved similarly (0.15 ± 0.07 A.U./s versus 2.8 ± 5.0 A.U./s, p = 0.005). The evaluation of indocyanine green measurements when wound healing disorders occurred also showed nonsignificant differences in the mean values. Fluorescence angiography after major lower limb amputations appears to be an option of depicting microperfusion. Especially, the early postoperative detection of reduced perfusion can indicate a subsequent need for revision. Therefore, this method could possibly serve as a tool for intraoperative quality control after major limb amputation.

Treatment of patients with gunshot traumatic amputations of the lower limbs due to explosive injury in the conditions of today’s war in Ukraine

Annotation. In the conditions of today's war, limb injuries due to explosive injuries and wounds reach 63.9%, of which gunshot traumatic limb amputations account for an average of 5.0%. The goal is to analyze the results of the treatment of the wounded with gunshot traumatic amputations of the lower limbs in case of an explosive injury and to identify their shortcomings and propose ways to eliminate them. The results of treatment of 306 patients with traumatic amputations of the lower limbs from February 24, 2022 to August 1, 2023 were analyzed. Complete detachment of the limb occurred in 162 patients, massive destruction of the limb with soft tissue defects – in 79, and explosive injury of the limb with damage to the main vessels with the subsequent development of decompensated ischemia, which required amputation – in 48, wounded with prolonged tourniquet time, which led to irreversible changes in the limb – in 17 cases. At the third level of medical care, 105 patients were operated on urgently. The reasons were damage to the main vessels of the limb, which led to decompensated ischemia of the limb in 28 cases, pronounced necrotic changes of the stump of the limb – in 67, and erosive bleeding – in 8. 201 patients underwent planned surgery in the form of radical complex repeated (secondary) surgical treatment of defects of the tissues of amputated limb stumps. In the early postoperative period suppuration of amputation stumps occurred in 67 patients, bleeding occurred in 8. In the late postoperative period defective stumps were observed in 23, ligature fistulas – in 9, osteophytes – in 4, neurilemmoma formation – in 6 patients. Thus, purulent-inflammatory complications associated with non-radical primary surgical treatment, suturing of tissues for the formation of a stump, by increasing the time interval between surgical treatments. Primary surgical treatment should be radical without suturing the limb stump. For their prevention and treatment at the tertiary level, it is advisable to use the proposed radical complex repeated (secondary) surgical treatment.

Internal Iliac Artery Patency as a Predictor of Above-Knee Amputation Stump Healing

PurposeThe primary aim of this study is to assess role of internal iliac patency in predicting outcome of AKA stump healing. The secondary objectives were assess accuracy of Wound, Ischemia, and foot Infection (WIfI) classification system in predicting AKA stump healing and association of delayed mortality. Materials and MethodThis is a retrospective study performed in Vascular Surgery Unit, in a tertiary hospital, on patients who underwent above-knee amputations over one year, from July 2021 until June 2022. Patient demographic data, WIfI scoring, outcome of above-knee amputations and patency of profunda femoris and internal iliac artery were collected. To minimize confounding, a single vascular surgeon performed all CT imaging reviews and arterial measurements. Approval for this study was obtained from the National Research Registry NMRR ID-23-01865-KQ4 (IIR). ResultNinety patients underwent AKA over one year, from July 2021 until June 2022. Occluded internal iliac artery in the presence of patent profunda femoris did not affect the wound healing of AKA stump. There was significant association between WIfI scoring with mortality. Patients with WIfI scoring 3 to 4 was observed to have higher mortality rate compared to patients with normal healing 47 (72.0%) vs 4 (80.0%); p= 0.021. ConclusionIn this study, the internal iliac artery patency shows no statistically significant effect on AKA stump healing; however, the small number of patients is a study drawback. This study also demonstrates that the WIfI score can be a prognostic factor for mortality in patients undergoing above-knee amputation.

Management interventions for amputation stump neuromas: evidence based review and cost-benefit analysis

Amputation is a common military and civilian surgery with high morbidity. Patients without prostheses due to neuroma pain lose productivity and lifelong contributions, which is often underestimated. The surgical and non-surgical treatment of painful stump neuromas is controversial. An evidence-based assessment and cost-benefit analysis of painful stump neuroma management modalities emphasizes institutional awareness and disruptive technologies. An Oxford Centre for Evidence Based Methodology critical appraisal and structured literature review were used in the research. We found 154 records using a reproducible literature search strategy that included electronic databases and references. A full review of 27 manuscripts after exclusion criteria yielded data for analysis. Surgical, injectable, and electromagnetic spectrum methods were used. Surgical interventions had longer follow-up times than injection and radiofrequency treatments, which affected outcomes. CEBM level 4 evidence dominated primary literature, indicating low quality. No therapy was superior, but the risks varied. Injection therapies like sclerosing alcohol had limited success and side effects. Despite limited evidence, electromagnetic spectrum modalities showed potential. Including direct and indirect costs, amputation stump refitting costs millions annually. Compared to outpatient non-surgical interventions, laser therapy could save a lot of money. According to the study, surgical interventions are common but expensive and have limited functional success. Low-risk non-surgical methods like co-ablation, pulsed radiofrequency, and transcutaneous laser therapy have mixed results. The short follow-up of all non-surgical studies seems to limit them. Follow-up duration is crucial to outcome assessment. Long-term, low-risk laser-induced thermotherapy is promising for future research. This study emphasizes the need for more research and the economic benefits of disruptive technologies in treating painful stump neuromas.

Health Care Utilization After Major Limb Loss in Adults (18-64) Receiving Care in the Military Health System From 2001 to 2017

ObjectiveTo characterize and quantify health care utilization of Military Health System beneficiaries with major limb loss. DesignRetrospective cohort study. SettingMilitary treatment facilities and civilian health care facilities that accept TRICARE insurance across the United States. ParticipantsA total 5950 adult Military Health System beneficiaries with major limb amputation(s) acquired between January 1st, 2001, and September 30th, 2017 (N=5950). InterventionsNot applicable. Main Outcome MeasuresThis study was an exploratory analysis designed to identify common care specialties, services, and devices utilized by Military Health System beneficiaries with major limb loss. ResultsMost beneficiaries were retirees/dependents (63.3%), men (73.1%), and had a single amputation (88.7%), with a mean age of 42 years. Differences between beneficiary categories were found. Active-duty service members used a larger proportion of inpatient, emergency, primary care, physical and occupational therapy, prosthetics and orthotics, physical medicine and rehabilitation, and psychiatry services than retirees/dependents. Most common procedures included “revision of amputation stump” (57.2%) for the active-duty population and “other amputation below knee” (24.3%) for the retirees/dependents. ConclusionsThese findings highlight the rehabilitation trajectories of beneficiaries receiving treatment for major limb loss in military and civilian care settings. The results could inform staffing decisions and training programs for military treatment facilities, American trauma centers, rehabilitation hospitals, and outpatient health care providers treating individuals with amputation.

METABOLIC (TCPO2) AND HEMODYNAMIC DISCORDANCE IN PERIPHERAL VASCULAR EVALUATION OF POSTOPERATIVE STUMP NECROSIS. ABOUT TWO CASES AND LITERATURE REVIEW

Objective: Amputation levels are discussed based on hemodynamic approach. Transcutaneous oximetry (TcPO2) is a metabolic test of the local perfusion of peripheral tissues. we report two cases of discordance between hemodynamic and metabolic tests in the evaluation of the level of amputation on stump necrosis. Design and method: study of two cases of amputation level decision using ABI, arterial doppler ultrasound and TcPO2 Results: 1st case: patient A D 52 years old, type 2 diabetic for 11 years, admitted 12 days after amputation of the left forefoot following a complication of the infectious and neuropathic diabetic foot. The clinical examination found an infected necrosis of the amputation stump, the ABI is at 1.22. The arterial Doppler ultrasound objective an atheromatous overload and a good arterial flow. The TcPO2 is 69 mmHg next to the stump, contrasting with a TcPO2 of 27 mmHg on the right. The decision was a necrectomy associated with an antibiotic therapy adapted to the antibiogram. The evolution was favorable. 2nd case: patient S B 71 years old, hypertensive for 20 years, paraplegic for 20 years following a spinal trauma. Hospitalized for management of acute ischemia of the lower limbs on paroxysmal AF. Doppler ultrasound performed in the context of the emergency was in favor of the total occlusion of the regular poplar and leg arteries. Rejected from revascularization, evolution under anticoagulant was marked by the appearance of dry gangrene of both feet. The preoperative evaluation was in favor of a TcPO2 of 41 mmHg on the left and 75 mmHg on the right. An amputation of the two forefeet was performed. The postoperative evolution was characterized by a necrosis of the left stump requiring a complementary gesture with good consequences. Conclusions: The two cases clearly demonstrate the discrepancy between the classic evaluation (anatomical and hemodynamic) and the metabolic evaluation (TcPO2) The TcPO2 provides valuable assistance in deciding the level of amputation regardless of the diabetic, hypertensive, elderly patient profile….and regardless of the vascular profile; normal, PAD, post acute ischemia The TcPO2 is essential before each amputation procedure independently of the hemodynamic evaluation.

Enhancing Prosthetic Control through High-Fidelity Myoelectric Mapping with Molecular Anchoring Technology.

Myoelectric control utilizes electrical signals generated from the voluntary contraction of remaining muscles in an amputee's stump to operate a prosthesis. Precise and agile control requires low-level myoelectric signals (below 10% of maximum voluntary contraction, MVC) from weak muscle contractions such as phantom finger or wrist movements, but imbalanced calcium concentration in atrophic skin can distort the signals. This is due to poor ionic-electronic coupling between skin and electrode, which often causes excessive muscle contraction, fatigue and discomfort during delicate tasks. To overcome this challenge, a new strategy called molecular anchoring has been developed to drive hydrophobic molecular effectively interact with and embed into stratum corneum for high coupling regions between ionic fluxes and electronic currents. The use of hydrophobic poly(N-vinyl caprolactam) gel has resulted in an interface impedance of 20 kΩ, which is 1/100 of a commercial acrylic-based electrode, allowing the detection of ultralow myoelectric signals (∼1.5% MVC) that approach human limits. With this molecular anchoring technology, amputees operated a prosthesis with greater dexterity, as phantom finger and wrist movements w ere predicted with 97.6% accuracy. This strategy provides the potential for a comfortable human-machine interface when amputees accomplish day-to-day tasks through precise and dexterous myoelectric control. This article is protected by copyright. All rights reserved.

EXPERIENCE IN TREATMENT OF GUNSHOT WOUNDS OF LIMBS IN TRAUMATIC AMPUTATIONS DUE TO EXPLOSIVE TRAUMA

Abstract. Aim. To improve the results of surgical treatment in patients with traumatic limb amputations by developing diagnostic and treatment strategy for managing patients with soft tissue wounds of amputation stumps.&#x0D; Materials and methods. 283 wounded in-patients of Military Medical Clinical Center of the Central Region with gunshot traumatic limb amputations or their segments as a result of explosive injury were retrospectively studied during the period of February 24, 2022 to February 24, 2023.&#x0D; Results and discussion. Being admitted to the third level of medical service, surgical clinic, full-scale medical aid was provided to&#x0D; 283 wounded servicemen including surgical interventions with continuous intensive therapy. If necessary, the strategy of damage control surgery was continued and extended.&#x0D; Diagnostic and treatment strategy consisted of mandatory primary examination of amputation stump in the dressing room, X-ray examination of the limb, ultrasonography and Doppler ultrasound of the extremity (stump) vessels, and spiral computer tomography. 52 patients (18.37 %) underwent emergency operations. In 231 patients (81.63 %) treatment consisted of staged repeated (secondary if indicated) debridement of amputation stump and gunshot wounds of the limbs, and placement of VAC systems using negative pressure therapy. Repeated debridement was carried out every 3-5 days, performing necrectomy and using sanitation with antiseptic solutions. Polyurethane sponges were used to fill wound defect of the stump tissue, followed by 3-4 dermatotension sutures, and then VAC bandage was formed by conventional method.&#x0D; The following early complications occurred: bleeding — in 8 (2.83 %) patients, development of tension hematomas in 7 (2.47 %) and purulent inflammation in the form of suppuration, phlegmon and abscess in 43 (15.19 %) patients, requiring a greater number of repeated and secondary surgical debridements and placement of VAC systems. Late postoperative complications were: "defective stumps" in 17 (6.01 %) patients, ligature fistulas in 11 (3.89 %), formation of osteophytes in 3 (1.06 %), neurinoma — in 2 (0.71 %) and phantom pain syndrome in 11 (3.89 %) patients.&#x0D; Conclusions. To decrease the number of complications associated with purulent inflammation in amputation stump, primary surgical intervention should be carried out in the form of radical primary surgical debridement of gunshot wound, leaving long stump with no sutures. Following clear diagnostic and treatment strategy in managing patients with wound defects of soft tissues of amputation stumps in gunshot traumatic limb amputations leads to decreased number of postoperative complications.

Rare Case of C4 Perineurinoma with Lambdatic Parieto-occipital Neuroma in Von Recklinghausen Disease in a 5 Years Old Child: A Case Report

Neuro fibromatosis groups together distinct diseases that most often share only certain cutaneous signs. Neurofibromatosis (NF) is a neurocutaneous syndrome characterized by the development of tumors of the central or peripheral nervous system including the brain, spinal cord, organs, skin, and bones. Prineurinoma is a relatively rare tumour that has been shown to be a proliferation of perineural cells with an incomplete basal lamina and no onion bulb appearance. Neuroma also known as traumatic neuroma or amputation neuroma or stump neuroma, is a focal non-neoplastic area of proliferative hyperplastic reaction secondary to peripheral nerve damage that commonly occurs after a focal trauma (acute or chronic) or surgery, such as amputation or partial transection; We report an extremely rare clinical case of a 5 year old child with neurfibromatosis congenita type 1 with asyntomatic medullary comrepssion and incidental discovery of a left intraductal C4 perineurinoma during the exploration of an occipital-parietal neuroma associated with a dehiscence of the lambda suture. He was operated on, with the postoperative course marked by paresis of the cervical muscles, which was in the process of recovery by physiotherapy.

Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake.

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. Between February 6th, 2023 and February 20th, 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. 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. 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.