Indication For Amputation Research Articles

Salvataje de amputación mediante la aplicación de células madre autólogas de médula ósea en isquemia crítica de miembro inferior: reporte de caso

Critical ischemia of the lower limbs can seriously impair the quality of life of patients due to the intense pain associated with it and the amputation that can result in those who are not candidates for revascularization. Therefore, it is worthwhile to search for therapies that provide a recovery option for this group of patients. We describe the case of a 71-year-old male patient with critical ischemia in the right lower limb, associated with severe ulceration and infection, with an indication for amputation, who was saved from this procedure by the intramuscular administration of autologous bone marrow stem cells. The intramuscular administration of autologous bone marrow stem cells could promote angiogenesis and the survival of amputation.

Major Nerve Resections in Extremity Soft Tissue Sarcomas-Functional and Oncological Outcomes.

Soft tissue sarcomas form 1% of all cancers and are rare. The lower limb is one of the commonest sites of sarcoma, with the thigh accounting for the majority of these tumors. Large tumors abut the neurovascular bundles both anteriorly and in the hamstring compartment. Nerve involvement, especially the major nerves such as the femoral and the sciatic, by these tumors, was considered to be an absolute contraindication for limb salvage procedures. We present our data of major nerve resection without amputation, in an attempt to demonstrate the possibility of equivalent functional and oncological outcomes in these rare tumors. A total of 86 cases of extremity soft tissue sarcomas were operated on during the period September 2019 to September 2022, of which there were 12 cases of major nerve resections of the lower extremity. These patients were followed up and their clinicopathological data collected and analyzed. The functional outcome was recorded at different intervals. Of the 12 patients who underwent nerve resection along with the tumor, only 1 patient developed a local recurrence. Two patients developed multiple lung metastases, and the other 9 patients are alive and free of disease, with a median follow-up of 26months. The MSTS score was assessed at 1month post-surgery, 3months, 6months, and 1year post-surgery. Except for one patient where the score was 20%, all the other patients had scores of 80% or more. Major nerve involvement by soft tissue sarcomas is not an indication for amputation. Limb salvage can be performed with no effect on the oncological outcomes.

Prosthetic fitting associated with better survival at 5 years after above-knee amputation due to vascular insufficiency.

Individuals requiring non-traumatic Gritti-Stokes amputation or mid-thigh amputation usually have multiple comorbidities that place them at high risk of mortality. To determine survival rate 5 years after Gritti-Stokes and mid-thigh amputation in individuals with vascular insufficiency and to identify the predictors of survival. We conducted a retrospective observational study including all individuals with vascular insufficiency who underwent amputation from September 2007 to December 2015 in our University Hospital. The indication for amputation was limb necrosis in 86% of cases, infection in 10%, and complications with the stump (discomfort, neuroma or scar dehiscence) in 4%. Medical records were analysed to determine factors and comorbidities. The date of death was retrieved from the national death registry at a minimum of 5 years after amputation. Cox proportional-hazard regression was used to estimate associations between factors and post-amputation survival with hazard ratios (HR) and 95% confidence intervals (CIs). We included 126 people with vascular insufficiency (83 men), mean age was 70 years [20; 97]; eighty-nine participants (71%) died during the study period. Survival rate was 68% at 1 year, 48% at 3 years and 37% at 5 years. Survival was associated with prosthetic fitting (HR 0.306 [95% CI 0.180; 0.521], p<0.001) and length of stay (HR 0.992 [95% CI 0.987; 0.997], p=0.003). Conversely, limb necrosis was associated with a lower survival rate (HR 3.801 [95% CI 1.615; 8.949], p=0.002). In a secondary multivariable analysis, Gritti-Stokes amputation was the only factor positively associated with prosthetic fitting (odds ratio 7.407 [95% CI 2.439; 22.489], p<0.001). The survival rate at 5 years after Gritti-Stokes and mid-thigh amputation in people with vascular insufficiency was 37%. Prosthetic fitting was independently associated with better survival, and Gritti-Stokes amputation was the only factor positively related to prosthetic fitting.

86. 5 Years of Lower Limb Osseointegrated Prostheses: Anticipating the “Who and What” of Poor Outcomes

PURPOSE: Osseointegrated prostheses are a novel alternative to socket-suspended prostheses, especially when the latter are complicated by poor fit, soft tissue damage, or pain. However, osseointegrated prostheses can also lead to post-operative issues that rely on plastic surgery intervention. Little is known about the timeline of or risk factors for these complications as few centers currently perform the procedure. METHODS: A retrospective analysis was performed on all patients who received single-stage lower-limb osseointegration at our institution between 2017 and 2022. Demographics, medical history, and postoperative complications were reviewed. Fisher’s exact test and unpaired t-tests were performed (alpha=0.05). RESULTS: 70 patients met our study criteria: 48 males and 22 females with 41 transfemoral and 29 transtibial amputations. These patients had an average age of 38.2 years at initial amputation, and 46.7 years at osseointegration. They were followed for 20 months on average. Indications for amputation were trauma (56), prior surgical complication (7), cancer (4) and other (3). Postoperative complications included soft tissue infection (26), need for soft tissue revision (7), neuroma (6), osteomyelitis (5), limb fracture (4), and hardware failure (2). Statistically significant linear correlations existed between increased age at implantation and neuroma development, as well as decreased time from amputation to implantation and limb fracture. Additionally, transfemoral implants, as compared to transtibial implants, were associated with increased risk of limb fracture (OR=4.3). Soft tissue infection was significantly correlated with obesity (OR=3.1) and female gender (OR=3.5). Decreased surgeon experience, defined as the first 20 cases, was associated with increased risk of osteomyelitis (OR=4.6) and neuroma (OR=6.6). Subgroup analysis by amputation indication or level did not affect outcomes. Hypertension (15), tobacco use (27), and history of infection (23) did not correlate with any complications. CONCLUSION: Certain modifiable factors (BMI, timing of surgery, surgeon experience) and unmodifiable factors (age, gender) correlate with increased risk of complications following lower limb osseointegration. These results can aid surgeons in better selecting appropriate candidates and anticipating post-operative outcomes.

16. 5 Years of Lower Limb Osseointegrated Prostheses: Anticipating the “Who, What, and When” of Poor Outcomes

PURPOSE: Osseointegrated prostheses are a novel alternative to socket-suspended prostheses, especially when the latter are complicated by poor fit, soft tissue damage, or pain. However, osseointegrated prostheses can also lead to post-operative issues that rely on plastic surgery intervention. Little is known about the timeline of or risk factors for these complications as few centers currently perform the procedure. METHODS: A retrospective analysis was performed on all patients who received single-stage lower-limb osseointegration at our institution between 2017 and 2022. Demographics, medical history, and postoperative complications were reviewed. Fisher’s exact test and unpaired t-tests were performed (alpha=0.05). RESULTS: 70 patients met our study criteria: 48 males and 22 females with 41 transfemoral and 29 transtibial amputations. Indications for amputation were trauma(56), prior surgical complication(7), cancer(4) and other(3). Postoperative complications included soft tissue infection(26), osteomyelitis(5), neuroma(6), limb fracture(4), soft tissue revision(7), and hardware failure(2). Statistically significant correlations existed between increased age at implantation and neuroma development, decreased time from amputation to implantation and limb fracture, obesity and soft tissue infection, and female gender and soft tissue infection. Decreased surgeon experience was significantly associated with increased risk of osteomyelitis and neuroma. Subgroup analysis by amputation indication or level did not affect outcomes. Hypertension(15) and tobacco use(27) did not correlate with any complications. CONCLUSION: Certain modifiable factors (BMI, timing of surgery) and unmodifiable factors (age, gender) correlate with increased risk of complications following lower limb osseointegration. These results can aid surgeons in better selecting appropriate candidates and anticipating post-operative outcomes.

Osseointegration for Lower Limb Amputation: Understanding the Risk Factors and Time Courses of Soft Tissue Complications.

Lower-limb osseointegrated prostheses are a novel alternative to traditional socket-suspended prostheses, which are often associated with poor fit, soft tissue damage, and pain. Osseointegration eliminates the socket-skin interface and allows for weight-bearing directly on the skeletal system. However, these prostheses can also be complicated by postoperative issues that can negatively impact mobility and quality of life. Little is known about the incidence of or risk factors for these complications as few centers currently perform the procedure. A retrospective analysis was performed on all patients who underwent single-stage lower limb osseointegration at our institution between 2017 and 2021. Patient demographics, medical history, operative data, and outcomes were collected. Fisher exact test and unpaired t tests were performed to identify risk factors for each adverse outcome, and time-to-event survival curves were generated. Sixty patients met our study criteria: 42 males and 18 females with 35 transfemoral and 25 transtibial amputations. The cohort had an average age of 48 years (range, 25-70 years) and follow-up period of 22 months (range, 6-47 months). Indications for amputation were trauma (50), prior surgical complication (5), cancer (4), and infection (1). Postoperatively, 25 patients developed soft tissue infections, 5 developed osteomyelitis, 6 had symptomatic neuromas, and 7 required soft tissue revisions. Soft tissue infections were positively correlated with obesity and female sex. Neuroma development was associated with increased age at osseointegration. Neuromas and osteomyelitis were both associated with decreased center experience. Subgroup analysis by amputation etiology and anatomic location did not show significant differences in outcomes. Notably, hypertension (15), tobacco use (27), and prior site infection (23) did not correlate with worse outcomes. Forty-seven percent of soft tissue infections occurred in the 1 month after implantation, and 76% occurred in the first 4 months. These data provide preliminary insights into risk factors for postoperative complications arising from lower limb osseointegration. These factors are both modifiable (body mass index, center experience), and unmodifiable (sex, age). As this procedure continues to expand in popularity, such results are necessary to inform best practice guidelines and optimize outcomes. Further prospective studies are needed to confirm the above trends.

Retrospective analysis of mortality and quality of life after hip disarticulation or hemipelvectomy: a report on 15 patients

BackgroundHip disarticulation and hemipelvectomy are defined as major ablative amputations of the lower limb. Due to the small number of patients, little is known about the outcome and follow-up.AimsWe aimed to assess (1) reasons for performed major ablative surgeries such as hip disarticulation and hemipelvectomy in a German center for trauma and orthopedic surgery. (2) In addition, mortality and quality of life after hip disarticulation and hemipelvectomy as well as (3) patient and treatment characteristics should be investigated.MethodsDuring a period of twelve years, 15 patients underwent hip disarticulation or hemipelvectomy. Mortality, EQ-5D-3L quality of life by EQ-5D-3L and time-trade-off (TTO), VAS, cause of disarticulation, length of hospital stays, revisions, comorbidities, Charlson comorbidity index (CCI), and ASA score were evaluated retrospective for all patients.ResultsThe overall mortality rates were 26.7% at 30 days, 60.0% after one year and 66.7% after three years. The five surviving patients reported about moderate problems in the EQ-5D-3L. The average VAS score reached 45 (range 15–65). The mean TTO was 9.8 (range 6–12). Indications for amputation were infection (n = 7), tumor (n = 6), trauma (n = 1) and ischemia (n = 1).ConclusionHip disarticulation and hemipelvectomy are followed by a high postoperative mortality. Quality of life of the affected patients is impaired in long-term follow-up. Especially amputations performed due to infections show high mortality within one month after surgery despite average young age and low CCI. Surgeons should be aware of this devastating outcome and extraordinary vigilant for these vulnerable patient cohorts.

DEMOGRAPHIC PROFILE AND SURGICAL OUTCOME OF VARIOUS TYPES OF LOWER LIMB AMPUTATIONS'

Background- Amputations is one of the oldest surgery known to mankind.Knowledge on the current trends in amputation is necessary to devise effective preventive measures at community level and to reduce this devastating event. : - 1)To know the incidence of various types of lower-limb amputations in our hospital.2)ToAim And Objectives study the demographic pattern in lower limb amputations in our hospital.3)To know the various risk factors leading to lower limb amputations.4)To know the immediate postoperative complications associated with lower-limb amputations. MATERIALS AND METHODS-This study is a prospective observational study.All patients who have undergone lower limb amputation during 1 year period fulfilling the inclusion criteria were included in the study.Main outcome measures were patient's age, gender, limb affected, indication for amputation, complications, reamputation rate,associated procedure performed, duration of hospital stay and outcome. Of the 96 patients who have underwent lowerResults- limb amputations,the mean age was 57.34 with male: female ratio 3:1.Hospital stay ranged from 3 days to 90days.The presence of comorbidities such as Diabetes Mellitus,Peripheral vascular disease and osteomyelitis were associated with an increased rate of complications postoperatively. The most common complication was stump infection , followed by phantom limb.10 patients died during the hospital stay. Sepsis with MODS was the main cause of death.Reamputation rate in this study was 5%. Diabetic foot and its complications is the leading cause of amputations.ThusConclusion- educating diabetics on proper foot care can prevent diabetic patients from ending up with amputations. Prevention is better than cure.

Analysis of patient outcome and owner satisfaction with double limb amputations: 14 dogs and four cats.

To evaluate the indications for, complications of, and surgical outcomes of dogs and cats that were treated with double limb amputations. 14 dogs and 4 cats that underwent double limb amputations. Data collected retrospectively included patient-specific (species, age, weight, breed, sex, existing comorbidities) and amputation-specific (indication for amputation, full or partial limb amputation, associated complications, need for revision surgeries) variables. Owner satisfaction scores were also collected. The most common indication for double amputations was trauma (12/18) patients. Eleven patients had both amputations performed simultaneously. Nine patients had double partial limb amputations versus full limb amputations. Twelve patients underwent bilateral pelvic limb amputations, 4 underwent bilateral thoracic limb amputations, and 2 had 1 pelvic and 1 contralateral thoracic limb amputated. Five patients had reported complications over the course of the follow-up period, and complications for 3 patients were considered major. Revision surgery was reported for 2 animals. Owner satisfaction scores were reported as very satisfied/excellent (14/18), mildly satisfied (3/18), and strongly dissatisfied (1/18). Median time to follow-up was 450 days (range, 85 to 4,380 days). Double limb amputation may be a viable alternative to advanced limb-sparing procedures or humane euthanasia based on the owner satisfaction data and the relatively low rate of major complications in this study. Future studies should clarify patient selection criteria and differences in function between surgical types.

Indications for and outcomes of major lower limb amputations at a tertiary-referral centre in Australia.

Major amputations are classically associated with significant morbidity and mortality. With the increasing prevalence of risk factors for amputation, namely, diabetes and peripheral arterial disease, we sought to identify the major indications for lower limb amputation in an Australian cohort. A secondary aim was to assess the outcomes, namely, mortality, of amputees over the previous decade. This study assessed all patients undergoing major lower limb amputations between 2012 and 2020. Variables analysed included comorbidities, indication for amputation, in-hospital complications and mortality, duration of hospital stay, and out-patient mortality. 317 amputations were performed on 269 patients. 55% of amputations were below knee, 45% above knee, with one through-knee amputation. Indications included ischaemia (55.2%), infection (30.6%), malignancy (6.9%), trauma (4.4%), and chronic pain or instability (2.5%). In-patient mortality rate was 7.6%, with mortality rates of 21.5% at one year, and 70.1% at 10years. Post-operative complications occurred in 43% of amputations. Rural, regional, and remote (RRR) patients did not suffer disproportionately from major amputations, however, were more likely to require amputations for ischaemia. Patients undergoing amputation for infective causes demonstrated lower mid-term mortality rates compared to those undergoing amputations for ischaemia (56.1 vs 60.4% at 5years, p = 0.007). Major amputations continue to be associated with significant morbidity and mortality, both in the short and long term. Patients undergoing amputations for ischaemic causes demonstrate poorer outcomes than their infective counterparts, with outcomes being even worse in RRR populations. Prevention of amputations via intense management of comorbidities would benefit both patients and the healthcare system.

Microsurgical Reconstruction in an Orthopedic Hospital: Indications and Outcomes in Adults.

Objective Advances in reconstructive microsurgery in orthopedic surgery provided better functional and aesthetic results and avoided many indications for amputation. In high-volume trauma and orthopedic hospitals, microsurgical reconstruction is essential to reduce costs and complications for these complex orthopedic defects. We describe a microsurgical approach to traumatic wounds, tumor resection, bone defects, and free muscle transfer, performed by an orthopedic microsurgery unit. The objective of the present study was to evaluate predictor factors for outcomes of microsurgical flaps for limb reconstruction, and to provide a descriptive analysis of microsurgical flaps for orthopedic indications. Methods Cross-sectional prospective study that included all consecutive cases of microsurgical flaps for orthopedic indications from 2014 to 2020. Data were collected from personal medical history, intraoperative microsurgical procedure, and laboratory blood tests. Complications and free-flap outcomes were studied in a descriptive and statistical analysis. Results We evaluated 171 flaps in 168 patients; the indications were traumatic in 66% of the patients. Type III complications of the Clavien-Dindo Classification were observed in 51 flaps. The overall success rate of the microsurgical flaps was 88.3%. In the multivariate analysis, the risk factors for complications were ischemia time ≥ 2 hours ( p = 0.032) and obesity ( p = 0.007). Partial flap loss was more common in patients with thrombocytosis in the preoperative platelet count ( p = 0.001). Conclusion The independent risk factors for complications of microsurgical flaps for limb reconstruction are obesity and flap ischemia time ≥ 2 hours, and presence of thrombocytosis is a risk factor for partial flap loss.

Contemporary Outcomes of Transfemoral Amputation After Total Knee Arthroplasty

BackgroundTransfemoral amputation (TFA) is a salvage procedure for unreconstructable failed total knee arthroplasty (TKA). Prior studies have reported poor outcomes, patient survival, and prosthetic use. The purpose of this study was to analyze patient outcomes and prosthetic utilization in a contemporary group of patients undergoing TFA in the setting of a TKA. MethodsWe reviewed 112 patients undergoing TFA with a prior TKA. Indications for amputation and postoperative functional measures were captured through chart review. Patients were contacted by survey to assess the quality of life. The mean follow-up after TFA was 4 years. ResultsAmputations were performed for a chronically infected TKA (n = 87, 78%) and an ischemic limb without signs of an infected TKA (n = 22, 20%). The 10-year survival after TFA was 21%. Of the patients not lost to follow-up, 53 (47%) patients were fitted for a prosthesis. Patients who underwent a TFA after the year 2000 were more likely to be fit for a prosthesis (odds ratio 7.27, P < .01); however, patients were likely to be ambulatory before TFA than after TFA (odds ratio 3.68, P < .01). After TFA, the mean 12-Item Short Form Survey scores for the mental and physical components were 54 ± 13 and 34 ± 7, with no difference in scores between patients fitted for a prosthesis and those who were not (P > .05). ConclusionPatients undergoing a TFA after TKA due to failure of the TKA are more likely to be fit for a prosthesis; however, they reported no better quality of life and satisfaction compared with patients not fit for a prosthesis. Levels of EvidenceLevel III, Therapeutic.

Pie diabetico y estilo de vida: Reporte de Caso

Diabetes is still the leading cause of non-traumatic amputation in most Western countries, epidemiological reports indicate that more than a million amputations are performed in people with diabetes each year, this is equivalent to an amputation for diabetes somewhere in the world every 30 seconds, most of these amputations are preceded by ulcers. We present a case of a 39-year-old male patient suffering from diabetes mellitus and uncontrolled hypertension, with late complications, chronic kidney disease, anemia, retinopathy, and ischemic and neuropathic diabetic foot, with indication for amputation. Healthy lifestyles are used, controlling glycemia, hypertension, without requiring medication and reducing proteinuria. There were no adverse effects. With favorable evolution since then. Conclution: A healthy lifestyle is an intervention that the earlier it is used, the greater its benefits, without the risk of adverse effects or unnecessary costs, but even in late stages it has shown benefits in glycemic, hypertensive and renal control.

The frequency and Risk Factors of Re-amputation in Diabetic Foot Disease at a tertiary care hospital.

Introduction: The prevalence of diabetes in Pakistan is 11.7% and the preva-lence of diabetic foot in Pakistan is 13.9% with amputation rate of as high as 48%. Re-amputation carries significant morbidity in form of economic im-pact. Like most re-operations, it reflects failure of previous surgery and thus translates into wastage of resources.Objective: To determine the frequency and associated risk factors of re-amputation, in patients who undergo amputation secondary to diabetic foot syndrome in our population.Methodology: This study was conducted at the Department of Surgery De-partment of Surgery, and Diabetic Clinic Ruth Pfau Civil Hospital Karachi, from August 2020 to July 2021, after approval of ethical review board. We enrolled a total of 125 patients in our study. Data was entered and analyzed using SPSS version 22.0. Mean ±SD/ Median (IQR) was computed for age, HbA1C, duration of diabetes, duration of symptoms leading to amputation, ulcer size, ankle-brachial index and duration of re-amputation. Frequency and percentage were computed for all the categorical variables like gender, co-morbid, type of diabetes, diabetic neuropathy, morphology of diabetic foot ulcer, indication of amputation, peripheral arterial disease, level of am-putation, indication of re-amputation, and level of re-amputation.Result: Among enrolled 125 patients, 85 patients (68%) were male and 40 patients (32%) were females. Mean age was 48.75 ±9.702years. Mean dura-tion of diabetes was 11.12 ±6.64 years and mean HbA1C was 8.246 ±1.1357. During study period 61(48.8%) patients required re-amputation. Mean ABPI in patient requiring re amputation is 0.790 ±0.2501(p=0.000).Conclusion: Patients at risk of re-amputation may be identify by focusing upon good evaluation that includes assessing additional risk factors and deciding initial level of amputation. It is important to have enhance in-formed consent in avoiding the morbidity of additional surgery.Key words: Diabetic foot disease. Amputation, Re amputation.

Art, craft and science of limb amputation Part 2. Сraft of amputation: from Ambroise Pare to Pierre Dionis (late XVI century – early XVIII century)

Since the XVI century until the beginning of the XVII century an operation of limb amputation has undergone changes and improvements that have affected all its aspects: preparation for carrying out, the technique of performing and postoperative treatment of patients. The invention of the ligature (1552) and the tourniquet (1674) became revolutionary. Wet and dry gangrene, extensive trauma to soft tissues and bones, traumatic limb amputation and osteomyelitis were considered of indications for amputation. The deontological and legal framework for amputation was developed, including the patient’s consent to the operation and the awareness of relatives about its outcomes. The article presents an instrumental and dressing apparatus of the XVII century for the operation; medicines used for general and local treatment of the patient before and after truncation of the stump; sedation and pain relief issues; technique of circular and one soft tissue flap (1679) amputation; the choice of tissue dissection level; methods of stopping bleeding (astringents, pressure bandage, cauterization, ligation and stitching of blood vessels); a method of stitching a stump wound, applying a bandage on it and strengthening it; postoperative management (regimen and diet, dressing change, staged wound treatment, complications); the phenomenon and causes of “phantom limbs”.

Below knee amputation with resection of the gastrocnemius and soleus muscles. (BG)

<h3>Introduction</h3> There are many techniques described for below knee amputation. All of these techniquesdescribe a method to cover the end of the tibia with portions of the soleus and gastrocnemius muscles, fascia, subcutaneous tissue and skin. Some lower legs are large and it is difficult to close the fascia and skin over bulky muscle under tension. The commonly used Burgess technique (BT) removes the soleus muscle leaving the gastrocnemius muscle. The circulation in the muscle in the stump may be compromised due to the tension required to close the wound. In the BG technique the gastrocnemius and soleus muscles are removed. Closure is easier and under less tension. Previous cadaver angiographic studies have shown that the blood supply to the posterior calf skin is via subfascial arteries and veins and does not depend on the underlying muscle. Some may argue that muscle and fascia over the end of the tibia is protective, however, weight bearing with a total contact prosthesis is on the proximal tibia and patellar tendon. The end of the tibia only pushes the prosthesis back and forth. The muscle atrophies as seen in older BKA stumps. The objective of this report was to compare BG to BT for wound healing. <h3>Method</h3> A retrospective chart review was done from January 1, 2017 - November 1, 2019. A single surgeon performed 41 below knee amputations on patients 46-84 years old. 26 were BG and 15 BT. Indications for amputation in the BG group were: Osteomyelitis 5, Diabetic foot infection 5, ischemic gangrene 11, wet gangrene 2, chronic pain 1, venous stasis ulcers 1 and open dislocation fracture 1. Indications for amputation in the BT group were: Osteomyelitis 2, diabetic foot infection 3 and ischemicgangrene 10. <h3>Results</h3> In the BG group primary wound healing was observed in 18 patients, 2 patients fell, needing long term care and revision, 2 had infection needing wound care, 2 died within the 1^st month and 2 werelost to follow-up. In the BT group primary healing was observed in 9 patients, 3 had wound issues, 1 died within the 1^st month, 1 required revision of the BKA to AKA and 1 was lost to follow-up. <h3>Conclusion</h3> BG is a technique for BKA that avoids closing the wound under tension. Primary wound healing appears consistent with other techniques. A prospective randomized study comparing BG to other BKA methods would be necessary to prove the benefits of BG over other methods.

Analysis of the curative effect of limb salvage therapy in patients with soft tissue sarcoma who underwent extensive resection combined with skin flap transplantation

Purpose: Patients who were diagnosed with soft tissue sarcoma (STS) of limbs and met the indications for amputation because of no effective soft tissue coverage after extensive tumor resection were treated with skin flap transplantation and therapeutic courses were observed. &#x0D; Methods: A total of 23 patients, pathologically diagnosed as soft tissue sarcoma from January 2011 to June 2015 and whose effective soft tissue coverage was not guaranteed due to extensive tumor resections were included. They underwent extensive tumor excision and skin flap grafting. The postoperative follow-up, tumor control and functional recovery was evaluated as per the Musculoskeletal Tumor Society (MSTS) score. &#x0D; Results: The follow-up time was from 8 to 60 months, with an average follow-up of 39.69 months. Of the 23 patients, 10(43.47%) died of tumor metastasis from 8th to 23rd months after surgery. In these 10 cases, 2 cases (8.70%) subsequently underwent amputation because of local tumor recurrence. The remaining 13 patients are recurrence free till date of follow up. The MSTS limb function score at 3 months after surgery of all patients were 7-28 points, with an average of 22.56 points, and the excellent and fair scores are observed in 91.30% of patients. &#x0D; Conclusion: For patients who cannot achieve effective soft tissue coverage after extensive resection of soft tissue sarcoma and meet the indications of amputation can have limb preservation by extensive tumor resection combined with skin flap transplantation with a good functional results

Indications for amputation after traumatic brachial plexus injury in adults: Case report and review of new prosthetic technologies

Hand amputation can be discussed after traumatic brachial plexus injury when the patient’s hand is non-functional, painful and/or insensitive. That indication is more common in English-speaking countries than in European or Latin countries. New prostheses are now on the market and can be used after hand amputation to improve the functional prognosis in well-selected patients. A 26-year-old male was involved in a road accident in January 2016. He had a traumatic brachial plexus injury and underwent nerve surgery to restore the biceps brachii and triceps brachii. One year after nerve transfer, his hand was insensitive and non- functional. After multidisciplinary consultation, it was decided to amputate his hand to replace it with a myoelectric prosthesis. Shoulder subluxation pain and complications associated with an insensitive and heavy arm were improved after hand amputation. Functional outcomes were improved with this revolutionary myoelectric prosthesis technique. The patient was able to use his prosthesis for many daily activities. Selective amputation indications after traumatic brachial plexus injury are a heavy and stiff arm with shoulder subluxation pain and an unusable claw hand. The patient’s motivation must be high.

Diabetic Foot in Algeria-The Debridement of Wounds-Our Attitude

The management of the diabetic foot suffers or benefits from a plethora of methods and techniques. However, regardless of the therapeutic choice, one step is common: it is debridement. As a specialized center in the diabetic foot and its complications, we see very often, for their first visit to our outpatient’s clinic, patients in care in other medical clinics/hospitals, and where the indication for amputation has already been made. Often, we find ourselves confronted with debrided wounds with irreversible damages hardly recoverable. Our understanding of debridement is straightforward and is based on clear, universally recognized definitions [1].

Ways to reduce the frequency of high amputations, post-amputation complications and mortality in diabetic foot syndrome

Despite the success in treatment, currently 30.0% of patients with diabetic foot syndrome (DFS) still undergo high amputations with a mortality rate of up to 54.0–68.0 %. The causes of high low limb amputations in 28.0 % of patients are infection, and in 46.0 % – arterial insufficiency in the stage of critical limb ischemia.Objective: to improve the results of patients treatment by reducing the number of high amputations of the lower extremities, reducing the occurrence of complications and deaths of the disease.Materials and methods. To study the results of treatment of patients with DFS, they were divided into two comparison groups and two main groups. From 1982 to 2019, the frequency of amputations, mainly at the hip level, was 71.0 % (177 amputations in 248 patients). These patients formed the first comparison group of observations. The second comparison group (1988–1994) included 58.3 % of patients in whom amputations were performed according to more stringent indications (157 amputations in 269 patients). The first main group of observations (1995–2013) included 9.9 % of patients with DFS who were amputated only for wet gangrene, incurable critical limb ischemia, and infection with a systemic inflammatory response (130 amputations out of 1312 patients). In ischemia with preserved blood flow through the deep artery of the thigh, amputation of the lower leg was performed in a sequential-two-flap method with removal of the soleus muscle. Amputations were completed with the imposition of drainage removable muscle-fascial sutures. The second main group (2014) consisted of 11.4 % of patients who underwent amputations only for sepsis or wet gangrene (124 amputations in 1083 patients). The difference between the second main group and the first was the division of the high amputation intervention into 2 stages.Results. Comparison of the treatment results in the main groups and in the comparison groups revealed a 6-fold decrease in the number of high amputations (from 64.6 to 10.69 %) and a significant improvement in the main quality indicators. This concerns a 6-fold decrease in mortality, which was a consequence of the introduction of a two-stage tactic for high amputation treatment of the most severe patients and the limitation of indications for amputation of the hip. Using of removable drainage muscle-fascial sutures decreased postoperative wound complications from 51.9 to 13.0 %, and the number of re-amputations decreased in 17th times.Conclusion. Amputation of the lower extremities for irreversible critical limb ischemia can be performed with a decrease in TcP02 of the stitched stump tissues to no more than 30 mm Hg. Preserving the knee joint improves the possibilities of prosthetics, which allows older diabetics to lead an active life. Methods of performing parallel- or sequential-two-flap high amputation improve the conditions for cutting out racquet-shaped wound flaps, which provides free displacement of the soft tissues of the stump connected by removable drainage sutures.