Amputation Stump Research Articles

Role of vacuum assisted closure (VAC) in treatment of difficult to heal wounds in lower extremity- our experience in 100 cases

Aims and objectives 1. To study effectiveness of lower limb problems like: lower limb injuries, difficult to heal wounds like amputation stumps, necrotizing fasciitis, diabetic foot, burns wounds and deep electrical burns wounds, cellulitis and extensively oozing wounds. 2. Improvement in take of graft or flap. 3. Reduction of infection and surface bacterial count in wounds reducing morbidity and mortality and making treatment cost effective, also. 4. Salvaging lower limbs. Methods: Standard method of VAC application is used in our study with step wise manner. Wound debridement, hemostasis done, VAC applied by standard method. Negative pressure around 125 to 150 kept in our study. Out of 100 cases, 50 cases are lower limb injuries due to trauma, accident, amputation stumps, 40% cases are due to necrotising fasciitis and cellulitis, septicaemia. 10% cases are due to bedsore and its infection management. Lower limb wounds with exposed tendons or bones, orthopaedic implants exposed,-are well managed with VAC. Standard method of VAC application is followed in each case. Result: Out of 100 cases of lower limb problems with difficult to heal wounds, amputation stumps treated, we found infection is effectively reduced, wound discharge is reduced, wounds granulated well and early, and wound bed prepared early for skin graft take or flap take. Conclusion: Vacuum assisted closure (VAC) is very good modality of treatment, which assists plastic surgeons in healing wounds specially in difficult to treat lower limb wounds.

Use of adjuvant hyperbaric oxygen therapy in a patient with traumatic inoculation of mucormycosis resulting in extremity amputation

A 64-year-old man with uncontrolled diabetes mellitus presented to the emergency department with worsening left lower extremity pain, hypotension, fever and altered mental status (figure 1). Eleven days prior, he...

Primary vs delayed primary closure in patients undergoing lower limb amputation following trauma: A randomised control study

Lower limb crush injury is a major source of mortality and morbidity in trauma patients. Complications, especially surgical site infections (SSIs) are a major source of financial burden to the institute and to the patient as it delays rehabilitation. As such, every possible attempt should be made to reduce any complications. We, thus, aimed to compare the outcomes in early vs delayed closure of lower extremity stumps in cases of lower limb crush injury requiring amputation, so as to achieve best possible outcome. A randomised controlled study was conducted in the Division of Trauma Surgery & Critical Care at Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi from 1 September 2018 to 30 June 2019 and included patients undergoing lower limb amputation below hip joint. Patients were randomised in two groups, in one group amputation stump was closed primarily, while in the second group delayed primary closure of stump was performed. We compared rate of SSI, length of hospital stay, and number of surgeries in both the groups. Fifty-six patients with 63 amputation stumps were recruited in the study. Mean age of patients in the study was 34 years, of which about 95% patients were males. The most common mechanism of injury was road traffic injury in 66% of patients. Mean injury severity score was 12.28 and four patients had diabetes preoperatively. Total 63 extremities were randomised with 30 cases in group I and 33 cases in group II as per computer-generated random number. Above knee amputations was commonest (57.14%) followed by below knee amputations (33.3%). Two patients died in the current study. In group I, In-hospital infection was detected in 7 cases (23.3%) and in group II 9 cases (27.3%) had SSI during hospital admission (P > .05). Mean hospital stay in group I was 10.32 ± 7.68 days and in group II was 11 ± 8.17 days (P > .05). Road traffic injuries and train-associated injuries are a major cause of lower limb crush injuries, leading to limb loss. Delayed primary closure of such wounds requires extra number of surgical interventions than primary closure. There is no difference in extra number of surgical interventions required in both the groups. Thus, primary closure can be safely performed in patients undergoing lower limb amputations following trauma, provided that a good lavage and wound debridement is performed.

The Microsurgical Calcaneus Osteocutaneous Fillet Flap After Traumatic Amputation in Lower Extremities: Flap Design and Harvest Technique.

Attempts to salvage upper and lower extremities have performed more frequently in recent decades, although there are clear cases that cannot be salvaged. The purpose of this retrospective study was to present our experience in using free calcaneus osteocutaneous fillet flap for preserving below-knee amputation stump after traumatic amputations or functional preserving after nonsalvageable lower extremities. Between January 2012 and May 2017, 11 free calcaneus osteocutaneous fillet flap were used to preserving or lengthening below-knee amputation stump secondary to amputation on 8 males and 3 females. Patients' information and postoperative data were collected, including age of patient, sex, amputation site, flap survival, sensation recovery, and number of complications. All amputations were trauma related and secondary to motor vehicle accidents (n = 8) and industrial accidents (n = 3). The age of the patients ranged from 16 to 59 years, with a mean of 34.4 years. Free calcaneus osteocutaneous fillet flap were designed and harvested from all patients. All flaps survived and 2 complications developed in 2 patients. Nine of 11 patients obtained protective sensory recovery during the period of follow-up. The free calcaneus osteocutaneous fillet flap harvested from the amputated limb provides reliable and robust tissue for reconstruction of large defects of the residual limb without additional donor-site morbidity.

Autologous micro-fragmented adipose tissue for the treatment of diabetic foot minor amputations: a randomized controlled single-center clinical trial (MiFrAADiF)

BackgroundThe diabetic foot ulcer (DFU) is one of the most prevalent complications of diabetes mellitus and often develops severe effects that can lead to amputation. A non-healing “minor” amputation often precedes a major amputation resulting in a negative impact on the function and quality of life of the patients. Stem cell-based therapies have emerged as a promising option to improve healing, and the adipose tissue is an abundant and easy to access source. The injection of autologous micro-fragmented adipose tissue at the amputation stump of a diabetic population undergoing a lower limb minor amputation was evaluated and compared with the standard care.MethodsIn this randomized controlled trial with two arms (parallel assignment) and no masking, 114 patients undergoing a lower limb minor amputation were randomized to standard of care or to micro-fragmented adipose tissue injection prepared using a minimal manipulation technique (Lipogems®) in a closed system. Clinical outcomes were determined monthly up to 6 months. Primary endpoint of the study was the evaluation of the healing rate and time after the minor amputation. Secondary endpoints included the assessment of safety, feasibility, technical success, relapse rate, skin tropism, and intensity of pain.ResultsAt 6 months, 80% of the micro-fragmented adipose tissue-treated feet healed and 20% failed as compared with the control group where 46% healed and 54% failed (p = 0.0064). No treatment-related adverse events nor relapses were documented, and technical success was achieved in all cases. The skin tropism was improved in the treatment group, and the pain scale did not differ between the two groups.ConclusionThe results of this randomized controlled trial suggest that the local injection of autologous micro-fragmented adipose tissue is a safe and valid therapeutic option able to improve healing rate following minor amputations of irreversible DFU. The technique overcomes several stem cell therapy-related criticisms and its potential in wound care should be better evaluated and the therapeutic indications could be expanded.Trial registrationClinicalTrials.gov number: NCT03276312. Date of registration: September 8, 2017 (retrospectively registered).

Spatially Filtered Low-Density EMG and Time-Domain Descriptors Improves Hand Movement Recognition.

Surface Electromyogram (EMG) pattern recognition has long been utilized for controlling multifunctional myoelectric prostheses. In such an application, a number of EMG channels are usually utilized to acquire more information about the underlying activity of the remaining muscles in the amputee stump. However, despite the multichannel nature of this application, the extracted features are usually acquired from each channel individually, without consideration for the interaction between the different muscles recruited to achieve a specific movement. In this paper, we proposed an approach of spatial filtering, denoted as Range Spatial Filtering (RSF), to increase the number of EMG channels available for feature extraction, by considering the range of all possible logical combinations of each n channels. The proposed RSF method is then combined with conventional time-domain (TD) feature extraction, as an extension of the conventional single channel TD features that are heavily considered in this field. We then show how the addition of a new feature, specifically the minimum absolute value of the range of each two windowed EMG signals, can significantly reduce the different patterns misclassification rate achieved by conventional TD features (with and without our RSF method). The performance of the proposed method is verified on EMG data collected from nine transradial amputees (seven traumatic and two congenital), with six grip and finger movements, for three different levels of forces (low, medium, and high). The classification results showed significant reduction in classification error rates compared to other methods (nearly 10% for some individual TD features and 5% for combined TD features, with Bonferroni corrected p-values <; 0.01).

Role of Fat Graft Alone versus Enriched Fat Graft with Stromal Vascular Filtrate in Painful Amputation Stump.

Background:Traumatic amputations are very prevalent in today's world. Successful rehabilitation of an amputee largely depends on how well he/she adapt to prosthesis. However, because of poor scar characteristics, these patients often complain of pain while using prosthesis. Autologous fat graft is being vastly used all over the world to improve the scar of various etiologies. However, it has been associated with unpredictable resorption rate.Objectives:We report the results of the study which was done to assess the consequences of fat grafting over scars and to see its effects on pain management in amputated stump and compare the autologous fat graft with stromal vascular filtrate (SVF)-enriched fat graft for scar remodeling and pain modulation on amputation stumps.Materials and Methods:A prospective randomized trial was conducted from July 2014 to December 2015. A group of ten patients, who were unable to wear prosthesis due to painful amputation stump, incorporated in the study and randomly distributed in two groups. Group A of five patients (case group) was treated with autologous fat graft enriched with SVF while Group B (control group) of remaining five patients was treated with fat graft alone. The results were assessed at baseline, at 1 month, and at 6 months postoperatively using patient and observer scar assessment scale (POSAS) score. Magnetic resonance imaging (MRI) was done to compare fat content preoperatively and 6 months postoperatively.Results:All ten patients reported improvement in scar characteristics, most notably in pain in both scales of POSAS score. The improvement was comparable in both groups. However, the fat content in case group was significantly more in comparison to control group when assessed 6 months postoperatively using MRI scan.Conclusion:Autologous fat grafting is a viable and minimally invasive solution for painful amputation stump. Enrichment of fat graft with SVF can enhance its viability over long term. This study was done as a pilot project. Hence, further long term studies with large sample size are needed to ascertain the benefits observed in this study.

Role of negative pressure wound therapy in orthopaedics: Our experience in 20 cases

Background: Open injuries and infections are still the concern for the orthpadecians. Negative pressure wound therapy is one of several methods enabling to obtain better treatment results in case of open infected wounds. The use of negative pressure therapy enables to obtain a reduction in the number of bacteria which significantly reduces the number of complications and helps to decrease th wound size significantly.Aims and Objectives: To review the usefulness of negative pressure wound therapy in Orthopaedics. Materials and Methods: The cases presented in this study are those who were admitted in King George Hospital in the time period from September 2013 to September 2016. This is a prospective interventional study. In this study, 20 patients were assigned to the study group (Negative Pressure Wound Therapy- NPWT) based on their willingness for undergoing treatment. Observations and Results: 12 males and 8 females are involved in the study. There is decrease in the mean wound area from 64 cm2 to 38 cm2. There is decrease in the duration of hospital stay. Finally, wound is closed by SSG or secondary suturing.Discussion: NPWT is known to decrease bacterial counts. NPWT significantly decreases infection rates, enhances wound healing there by decreases the hospital stay to the patients. In our series, we had 70% (14 cases) excellent results and 30% (6 cases) good results and no poor results. As interpretation with results, VAC therapy is effective mode of adjuvant therapy for the management of infected wounds.Conclusion: VAC has been proven to be a reliable method of treating a variety of infected wounds. It greatly increases the rate of granulation tissue formation and lowers bacterial counts to accelerate wound healing. It can be used as a temporary dressing to prepare wounds optimally prior to closure or as a definitive treatment for nonsurgical and surgical wounds. VAC is now being used in a multitude of clinical settings, including the treatment of surgical wounds, infected wounds, traumatic wounds, pressure ulcers, diabetic foot ulcers and venous stasis wounds, amputation stumps.

Reamputation rates, morbidity and rehabilitation after lower limb amputations

Background: This study attempted to document the indications for lower limb amputation (LLA) and its outcomes especially the wound healing problems, reamputations and subsequent use of prosthesis for mobilization in Indian population.Methods: This observational study included 92 patients over a period of 18 months. Indications, level of LLA, morbidity and reamputation rates after LLA were recorded. Stump status, wound healing and other morbidity was followed over period of one month. The use of prosthesis and level of mobility were assessing in follow-up over a period of six months.Results: There were total 109 LLA in 92 patients as some of these patients had to undergo revision of amputation stump at a higher level. Atherosclerosis (29.3%) was the main cause for LLA. Age group 35-55 years and male patients were most commonly needed LLA. Total 64.13% patients developed post-operative wound infection and 18.4% patients underwent reamputation. E. coli and Staphylococcus were the most common organism cultured from the infected surgical site. Conversion of below knee amputation (BKA) to above knee amputation (AKA) was the most frequent reamputation and atherosclerosis was the leading cause. According to final level LLA, 54 had major amputations (above ankle joint), only 37% were using a prosthesis whereas majority of patients were dependent on crutches/walker.Conclusions: Patients of atherosclerosis and trauma had a higher frequency of reamputations. Only 37% of major LLA opted for prosthesis whereas majority of patients mobilize by other means like crutches or walker.

An Experimental Study in the Surgical and Anesthesio-Pharmacological Implications of the Practical Applicability of the Concept of Myoplastic Transposition Through a Forearm Fascia Breach

The traumatic or surgical amputation of the forearm or of the hand is a challenging interdisciplinary domain, requiring the collaboration of surgeons, engineers, prostheticians, clinical pharmacology experts in chronic pain management, exoprosthesis manufacturing companies, social workers and last but not least the patient himself/herself. There are a relative few methods of surgical preparation of the amputation stump for use use an external prosthesis. Most of these techniques do not provide a sufficient number of electrical sEMG signals for the efficient control of a modern myoelectric exoprosthesis. We present the surgical aspects and anesthesio-pharmacological implications of the practical study into the applicability of the concept of myoplastic transposition through a forearm fascia breach. We present the data and we discuss the results of sEMG signal acquisition, both before and after the procedure, and we conclude regarding the potential of the method as a means of improving the current standard surgical technique.

Honey-Based Salve and Burdock Leaf Dressings as an Alternative to Surgical Debridement of a Traumatic Wound Eschar.

Objective: Nonviable necrotic eschar is an impedance to wound healing and can ultimately lead to failure of soft tissue coverage in traumatic or high-risk wounds. Topical therapeutic agents can provide a less invasive management alternative to surgical debridement of eschar.Approach: The case of a 40-year-old male with a traumatic right lower extremity amputation complicated by surgical incision ischemic eschar formation is reported. Honey-based salve with burdock leaf dressings was used to noninvasively manage eschar extending over the incision site. Images were obtained for 5 months of follow-up.Results: Five-month follow-up demonstrated complete resolution of eschar and re-epithelialization of skin in the affected region.Innovation: Honey-based salve with burdock leaf dressings shows promise for enhancing healing outcomes in traumatic wounds that develop nonviable eschar.Conclusion: Surgical debridement of an amputation stump with large ischemic eschar was avoided with the use of honey-based salve with burdock leaf dressings.

Mechanical and Finite Element Analysis of an Innovative Orthopedic Implant Designed to Increase the Weight Carrying Ability of the Femur and Reduce Frictional Forces on an Amputee's Stump.

This study was designed to test the hypothesis that: "A properly designed implant that harnesses the principle of the incompressibility of fluids can improve the weight carrying ability of an amputee's residual femur and reduce the frictional forces at the stump external socket interface." The hypothesis was tested both mechanically on an Amputee Simulation Device (ASD) and through Finite Element Analysis (FEA) modeling software. With the implant attached to the femur, the FEA and ASD demonstrated that the femur carried 90% and 93% respectively of the force of walking. Without the implant, the FEA model and ASD femur carried only 35% and 77%, respectively, of the force of walking. Statistical calculations reveal three (3) degrees of separation (99% probability of non-random significant difference) between with and without implant data points. FEA modeling demonstrates that the normal contact forces and shear forces are pushed the distal weight-bearing area of the amputee stump, relieving the lateral stump of frictional forces. The ASD mechanical and FEA modeling data validate each other with both systems supporting the hypotheses with confidence intervals of three degrees of separation between with implant and without implant models.

Iliac crest apophysis transfer to treat stump overgrowth after limb amputation in children: case series and literature review.

Stump overgrowth is the main problem of limb amputation in children. Many surgical procedures have been developed to overcome the problem, but all have shown inconsistent results. The only surgical procedure that has been successful in preventing overgrowth is capping of the amputated limb with a cartilaginous cap taken from the amputated limb, usually from the head of fibula. A donor site is not available in revision cases. Iliac crest apophysis transfer was suggested to treat the condition, but has never been previously reported. The purpose of this study is to review the results of iliac crest apophysis transfer to prevent stump overgrowth. Five children with amputation stump overgrowth underwent iliac apophyseal transfer to cap the resection site of the overgrowth. Retrospective review showed that three of the five suffered recurrent stump overgrowth two to fouryears after the index surgery. All three were revised again. One patient was lost to follow-up. Although many studies showed capping of the stump with cartilaginous cap to be successful in preventing stump overgrowth, iliac crest apophysis transfer was only successful in one of four cases available to follow-up (25%). This is not a reliable enough method to be used routinely.

Free muscle sparing vertical rectus abdominis myocutaneous flap

Introduction: Abdominal region is a unique donor area in the reconstructive surgery to provide numerous flaps. The aim of this study is to show effectivity of the free vertical rectus abdominis muscle (VRAM) flap in the complex wounds reconstruction without damaging integrity of the rectus abdominis muscle and sacrificing the opposite deep inferior epigastric artery. Materials and Methods: The study population was composed of all patients who applied to our department for evaluation and management of the complex wounds reconstruction with the free muscle sparing (MS) vertical rectus abdominis flap, between September 2011 and October 2015. Results: We utilized the free MS vertical rectus abdominis flap to closure complex wounds in seven patients (6 males and 1 female) in our department. Etiologies were malign skin tumors, amputation stump, unstable scar, and crush injury in three, two, one, and one patients, respectively. All MS vertical rectus abdominis flaps survived completely. A hematoma developed in the recipient site in one case, and it was immediately evacuated without any problem. Conclusions: Free MS vertical rectus abdominis flap is a quite easy and reliable flap to harvest from abdominal wall, reducing the possibility of bulging or hernia formation with less morbidity of the donor site.

Squamous Cell Carcinoma over Cutaneous Verrucous Lichen: One Case in Parakou (Benin)

Introduction: We report an unusual case of squamous cell carcinoma on a verrucous lichen of chronic evolution taken in charge in Borgou/Alibori UHC in Parakou (Benin). Observation: A 75-year old Beninese woman with a history of portal hypertension post-viral cirrhosis C treated with negative viral load, had consulted for a large chronic ulceration of the right foot back. The beginning of the symptomatology would go back to about 30 years, marked by lichenified, pruriginous popular lesions; these lesions would initially be treated as eczema and then mycosis by health personnel not specialised in dermatology and multitreated with unspecified topicals. General state was altered. In addition to ulceration, the dermatological examination found plates of hyperpigmented lichen lesion, homogeneous and well limited bilateral and symmetrical topography on the pelvic limbs making difficult to walk. Anatomopathological examination of the biopsy sample straddling the ulceration and its edges suggested a hypertrophic cutaneous lichen associated with keratinizing, infiltrating epidermal carcinoma. The chest-abdominal-pelvic scan showed no metastasis. A complete amputation of the right leg and knee was performed after a psychological interview. The follow-up was marked by an over-infection of the amputation stump by Escherichia coli, which was successfully treated. Healed, she is waiting for orthopedic equipment and possible chemotherapy. Conclusion: This clinical case indicates the need for adequate management of certain potentially precancerous dermatoses, in order to limit the progression to carcinogenic transformation.

Mechanically Induced Stump Dermatoses: High Prevalence Concern and Measures of Prevention

Prosthetic sockets, after fitting, prevent flow of air around the residual limb. It results in trapping of sweat, creating ideal conditions for bacteria and fungus to thrive. This can lead to skin irritation, abrasion and skin breakdown. Various factors make the stump vulnerable to skin diseases, which can hamper quality of life (QoL) of an amputee. Amputation stump dermatoses (ASD) can occur immediately after socket fitting, or many years after amputation. It has been reported that Amputation stump dermatoses affects 34–78% amputees. Of these ~29% are caused due to mechanically induced stump dermatoses. The design of the stump is a major contributor to stump dermatoses as improper design results in poor fitting, trapping of sweat in closely fitted socket of prosthesis, close contact of materials leading to irritation or an allergy. The high prevalence of stump dermatoses has let to there being a growing importance given to prevention, early management and advanced treatment of skin diseases. The use of new edge technologies in designing the stump socket helps to a greater extent in preventing skin diseases resulting from the above mentioned factors. Biomaterials used in the prosthesis further reduces the risk of these skin diseases. This paper discusses the design techniques and considerations of the stump socket as key measure in prevention of the mechanically induced stump dermatoses.

Anterolateral musculocutaneous flap for reconstruction of bone expose of lower leg amputation stump which on the verge of reamputation

Objective To explore the curative effect of anterolateral musculocutaneous flap to repair the soft defect of the lower leg amputation stump which on the verge of reamputation, and preserved the length of leg or the knee joint to improve prosthetic limb function. Methods Four patients with soft defect and bone expose of proximal leg amputation stump were enrolled in this study from April, 2013 to November, 2016. Each patient underwent stump revision using anterolateral musculocutaneous flap, including 3 free musculocutaneous flaps and 1 pedicle musculocutaneous flap. The patients were all male with the mean age of 20(8-48) years. The wound was treated debridement, and reconstructed on the second stage. Defect area was from 7.0 cm×6.0 cm to 25.0 cm×10.0 cm. Anterolateral musculocutaneous flaps was from 13.0 cm×10.0 cm to 28.0 cm×12.0 cm. The length of preservation tibia stump was from 5.2 cm to 9.4 cm. Results All patients were followed-up from 12 months to 37 months (average, 19 months). All the musculocutaneous flaps survived completely with a soft tissue texture, elastic, and very wear-resisting. The sensory return was determined to be S2 in 2 patients, S3 in 1 patient and S3+ in 1 patient. The 6-Minute Walk Test: grade IV in 2 cases, grade III in 2 cases; Stanmore movement classification: gradeV in 2 cases, grade IV in 2 cases. Conclusion The anterolateral musculocutaneous flap maybe is an ideal flap to provid stable coverage for the stump of leg amputation which on the verge of reamputation. Key words: Anterolateral thigh musculocutaneous flap; Amputation; Reconstruction; Microsurgical technique

Clinical application of computed tomography angiography and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps

Objective: To explore the application value of computed tomography angiography (CTA) and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps. Methods: From December 2014 to December 2018, 12 patients with high-voltage electrical burns in necks, shoulders, axillas, and upper arms were hospitalized. The size of wounds ranged from 13 cm×10 cm to 32 cm×15 cm after complete debridement. Before tissue flap repair, the subclavian artery-axillary artery-brachial artery and their branches were examined by CTA. The main target vessels and their branches were conducted by three-dimensional reconstruction, and the development of the axis vessels for the tissue flaps planning to dissect and their branches were observed. For wounds in upper arms, amputation stump bone exposed wounds, and wounds in axillas and the anterior, the latissimus dorsi myocutaneous flap is the first choice for repair, if the thoracodorsal artery and internal and external branches are well developed according to CTA examination. Latissimus dorsi myocutaneous flaps were used in 6 patients with the area of myocutaneous flap ranging from 16 cm×12 cm to 32 cm×17 cm. All the donor sites were covered by split-thickness skin graft of thighs. For large wounds in occiputs, necks, and scapulas, the contralateral lower trapezius myocutaneous flap is the first choice for repair, if the superficial descending branch and deep branch of the contralateral transverse cervical artery are well developed according to CTA examination. For small wounds in necks and scapulas, the ipsilateral lower trapezius myocutaneous flap can be used for repair, if the superficial descending branch of the ipsilateral transverse cervical artery is well developed according to CTA examination. Lower trapezius myocutaneous flaps were used in 4 patients with the area of myocutaneous flap ranging from 18 cm×12 cm to 25 cm×17 cm. The donor site of one patient was sutured directly and the donor site of the other 3 patients was covered by split-thickness skin graft of thighs. For wounds in the posteromedial side of upper arms and the anterior side of axillas, the lateral thoracic skin flaps can be used for repair, if the latissimus dorsi myocutaneous flap can not be utilized for reasons of back burn or no muscle is needed for dead space, when the blood supply of side chest skin is reliable according to CTA examination. Lateral thoracic skin flaps were used in 2 patients with the area of skin flap ranging from 16 cm×12 cm to 17 cm×14 cm. The donor site of one patient was sutured directly and the donor site of the other one patient was covered by split-thickness skin graft of thigh. Results: During the operation of tissue flap repair in 12 patients, the orientation and starting position of the axis vessels were consistent with those observed by CTA examination before operation. All the tissue flaps survived after operation. During follow-up of 1 to 24 months, the patients were satisfied with no serious scar contracture affecting the function nor secondary infection or chronic ulcer. Conclusions: CTA and its three-dimensional reconstruction technique can clearly reconstruct the subclavian artery-axillary artery-brachial artery and their branches before repair of high-voltage burn wounds in necks, shoulders, axillas, and upper arms. It can be used to observe whether the vessels are embolized or not and the starting position and orientation of blood vessels, which can provide an important reference for the selection of tissue flap transplantion.

Role of Electrolyte Gels in Signal Transmission Across the Interface Between Skin and Surface Electrodes in Hand Exoprosthesis

A key component of a successful external myoprosthesis is not a part of the prosthesis, but an area: the interface between the prosthesis and the amputation stump. This is because in this area takes place a critical exchange of information, in the form of a myoelectrical signal being transferred from the muscles, through the fascia, fat and skin, to the surface EMG sensors, that in turn transfer this information to a part of the prosthesis that is responsible with the analysis, augmentation and use of this signal in order to control the movements of the electromechanical parts of the prosthesis. Any condition that leads to an impaired transmission of information from the skin to the EMG sensors inevitably leads to an underperformance of what may otherwise be a highly developed model of exoprosthesis, thus potentially rendering it no more useful than a basic mechanical model. We aim to review the possible difficulties that may arise in this area, and that may lead to a faulty transfer of signal, with a loss in quantity or quality. For this purpose, we will review the current literature for this subject, including reference books and articles, and complete this information with our personal experience. In doing this, we hope to provide a guide to practitioners, bioengineers and patients alike, in order to be able to anticipate and correct any potential problem as they may arise.

Amputation-Site Soft-Tissue Restoration Using Adipose Stem Cell Therapy.

Soft-tissue deficits in amputation stumps can lead to significant pain and disability. An emerging treatment option is stem cell-enriched fat grafting. This is the first study assessing the potential for this treatment modality in lower extremity amputation sites. In this prospective cohort study, five injured military personnel suffering from pain and limited function at amputation sites were recruited. Fat grafting enriched with stromal vascular fraction was performed at amputation sites to provide additional subcutaneous tissue padding over bony structures. Outcomes measures included complications, demographic data, physical examination, cellular subpopulations, cell viability, graft volume retention, pain, Lower Extremity Functional Scale, Functional Mobility Assessment, 36-Item Short-Form Health Survey, and rates of depression. Follow-up was 2 years. There were no significant complications. Volume retention was 61.5 ± 24.0 percent. Overall cell viability of the stromal vascular fraction was significantly correlated with volume retention (p = 0.016). There was no significant correlation between percentage of adipose-derived stem cells or number of cells in the stromal vascular fraction and volume retention. There was a nonsignificant trend toward improvement in pain scores (3.0 ± 2.5 to 1.2 ± 1.6; p = 0.180 at 2 years). There were no significant changes in disability indexes. Results from this pilot study demonstrate that stromal vascular fraction-enriched fat grafting is a safe, novel modality for the treatment of symptomatic soft-tissue defects in traumatic lower extremity amputations. Volume retention can be anticipated at slightly over 60 percent. Further studies are needed to assess efficacy. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.