Forelimb Amputation Research Articles

Prolongation of the Time Window From Traumatic Limb Amputation to Replantation From 6 to 33 Hours Using Ex Vivo Limb Perfusion.

Continuous extracorporeal perfusion (ECP), or machine perfusion, holds promise for prolonged skeletal muscle preservation in limb ischemia-reperfusion injury. This study aimed to extend the amputation-to-replantation time window from currently 6 hours to 33 hours using a 24-hour ECP approach. Six large white pigs underwent surgical forelimb amputation under general anesthesia. After amputation, limbs were kept for 9 hours at room temperature and then perfused by 24-hour ECP with a modified histidine-tryptophan-ketoglutarate (HTK) solution. After ECP, limbs were orthotopically replanted and perfused in vivo for 12 hours. Clinical data, blood, and tissue samples were collected and analyzed. All 6 forelimbs could be successfully replanted and in vivo reperfused for 12 hours after 9 hours of room temperature ischemia followed by 24 hours ECP. Adequate limb perfusion was observed after replantation as shown by thermography and laser Doppler imaging. All pigs survived without severe organ failure, and no significant increase in inflammatory cytokines was found. Macroscopy and histology showed marked interstitial muscular edema of the limbs, whereas myofiber necrosis was not evident, implying the preservation of muscular integrity. The use of a 24-hour ECP has successfully extended limb preservation to 33 hours. The modified histidine-tryptophan-ketoglutarate perfusate demonstrated its ability for muscle protection. This innovative approach not only facilitates limb replantation after combat injuries, surmounting geographical barriers, but also broadens the prospects for well-matched limb allotransplants across countries and continents.

Gait Analysis of Amputee Dogs Using a Pressure-Sensitive Walkway.

The aim of this study was to perform gait analysis using a pressure-sensitive walkway in dogs submitted to high (total) or low amputation (partial) of one forelimb or hindlimb. A total of 39 dogs met the inclusion criteria. The reasons for the amputations were motor vehicle accidents in 38 dogs and possible limb malformation in 1 dog. The amputee dogs were divided into four groups: G1 (n = 10)-high forelimb; G2 (n = 10)-low forelimb; G3 (n = 9)-high hindlimb; and G4 (n = 10)-low hindlimb. For kinetic evaluation, the dogs were walked across a pressure-sensitive walkway. In dogs with forelimb amputation, the percentage of body weight (%BW) distribution on the contralateral forelimb was 50.7% in cases of high amputation and 55.5% in cases of low amputation, while the %BW distribution on the hindlimbs, mainly in the ipsilateral hindlimb, was 27.9% in cases of high amputation and 27.1% in cases of low amputation. In cases of high amputation of the hindlimb, the %BW distribution was 71.5% on the forelimbs and 29.7% on the contralateral hindlimb, while in cases of low amputation, the distribution was mainly for the contralateral hindlimb and ipsilateral forelimb. No statistical difference was noted between the amputation levels, except for the contralateral limb in cases of low and high amputation of the hindlimbs concerning the overload percentage and %BW distribution. The amputation level of one forelimb did not influence the %BW distribution; however, in the hindlimb, this was higher for the contralateral limb in dogs submitted to high amputation.

Insights into the spatial ecology of severely injured free-living felids: Iberian lynx, bobcat, and snow leopard.

Severe musculoskeletal diseases, such as those associated with congenital or traumatic events, that result in missing limbs may compromise the fitness and survival of free-living felids. Here we report the space use of four amputee individuals from three felid species captured from 2017 to 2022 in Missouri (USA), Toledo and Badajoz (Spain), and Suitai Khairkhan Mountain (Mongolia). We describe home ranges and daily travel distances post-release of free-living felids that had either suffered a traumatic amputation or following a surgical amputation. We compared these data with those reported in the literature for felids without amputations. Forelimb or hindlimb amputation did not affect the hunting, mating, or territory patrolling behavior of any of the individuals. However, we recorded significant differences in the daily movement before and after the traumatic event of the Iberian lynx forelimb amputee. We attribute this difference to the physical impairment, although we consider other variables that may have played a role. Nevertheless, all animals appeared to cope well with their limb loss, showing home ranges and daily distances within those recorded for their sex and species. Unless amputee felids represent a threat to domestic livestock or humans, our data suggest these individuals may remain free-living as they contribute to local population persistence and appear to maintain good general health and welfare.

Three cases of dogs with osteosarcoma of the forelimb treated with liquid nitrogen for limb-sparing surgery using autologous bone.

Osteosarcoma treatment with limb-sparing surgery using liquid nitrogen can be applied to canine patients experiencing diminished quality of life after leg amputation. In particular, forelimb amputation may affect gait more than hindlimb amputation. In this study, limb-sparing surgery using liquid nitrogen was applied to primary osteosarcomas arising in the proximal scapula of a Welsh Corgi, the proximal humerus of a Golden Retriever, and the distal radius of a Great Pyrenees, according to the protocol of Tsuchiya et al. In all cases, postoperative radiographic examination revealed bone union between the treated and matrix bones. All patients recovered their gait postoperatively. These results suggest that limb-sparing surgery using liquid nitrogen-treated autologous bone is an effective option for patients with osteosarcoma.

Lower jaw-to-forepaw rapid and delayed reorganization in the rat forepaw barrel subfield in primary somatosensory cortex.

We used the forepaw barrel subfield (FBS), that normally receives input from the forepaw skin surface, in rat primary somatosensory cortex as a model system to study rapid and delayed lower jaw-to-forepaw cortical reorganization. Single and multi-unit recording from FBS neurons was used to examine the FBS for the presence of "new" lower jaw input following deafferentations that include forelimb amputation, brachial plexus nerve cut, and brachial plexus anesthesia. The major findings are as follows: (1) immediately following forelimb deafferentations, new input from the lower jaw becomes expressed in the anterior FBS; (2) 7-27weeks after forelimb amputation, new input from the lower jaw is expressed in both anterior and posterior FBS; (3) evoked response latencies recorded in the deafferented FBS following electrical stimulation of the lower jaw skin surface are significantly longer in both rapid and delayed deafferents compared to control latencies for input from the forepaw to reach the FBS or for input from lower jaw to reach the LJBSF; (4) the longer latencies suggest that an additional relay site is imposed along the somatosensory pathway for lower jaw input to access the deafferented FBS. We conclude that different sources of input and different mechanisms underlie rapid and delayed reorganization in the FBS and suggest that these findings are relevant, as an initial step, for developing a rodent animal model to investigate phantom limb phenomena.

Artificial extension for a canine with partial forelimb amputation

Artificial extension for a canine with partial forelimb amputation

Forelimb amputation and long‐term follow‐up in a White Dorper ram

AbstractThis paper aimed to report a successful forelimb amputation and long‐term follow‐up in a White Dorper ram. An 8‐month‐old 45.5 kg White Dorper ram was found standing on the exposed metacarpal bone of the right forelimb. Detailed clinical examination and radiographic evaluation confirmed metacarpophalangeal avulsion. Limb amputation was performed by radiocarpal disarticulation. Postoperative complications included wound infection and dehiscence. Fifteen days post‐surgery, the necrotic accessory carpal bone was retrieved during wound cleaning. After this, the stump healed rapidly by secondary intention within 30 days. During this recovery time, the ram showed good adaptation to walking on three legs, and the owner gave up buying the prosthesis. The ram returned to the flock fully adapted 45 days after surgery. We emphasize that documenting more limb amputations in livestock is critical to obtain conclusions about the prognosis, life expectancy and expected quality of life.

Myelination of Callosal Axons Is Hampered by Early and Late Forelimb Amputation in Rats.

Deafferentation is an important determinant of plastic changes in the CNS, which consists of a loss of inputs from the body periphery or from the CNS itself. Although cortical reorganization has been well documented, white matter plasticity was less explored. Our goal was to investigate microstructural interhemispheric connectivity changes in early and late amputated rats. For that purpose, we employed diffusion-weighted magnetic resonance imaging, as well as Western blotting, immunohistochemistry, and electron microscopy of sections of the white matter tracts to analyze the microstructural changes in the corticospinal tract and in the corpus callosum (CC) sector that contains somatosensory fibers integrating cortical areas representing the forelimbs and compare differences in rats undergoing forelimb amputation as neonates, with those amputated as adults. Results showed that early amputation induced decreased fractional anisotropy values and reduction of total myelin amount in the cerebral peduncle contralateral to the amputation. Both early and late forelimb amputations induced decreased myelination of callosal fibers. While early amputation affected myelination of thinner axons, late amputation disrupted axons of all calibers. Since the CC provides a modulation of inhibition and excitation between the hemispheres, we suggest that the demyelination observed among callosal fibers may misbalance this modulation.

Forelimb amputation of a feline with a humeral fracture: a patient care report

This report looks at the nursing care of a feline patient that underwent a forelimb amputation. Key areas of care for amputee patients include targeted and appropriate analgesia, alongside appropriate wound care and rehabilitation. Veterinary nurses are essential in aiding the return of these patients to normal ambulation and therefore require good knowledge of physiotherapy practices.

Prognosis and outcomes of forelimb amputation in two raccoon dogs

Limb amputation is a salvage surgical procedure relatively common in small animals and other species. Wild animals after forelimb amputation have many difficulties in returning to normal life because forelimbs of arboreal quadrupeds are used to carry most of their weight and hold feed. This study investigated forelimb amputation and its outcomes in two raccoon dogs. Two male raccoon dogs presented for radio-ulnar fractures. Shoulder disarticulation amputation was applied to protect the thoracic cavity and reduce surgical time. After the operation, they could run comparatively faster with three legs. As they had good body condition and regular appetite during the hospitalization period, they were released to the area from which they were captured. Six months after the release, one of the raccoon dogs represented for hair loss by mites. It showed satisfactory function of the existing three limbs. Thus, amputation of forelimb could be considered as a treatment in raccoon dogs with severe limb status.

Forelimb Amputation due to Radial Osteosarcoma in a Chinkara Deer (Gazella bennettii) in Pakistan

Forelimb Amputation due to Radial Osteosarcoma in a Chinkara Deer (Gazella bennettii) in Pakistan

Giant cell sarcoma managed with forelimb amputation in a harbour seal (Phoca vitulina geronimensis)

A 22-year-old harbour seal (Phoca vitulina geronimensis) presented with a subcutaneous mass on the right dorsal carpus. The mass measured 5 cm by 2 cm and was firmly attached to...

Forelimb Amputation and Long-Term Follow-Up in a Female Donkey

Background: Limb amputation may be a life-saving procedure for animals and minimally impact their comfort and quality of life, as previously reported in pets. This procedure is an appropriate alternative to euthanasia when catastrophic injury to a limb prevents its successful restoration. In horses, limb amputation has been performed for the past 40 years. Although in the reviewed literature there are no scientific reports of limb amputation in donkeys. This paper aimed to report a successful forelimb amputation and long-term follow-up in a female donkey.Case: A 10-month-old and 95 kg female Nordestino donkey was evaluated for a wound with bone exposition on the left forelimb. Physical examination revealed that the donkey was alert with moderate body condition score, tachycardia, tachypnea, and a medial wound revealing the necrotic aspect of the left radius. Radiographic examination presented Salter-Harris type 1 exposed radius fracture. Hematology revealed normocytic and normochromic anemia, and hyperfibrinogenemia. Due to the catastrophic injury and no forecast for building a prosthesis, the donkey underwent general anesthesia for left forelimb amputation through the midhumerus diaphysis. A fish-mouth skin incision was performed on the midhumerus, the underlying musculature was dissected and the vessels ligated until the bone could be accessed. Then, a sterile saw wire was used to transect it, and bone edges were rounded. Muscle and fascia were harvested with the skin to provide additional padding at the end of the stump. Postoperatively, the donkey was submitted to broad spectrum antibiotic, anti-inflammatory and analgesic therapy, and tetanus prophylaxis. Preventative treatment for overload laminitis included frog support pads and resting leagues on all three legs. No short-term complications were observed and the donkey made a full recovery. Long-term complications included fistula formation on the stump, and distal interphalangeal joint hyperflexion, probably by weight overload causing acquired deep digital tendon contracture on the right forelimb. Currently, eight years (96-months) past surgery, the donkey is still well adapted and has a good quality of life even without a limb prosthesis.Discussion: Traditionally, catastrophic leg injury in equids often requires euthanasia. Currently, limb amputation is becoming more accepted by owners and a viable life salvage option. In horses, limb amputation by disarticulation using a caudal flap technique is the most usual surgical technique, but presents some chronic complications, such as osteomyelitis of the stump, pressure sores from the prosthesis and contralateral limb failure. Although not commonly performed in equids, limb amputation through the midhumerus diaphysis was well accepted by the donkey. In horses, survival rate reached 50% and 32.5% at 18 and 24 months after amputation with prosthetic fitting, respectively. The donkey herein reported is still alive and presenting a good life quality at 96-months post-surgery, even without a forelimb prosthesis. This kind of feature has been only reported in a Samba deer followed-up for 10-months, showing good corporal condition, walking and even running at slow speed, using three legs. To the authors knowledge this is the first scientific report of limb amputation in a donkey. We emphasize that documenting more limb amputation in equids is essential to obtain conclusions about the prognosis, life expectancy and expected quality of life.

Nerve Stimulator-Guided Brachial Plexus Block Performed in the Amputation of a Calf’s Forelimb

Background: Locoregional anesthesia techniques enable the performance of procedures in the distal portion of the limbs, through the parenteral administration of local anesthetic nerve block. There are devices that can increase the effectiveness of these blocks by accurately locating the nerves. These devices include peripheral nerve stimulators, which enable anesthetic to be injected near the plexus, thus reducing the volume of anesthetic required and allowing for the specific blockade of a nerve branch by desensitizing exclusively the area of interest. This paper describes the use of nerve stimulator in the brachial plexus block (BPB) of a calf subjected to amputation of the left foreleg.Case: A newborn calf weighing 30 kg, with a history of injury to the left foreleg, was treated at the Veterinary Hospital of the Federal Rural University of the Semi-Arid Region. Clinical and X-ray examinations revealed a fracture in the medial portion of the metacarpus and radiographic alterations indicative of osteomyelitis, so amputation of the affected limb was recommended. Prior the beginning, during and after the surgical procedure, the animal was submitted to the evaluation of its physiological parameters (heart and respiratory rate, capillary refill time, diastolic, systolic and mean blood pressure and rectal temperature). Because it is a newborn animal, it was decided not to pre-operatively fast. After applying preanesthetic medication (xylazine 0.01 mg/kg IV), anesthesia was induced with ketamine (2 mg/kg IV) and midazolam (0.3 mg/kg IV) and maintained with isoflurane. For the brachial plexus block, 0.4 mL/kg (1.5 mg/kg) of 0.375% bupivacaine was used and aided by a peripheral nerve stimulator to generate 10 mA current, 1 HZ frequency and 100 μs pulse duration, coupled to a nerve stimulation needle, it was possible to observe flexion movements of the limb. The stimulus was decreased until movements were triggered at currents lower than 5 mA and nonexistent at 2 mA, whereupon the anesthetic solution was slowly injected. The blockade promoted anesthesia of the entire distal region of the scapulohumeral joint after 30 min, providing supplemental analgesia throughout the surgical procedure, whose effect persisted up to 6 h after the blockade, thus enabling amputation surgery of the limb. The anesthetic recovery was smooth and without signs of excitation. Post-operatory therapy was dipyrone (25 mg / kg) intravenously (IV), every 12 h for five days, meloxicam (0.5 mg / kg) IV every 24 h for three days; and morphine (0.1 mg / kg) intramuscularly every 6 h for three days.Discussion: The use of nerve stimulation enabled the safe and effective use of BPB in a calf subjected to forelimb amputation surgery. In terms of its analgesic contribution during the intraoperative period, the effectiveness of the blockade was satisfactory, considering that the animal presented no variations in the parameters evaluated during the entire surgical period, when compared to those obtained in the preoperative, and no supplemental analgesic was needed during the surgery. In cattle, BPB is usually performed using a blind approach, using anatomical points as references for its execution, and the anesthesiologist’s experience and skills are a determining factor in the success rate of the technique. Nerve stimulator-guided plexus block is still rarely used in ruminants, and is described experimentally only in sheep, using a technique similar to that employed for dogs, which means this is a pioneering technique in calves.Naftáli Silva Fernandes, Simone Rodrigues Barbosa, Maria Gláucia Carlos de Oliveira, Fábio Franco Almeida, Desirée Coelho de Mello Seal, Ugo Monteiro de Moraes, Luã Barbalho de Macêdo &Valéria Veras de Paula

De ontwikkeling van postoperatieve wondinfecties bij twee honden ondanks perioperatieve toediening van antimicrobiële middelen

Postoperatieve wondinfecties zijn een veel voorkomend probleem. Een prevalentie van 0,8 tot 18% wordt beschreven in de diergeneeskunde. Factoren met betrekking tot de patiënt, omgeving en chirurgie hebben een invloed op het ontstaan van postoperatieve wondinfecties. Twee honden die na voorpootamputatie een postoperatieve wondinfectie ontwikkelden, worden besproken. De eerste hond werd aangeboden met een complexe open intra-articulaire fractuur van de rechterelleboog. De andere hond onderging een amputatie omwille van een wekedelensarcoma ter hoogte van de rechterelleboog. In beide gevallen werd er perioperatief cefazoline toegediend. Bij de eerste patiënt werd het antibioticum postoperatief verdergezet. De andere hond kreeg geen postoperatief antibioticum. Beide honden ontwikkelden na vier tot vijf dagen een postoperatieve wondinfectie. De aanwezigheid van verschillende risicofactoren kan de kans op postoperatieve wondinfecties doen toenemen. Naast het correct gebruik van antimicrobiële middelen speelt ook het vermijden van deze risicofactoren een belangrijke rol in de preventie van postoperatieve wondinfecties.

Single-cell analysis uncovers convergence of cell identities during axolotl limb regeneration.

Amputation of the axolotl forelimb results in the formation of a blastema, a transient tissue where progenitor cells accumulate prior to limb regeneration. However, the molecular understanding of blastema formation had previously been hampered by the inability to identify and isolate blastema precursor cells in the adult tissue. We have used a combination of Cre-loxP reporter lineage tracking and single-cell messenger RNA sequencing (scRNA-seq) to molecularly track mature connective tissue (CT) cell heterogeneity and its transition to a limb blastema state. We have uncovered a multiphasic molecular program where CT cell types found in the uninjured adult limb revert to a relatively homogenous progenitor state that recapitulates an embryonic limb bud-like phenotype including multipotency within the CT lineage. Together, our data illuminate molecular and cellular reprogramming during complex organ regeneration in a vertebrate.

Histopathological and Immunohistochemical Characteristics of a Local Aggressive Canine Hemangiopericytoma (CHP) after Surgery

Case description: In the present paper, we describe the gross morphology, histopathology and immunoreactivity of a hemangiopericytoma (HP) as a PWT in a dog with recurrence after surgical excision. Clinical findings: The mass was 3-4 cm, solitary, soft, unencapsulated, well circumscribed and grey to brown color. Cut surfaces of the mass contained discrete, round and relatively homogeneous tumors without any lobulation and liquefied foci in the centers. Histologically, the tumor was richly vascularized which arranged in staghorn vessels pattern. The neoplastic cells were uniform in appearance with mild to moderate pleomorphism and had spindle-shaped to oval/round nuclei with vesicular to hyperchromatic chromatin and eosinophilic to the amphophilic cytoplasm with variable amounts of the collagenous stroma. In the immunohistochemical evaluation, proliferating stromal and vascular cells in this tumor demonstrated strong immunoreactivity for vimentin and α-smooth muscle actin. Although, these cells were negative for S100, lysozyme, CD31, and CD34. Treatment and outcome: Regarding to the repeated recurrence of this tumor after surgical excision, amputation of forelimb will probably be performed. Clinical relevance: The present findings show that hemangiopericytoma in dogs can be a locally aggressive behavior with a repeated recurrence that led to the surgical amputation of limbs or even euthanasia of dogs.

Cortical functional reorganization in response to intact forelimb stimulation from acute to chronic stage in rodent amputation model.

Brain plasticity after amputation is related to the short-term unmasking of latent synapses as well as the long-term reorganization due to the sprouting new synaptic connections. The cortical functional reorganization has been reported along the intact somatosensory pathway after unilateral deafferentation. Cerebral blood flow (CBF) change serves as an important biomarker of the functional reorganization of brain. Using laser speckle contrast imaging (LSCI) technology, we performed a longitudinal study to unveil the cortical functional reorganization after forelimb amputation in rodent model, particularly along the intact somatosensory pathway. Our results showed that the CBF response to electrical stimulation of the intact forepaw increased significantly at 9 hours after amputation in acute stage. While in chronic stage (>14 days), the CBF response showed a pattern similar to the control group. The results showed the dynamic brain functional response along the intact somatosensory pathway at different stages after amputation and indicated that cortical functional reorganization occurred within the acute stage. Our work provided additional insights in understanding the inter-hemispheric functional changes from acute to chronic stages of amputation.

Amputation of fore limb following compound fracture of radius ulna in a female camel

Amputation of fore limb following compound fracture of radius ulna in a female camel

The effect of limb amputation on standing weight distribution in the remaining three limbs in dogs.

Despite the fact that limb amputation is a commonly performed procedure in veterinary medicine, quantitative data regarding outcomes are lacking. The intention of this study was to evaluate the effect of limb amputation on weight distribution to the remaining three limbs at a stance in dogs. Ten dogs with a prior forelimb amputation and ten dogs with a prior hindlimb amputation; all of which had no history of orthopaedic or neural disease in the remaining three limbs were included in the study. Standing weight bearing was evaluated with a commercial stance analyzer in all dogs. Five valid trials were obtained and a mean percentage of weight bearing was calculated for each remaining limb. The dogs with a previous forelimb amputation, and also those with a previous hindlimb amputation, had the largest mean increase in weight bearing in the contralateral forelimb. In conclusion, proactive monitoring of orthopaedic disease in the contralateral forelimb may be advisable in dogs with a previous limb amputation. In addition, when determining candidacy for a limb amputation, disease of the contralateral forelimb should be thoroughly evaluated.