Lower Limb Amputation Research Articles

The misleading terminology of minor amputation of the lower limb.

A pronounced loss of function of the lower limb of various origins, especially with an infection-related course, may require a minor (MIN) or major (MAJ) amputation of the lower limb. Our aim was to contrast the underlying etiology, including previous trauma, surgical procedure, and the subsequent function. Between 2012 and 2022, 366 lower limb amputations were considered. After excluding isolated toe amputations and knee disarticulations, 80 amputations of 77 patients (66 male; 11 female; mean age: 57.2 years) were included in this monocentric retrospective study and their clinical outcome was evaluated. Briefly, 23 patients underwent MIN and 54 patients, including three bilateral cases, underwent MAJ. Patient demographics, etiology, level of amputation, prosthesis fitting, mobility based on the K-Level categories, SF-12 questionnaire, PLUS-M 12-item short form, and problems in coping with everyday life were recorded. The mean follow-up period was 3.9 years. The mean SF-12 score of all patients was 36.9 (MIN: 37.24; MAJ: 36.85) for the physical summary component and 50.0 (MIN: 52.32; MAJ: 48.46) for the mental summary component; the mean Plus-M 12 score was 49.5 (MIN: 50,08; MAJ: 48,46) (p > 0.05). K-level 3 was the most common in all patients (MIN: 47.8%, MAJ: 42.6%), defined as an unrestricted outdoor walker. With MIN and MAJ results comparable in all scores and queries, it emphasizes the fact that even supposedly lower-limb MIN represents a considerable impairment of coping with daily life. If there is no prospect of preserving the limb, early transtibial amputation should be considered. However, our results support the good outcome despite lower-limb MAJ through modern prosthetic fitting.

Examining heterogeneity and reporting of mirror therapy intervention for phantom limb pain: A scoping review.

Mirror therapy shows promise in the treatment of phantom limb pain but lacks robust evidence. To address this gap, we conducted a scoping review aiming to comprehensively explore the landscape of mirror therapy practice, gather details about the session content, and offer recommendations for future research. We searched seven databases for published work from 1995 to May 2023. Two independent reviewers selected, assessed, and extracted data from eligible articles. Articles, regardless of study design, were considered eligible if they investigated mirror therapy as an intervention for phantom limb pain. A total of 44 articles were included, comprising 16 randomized control trials, 14 prospective cohort studies, 15 case reports, and 3 protocols. These studies collectively involved 942 patients, with male patients representing 70 % of the participants. Lower limb amputation, primarily attributed to trauma, accounted for 88 % of the included patients. Pain intensity was predominantly assessed by a visual analog scale (61 %). However, there was a notable absence of detailed descriptions regarding mirror therapy sessions, particularly concerning the number of exercises, duration per exercise, and repetitions. Typically, sessions lasted 15 min each, conducted once daily. The exercises primarily focused on motor exercises targeting the distal part of the limb. The practice of mirror therapy was characterized by poor description, showed significant heterogeneity, and a lack of standardized protocols, which contributes to an overall low level of evidence. Addressing these gaps in practice description and standardization is crucial for improving reproducibility and strengthening the evidence base for the prescription of mirror therapy.

Influence of prosthetic foot selection on walking performance during various load carriage conditions.

Ambulatory individuals with lower limb amputations often face challenges with body support, body propulsion, and balance control. Carrying an infant, toddler, backpack, or other load can exacerbate these challenges and highlights the importance of prescribing the most suitable prosthetic foot. The aim of this study was to examine the influence of five different prosthetic feet on walking performance during various load carriage conditions. Biomechanical data were collected from twelve participants wearing five different prosthetic feet (four passive, one powered) while walking with no added load and carrying a load of 13.6kg in four different positions: posterior, anterior, prosthetic side, and intact side. Based on our study population, a powered-ankle-foot offers additional body support when a load is carried posteriorly. If additional forward propulsion is needed while carrying a load anteriorly, a heel wedge is better than a stiffer foot. For individuals who may need additional sagittal plane balance control, no study foot was advantageous regardless of how the load was carried. For those who need additional frontal plane balance control during posterior load carriage, a heel wedge is better than a stiffer or powered foot. Lastly, the standard-of-care, heel wedge, and dual keel feet provided more frontal plane balance control than a powered foot when a load was carried anteriorly. For individuals with lower limb amputation who carry loads, consideration of their preferred load carrying method may help select an appropriate prosthetic foot for body support, propulsion, and balance control.

“I was angry that I fell” all the way to “if I fall, I fall”: a qualitative study of the spectrum of behavioral fall risk factors for veterans with dysvascular lower-limb amputation

Purpose To explore behavioral risk factors contributing to fall and near-fall scenarios for Veterans with dysvascular lower-limb amputation. Materials and methods Participants were a convenience sample of Veterans with unilateral dysvascular lower-limb amputation, receiving care at a single Veterans Administration Regional Amputation Center, who participated in an interview (12/2021–04/2023). We used phenomenological research and directed content analysis to explore participant perspectives on fall scenarios. Two frameworks informed a priori codes (The Health Action Process Approach, and the Falls-Type Classification Framework); however, analysis was also inductive, with additional codes emerging. Following an independent and iterative coding process, codes were categorized, and patterns identified to create final themes. Results Twenty-one veterans completed interviews. Five themes were identified that were salient across a behavioral fall risk factor spectrum from low to high: self-efficacy, trust in the prosthesis, dual-task awareness, participation, and emotional regulation, and one theme pertaining to context surrounding the index fall. Conclusion Different levels of behavioral fall risk factors exist for Veterans with dysvascular lower-limb amputation. Understanding individuals’ perceptions of these behavioral risk factors is important as a first step in developing comprehensive fall-risk management rehabilitation interventions for Veterans with amputation.

Experiences of receiving formal psychological support following lower limb amputation: a qualitative study

Purpose This study sought to explore the experiences of receiving formal psychological support following non-vascular-related lower limb amputation. Materials and Methods Semi-structured interviews were conducted with five individuals (3 males, 2 females, aged 38–56) with lower limb loss. Two had unilateral above knee amputations, one a unilateral below knee amputation, one a unilateral through-knee amputation, and one had bilateral above knee amputations. Four had trauma-related amputations, one had an amputation due to cancer. All had received formal psychological support related to their amputation. Interpretative phenomenological analysis was used for the analysis of the data. Results Four themes were developed: (1) The need for psychological intervention—denial and acceptance; (2) “Safe space”—being valued, heard, and validated; (3) The importance of focus, transparency, and specialist knowledge; and (4) The most helpful techniques and approaches. Findings highlighted aspects of psychological support that were helpful and unhelpful. Conclusions The findings provide insights into how psychological support for people with lower limb amputation can be delivered or improved. These include: the importance of psychological support throughout rehabilitation; the benefit of transparency and collaborative goal setting in sessions; and participants’ preference that those providing formal psychological support have limb loss specific knowledge.

Diabetes complications in people with alcohol use disorder and type 2 diabetes.

People living with alcohol use disorder (AUD) who develop Type 2 Diabetes (T2DM) may be at higher risk of diabetes-complications. Our aims were to compare diabetes-monitoring and incidence of diabetes-complications between people with and without AUD prior to T2DM diagnosis attending primary care in England. We used the Clinical Practice Research Datalink (CPRD) Aurum linked with Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality data. The target population was people with incident T2DM diagnosed between 2004-2019. We defined AUD from codes indicating i) clinical diagnosis; ii) alcohol withdrawal; or iii) chronic alcohol-related harm. Outcomes were end stage renal disease (ESRD), lower limb amputation, myocardial infarction (MI), stroke, cardiovascular disease (CVD) mortality and all-cause mortality. We compared yearly HbA1c, creatinine and cholesterol monitoring activities for the first 5 years post T2DM diagnosis. The study population was 543,509 people, of whom 15 237(2.8%) had a code for AUD. Adjusting for measured confounders, people with AUD had higher rates of ESRD (IRR 1.95 95% CI 1.71, 2.23), lower limb amputation (IRR 1.78 95% CI 1.50, 2.21), stroke (IRR 1.35 95% CI 1.25, 1.46), CVD mortality (IRR 1.74 95% 1.63, 1.86) and all-cause mortality (IRR 2.10 95% CI 2.04, 2.17) but not MI (IRR 0.91 95% CI 0.82, 1.00) compared with people without AUD. Laboratory diabetes-monitoring was high in people with (83.5-91.1%) and without (83.7-92.4%) AUD. People with AUD had nearly double the rates of most of the diabetes-complications investigated than people without AUD.

Physical activity patterns following major lower limb amputation

Introduction and aim of study: Lower limb amputation is one of the most common acquired disabilities. The main aim of the study was to assess global trends regarding the procedure, investigate the current trends in post-amputation care, particularly in terms of returning to physical fitness, and identify potential fields of interest in order to improve the everyday life of people with lower limb amputation. Materials and methods: The authors based this review paper on a widespread analysis of scientific articles published in Science Direct, PubMed, UpToDate, Cochrane, Springer, and Google Scholar, the 2021 Global Burden of Disease Study, and government platforms. Results: The collected information emphasizes the existence of numerous barriers discouraging from participating in sports. The post-amputation care is crucial and requires a multidisciplinary team approach. Chronic pain restricts physical activity significantly. Different types of movement focused on specific muscle groups improve functionality. Conclusions: Disability as a result of lower limb amputation is a significant social issue requiring more action to improve its visibility. New strategies ought to be implemented to educate people with disabilities on the importance of physical activity. The new technologies that are currently under investigation may bring some novelty to the topic in the future. Keywords: Amputation, Artificial limbs, Rehabilitation, Para-Sports

Assessing walking speed in persons with a lower-limb amputation: Test-retest reliability of the 10-m walk test.

Preferred walking speed (PWS), maximal walking speed (MWS), and walking speed reserve (WSR)-the difference between MWS and PWS-can be easily obtained from the 10-m walk test (10MWT) to assess walking ability and function. However, their test-retest reliability has not been determined in persons with unilateral lower-limb amputation (LLA). To determine the reliability of the PWS, MWS, and WSR obtained from the 10MWT in persons with LLA. Test-retest with a 48- to 120-h interval between test days. Test-retest relative and absolute reliability was assessed by the intraclass correlation coefficient (ICC) and the %change in mean (%CM) and coefficient of variation (CV), respectively. Preferred walking speed showed excellent reliability between day 1 (familiarization day) and day 2 (ICC = 0.97; %CM = -1.8; CV = 7.7) and a significant speed increase from day 2 to day 3 (ICC = 0.96; %CM = 8.5, p < 0.003; CV = 7.4). Maximal walking speed showed excellent reliability between day 1 and day 2 (ICC = 0.94; %CM = 2.9; CV = 8.3) and between day 2 and day 3 (ICC = 0.94; %CM = 1.8; CV = 8.6). Overall, WSR was poorly reliable between day 1 and day 2 (ICC = 0.65; %CM = 39.2; CV = 39.2) and between day 2 and day 3 (ICC = 0.74; %CM = 30.0; CV = 30.0). Preferred walking speed obtained from a single 10MWT and MWS obtained after a 10MWT familiarization day are reliable walking speed measures for persons with LLA with similar characteristics to those of our sample. Nonetheless, it is critical that both PWS and MWS are obtained after a 10MWT familiarization to obtain a reliable WSR.

Spatiotemporal gait parameters influencing functional mobility of people with lower limb amputation.

Walking speed is a measure of functional mobility that is relatively easy to quantify. In people with lower limb amputation, reduced walking speed has been linked with specific atypical spatiotemporal gait parameters. However, the influence of atypical spatiotemporal gait parameters on the walking speed of people with unilateral transtibial amputation (TTA) and transfemoral amputation (TFA) remains unclear. To identify spatiotemporal gait parameters influencing walking speed of people with unilateral TTA or TFA. Cross-sectional. The 10-meter walk test (10mWT) was used to measure walking speed, and an instrumented walkway was used to record spatiotemporal gait parameters. Regression analyses were used to determine the best subset of spatiotemporal gait parameters that influence the walking speed of people with TTA and TFA. The study included 43 people with TTA and 49 with TFA. In the TTA group, spatiotemporal gait parameters accounted for 65.5% of the variance in walking speed, with prosthetic single limb support accounting for 52.2%, prosthetic terminal double limb support accounting for 8.9%, and stride width accounting for 4.4%. In the TFA group, intact swing accounted for 46.7% of the variance in walking speed. There was no significant difference in walking speed between the TTA and the TFA groups (p > 0.05). The study's results highlight specific spatiotemporal gait parameters that affect the walking speed of people with unilateral TTA and TFA. In addition, results suggest that walking speed over short distances is not confounded by amputation level (i.e., TTA and TFA).

Prevalence and Molecular Characterization of Carbapenemase-Producing Multidrug-Resistant Bacteria in Diabetic Foot Ulcer Infections.

Background: Diabetic foot ulcers (DFUs) represent severe complications in diabetic patients, often leading to chronic infections and potentially resulting in nontraumatic lower-limb amputations. The increasing incidence of multidrug-resistant (MDR) bacteria in DFUs complicates treatment strategies and worsens patient prognosis. Among these pathogens, carbapenemase-producing pathogens have emerged as particularly concerning owing to their resistance to β-lactam antibiotics, including carbapenems. Methods: This study evaluated the prevalence of MDR bacteria, specifically carbapenemase-producing pathogens, in DFU infections. A total of 200 clinical isolates from DFU patients were analyzed via phenotypic assays, including the modified Hodge test (MHT) and the Carba NP test, alongside molecular techniques to detect carbapenemase-encoding genes (blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48). Results: Among the isolates, 51.7% were confirmed to be carbapenemase producers. The key identified pathogens included Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Escherichia coli. The most commonly detected carbapenemase genes were blaKPC (27.6%) and blaNDM (24.1%). Carbapenemase-producing isolates presented high resistance to β-lactam antibiotics, whereas non-carbapenemase-producing isolates presented resistance through mechanisms such as porin loss and efflux pumps. Conclusions: The findings of this study highlight the significant burden of MDR infections, particularly carbapenemase-producing organisms, in DFUs. MDR infections were strongly associated with critical clinical parameters, including pyrexia (p = 0.017), recent antibiotic use (p = 0.003), and the severity of infections. Notably, the need for minor amputations was much higher in MDR cases (p < 0.001), as was the need for major amputations (p < 0.001). MDR infections were also strongly associated with polymicrobial infections (p < 0.001). Furthermore, Wagner ulcer grade ≥II was more common in MDR cases (p = 0.002). These results emphasize the urgent need for enhanced microbiological surveillance and the development of tailored antimicrobial strategies to combat MDR pathogens effectively. Given the high prevalence of carbapenem resistance, there is an immediate need to explore novel therapeutic options to improve clinical outcomes for diabetic patients with DFUs.

Biomechanical effects of saddle height changes in leisure cycling with unilateral transtibial prostheses: A simulated study.

Cycling is a beneficial physical activity for rehabilitating individuals with lower-limb amputations and serves as a feasible leisure sport. However, the optimal bicycle configuration for cycling with a unilateral transtibial prosthesis at leisure levels has not been investigated. For saddle height at professional cycling levels, existing literature suggests utilizing the same configuration as that used by intact cyclists, where the knee reaches 25-35° at maximum extension. However, leisure cyclists tend to select lower saddle heights, and cycling with a unilateral transtibial prosthesis infers altered biomechanics during cycling practice. This study aimed to investigate the effects of cycling at different saddle heights with a simulated unilateral prosthesis. Ten able-bodied participants wore orthoses to simulate prosthetic conditions. The experimental task was performed on an ergometer at 40 W resistance, 60 rpm to simulate leisure cycling. Standard saddle height was defined as maximum knee extension of 45°. This height was used as the control condition and its trials were performed without orthoses. The variable heights were set as height percentage variations (-7%, -3.5%, 0, +3.5%, and +7%). Muscle activity, joint movement, force application to the pedals, perceived exertion, and comfort were evaluated. The -3.5% and -7% saddle heights resulted in joint movement and muscle activity levels closer to those in the control conditions, which also showed improved power symmetry between the affected and non-affected legs. In addition, the -3.5% height increased comfort level in participants. In conclusion, selecting lower saddle heights may be beneficial for unilateral transtibial amputees during leisure cycling. The optimal saddle height for this population may maintain maximum knee extension within the 37-45° range, dynamically measured on the affected side.

Increased risk of type 2 diabetes after traumatic amputation: a nationwide retrospective cohort study.

Amputation confers disabilities upon patients and is linked to cardiometabolic morbidity and mortality. We aimed to compare the incidence of type 2 diabetes (T2DM) between individuals following amputation with those of the general population. We performed a population-based retrospective cohort study using the Nationwide Health Insurance Service database. A total of 21,343 individuals with amputation during 2010-2018 and their 1:3 age- and sex-matched controls was included. We conducted Cox proportional hazard analysis to calculate the risk of T2DM among individuals with amputation. During the 4.2 ± 2.5 year mean follow-up period, there were 912 incident T2DM cases (10.7 per 1,000 person-years) among individuals with amputation. Individuals with amputation had a higher risk for T2DM (adjusted hazard ratio [aHR] 1.11, 95% confidence interval [CI] 1.03-1.20) compared with matched controls. The risks were increased further when accompanied with disability; those with severe disability had a higher risk of T2DM (aHR 1.77, 95% CI 1.20-2.60) than matched controls. Individuals with proximal upper limb amputation (aHR 1.10, 95% CI 1.02-1.18) and proximal lower limb amputation (aHR 3.60, 95% CI 1.50-8.64) had a higher risk of T2DM compared with matched controls. Individuals with amputation were at significantly greater risk for T2DM than the general population, particularly those with severe disability and proximal amputation. Innovative strategies that improve and support the long-term T2DM risk for severely injured individuals with proximal amputation are warranted.

Changes in Muscle Activation and Joint Motion During Walking After Transtibial Amputation with Sensory Feedback from Spinal Cord Stimulation: A Case Study.

The goal of this study was to examine the effects of spinal cord stimulation (SCS) on muscle activity during walking after lower-limb amputation. Amputation results in a loss of sensory feedback and alterations in gait biomechanics, including co-contractions of antagonist muscles about the knee and ankle, and reduced pelvic obliquity range-of-motion and pelvic drop. SCS can restore sensation in the missing limb, but its effects on muscle activation and gait biomechanics have not been studied in people with lower-limb amputation. This case study included a participant with transtibial amputation who was implanted percutaneously with SCS electrodes over the lumbosacral enlargement for 84 days. SCS was used during in-lab experiments to provide somatosensory feedback from the missing limb, relaying a sense of plantar pressure when the prosthesis was in the stance phase of the gait cycle. We used electromyography (EMG) to record muscle activity from the residual and intact limbs, and 3D motion capture to measure pelvic obliquity. EMG signals were recorded during walking with and without SCS at early and late time points across the implant duration. During walking, co-contraction of knee antagonist muscles was reduced following multiple sessions of SCS-mediated sensory restoration. Additionally, the activation of the hip abductor (tensor fasciae latae) muscle increased activity during gait with SCS-mediated sensory restoration, which corresponded to an increase in pelvic obliquity range-of-motion and pelvic drop, towards normal. Restoring sensation in the missing limb using SCS modulated muscle activity during walking leading to improved coordination and pelvic motion in an individual with lower-limb amputation.

Skin adaptation in lower limb amputees assessed through Raman spectroscopy and mechanical characterization.

Following lower limb amputation residuum skin from the lower leg is used to reconstruct the residual limb. Unlike skin on the sole of the foot (plantar skin), leg skin is not inherently load bearing. Despite this, leg skin is required to be load bearing in the prosthetic socket. Current hypotheses propose that lower limb amputee skin can adapt to become load bearing with repeated prosthesis use. Here, we show using confocal Raman spectroscopy, mechanical characterization and cytokine analysis that adaptations occur which actually result in impaired barrier function, higher baseline inflammation, increased coefficient of friction and reduced stiffness. Our results demonstrate that repeated frictional trauma does not confer beneficial adaptations in amputee skin. We hypothesize that non-plantar skin lacks the biological capabilities to respond positively to repeated mechanical trauma in the same manner observed in plantar skin. This finding highlights the need for improved therapies as opposed to current mechanical conditioning or product solutions that directly relate to improving load-bearing capacity on the skin of lower limb amputees. This study also highlights the importance of measuring multiple parameters of application-specific skin at different scales for skin tribology applications.

Methods for tissue perfusion assessment after Dellon decompression of tarsal tunnels in diabetic neuropathy: key to effective management-a narrative review.

Diabetic neuropathy significantly elevates the risk of foot ulceration and lower-limb amputation, underscoring the need for precise assessment of tissue perfusion to optimize management. This narrative review explores the intricate relationship between sympathetic nerves and tissue perfusion in diabetic neuropathy, highlighting the important role of autonomic neuropathy in blood flow dynamics and subsequent compromises in tissue perfusion. The consequences extend to the development of diabetic peripheral neuropathy and related foot complications. By analyzing both non-invasive diagnostic methods and surgical interventions, such as tarsal tunnel decompression, the paper seeks to highlight their effectiveness in improving tissue perfusion, preventing ulcers, and reducing the risk of amputations in patients with diabetic peripheral neuropathy. We reviewed current literature on both non-invasive diagnostic tools and surgical techniques for assessing and improving tissue perfusion in diabetic neuropathy. Methods discussed include transcutaneous oxygen pressure (TcPO2), Doppler ultrasound, Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI, and the SPY Laser Angiographic System. Emphasizing the critical importance of surgical interventions, such as tarsal tunnel decompression and neurolysis of the posterior tibial nerve, the article underscores their efficacy in enhancing tissue perfusion and preventing ulcers and amputations. Additionally, it addresses the significance of precise blood flow measurement and timely intervention in the management of diabetic neuropathy and foot ulcers. The non-invasive techniques for assessing tissue perfusion and blood flow in diabetic neuropathy such as TcPO2, Doppler ultrasound and Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI are explained. Also, this review introduces the SPY Laser Angiographic System, which employs near-infrared fluorescence imaging to assess blood flow and perfusion in tissues. This advanced tool generates real-time microvascular blood flow images and proves instrumental in diagnosing and monitoring diabetic foot ulcers. In conclusion, surgical interventions, both vascular and peripheral nerve are pivotal for optimizing patient care. Early identification of foot ulcers and peripheral arterial disease is imperative, and an understanding of blood flow dynamics, combined with effective surgical techniques, constitutes key elements in managing diabetic neuropathy, healing and preventing ulcers, and limb salvage.

'I cut toenails with scissors and trim it with sand paper'. Patients' perspectives on diabetic foot complications.

This study aimed to explore type 2 diabetes mellitus patients' perspectives on diabetic foot complications and challenges of footcare management in Sigatoka, Fiji. This study applied a qualitative approach among persons with diabetes who attended diabetic foot clinics from August to September 2021. Participants were selected through purposive sampling and included any self-identified Fijian aged 18 years and over who had type 2 diabetes with a minimum diagnosis duration of 6 months and no experience of an amputation. Data were collected using semi-structured in-depth interviews, and the content of interviews was transcribed and analysed using thematic analysis to generate themes and subthemes outlined in the study. The study included 30 participants. Three major themes were identified. The first was patient perceptions of diabetic foot complications, which showed that there was very limited patient knowledge of how diabetes caused foot complications. The second was practising foot care, which reflected that commonly practised recommendations were associated with daily activities like washing the feet. Third was patient perceptions of footcare services, whereby the majority were generally happy with the footcare services available to them. The study results indicated that patients lacked sufficient knowledge about the symptoms and prevention of type 2 diabetes mellitus, and healthy practices related to food complications. More effort needs to be invested into diabetes and footcare knowledge and practices for patients at the Sigatoka Hospital. This will help guide patients to make life-altering decisions that can help reduce the rate of diabetes related lower limb amputations, which are easily preventable.

Epidemiology of major amputation following diabetic foot ulcer: Insights from recent nationwide data in the french national health registry (SNDS).

The out-of-hospital care pathways of people with DFU have been little studied. We used the French National Health Data System (SNDS) to collect refund and care pathway data for all French residents. The aim of this study was to determine the incidence of major lower limb amputation (MA) and associated risk factors in a population with an incident DFU. We included any person living with diabetes and incident DFU. The primary endpoint was the occurrence of MA within one year. We considered the course and consumption of care one year before and one year after the initial event. In 2018, 133,791 people were included, and during the follow-up, MA was performed in 4,733 (3.5 %). Among these people with MAs, 16.4 % were included via the out-of-hospital part of the protocol, and their first contact with the hospital led to MA. Factors associated (hazard ratio, HR [95 % confidence interval, CI]) with MA were: being male (1.92 [1.78;2.08]), arteriopathy of the lower limb (10.16 [9.36;11.03]), psychiatric disease (1.10 [1.01;1.20]) and end-stage renal disease (2.12 [1.93;2.33]). Regarding the care pathway, associations (HR [95 %CI]) were observed between lower MA rates and people with more general practitioner (0.83 [0.75-0.91]), private nurse (0.88 [0.81-0.95]) and diabetologist (0.88 [0.81-0.95]) visits. Living in the most disadvantaged municipalities was associated (HR [95 %CI]) with a higher MA rate (1.17[1.06-1.29]). This is the first national study of the care pathways followed by people with DFU. Failures in the care pathway, precariousness and several comorbidities were identified, with an impact on the MA risk.

Financial Toxicity And Unemployment In Patients With Major Lower Limb Amputation Are High

Financial Toxicity And Unemployment In Patients With Major Lower Limb Amputation Are High

Leptin deficiency leads to nerve degeneration and impairs axon remyelination by inducing Schwann cell apoptosis and demyelination in type 2 diabetic peripheral neuropathy in rats

Diabetic peripheral neuropathy, characterized by symptoms such as paresthesia, neuropathic pain, and potential lower limb amputation, poses significant clinical management challenges. Recent studies suggest that chronic hyperglycemia-induced Schwann cells (SCs) apoptosis contributes to neurodegeneration and impaired nerve regeneration, but the detailed mechanisms are still unknown. Our study investigated a mixed-sex type 2 diabetes mellitus (T2DM) rat model using leptin knockout (KO) to simulate obesity and diabetes-related conditions. Through extensive assessments, including mechanical allodynia, electrophysiology, and microcirculation analyses, along with myelin degradation studies in KO versus wild-type rats, we focused on apoptosis, autophagy, and SCs dedifferentiation in the sciatic nerve and examined nerve regeneration in KO rats. KO rats exhibited notable reductions in mechanical withdrawal force, prolonged latency, decreased compound muscle action potential (CMAP) amplitude, reduced microcirculation, myelin sheath damage, and increases in apoptosis, autophagy, and SCs dedifferentiation. Moreover, leptin KO was found to impair peripheral nerve regeneration postinjury, as indicated by reduced muscle weight, lower CMAP amplitude, extended latency, and decreased remyelination and SCs density. These findings underscore the effectiveness of the T2DM rat model in clarifying the impact of leptin KO on SCs apoptosis, dedifferentiation, and demyelination, providing valuable insights into new therapeutic avenues for treating T2DM-induced peripheral neuropathy.

P06 Antibiotic usage post lower limb amputation in a single UK centre: do we need a targeted national approach?

P06 Antibiotic usage post lower limb amputation in a single UK centre: do we need a targeted national approach?