Case Of Amputation Research Articles

Surgical amputation of a limb 31,000 years ago in Borneo

The prevailing view regarding the evolution of medicine is that the emergence of settled agricultural societies around 10,000 years ago (the Neolithic Revolution) gave rise to a host of health problems that had previously been unknown among non-sedentary foraging populations, stimulating the first major innovations in prehistoric medical practices1,2. Such changes included the development of more advanced surgical procedures, with the oldest known indication of an ‘operation’ formerly thought to have consisted of the skeletal remains of a European Neolithic farmer (found in Buthiers-Boulancourt, France) whose left forearm had been surgically removed and then partially healed3. Dating to around 7,000 years ago, this accepted case of amputation would have required comprehensive knowledge of human anatomy and considerable technical skill, and has thus been viewed as the earliest evidence of a complex medical act3. Here, however, we report the discovery of skeletal remains of a young individual from Borneo who had the distal third of their left lower leg surgically amputated, probably as a child, at least 31,000 years ago. The individual survived the procedure and lived for another 6–9 years, before their remains were intentionally buried in Liang Tebo cave, which is located in East Kalimantan, Indonesian Borneo, in a limestone karst area that contains some of the world’s earliest dated rock art4. This unexpectedly early evidence of a successful limb amputation suggests that at least some modern human foraging groups in tropical Asia had developed sophisticated medical knowledge and skills long before the Neolithic farming transition.

The Efficacy of Autologous Platelet-Rich Gel and Traditional Chinese Medicine in Diabetic Foot Treatment: A Parallel Randomized Controlled Clinical Trial

Diabetic foot (DF) is a prevalent metabolic infection. DF wounds are the basis for all cases of nontraumatic lower limb amputations in diabetes. DF care approaches include debridement of wound, pressure relief in the wounded area, proper wound, infection, and ischemia management. However, there is a need for research to develop more effective therapeutic approaches. This study investigated the effectivity and safety of autologous platelet-rich gel combined with conventional treatment and traditional Chinese medicine (TCM) in DF ulcer therapy. Sixty DF ulcer patients were divided into treatment and control groups of 30 patients each. The treatment group involved a combination of autologous platelet-rich gel, conventional treatment, and TCM. The control group was only treated with a combination of conventional therapy and TCM. Laboratory variables, including platelets, hemoglobin (Hb), albumin, and HbA1c, were analyzed and compared between the treatment and the control groups at baseline and endpoint. Healing area, volume, and rates were compared in both groups. Basic patients' data and the wound conditions had no significant difference between the treatment and the control group. The treatment and control groups cure rates were 93.3% vs. 50%, respectively. The healing rate per 2weeks was significantly higher in the treatment than in the control group (0.78±0.05 vs. 0.43±0.04). There was no statistically significant difference in the platelets, Hb, albumin, and HbA1c levels in the treatment and control groups. Autologous platelet-rich gel combined with conventional treatment and TCM is effective and safe for DF ulcer treatment.

Establishment of a Survival Risk Prediction Model for Adolescent and Adult Osteosarcoma Patients.

To build a nomogram model for predicting the survival risk of teens and adults with osteosarcoma based on the TARGET database, patients with osteosarcoma were collected via the TARGET database, and the survival curves of the patients were plotted using the Kaplan-Meier method in SPSS 24.0. Least absolute shrinkage and selection operator (LASSO) univariate regression analysis was performed to identify risk factors that influence osteosarcoma survival. A model (nomogram) for predicting the survival risk of adolescent and adult patients with osteosarcoma was built or plotted using the rms26 package as implemented in R (ver. 3.5.3). The predictive accuracy and discriminating power of the nomogram were determined by the C-index and calibration curves. A total of 94 patients with osteosarcoma were included. Classification of cases based on the tumor site revealed 59 cases involving the femur (62.8%), 5 involving the fibula (5.3%), 6 humerus (6.4%), 2 radius (2.1%), 19 tibia (20.2%), and 3 ulna (3.2%). Classification of cases based on surgical method showed 81 cases involving limb sparing (86.2%), 9 cases of amputation (9.6%), and 4 without surgery (4.2%). Among the 94 cases, bone metastasis occurred in 3 cases (3.2%) and lung metastasis in 14 cases (14.9%). Among all survivors, the median rate of survival is 8.6 years (95% CI: 8.0210.92); the three-year and five-year survival rates are 64.6% and 52.6%, respectively. The LASSO regression analysis showed that metastasis site, definitive surgery, and histologic response were potential risk predictors. The C-index of the nomogram plotted was 0.729, and the C-index of the validated sample was 0.742. The nomogram used in this study allows physicians to objectively and accurately predict the prognosis and survival of osteosarcoma patients. In order to determine whether the method is applicable to other groups of patients, additional studies need to be conducted.

Extra-anatomic temporary intravascular shunting to assist with replantation of an amputated hand with prolonged ischemic time.

Although temporary intravascular shunting has been reported to assist with hand revascularization and replantation after traumatic amputation, most reports have described using ipsilateral upper limb inflow. We present a case of a traumatic hand amputation in a patient who had presented with 4 to 5 hours of warm ischemic time. Because the replantation team believed that extra-anatomic revascularization would be necessary, we performed a novel type of temporary intravascular shunting by connecting two arterial sheaths placed in the ulnar and superficial femoral arteries. This permitted the hand to be successfully replanted away from the inflow source and resulted in a good long-term functional outcome.

Wound Care and Management: A Review

This study aimed to identify the importance of wound care and management. The study also looked into the different effects that result from the improper provision of wound care. On the other hand, there was also the provision of initiatives that enhanced the healing process. The study was qualitative and embraced the use of primary and secondary research sources to obtain information on the importance of embracing wound care and management. From the findings, improper wound care was associated with increased patient stress levels. Similarly, there was also the provision of two forms of wound dressing that entailed the traditional and modern. The traditional methods are most preferred because of their cost-efficient nature. However, the modern ones are the most ideal because of enhancing healing. On the other hand, patients experience a high medication cost through improper wound care that significantly impacts them. The mentioned initiatives in enhancing the healing process encompassed dressing the wounds, use of antibiotics, and medicinal plants. Additionally, incorporating general practice practitioners and nurse practitioners also enhanced the healing process. This is because these individuals are usually empowered on the different measures to implement in taking care of patients; therefore, it is possible to reduce cases of amputations that have been so prevalent among diabetes patients. In conclusion, wound care and management have been termed critical approaches to enhancing the overall health of individuals. Through this approach, individuals can avoid the increased cost of care, stress, and amputation, among other cases.

Diagnostic Efficacy of CT Radiomic Features in Pulmonary Invasive Mucinous Adenocarcinoma.

In order to solve the problem of the effect of CT images on the diagnosis of lungs, the authors proposed a method for the diagnosis of invasive mucinous adenocarcinoma of the lungs based on CT radiomic features, and the modified method is found by reviewing past cases: among the 34 cases of primary pulmonary lymphoma, 12 cases were nodular mass type, 19 cases were nonnodular mass type, and 3 cases were mixed type; 13 cases involved bilateral lung lobes, 7 cases involved right lung, and 4 cases involved left lung example. There were 17 cases of tumor consolidation density shadow, 17 cases of mixed density shadow, the average CT value was about 32HU, 15 cases of cavitation sign, 6 cases of cavity, 9 cases of angiography sign, 30 cases of air bronchus sign, 22 cases of bronchiectasis, bronchial stenosis or amputation in 8 cases, pleural effusion in 12 cases, lymph node enlargement in 15 cases, and pleural metastasis in 2 cases. The final pathological results included 24 cases of membrane-associated lymphoid tissue (MALT) lymphoma, 9 cases of diffuse large B-cell lymphoma (DLBCL), and 1 case of T-cell lymphoma. The CT manifestations of primary pulmonary lymphoma (PPL) are diverse and do not have obvious specificity, the imaging manifestations are correlated with pathological types, and air bronchial signs, bronchiectasis, angiography signs, and other signs are used for the diagnosis of PPL. This is of great significance for the diagnosis of PPL.

Functional improvement by body-powered 3D-printed prosthesis in patients with finger amputation

Rationale:The most common upper limb amputations are finger amputations, resulting in functional limitations that lead to problems with activities of daily living or job loss. For many years, prosthetic options for finger amputations have been limited to passive prostheses. In many countries including South Korea, body-powered finger prostheses have rarely been prescribed due to high cost, lack of experience of physicians and prosthetists, low interest and no coverage by insurance benefits. We report 2 cases of work-related finger amputations in patients who received body-powered 3D-printed finger prostheses.Patient concerns and diagnosis:Patient 1 was a 25-year-old woman with second and third finger amputations at the proximal interphalangeal level. Patient 2 was a 26-year-old man who sustained a second finger amputation at proximal interphalangeal level.Interventions:We created body-powered 3D-printed finger prostheses that mimicked distal interphalangeal joint motion through patient-driven metacarpophalangeal joint motion using a string connected to a wrist strap and a linkage system. The source code “Knick Finger” was downloaded from e-NABLE.Outcomes:After 1 month of prosthesis training, both patients were satisfied with the prostheses and showed improved performance in patient-derived goals of cooking (patient 1) and typing on a computer (patient 2).Lessons:Over the past decade, significant advances have been made in 3D-printed prosthetics owing to their light weight, low cost, on-site fabrication, and easy customization. Although there are still several limitations in the general application of 3D-printed finger prostheses, our study suggests that for patients with finger amputations, body-powered 3D-printed finger prostheses have high potential as an additional prosthetic option to the existing passive cosmetic prostheses.

Self-biting behavior in patients with neonatal brachial plexus palsy.

Self-biting behavior in patients with neonatal brachial plexus palsy (NBPP) has been associated with finger amputation. Our objective is to describe the incidence of this complication, risk factors, and clinical management. We retrospectively analyzed 612 patients with NBPP. There were 303 males and 309 females. 51.8% of patients had C5-C6 lesions, 28.9% had C5-C7, 18.9% had C5-T1, and 0.3 had C7-T1 involvement. We identified 15 patients with self-biting behavior (2.5%). Ten patients had C5-T1 lesions, and five had C5-C7 lesions. Eight patents were submitted to brachial plexus surgery and seven were not. This behavior appeared between 8 and 46months of life (mean 23.5), and it was always temporary. There was no difference between operated and non-operated patients (p > 0.05), and no correlation between age at surgery and age of appearance of self-biting behavior (p > 0.05). Physical restriction was effective in treating this complication and we had no case of finger amputation. Self-biting behavior is a rare complication of NBPP, and it is usually associated with severe motor involvement. The behavior duration is limited to a few months. This condition can be effectively treated with physical restriction to prevent hand biting.

Reverse homodigital dorsal wraparound flap for reconstruction of distal thumb

Reconstruction of degloving injury or amputation of distal thumb with no indication of replantation has always been a challenging problem for hand surgeons. In this study, a reverse homodigital dorsal wraparound flap innervated by the dorsal digital nerve was devised to repair degloving injury or amputation of distal thumb in 20 consecutive cases. In nine cases of thumb amputation, we skeletonized the phalanxes of the amputated part as a free cortical bone with Kirschner wires. All flaps survived uneventfully. The radiographs showed bone healing in all the patients of thumb amputation within 6 weeks postoperatively. At final follow-up, the appearance of the reconstructed thumb was acceptable and flap sensation and range of joint motion were satisfactory. This flap is a simple and reliable alternative method for degloving injury or amputation of distal thumb when replantation is impossible and patients refuse to donate tissues from toes. Type of study/level of evidence Therapeutic IV.

Social Support and Its Association With the Quality of Life (QoL) of Amputees

Objectives: Social support is an essential source of psychological support that a disabled person needs in daily life. Social support and level of satisfaction affect how the patient perceives the various stresses of life. Because of few studies on amputees, it is necessary to study social support and its impact on their quality of life (QoL). This study investigates social support and its relationship to QoL among amputation cases living in Kut City, Iraq. Methods: This correlational study was conducted on 150 participants attending the Prosthetics Center in Kut. We investigated the relationship between social support and the QoL of amputees. The study questionnaire’s reliability was assessed through a pilot study, and it was subsequently presented to experts for validation. The information was collected through interview techniques and evaluated using descriptive and inferential statistical analysis. Results: The Mean age of the participants was 38 years. They were mostly married males and unemployed with low economic status. Findings show that 68% of the participants expressed poor social support. Their social status, residents, and income had been influenced the social support (Mean±SD: 34.18±14.978), and 62% expressed a poor QoL (Mean±SD: 85.37±21.008). There was a significant correlation between social support and QoL (P=0.000), and social support significantly affected the QoL for amputation cases (P=0.000). Discussion: There is a strong significant positive correlation between social support and QoL. The QoL among amputated cases was dependent on their social support. If family, friends, and community members provide embellished social support for amputees, they can face adversity and crises and lead their lives more effectively.

Body Image and Its Association With Self-esteem Among Amputation Cases at Prosthetics Center in Hilla City, Iraq

Objectives: Throughout history, people have lived through various situations of security, peace, recovery, and war, as well as the cruelty over the diversity, intensity, duration, or shortness of life. This study aimed to assess the self-esteem of amputees living in Hilla City, Babylon Province, in Center of Iraq. Methods: A descriptive correlational study was conducted to determine the association between body image and self-esteem of amputees. By a purposive sampling method, 200 subjects from both genders and different age groups (25-35, 36-46, 47-57, 58-68, and >69 years) were recruited. The study data were collected through the modified questionnaire of multidimensional body-self relations questionnaire, Rosenberg self-esteem scale, and interviews with the patients individually. The obtained data were collected and analyzed with descriptive and inferential statistics. Results: Most participants were male patients aged between 58 and 68 years. The lower limbs were the most amputation site caused by the war for less than five years. The majority of amputees had negative responses toward their body image. As well as depicts (39%) as a majority response of amputated patients were never feel with their self-esteem. There was a high reverse association between body image and self-esteem (P<0.01). Discussion: Our analysis reflects that amputees see themselves negatively, which leads to a lack of self-esteem. Also, a feeling of negative body image affects their self-esteem. Hospitals should provide specialists in mental health and psychological therapy to increase the chance for early intervention and psychological treatment in these cases. The hospitals must provide programs to guide amputees and reduce their psychological problems.

On some paleopathological examples of amputation and the implications for healthcare in 13th-17th century Lithuania

ObjectiveTo explore care that was likely provided to an adult male amputee from medieval Lithuania, positioning analysis within what is known of contemporary amputation practices. MaterialsThree sets of skeletal remains with evidence for amputation, dating to between the 13th-17th centuries AD and recovered during different archaeological excavations in Vilnius, Lithuania. MethodsMacroscopic inspection of lesions, with additional X-ray analysis of the main subject. The Index of Care was used to investigate possible caregiving. ResultsTwo individuals experienced amputation of a single element, and the third experienced bilateral hand amputation. Only one individual displayed healing. Historic sources suggest use of amputation for punitive purposes during this period, and judicial punishment is proposed as the most likely reason for amputation in at least two cases. ConclusionsEvidence of long-term healing in one individual suggests receipt of care. This individual likely relied on family and/or community members for survival immediately following amputation, and subsequently for support in managing disability. SignificanceSuccessfully combining osteology with history in a framework for analyzing care provision in past Eastern European society, this study underlines the critical importance of context in undertaking bioarchaeology of care analyses. It also adds two examples of perimortem abscissions in this region to the paleopathological record. LimitationsOur approach relied on skeletal interpretation. Soft tissue was lost to decomposition and no relevant archaeological evidence was found in association with the remains. Suggestions for further researchA review of skeletal collections may allow identification of overlooked cases of amputation (and care).

Self-penile amputation and castration: A rare and life-threatening form of genital self-mutilation

Self-castration and penile amputation are rare life-threatening types of genital self-mutilation. The microsurgical technique of penile replantation is the gold standard; however, there are conflicting reports of successful macrosurgical penile replantations. Being rare, this condition may even be mistaken as criminal genital mutilation. The surgical management of penile amputation evolves over a few case reports and case series; therefore, it is prudent to publish such rare phenomena to make more awareness among the clinicians to initiate prompt and effective treatment. We report a case of self-multiple penile amputations and castration in a 70-year-old man suffering from bipolar disorder who also had failed macrosurgical penile replantation. To the best of our knowledge, this is the first case of self-multiple penile amputation with castration reported in the literature. Although ours is a single case experience, yet the macrosurgical replantation in multiple penile amputations is likely to be unsuccessful.

A Rare Case of Quadruple Limb Amputation due to Factor V Leiden Mutation

Factor V Leiden, an autosomal dominant gene mutation that leads to increase risk of forming thrombophilia. Amputation in patients with Factor V leiden mutation is known but none describe quad-limb amputation in this setting. We present a case of a quad-limb amputee due to sepsis with factor V Leiden mutation and how he was rehabilitated.

FUNCTIONAL RESTORATION OF THE PARTIAL HAND AMPUTEE USING DIGITAL DISTRACTION LENGTHENING. A CASE SERIES STUDY.

FUNCTIONAL RESTORATION OF THE PARTIAL HAND AMPUTEE USING DIGITAL DISTRACTION LENGTHENING. A CASE SERIES STUDY.

Parallels of diabetic foot infections antibiotic resistance at inpatient and outpatient stages of treatment

Introduction. The risk of infectious complications in patients with diabetic foot syndrome (DFS) is 25.2 to 58%, the risk of hospitalization among the patients with complications of DFI is 56 times, and the risk of amputation is 155 times higher than non-diabetics. Detection of the etiologic agent has a crucial role in effective treatment, prevention of dissemination of the infection, and avoiding amputation.Aim of the study: to analyze the specific characteristics of the severe diabetic foot infection and antibiotic resistance of the pathogens during the inpatient and outpatient stages of treatment.Materials and methods. We included 62 type 2 diabetic inpatients (38 male and 24 female, group 1) with severe foot infection in to the study. 102 diabetic foot outpatients (56 male and 46 female, group 2) with postoperative wounds were included after discharged from the hospital. Cultures were obtained after surgery interventions immediately and on 14 days of hospitalization in group 1 of patients and in group 2 of patients with clinical signs of infection. Microbe species and resistant of pathogens to antibiotic were assessed.Results. There were prevalence of multidrug resistant Staphilococcus aureus (MRSA), Enterobacterales and Acinetobacter baumannii both outpatient and inpatient stages of diabetic foot infections treatment. The multidrug resistant pathogens were associated with ineffective empiric antibiotic therapy, delay of wound healing and amputations. The presence of multidrug resistant pathogens should be expected in cases of wound size more than 18 sm2, history of diabetic foot amputations, chronic osteomyelitis and time before wound professional care more than 14 weeks.Conclusion. The multidrug resistant pathogens were the main risk factor of amputations in diabetic foot inpatients with severe infections. At the outpatient stage of treatment multidrug resistant pathogens along with chronic osteomyelitis lead to delay of wound healing and new cases of foot amputations in diabetic patients.

Trend and Seasonality of Diabetic Foot Amputation in South Korea: A Population-Based Nationwide Study.

The number of lower extremity amputations in diabetic foot patients in Korea is increasing annually. In this nationwide population-based retrospective study, we investigated the data of 420,096 diabetes mellitus patients aged ≥18 years using the Korean Health Insurance Review and Assessment Service claim database. We aimed to study the seasonal and monthly trends in diabetic foot amputations in Korea. After applying the inclusion criteria, 8156 amputation cases were included. The analysis showed an increasing trend in monthly amputation cases. In terms of seasonality, the monthly frequency of amputation was commonly observed to be lower in February and September every year. Diabetic foot amputations frequently occurred in March, July, and November. There was no difference between the amputation frequency and mean temperature/humidity. This study is meaningful as it is the first nationwide study in Korea to analyze the seasonal and monthly trends in diabetic foot amputation in relation to climatic factors. In conclusion, we recognize an increased frequency of amputation in March, July, and November and recommend intensive educational program on foot care for all diabetes patients and their caregivers. This could improve wound management and amputation prevention guidelines for diabetic foot patients in the Far East with information on dealing with various seasonal changes.

Risk Factors for Amputation in the Surgical Treatment of Hemophilic Osteoarthropathy: A 20-Year Single-Center Report.

Purpose Hemophilic osteoarthropathy (HO) is a common cause of spontaneous bleeding in hemophiliacs. Surgical procedures are necessary for patients with severe HO. As a last resort, amputation is sometimes needed to treat complex HO cases. This study aimed to review the existing records of patients who underwent amputations in HO surgical treatment, summarize the risk factors, and provide relevant references for surgeons. Methods We retrospectively reviewed the records of hemophilic patients received surgeries at Peking Union Medical College Hospital between 2000 and 2020. The amputation patients without neoplasm or acute trauma were screened out. Patient information was extracted from medical records. A literature retrieval of hemophilic amputation cases was conducted via PubMed. The risk factors of amputation were summarized and analyzed via descriptive statistics and Fisher's precision probability test. Results Four male hemophilia A patients out of 201 patients underwent lower limb amputation. The reasons of amputation contained severe pseudotumor with factor inhibitor and large bone defects, recurrent pathological fracture with pseudotumor, skin ulcer with chronic osteomyelitis, and pseudotumor with systematic infection. In cases reported in retrieved literature, severe pseudotumor with complications, bacterial infection and factor inhibitor were common factors. Discussion. As the first study on amputations in HO patients, we found that severe hemophilic pseudotumor, chronic bacterial infection, and coagulation factor inhibitor was potential risk factors for amputation. Sufficient factor replacement therapy is fundamental in the prevention of amputation. The early diagnosis and specially designed surgical techniques could improve the rate of limb salvage.

Prolapse and amputation of phallus in a greater rhea (Rhea americana) kept in captivity: Case report

Rheas are the largest birds in South America. Belonging to the order of Struthioniformes, they are bred in captivity for their beauty and also for the quality and use of their meat, leather, feathers and eggs. The objective of this report was to describe a case of prolapse and amputation of the phallus after clinical and surgical care of a greater rhea (Rhea americana), to contribute to the literature on the occurrence of this condition in ratites. The animal was raised and is kept in captivity at Federal University of Piauí (UFPI), in Teresina, Piaui state, Brazil. The animal relapsed after two attempts to reduce the phallus prolapse, requiring amputation, since the animal’s organ presented areas of necrosis. After the intervention, the animal was returned to the previous enclosure, regrouping with the flock without complications and maintained a normal pre-surgery behavior. To the author’s knowledge, this is the first case of phallus and cloaca prolapse reported in Rhea americana.

Effectiveness and safety of dapagliflozin in real-life patients: data from the DAPA-RWE Spanish multicentre study.

BackgroundThis study aims to evaluate dapagliflozin in patients with type 2 diabetes (T2D) in clinical practice in Spain.MethodsThis is a retrospective study including adults with T2D under stable antidiabetic therapy, with either dapagliflozin or sitagliptin ≥6 months, before inclusion. Data about the effectiveness and safety of dapagliflozin are presented.ResultsA total of 594 patients (61.8±9.9 years, 21.7% cardiovascular disease) were included. After 6 months, HbA1c, weight, blood pressure, urine albumin-to-creatinine ratio and uric acid significantly decreased (1.63%, 2.88 kg, 4.82/2.70 mmHg, −17.38 mg/g and −0.30 mg/dL, respectively), whereas glomerular filtration rate and haematocrit significantly increased (3.72 mL/min/1.73 m2 and 1.8%, respectively). No cases of hypoglycaemia, diabetic ketoacidosis, Fournier gangrene, fractures or amputations were reported.ConclusionThus, dapagliflozin provides a comprehensive cardiometabolic protection in patients with T2D.