Amputation Stump Research Articles

Critical Wound Complication Following Major Amputation for Acute Limb Ischemia

Limb amputation has a severe somatic and psychological impact, that can furthermore have complications, which lead to increased morbidity, mortality, hospitalization days, health care costs, delay prosthetic application, and social reintegration. Proper therapeutic management must be initiated in cases with amputation stump complications to ensure the best result. This paper aims to present the therapeutic management of a patient with sepsis after above–the–knee amputation, performed after acute limb ischemia. The patient presented in our clinic 10 days postoperatively with local infection, wound dehiscence, and sepsis.

A predictive score for 30-day survival for patients undergoing major lower limb amputation for peripheral arterial obstructive disease

To analyze outcomes following major lower extremity amputations (mLEAs) for peripheral arterial obstructive disease, gangrene, infected non-healing wound and to create a risk prediction scoring system for 30-day mortality. In this single-center, retrospective, observational cohort study. All patients treated with above-the-knee amputation (AKA) or below-the-knee amputation (BKA) between January 1st, 2010 and June 30th, 2018 were identified. The primary outcome of interest was early (≤ 30 days) mortality. Secondary outcomes were postoperative complications and freedom from amputation stump revision/failure. We identified 310 (77.7%) mLEAs performed on 286 patients. There were 188 (65.7%) men and 98 (34.3%) women with a median age of 79 years (IQR, 69–83 years). We performed 257 (82.9%) AKA and 53 (17.1%) BKA. There were 49 (15.8%) early deaths, which did not differ among the age quartiles of this cohort (15.4% vs. 14.3% vs. 15.4% vs. 19.5%, P = 0.826). Binary logistic regression analysis identified age > 80 years (OR 2.24, 95% CI 1.17–4.31; P = 0.015), chronic obstructive pulmonary disease (OR 2.12, 95% CI 1.11–4.06; P = 0.023), and hemodialysis (OR 2.52, 95% CI 1.15–5.52; P = 0.021) to be associated with early mortality. The final score (range 0–10) identified two subgroups with different mortality at 30 days: lower-risk (score < 4, 10.8%), and higher-risk (score ≥ 4: 28.7%; OR 3.2, 95% CI 1.63–6.32; P < 0.001). In our experience, mLEAs still have a 14% mortality rate over the years. Our lower-risk group (score < 4) is characterized by a lower rate of perioperative death and longer survival.Graphic abstract

Improvement of prosthetics technology and inpatient rehabilitation of patients with amputation hip stumps

Timely and comprehensive assessment of indications and contraindications for prosthetics of patients with a faulty amputation stump has proven to increase the prosthetics efficiency based on adequate approaches to treatment by selecting the correct timing of prosthetics and taking into account the general condition of the patient. Timely elimination of existing defects in the amputation stump with the help of surgical and complex physiotherapeutic procedures, as well as early prosthetics, enables patients with amputation stumps to quickly adapt to the prosthesis. The proposed Prosthetics Efficiency Evaluation Program (PEEP), developed by the authors, allows assessing the degree of prosthetics efficiency and complex rehabilitation of a patient objectively and reliably.

544 Temporizing Matrix in the Complex Wound: A Retrospective Three-year Review

Abstract Introduction A complex wound is a wound that will not heal spontaneously or with simple or standard closure techniques. Often functional structures (bone, tendon, fascia, joint capsule etc.) are exposed and a matrix can be used for bridging of these structures. The Temporizing Matrix is an entirely synthetic matrix made from polyurethane open-cell foam. This matrix was used in the burn center for three years for the indication “complex wound” with good success. The study objective was to evaluate success rate (leading to wound closure after STSG, duration of treatment) and complications (infection, failure, scarring) on this patient cohort. IRB approval was obtained. Methods All charts of patients receiving the Matrix between June 2017 through May 2020 were reviewed. Data collected were demographics, surgery dates, wound descriptions, healing, infection, failure, reapplication, time from application to STSG, time to healing, post discharge complications and scar quality. Results 33 patients with 37 complex wounds were identified to meet inclusion criteria, 61% male, 39% female, age ranging from 3 months to 72 years. The wounds were caused by Burns, necrotizing infections, trauma or amputation post burn. The Matrix was placed for widely exposed structures (70%), failed STSG(3%), thin subcutaneous tissue coverage over amputation stumps (15%) and other reasons (12%). Primary graft success was 97%. Infection rate was 15% with 8% reapplication. Most infections were treated locally. The average Vancouver scar scale rating after discharge was 9/15. Conclusions This temporizing Matrix in preparation to STSG led to successful wound closure in 97% of these complex wounds with low complication rates and an acceptable long-term scar.

Free Tissue Transfer after Open Transmetatarsal Amputation in Diabetic Patients.

Transmetatarsal amputation (TMA) preserves functional gait while avoiding the need for prosthesis. However, when primary closure is not possible after amputation, higher level amputation is recommended. We hypothesize that reconstruction of the amputation stump using free tissue transfer when closure is not possible can achieve similar benefits as primarily closed TMAs. Twenty-eight TMAs with free flap reconstruction were retrospectively reviewed in 27 diabetic patients with a median age of 61.5 years from 2004 to 2018. The primary outcome was limb salvage rate, with additional evaluation of flap survival, ambulatory status, time until ambulation, and further amputation rate. In addition, subgroup analysis was performed based on the microanastomosis type. Flap survival was 93% (26 of 28 flaps) and limb salvage rate of 93% (25 of 27 limbs) was achieved. One patient underwent a second free flap reconstruction. In the two failed cases, higher level amputation was required. Thirteen flaps had partial loss or other complications which were salvaged with secondary intension or skin grafts. Median time until ambulation was 14 days following reconstruction (range: 9-20 days). Patients were followed-up for a median of 344 days (range: 142-594 days). Also, 88% of patients reported good ambulatory function, with a median ambulation score of 4 out of 5 at follow-up. There was no significant difference between the subgroups based on the microanastomosis type. TMA with free flap reconstruction is an effective method for diabetic limb salvage, yielding good functional outcomes and healing results.

N-Acetyl-Cysteine Treatment after Lower Extremity Amputation Improves Areas of Perfusion Defect and Wound Healing Outcomes

Patients with critical limb-threatening ischemia (CLTI) and diabetes are at increased risk of poor major amputation site healing. Preclinical studies have demonstrated that the antioxidant N-acetyl-cysteine (NAC) can augment tissue perfusion and angiogenesis in mice. We hypothesize that perioperative administration of NAC in patients with CLTI improves amputation stump perfusion and healing. In a randomized prospective, double-blinded, placebo-controlled, pilot clinical trial, patients with CTLI were recruited at the time of major lower extremity amputation. Patients were randomized to a 5-day perioperative course of intravenous NAC or placebo treatment. Amputation stump perfusion was evaluated on postoperative days (POD) 0, 3, and 5 using noninvasive Laser-Assisted Fluorescent Angiography (LAFA; SPY Elite system). Rate of arterial inflow and peak perfusion were determined using dynamic intensity versus time analysis. Perfusion defects were determined at the time of peak perfusion as a percentage stump surface area (Fig). Amputation stump healing was also evaluated on POD 3, 5, and 30 using modified Bates-Jensen score. Continuous variables were analyzed using the Student t-test. Categorical variables were analyzed using Fisher’s exact test. A total of 33 patients were enrolled in the study. One patient withdrew consent and eight were excluded for missing or incomplete files. Four patients (three NAC, one placebo) had no perfusion defects. In the remaining 20 patients (7 NAC, 13 placebo) with baseline perfusion defects, NAC-treated patients had a more favorable recovery slope compared to control. From POD 3 to 5, NAC-treated patients had a greater relative reduction in defect size (–53% decrease vs +71%; P < .05), whereas perfusion defects increased in the placebo group. Patients that received NAC also had superior healing outcomes at POD30 (100% healing for NAC vs 46% for placebo; P < .01; Table). No differences in the LAFA-derived rate of arterial inflow or time to peak perfusion were observed between the study groups. In patients with CLTI and amputation stump perfusion defects at baseline, perioperative NAC administration may improve short-term perfusion and long-term tissue healing. Intraoperative LAFA may help identify patients with decreased stump perfusion who can benefit from early therapeutic intervention.

Microvascular free flaps from the lower abdomen for preservation of amputation length in the lower extremity.

The length of the amputation stump is crucial for optimal prosthetic fitting and rehabilitation. Especially in traumatic amputation, direct closure of the stump may be challenging, and bone shortening is frequently needed. To avoid excessive bone shortening, coverage of exposed bone with free flaps is a versatile option. Here we present our experience with the utilization of free flaps from the lower abdomen for the coverage of amputations stumps of the lower extremity. Between March 2008 and October 2010, five patients (three female, two male) with complex wounds on amputation stumps of the lower extremity were treated with a mean age of 50 years (range: 15-72 years). Six abdominal free flaps were performed in five patients (one bilateral case), including four deep inferior epigastric artery (DIEP-) and two muscle-sparing transverse rectus abdominis muscle (ms-TRAM-) flaps. Patient's and operative data were collected retrospectively. One complete flap failure occurred (overall success rate: 83.3%). Three of five patients gained full ambulatory status. Due to the low donor site morbidity a long vascular pedicle and the large amount of available tissue, abdominal based free flaps represent our first choice for microsurgical reconstruction of lower extremity stumps.

Is Toe Brachial Index a Better Tool than Ankle Brachial Index for Predicting Outcomes in Diabetic Foot Patients?

Introduction: Diabetes accounts for more than 50% of lower extremity amputation, of which 85% of lower limb amputation in diabetic patients are preceded by foot ulcers. The increasing prevalence of ischaemic ulcers has made ischaemia probably the most important cause of Diabetic Foot Ulcers (DFUs) today. Modalities for assessment of vasculopathy include clinical examination of pulses, Ankle Brachial Pressure Index (ABI), Toe Brachial Pressure Index (TBI), Transcutaneous partial pressure of Oxygen (TCpO2), Duplex imaging, Magnetic Resonance (MR) and Computed Tomography Angiography (CTA). Aim: This study was aimed at evaluation of ABI and TBI in assessment of vasculopathy in DFUs and their association with the various surgical outcomes. Materials and Methods: This study was done as a cross-sectional study on 100 patients with diabetic foot, from December 2016 to April 2018, with prospective follow-up till the outcome of “ulcer healed”, “minor/major amputation” with healing of the amputation stump, was achieved. The multimodality approach for treatment of DFU was taken. Variables like age, gender, duration of present ulcer, previous history of ulcers and interventions, comorbidities, history of smoking and duration of diabetes were recorded and assessed. The examination included examination of peripheral pulses, presence of neuropathy, measurement of ABI and TBI. Investigations included HbA1c levels, swab or pus cultures from the ulcers, objective evaluation of Peripheral Arterial Disease (PAD) by Duplex Ultrasonography and CT Angiography where an intervention was contemplated. The data was entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age was 62.55±9.21 years, with maximum patients belonging to the age group 61-70 years (38%) followed by 51-60 years age group (33%). Smoking as a risk factor was present in 59% of all the patients. A total of 53 patients underwent amputation among which 28 were smokers (52.8%). Neuropathy was present in 47.22% (n=51), with 60.87% of all patients with neuropathy undergoing amputation which was significant (p-value=0.005). When defined by ABI alone (ABI &lt;0.9), 46.3% patients had PAD, however, using TBI &lt;0.7 for defining PAD, incidence of PAD increased to 68.31% patients. Thus identifying 21 more patients with PAD as compared to ABI. Poor glycaemic control was significantly associated with poor outcome in the form of amputation (p&lt;0.001). Patients who underwent major amputation had a mean ABI of 0.54±0.22, for minor amputation the mean ABI was 0.85±0.19 and for those who had healed ulcers, had a mean ABI of 0.61±0.27. The cut-off value for ABI to predict amputation was &gt;0.51 with a sensitivity of 77.14 and a specificity of 56.1, which was not found to be significant (p-value=0.0796). The mean TBI for the diabetic feet was 0.25±0.12 for major amputation, 0.42±0.26 for minor amputation and 0.61±0.19 for ulcer healed. With a cut-off value of ≤0.3, the sensitivity and specificity for predicting amputation were 68.75 and 88.68 respectively which was found to be significant (p&lt;0.001). Conclusion: The ABI has been found to under-report ischemia as compared to TBI in diabetic patients. TBI also correlates better with the outcome of a DFU. Thus, making TBI a part of assessment of vasculopathy in DFU patients who have not undergone toe amputations, would help in correctly identifying ischemia and early institution of possible intervention in such patients.

Single-Cell Resolution of&amp;nbsp;MET- and EMT-Like Programs in Osteoblasts During Zebrafish Fin Regeneration

While humans have limited potential for limb regeneration, some vertebrates can regenerate bony appendages following amputation. During zebrafish fin regeneration, mature osteoblasts at the amputation stump dedifferentiate and migrate to the blastema, where they re-enter the cell cycle and then re-differentiate to form new bone. Osteoblastic cells differentially exhibit mesenchymal and epithelial characteristics during fin regeneration, however little is known about how these transitions occur. Here, we performed single-cell RNA-sequencing (scRNA-seq) studies to elucidate osteoblastic transcriptional programs during zebrafish caudal fin regeneration. In contrast to existing scRNA-seq resources, our dataset captures a large number of osteoblastic cells, allowing for their in-depth analysis. We found osteoprogenitors are enriched with components associated with the epithelial-to-mesenchymal transition (EMT) and its reverse, mesenchymal-to-epithelial transition (MET). In trajectory analyses, osteoblastic cells solely expressed EMT components, or transiently expressed MET components prior to expressing those for EMT. We found that cdh11, a cancer EMT marker, is expressed during osteoblast dedifferentiation. We also found that esrp1, a regulator of alternative splicing in epithelial cells whose expression is important for MET, is expressed in a subset of osteoprogenitors during outgrowth. This study provides a valuable single cell resource for the study of osteoblastic cells during zebrafish fin regeneration, and identifies MET- and EMT-associated components which may be important for successful appendage regeneration.

EEG-based Brain Computer Interface Prosthetic Hand using Raspberry Pi 4

Accidents, wars, or different diseases can affect upper limbs in such a manner so their amputation is required, with dramatic effects on people’s ability to perform tasks such as grabbing, holding objects, or moving them. In this context, it is necessary to develop solutions to support upper limb amputees to perform daily routine activities. BCI (brain-computer interface) offer the ability to use the neural activity of the brain to communicate or control robots, artificial limbs, or machines without physical movement. This article proposing an electroencephalography (EEG) mind-controlled prosthetic arm. It eliminates the drawbacks like the high price, heaviness, and dependency on the intact nerves related to the myoelectric and other types of prostheses currently in use. The developed prototype is a low-cost 3D-printed prosthetic arm controllable via brain commands using EEG-based BCI technology. It includes a stepper motor controlled by Raspberry Pi 4 to perform actions like open/close movement and holding objects. The project has successfully implemented and achieve the aim to create a prototype of a mind-controlled prosthetic arm system in addition to the necessary experimental tests and calculations regarding torque, force, and the weight that the hand can carry. The paper proves the feasibility of the approach and opens the route for improving the design of the prototype to attach it to the upper-limb amputation stump.

The Role of Negative Pressure Wound Therapy with Instillation and Dwell Time in the Preparation of Wound Bed

Introduction Although the negative pressure wound therapy (NPWT) is a time tested method of wound preparation, the role of NPWT with instillation and dwell time (NPWTi-d) in decreasing the downtime of wound preparation needs to be evaluated. Objective The objective of this study is assess the role of NPWTi-d in wound bed preparation. Materials and Methods This study was conducted in a tertiary care center, after getting informed consent and ethical clearance. NPWTi-d was done on a 36-years-old female with no known co-morbidities admitted with infected raw area over the right below knee amputation stump and exposed bone who was not responding well to conventional wound dressing. NPWT was applied with the help of sterile polyurethane sponge and two tubes. The antimicrobial solution used was ionic silver solution, just enough to wet the sponge completely and up to the point when the transparent occlusive covering begins to lift. Negative pressure was applied at 125 mmHg. The wound was bathed with ionic silver solution and it was allowed to stay in the wound for 10-minutes, after every 2-hours of negative pressure application. This was continued for 1-week. The dressing was opened at the end of 1-week, wound irrigated with normal saline, exudate swabs for culture taken and debrided, following which fresh NPWTi-d was applied. This was repeated for the next 3-weeks. Result By the end of third week, the wound became clean, fully covered with healthy granulation and the wound bed was ready to undergo the definitive wound cover procedure.

The Superficial Inferior Epigastric Artery Based Abdominal Flap for Reconstruction of Extensive Defects of the Hand and Forearm: A Modified Design With Primary Closure of the Donor Site.

The reconstruction of the hand and forearm targets the restoration of their function and aesthetic appearance. Inferiorly based abdominal flaps are reliable and versatile flaps that can cover large defects of the forearm and hand. Here we present a modified abdominal flap design based exclusively on the superficial inferior epigastric artery (SIEA) to reconstruct the hand and forearm's extensive defects. The donor site is closed primarily. This is a retrospective study of the patients who underwent reconstruction of hand and forearm defects with SIEA flap from 2006 to 2018. The flap was designed on the ipsilateral hemiabdomen with a narrow pedicle based on the SIEA. We describe the anatomical basis and the outcomes of SIEA flap for reconstruction of the hand and forearm's extensive defects. Forty-eight soft tissue defects of the hand and forearm were reconstructed with the SIEA-based abdominal flap. Twenty-nine (60.41%) dorsal defects, 4 (8.33%) volar defects, 4 (8.33%) circumferential defects, 6 (12.5%) hand amputation stump, and 5 (10.41%) finger and thumb defects were covered using the SIEA flap. Forty-seven (97.91%) flaps had complete survival, whereas 1 (2.08%) flap had distal necrosis at the time of division. One (2.08%) flap had marginal necrosis, and 1 (2.08%) flap had distal necrosis after the division. The donor site was closed primarily in all patients. One (2.08%) patient had wound dehiscence at the abdominal donor site. All flaps gave excellent coverage with a satisfactory contour. Abdominal flap based on SIEA is a safe, reliable, and versatile flap for the reconstruction of extensive soft-tissue defects of the hand and forearm. An ability to provide a large amount of skin and soft tissue and the abdominal donor site's primary closure make it a favorable option for upper limb reconstruction in regions with limited resources and technical expertise.

Клінічний досвід лікування та реабілітації пацієнтів з гетеротопічною осифікацією ампутаційних кукс внаслідок мінно-вибухового поранення

SummaryPurpose – to study the peculiarities of the clinical course and treatment ofservicemen (anti-terroristic operation/Joint Forces operation participants) withheterotopic ossification (HO) of amputation stumps as a result of a mine-explosivewound by clinical case reports.Materials and methods. Retrospectively, for the period from 26.12.2016 to12.05.2020, an analysis of clinical cases (n=2) of HO of amputation stumps after mineexplosive wounds was carried out in military personnel who were treated in theDepartment of rehabilitation of patients with amputated limbs of the Military MedicalClinical Treatment and Rehabilitation Center.Results. In the first clinical case, there was a HO of the amputation stump at thelevel of the middle third of the hip. In the second case, the HO of the amputation stumpat the level of the middle third of the shin was observed. The diagnosis of HO wasconfirmed by X-ray and histology. Both patients had a history of traumatic amputationdue to a mine blast wound. The period from the moment of injury to the onset of clinicalsymptoms (pain syndrome and induration) ranged from 1 to 8 months. In both cases,successful surgical removal of HO was performed. In order to prevent the re-formationof HO, a course of non-steroid anti-inflammatiry drugs (NSAIDs) was carried out for 10days. Management of patients with HO in amputation stumps included a multiprofessional approach and development of an individual rehabilitation program.Conclusion. Considering the mine-explosive nature of contemporary combattrauma, the peculiarities of clinical manifestations (pain syndrome, soft tissuecompaction, limitation of the use of the culprit) as well as additional X-ray examinationmethods, are obligatory to exclude the diagnosis of amputation stump HO. Presentedclinical cases indicate that the formation of HO can vary from 1 to 8 months. The goldstandard of diagnostics is X-ray, and for early diagnosis – multispiral computedtomography and magnetic resonance imaging. Surgical removal of HO is the mainmethod of treatment followed by a postoperative course of NSAIDs in order to preventthe re-formation of HO.

Development of 3-dimensional Printed Distal Finger Prosthesis With Assembly-free Joint

PURPOSE: Finger and fingertip amputation is common, with tens of thousands of cases occurring yearly in the United States.1 Distal fingertip amputation occurs more frequently than complete finger amputation and often in young and productive populations.2 Apart from loss of sensation, the loss of one or more fingertips often results in drastic functional deficits. Current options for functional finger prostheses are often cost-prohibitive and generally require additional refinement after fabrication. The purpose of this study was to design an option for prosthesis made exclusively via 3-dimensional (3D) printing. In doing so, we hoped to restore an adequate level of function to patients while keeping costs low and requiring minimal postproduction refinement and maintenance. METHODS: Our prototype was made for a patient with amputation at the distal interphalangeal joint (DIJ) of the left ring finger. The patient’s intact ring finger was measured in order to produce a digital model using computer-aided design (CAD) software. Measurements utilized included metacarpophalangeal (MCP) joint to distal tip, and the widths of proximal, middle, and distal phalanx segments. The length of the amputated digit was also measured from MCP joint to amputation stump. This CAD design was finally submitted to an online 3D printing service (Shapeways) to allow for replicas to be ordered by the patient directly while maintaining low production cost. RESULTS: Our final model utilized a single, flexible joint consisting of 2 pins molded directly into the medial and lateral aspects of the prosthesis immediately after 3D printing. High grade nylon material was used during the fabrication process to confer low cost while maintaining comfort and durability. Quality range of motion and improved anatomical grasping of objects was achieved, creating significant return of function. CONCLUSIONS: Our device accomplishes the goal of creating a functional prosthetic fingertip using exclusively 3D printing. In addition, while other 3D printing prosthetics have required significant postproduction customization and maintenance, this device’s intrinsic joint system makes it essentially maintenance free and can be used immediately following printing. The use of high-grade nylon confers stability and durability at a fraction of the cost of previously used materials. Utilizing a third-party 3D-printing company and freely available CAD plans, a patient will be able to upload their measurements and a device can be created and shipped to them for around $20 USD. We see particular utility of our device in pediatric populations as the customizable design and economical production allow for several devices to be used throughout a child’s development. REFERENCES: 1. Reavey PL, Stranix JT, Muresan H, et al. Disappearing digits: analysis of national trends in amputation and replantation in the United States. Plast Reconstr Surg. 2018;141:857e–867e. 2. Østlie K, Skjeldal OH, Garfelt B, et al. Adult acquired major upper limb amputation in Norway: prevalence, demographic features and amputation specific features. A population-based survey. Disabil Rehabil. 2011;33:1636–1649.

Interdigital neuroma in a patient with macrodactyly of the hallux

A patient with macrodactyly of the hallux, returned 2 years after amputation of the distal phalanx, complaining of pain and swelling in the plantar foot. The Tinel, Moulder, and Gauthier signs were all present. Diagnostic hypotheses were: neuroma of the amputation stump, compressive neuroma, neurofibroma, or schwannoma. Histopathological diagnosis demonstrated that the tumor was a neuroma. This is a rare and unique case associated with macrodactyly, in which nerves tend to be hypertrophic. The location in the first intermetatarsal space is uncommon. The treatment proposed was resection of the entire involved nerve; symptoms improved and there was no relapse. Level of Evidence V, Therapeutic Studies; Expert Opinion.

Role of topical insulin therapy in amputation stump

Wound healing is a complex process with overlapping steps of haemostasis, the inflammatory and proliferative phases, remodelling .Any problem with the edge of the wound can be detrimental to healing and may cause delay in wound healing. In this article, we share our experience of using topical insulin therapy for wound bed preparation in non-healing ulcer over the amputation stump.

Disturbing medical findings in war-related traumatic amputation patients: a clinical descriptive study from Gaza

ObjectivesThe aim of this study was to explore possible long-term negative health effects of injuries sustained by modern weaponry.SettingThe study was conducted in Gaza’s main hospital, Al-Shifa Hospital.ParticipantsDuring the last...

Wound infection with Vibrio harveyi following a traumatic leg amputation after a motorboat propeller injury in Mallorca, Spain: a case report and review of literature

BackgroundVibrio spp. are aquatic bacteria that are ubiquitous in warm estuarine and marine environments, of which 12 species are currently known to cause infections in humans. So far, only five human infections with V. harveyi have been reported.Case presentationA 26-year old patient was transferred to our center by inter-hospital air transfer from Mallorca, Spain. Seven days before, he had suffered a complete amputation injury of his left lower leg combined with an open, multi-fragment, distal femur fracture after he had been struck by the propeller of a passing motorboat while snorkeling in the Mediterranean Sea. On admission he was febrile; laboratory studies showed markedly elevated inflammatory parameters and antibiotic treatment with ampicillin/sulbactam was initiated. Physical examination showed a tender and erythematous amputation stump, so surgical revision was performed and confirmed a putrid infection with necrosis of the subcutaneous tissue and the muscles. Tissue cultures subsequently grew V. harveyi with a minimal inhibitory concentration (MIC) of 16 mg/L for ampicillin, and antibiotic treatment was switched to ceftriaxone and ciprofloxacin. Throughout the following days, the patient repeatedly had to undergo surgical debridement but eventually the infection could be controlled, and he was discharged.ConclusionsWe report the first human infection with V. harveyi acquired in Spain and the second infection acquired in the Mediterranean Sea. This case suggests that physicians and microbiologists should be aware of the possibility of wound infections caused by Vibrio spp. acquired in the ocean environment, especially during hot summer months. Since Vibrio spp. preferentially grow at water temperatures above 18 °C, global warming is responsible for an abundance of these bacteria in coastal waters. This will likely lead to a worldwide increase in reports of Vibrio-associated diseases in the future.

Study of a flexible ankle prosthetic through the stump skin temperature

The purpose of this study was to determine the effect on the ankle flexible prosthetic foot to the convenience of walking based on the parameters of temperature change on the surface of the skin stump on a transtibial amputee. This study using a crossover design, in which the amputee wears below knee prosthetic foot two different periods. The results of the skin surface temperature measurement when the amputee stump before running between the exoskeletal prosthetic foot without ankle and endoskeletal with flexible ankle show that p less than 0.05, which means there is no significant difference prior to the tests. Measurement of skin temperature when stump amputation after walking shows that p is more than 0.05, which means there is no significant difference after testing. Furthermore, the test walking on amputees before and after walking shows p less than 0.05, which means there are significant differences significantly to the decline in temperature on the surface of the skin stump. Concluded the use of flexible ankle on endoskeletal prosthetic foot lowers the temperature of the skin surface after walking as far as 80 meters at 0.97 percent. The decrease in skin temperature stump showed comfort in wear below knee prosthetic foot.

Residual rotation of forearm amputation: cadaveric study

BackgroundThe purpose of this study was to investigate residual rotation of patients with forearm amputation and the contribution of involved muscle to residual rotation.MethodsTesting was performed using five fresh-frozen cadaveric specimens prepared by isolating muscles involved in forearm rotation. Amputation was implemented at 25 cm (wrist disarticulation), 18 cm, or 10 cm from the tip of olecranon. Supination and pronation in the amputation stump were simulated with traction of involved muscle (supinator, biceps brachii, pronator teres, pronator quadratus) using an electric actuator. The degree of rotation was examined at 30°, 60°, 90°, and 120° in flexion of elbow.ResultsAverage rotation of 25 cm forearm stump was 148° (SD: 23.1). The rotation was decreased to 117.5° (SD: 26.6) at 18 cm forearm stump. It was further decreased to 63° (SD 31.5) at 10 cm forearm stump. Tendency of disorganized rotation was observed in close proximity of the amputation site to the elbow. Full residual pronation was achieved with traction of each pronator teres and pronator quadratus. Although traction of supinator could implement residual supination, the contribution of biceps brachii ranged from 4 to 88% according to the degree of flexion.ConclusionsClose proximity of the amputation site to the elbow decreased the residual rotation significantly compared to residual rotation of wrist disarticulation. The preservation of pronosupination was 80% at 18 cm forearm stump. Although the pronator teres and the pronator quadratus could make a full residual pronation separately, the supinator was essential to a residual supination.