Different Levels Of Amputation Research Articles

Match Running Performance Profile and Heart Rate Response in Amputee Soccer Players.

The purpose of this study was (a) to create a profile of the running performances of male amputee soccer players in different speed zones, (b) to investigate the relationship between heart rate (HR) and running distance in two soccer matches, and (c) to study the effect of the level of amputation on the running distance covered during a match. The participants were male amputee soccer players (n = 10, Greek, n = 5; Belgian, n = 5) who played two international, friendly matches. Distances were measured using a global positioning system, and HRs were recorded using a Polar Team Pro. No differences in the distances covered were observed between participants with different levels of amputation (p > 0.05). Nevertheless, there was a trend that participants with a below-the-knee amputation tended to cover longer distances in total (difference +262.3 m, Cohen's d = 0.40) and in zones 2 (+324.4 m, d = 0.79), 3 (+ 7.1 m, d = 0.65), 4 (+22.7 m, d = 0.43), and 5 (+0.4 m, d = 0.20) and less distance in zone 1 (-207.2 m, d = 0.88). They also tended to perform more accelerations (+3.9, d = 0.89) and decelerations (+4.2, d = 0.87) and had a higher mean HR (+8.4%, d = 2.04) than those with an above-the-knee amputation. Moreover, the mean HR corresponded to 83.3% of the HRmax and did not correlate with distance in any speed zone. It was concluded that the level of amputation might influence running performance and acute physiological response during a soccer match.

Animal experimental study on the effects of different levels of amputation on cardiovascular system

Vascular injury resulting from lower limb amputation leads to the redistribution of blood flow and changes in vascular terminal resistance, which can affect the cardiovascular system. However, there was no clear understanding of how different amputation levels affect the cardiovascular system in animal experiments. Therefore, this study established two animal models of above-knee amputation (AKA) and below-knee amputation (BKA) to explore the effects of different amputation levels on the cardiovascular system through blood and histopathological examinations. The results showed that amputation caused pathological changes in the cardiovascular system of animals, including endothelial injury, inflammation, and angiosclerosis. The degree of cardiovascular injury was higher in the AKA group than in the BKA group. This study sheds light on the internal mechanisms of amputation's impact on the cardiovascular system. Based on the amputation level of patients, the findings recommend more comprehensive and targeted monitoring after surgery and necessary interventions to prevent cardiovascular diseases.

THE INFLUENCE OF DOSED PHYSICAL EXERCISE ON INDICATORS OF THE CARDIOVASCULAR SYSTEM OF PERSONS WHO HAVE LOST LIMBS

The study of the reaction of the cardiovascular system of persons with amputation of the lower limbs at different levels at the initial stage of the application of physical rehabilitation and dosed veloergometric load with the execution of pedal rotation with the upper limbs. Material. In the course of the study, theoretical analysis and generalization of data from the scientific and methodological literature on issues related to the use of physical therapy in people after amputation of the lower limbs, variation pulsometry, determination of maximum oxygen absorption, measurement of blood pressure, dosed veloergometric load with the execution of pedal rotation of the upper limbs were used. Results. The analysis of modern scientific and methodological literature made it possible to consider the actual problem of scientifically based selection of rehabilitation measures to determine the amount of physical exertion for persons at the initial stage (post-hospital period) of the use of physical therapy means, depending on the level of amputation of the lower limbs and the reaction of the cardiovascular system to the performance of dosed cycle ergometric exercise load and control of their influence on hemodynamic indicators. The level of physical working capacity, the reaction of the cardiovascular system and the level of physical working capacity of persons with amputation of the lower limbs at different levels by means of dosed veloergometric load with the use of the upper limbs at the initial stage (post-hospital period) were studied, which are decisive in the individual appointment of the movement regime, the formation of the volume and intensity of physical exertion, selection of appropriate forms, methods and means of physical therapy. Conclusions. The applied adequate research methods made it possible to reveal the dependence of the reaction of the indicators of heart rate, blood pressure and maximum oxygen absorption on the amount of dosed veloergometric load depending on the localization, volume and level of amputation of the lower limbs, which will allow the application of a motor mode adequate to the functional state, the intensity of physical exercises, forms, methods and means of physical therapy for persons with different levels of amputation of the lower limbs.

Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

BackgroundMicrosurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe, and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor esthetics. Great toe transplantation achieves better esthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and esthetic satisfaction in thumb reconstruction.MethodsWe experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalanx transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ).ResultsOne patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and esthetic results of both the donor and the recipient sites were satisfactory. Results show that, for patients with traumatic thumb defects, the combined transfer of flap and second toe phalanx was the best option.ConclusionsCompared to the great toe or second toe transfer, combined free transfer of the great toenail flap and second toe phalanx achieved a substantially better functional and esthetic result in the thumb reconstruction.

Clinic Use at the Departments of Defense and Veterans Affairs Following Combat Related Amputations.

Little population-based research has described the transition from Department of Defense (DoD) to Department of Veterans Affairs (VA) healthcare following combat related amputations. The objectives were to describe (1) to what extent patients used either DoD only facilities, both DoD and VA facilities, or VA only facilities during the first 5 years postinjury, (2) which specific clinics were used and (3) clinic use among patients with different levels of amputation (upper versus lower), and among patients with early or late amputation. This was a retrospective analysis of health data extracted from the expeditionary medical encounter database (EMED) and national DoD and VA databases. Patients were 649 US service members who sustained a single major limb amputation following injuries in the Iraq and Afghanistan conflicts, 2001-2008. We compared yearly DoD and VA clinic use by patient groups with different levels of amputation (upper limb: above versus below elbow or lower limb: above versus below knee), different timing of amputation (early: within 90 days postinjury versus late: more than 90 days postinjury), military component (Active Duty versus National Guard/Reserve) and race (White versus Black). For all groups, we calculated the percentage of patients using: (1) DoD only, (2) both DoD and VA or 3) VA only clinics during each of postinjury years 1 through 5. We also calculated the percentage of patients who used specific clinics (e.g., social work, prosthetics, mental health) during each postinjury year. During postinjury year 1, over 98% of patients used DoD only or both DoD and VA clinics. Most individuals (70% to 78%) used both DoD and VA clinics during postinjury year 1. Use of VA only clinics increased gradually between postinjury year 2 (15% to 30% of patient groups) and year 5 (75% to 88%). This gradual transition to use of VA only clinics was seen consistently across patient groups with different anatomical levels or timing of amputation, military component or race. Patients with lower levels of amputation (versus higher levels) and individuals with early amputations (versus late) transitioned earlier to VA only care. Overall, clinic use was high as 91% to 100% of all patient groups used one or more clinics (DoD or VA) during each of the first 5 years. For specific clinics, most patients used DoD facilities related to rehabilitation (physical therapy, prosthetics) or transitional care (social work) particularly during postinjury year 1. Use of most VA clinics studied (social work, primary care, prosthetics, mental health) showed a modest increase primarily after postinjury year 1 and remained stable through postinjury year 5. The results indicated apparent underuse of psychiatric/mental health and prosthetics between postinjury year 1 and 2. The present study indicated a gradual transition from DoD to VA only healthcare which extended across 5 years following combat related amputations. Patients with lower levels of amputation or early amputation generally transitioned earlier to VA only healthcare. These results can inform medical planning to support a timely and clinically effective transition from DoD to VA healthcare.

Comparison of Burden of Caregiving among Different Levels of Amputation in Selected Hospitals in South- West Nigeria

Comparison of Burden of Caregiving among Different Levels of Amputation in Selected Hospitals in South- West Nigeria

Exoprosthetic Replacement of the Upper Extremity

During the last years, the prosthetic replacement in upper limb amputees has undergone different developments. The use of new nerve surgical concepts improved the control strategies tremendously, especially for high-level amputees. Technological innovation in the field of pattern recognition enables the control of multifunctional myoelectric hand prostheses in a natural and intuitive manner. However, the different levels of amputation pose different challenges for the therapeutic team which concern not only the prosthetic attachment; also the expected functional outcome of prosthetic limb replacement differs greatly between the individual levels of amputation. Therefore, especially in partial hand amputations the indication for prosthetic fitting has to be evaluated critically, as these patients may benefit more from biologic reconstructive concepts. The value of the upper extremity, in particular of the hand, is undisputable and, as such represents the driving force for the technological and surgical developments within the exoprosthetic replacement. This article discusses the possibilities and limitations of exoprosthetic limb replacement on the different amputation levels and explores new developments.

Effect of amputation level on the stress transferred to the femur by an artificial limb directly attached to the bone

Attachment of an artificial limb directly to the skeleton has a number of potential benefits and the technique has been implemented for several amputation sites. In this paper the transfer of stress from an external, transfemoral prosthesis to the femur during normal walking activity is investigated. The stress distribution in the femur and at the implant–bone interface is calculated using finite element analysis for the 3D geometry and inhomogeneous, anisotropic material properties obtained from a CT scan of a healthy femur. Attachment of the prosthetic leg at three different levels of amputation is considered. Stress concentrations are found at the distal end of the bone and adjacent to the implant tip and stress shielding is observed adjacent to the implant. It is found that the stress distribution in the femur distal to the epiphysis, where the femur geometry is close to cylindrical, can be predicted from a cylindrical finite element model, using the correct choice of bone diameter as measured from a radiograph. Proximal to the lesser trochanter the stress decreases as the femur geometry diverges significantly from a cylinder. The stress concentration at the distal, resected end of the bone is removed when a collared implant is employed. These findings form the basis for appropriate settings of an external fail-safe device to protect the bone from excessive stress in the event of an undue load.

Unilateral lower limb loss following combat injury

This is a case series of prospectively gathered data characterising the injuries, surgical treatment and outcomes of consecutive British service personnel who underwent a unilateral lower limb amputation following combat injury. Patients with primary, unilateral loss of the lower limb sustained between March 2004 and March 2010 were identified from the United Kingdom Military Trauma Registry. Patients were asked to complete a Short-Form (SF)-36 questionnaire. A total of 48 patients were identified: 21 had a trans-tibial amputation, nine had a knee disarticulation and 18 had an amputation at the trans-femoral level. The median New Injury Severity Score was 24 (mean 27.4 (9 to 75)) and the median number of procedures per residual limb was 4 (mean 5 (2 to 11)). Minimum two-year SF-36 scores were completed by 39 patients (81%) at a mean follow-up of 40 months (25 to 75). The physical component of the SF-36 varied significantly between different levels of amputation (p = 0.01). Mental component scores did not vary between amputation levels (p = 0.114). Pain (p = 0.332), use of prosthesis (p = 0.503), rate of re-admission (p = 0.228) and mobility (p = 0.087) did not vary between amputation levels. These findings illustrate the significant impact of these injuries and the considerable surgical burden associated with their treatment. Quality of life is improved with a longer residual limb, and these results support surgical attempts to maximise residual limb length.

Is hip muscle strength the key to walking as a bilateral amputee, whatever the level of the amputations?

Little data have been reported on the factors that are important in bilateral amputee walking ability especially the role of hip strength. Observational, case-control study where participants were evaluated at a single point in time. The aim of this study was to investigate the factors involved in bilateral amputee walking ability by assessment of walking speed, perceived exertion, exercise intensity, physiological cost index (PCI) and hip muscle strength. For a group of 10 bilateral amputees, with different levels of amputation, and a non-pathological reference group, walking ability was assessed using the two-minute walk test. Hip muscle strength was assessed using isokinetic strength tests. Bilateral amputees were found to have slower walking speeds and increased PCI of walking which were correlated to higher levels of amputation. Peak hip torques were reduced in the amputees, which was only significant for concentric extension torque (p = 0.029), and approaching significance for concentric flexion (p = 0.061) and abduction (p = 0.057). Bilateral amputee peak hip strength suggested a positive trend with increasing walking ability. Bilateral amputee walking ability was reduced and mainly related to level of amputation. The role of hip strength in bilateral amputee walking ability requires further investigation.

(P1-71) Can a Thick Snow Layer be Protective in Mine Injuries: Case Report

Despite their low mortality rate, mine injuries have high rate of morbidity. Depending on the severity, different levels of amputation may be required for the affected extremities. A mine injury composed of an atypical condition because of thick layer of snow is described in this presentation. A 21-year-old man was taken to the emergency department because of a mine injury. He had severe pain on his right heel. He was injured in an explosion in a rural state that had 50–60 cm of snow on the ground. Vascular access was provided and cast immobilization was applied to the right foot. The patient then was carried by ambulance helicopter. Vital signs were normal. Right ankle movements were limited and painful, and there were minimal edema and hematoma on both sides of the patient's heel in physical examination. Neither motor sensorial nor vascular deficit was determined. Comminuted calcaneus fractures were observed in x-ray and in the computerized tomography. A short leg circular cast was applied during follow-up. The cast was taken off at the end of the second month, and rehabilitation began. The follow-up was complete at the end of the sixth month with complete recovery. Mine injuries are special military injuries the sometimes affect civilians. In these injuries, lower extremities often are affected and amputation may be required. This case is similar to high-falling calcaneus fractures. This may have occurred as a result of an upwards blast impact that may have been weakened because of the thickness the layer of snow. Thick layers of snow may help protect civilians from mine injuries. This potential protective affect may be useful for researchers aiming to decrease mine injuries.

Children with limb deficiencies

The aim of this study is to determine the demographic data for amputations in children in relation of age, sex, level and cause of amputation. Data were collected from the records of amputees who attended the prosthetic clinic at the Royal Rehabilitation Center, King Hussein Medical Centre, Jordan, between 1 January 1995 and 31 December 2005. Demographic data (age, sex, level and cause of amputation) were analyzed. Some 120 children with different levels of amputation were included with mean age of 6.2 years. There were 64 (53.3%) males and 56 (46.7%) females. Male to female ratio was 1.15:1. The dominant level of amputation was trans-radial in 10 patients (15.62%) in the upper limb and trans-tibial in 18 patients (28.12%) in the lower limb. The dominant cause of amputation was congenital deficiency in 56 patients (46.67%) followed by trauma in 48 (40%). The results of this study presented greater similarities to others in the literature, congenital limb deficiency being the dominant cause of amputation in children. This study helps in planning the needs for materials and budgets for the treatment of amputee children in Jordan.

Summary and Conclusions From the Academy's Eighth State-of-the-Science Conference, on the Biomechanics of Ambulation After Partial Foot Amputation

Summary and Conclusions From the Academy's Eighth State-of-the-Science Conference, on the Biomechanics of Ambulation After Partial Foot Amputation

The Early Microvascular Results and the Statistic Tool for Predicting the Finger Survival Rate Of Finger Replantations and Revascularizations at Chang Gung Memorial Hospital

Three hundred and twenty-eight finger replantations and revas-cularizations in 247 patients were performed between January 1998 and March 2002 at the Trauma Center of the Department of Plastic & ReconstruCtive Surge, Chang Gung Memorial Hospital, Linkou Medical Center. Early microvascular results and certain potential factors were analysed retrospeCtively. The survival rates of fingers were compared among the different age groups, the different degrees of injury, the different mechanical types of injury, the different levels of amputation, and the different ischemia time. Ten risk factors for survival were analysed by multiple logistic regression analysis in this study: patient's age, smoking or not, degree of amputation, mechanical type of injury, amputated level, number of venous anastomosis, number of arterial anastomosis, using vessel graft for artery or not, using vein graft for vein or not, and ischemia time. The overall success rate is 75.6% (248/328). The statistic results by multiple logistic regression analysis reveal the incomplete amputation that doesn't need venous microanastomosis (type B) is the most important good factor for finger survival, and the diffuse crush amputation is the worst factor for finger survival. Furthermore, by using the multiPle logistic regression analysis based on the database of this series, we can prediCt the finger survival rate when a new finger-amputated patient coming.

Foot loading characteristics of amputees and normal subjects.

The foot loading characteristics of 100 consecutively attending amputees wearing their definitive prostheses were studied during their routine visits to the Artificial Limb and Appliance Centre. Results were compared with observations on 100 age and sex matched controls who were free from any locomotor disability. The parameters measured were the percentage of body weight borne on each foot, the positions of the centres of pressure under each foot and the position of the overall centre of foot pressure. The results demonstrate the range of variability of these parameters in normal subjects of different ages and provide preliminary indications of the patterns associated with different types of prostheses and different levels of amputation. The information was collected using the Double Video Forceplate (DVF) a tool developed for the rapid assessment of stance, at University College London Bioengineering Centre. It is proposed that the DVF may be useful in assisting prosthetic alignment, in clinical teaching of prosthetists, physiotherapists and doctors and in monitoring of patients with lower limb amputation.

A quantitative study of blastemal growth and bone regression during limb regeneration in Triturus cristatus

ABSTRACT Soft X-ray photographs show both the outlines of the soft parts of the regenerating limb and the bones. This enables one to make quantitative studies on bone regression and the growth of the regenerate, since good reference points are available. Bone regression of about 0·5 mm was observed to occur within about 20 days following amputation. Growth curves of regenerates cut at different levels confirm Spallanzani’s old observation that the total time for regeneration is fairly constant for different levels of amputation -regenerates from proximal levels regenerate faster. However, the intrinsic growth rate curves are remarkably similar for different levels of amputation; the difference in final length arises because the short period of high intrinsic growth rate continues for slightly longer in regenerates from proximal levels. In terms of the progress zone theory of limb development, three phases of regeneration are recognized: the formation of the blastema and progress zone; the laying down of the skeletal rudiments by the rapidly proliferating progress zone; and the subsequent slower growth of the rudiments. A quantitative model is put forward and it is shown that it can provide a good description of the observed growth curves. An important assumption is that the various skeletal rudiments are the same size when they leave the progress zone and the final differences in size reflect differences in the final growth phase. The progress zone model provides new quantitative insights into the relationship between the growth of the limb as a whole and the behaviour of individual cells.

Forelimb regeneration from different levels of amputation in the newt,Notophthalmus viridescens: Length, rate, and stages.

1. Some aspects of the influence of position on regeneration have been examined by comparing regeneration from two different levels along the newt forelimb. 2. We have defined a series of stages of forelimb regeneration in the newt,Notophthalmus viridescens, in order to facilitate this study. 3. Limbs amputated at either a proximal level (through the humerus) or a distal level (through the radius and ulna) pass through the same stages at the same times after amputation. 4. The histological sequence of events of digit regeneration was compared with that of limb regeneration from a proximal level of amputation and was found to be the same. 5. In limbs amputated at either proximal or distal levels, the rate of elongation of regenerates is the same during the phases of dedifferentiation, blastema accumulation, and blastema growth. 6. During the phase of differentiation and morphogenesis, the rate of elongation of regenerates from the proximal level is significantly greater than that of regenerates from the distal level. 7. The total length of regenerates from proximal and distal levels along the limb is significantly different. 8. The results indicate that positional information does not influence the developmental sequence of events of limb regeneration, but that it does influence the rate of growth of the regenerate and the specification of the structures to be replaced.

Néoblastes et limitation du pouvoir de regeneration céphalique chez la planaire Dendrocoelum lacteum

ABSTRACT The regeneration of the planarian Dendrocoelum lacteum has been tested at three different levels of amputation : just behind the eyes, half-way between the eyes and the pharynx, and just in front of the pharyngeal base. The plana-rians always regenerate in the first case, never in the last case, and about 7 times out of 10 in the intermediate case. Experiments involving amputations and irradiations show that there are regeneration cells (neoblasts) in the regions behind the pharyngeal base, regions which are unable to regenerate. When they are not irradiated, these neoblasts are able to move towards the head and to restore the irradiated regions. They reconstitute a blastema with eyes, the number of cases directly depending on the prepharyngeal level of the section. The histology confirms the experimental results and demonstrates the processes of regression, of necrosis, and then of colonization of the irradiated regions.