Total Amputation Research Articles

Isolated penile injury in boys: Accident, negligence, or abuse?

Aim:The aim of the study was to highlight the etiology, spectrum of presentation, and management of isolated penile trauma in boys.Methods:A retrospective review of boys treated for isolated penile trauma between January 2015 and June 2019 at a tertiary-level hospital.Results:Nine children were admitted over 4½ years. Etiology: The mechanism of penile injury (PI) was penile hair tourniquet (n = 5), postcircumcision (n = 2), dog bite (n = 1), and scald injury (n = 1). Extent of injury includes complete urethral transection at corona (n = 4); loss of urethral plate in a case of hypospadias (n = 1); complete loss of glans (n = 1); penile transection at corona (n = 1); total penile amputation (n = 1); and deep partial-thickness burns of penile shaft and adjacent suprapubic skin (n = 1). Management: One patient absconded. The remaining patients were managed as follows: calibration of urethral meatus (n = 1); penile burn was managed with dressing and antibiotics; coring of glans with urethral end–end anastomoses (n = 4); Bettocchi's quadrangular lower abdominal flap phalloplasty (n = 1); and Bracka's staged urethroplasty (n = 1). Complications include wound infection following trauma (n = 4), postsurgical infection (n = 3), urethrocutaneous fistula (n = 2), and reapplication of penile hair tourniquet (n = 1).Conclusion:Isolated PI in boys is not uncommon. Most are preventable if the parents are apprized and watchful. The clinician should also be vigilant regarding child maltreatment. A staged approach tailored to the type of injury provides a satisfactory outcome.

Polyethylene fiber post modification with vital pulp therapy in a traumatized immature incisor using Biodentine: A four year follow-up case report

In this case, it was aimed to restore a traumatized permanent incisor with open apex using a modified polyethylene fiber post after amputation as well as to present a four-year long term follow-up. A healthy 10-year-old boy was referred with a complaint of pain caused by tooth number 11. The patient fell and broke his upper incisor ten days ago and no treatment was done before. Total amputation was carried out after clinical and radiological examination. The exposed root pulp was covered with BiodentineTM (Septodent, Saint-Maur-Fosses Codex, France). Glass-ionomer cement (Fuji IX extra, GC Corp., Tokyo, Japan) was placed on the BiodentineTM, and after a 3-month follow-up, polyethylene fiber post (Ribbond, Seattle, WA, USA) was placed in the crown since healing was observed in the relevant tooth. The restoration was completed with composite resin (Clearfil Majesty Esthetic Kuraray, Osaka, Japan). Four years later, radiographic examination revealed completed root formation and complete root obliteration. Clinical examination revealed favorable esthetic and functional outcome. Traditional treatments can be modified in order to obtain long term clinical success. Polyethylene fiber post can be used as an alternative method to root canal therapy in complicated crown fractures in teeth with immature root formation due to the advantages such as the possibility of modification according to the crown, aesthetics, easy application, and supporting the vitality of the tooth.

Amputation Rates in More Than 175,000 Open Tibia Fractures in the United States.

Open tibia fractures are often associated with considerable soft tissue injuries. Management of open tibia fractures can be challenging, and some patients require amputation. The patient and treatment factors have not been described on a population level in the United States. A retrospective analysis was completed using the 2000 to 2011 Nationwide Inpatient Sample. Amputation rates during the index hospitalization after open tibia fracture were computed based on injury, patient, and hospital characteristics in patients 18 years or older. The overall amputation rate in open tibia fractures during the index hospitalization was 2.2% (n=3769). Patients with midshaft tibia fractures comprised the largest portion of patients undergoing amputation (46.8% of total amputations) compared with distal tibia (34.0%) and proximal tibia (19.3%) fractures. Patients with no neurovascular injury comprised the largest portion of patients undergoing amputation (85.9%), followed by isolated arterial injury (11.1%), combined neurovascular injury (1.9%), and isolated nerve injury (1.1%). Amputation rates were significantly increased for midshaft tibia fractures with neurovascular injury (odds ratio, 12.39; 95% CI, 5.52-27.83) and distal tibia fractures with neurovascular injury (odds ratio, 5.45; 95% CI, 1.73-17.19) compared with tibia fractures with no neurovascular injury while controlling for confounders. On the basis of a review of the Nationwide In-patient Sample during the past decade, the authors have shown that the early amputation rate in open tibia fractures for all-comers is 2.2%. Rates of amputation varied based on fracture site, associated neurovascular injury, medical comorbidities, and hospital location. [Orthopedics. 2021;44(1):48-53.].

Progress on Management of Penile Cancer in 2020.

Management of penile cancer represents a challenge to urologic oncologists due to the disease's rarity and sparse data in the literature. Squamous cell carcinoma represents the most common histologic subtype of penile cancer. Penile cancer has a disastrous effect on patients' psychological and physical health. Penile cancer accounts for approximately 1% of cancer deaths in the USA annually. However, in recent years, the management of penile cancer has achieved marked progress in both diagnostic and therapeutic approaches with the intent to avoid radical surgeries. The traditional total penile amputation has been replaced by penile preserving procedures in many patients. Nowadays, total penile amputation (total penectomy) is preserved only for patients with proximal lesions. The introduction of minimally invasive surgical techniques in the management of penile cancer-infiltrated lymph nodes has been reported. Given the dismal prognosis with conventional cytotoxic therapies, new systemic therapies have been investigated in patients with locally advanced or metastatic penile cancer. Multiple studies have shown promising outcomes. All these efforts have resulted in a remarkable improvement in patient quality of life. The objectives of our review are to update clinicians on the advances in the management of penile cancer and to summarize the recent guidelines and recommendations.

P6 Efecto del gel xenogénico rico en plaquetas sobre la cicatrización de una úlcera cutánea en un modelo en ratas con diabetes tipo 2

Introducción: las úlceras cutáneas pueden generar compromisos graves en personas con diabetes pudiendo generar amputación parcial o total del miembro comprometido. El gel rico en plaquetas se utiliza cada vez con más frecuencia para promover la curación de una úlcera cutánea. Sin embargo, los resultados clínicos en la cicatrización son a menudo variables debido a que los factores que influyen en este procedimiento aún no se comprenden completamente.Objetivos: evaluar el efecto del gel xenogénico rico en plaquetas sobre la cicatrización de una úlcera cutánea inducida en un modelo en ratas con diabetes tipo 2.Materiales y métodos: se emplearon 12 ratas Spraguedawley y se dividieron en 3 grupos de 4 ratas cada uno y se indujo una úlcera cutánea de 15mm. Grupo 1(con diabetes tipo 2): se aplicó gel xenogénico rico en plaquetas. Grupo 2 (ratas con diabetes) y grupo 3 (ratas sin diabetes): se aplicó solución salina y un apósito. La superficie de la herida se midió los días 0, 20, 29 y 33 utilizando un micrómetro digital y fotografías.

Assessment of the efficacy of endovascular treatment in chronic limb-threatening ischemia in diabetic and non-diabetic patients

Aim: Peripheral artery diseases are a very common manifestation of atherosclerosis. We assessed the clinical outcomes of diabetic versus non-diabetic patients with chronic limb-threatening leg ischemia who underwent Peripheral Transluminal Angioplasty (PTA). Methods: The patients (84 diabetic/66 non-diabetic) who underwent percutaneous transluminal angioplasty (PTA) in the lower extremity arterial lesions (stenosis/occlusion) because of chronic limb-threatening leg ischemia (Rutherford class 4 and above) between June 2013 and March 2020 were included in the study. Results: Six-month primary patency rates were 86.5% and 93.3% in the diabetic and non-diabetic group, respectively. The 12-month primary patency rates were 73.0% and 73.3%; and 12-month secondary patency rates were 66.7% and 77.8%. No differences were detected between the groups in terms of patency rates. Major amputation and total amputation rates were higher at statistically significant levels in the diabetic patient group (%16.7% vs. 6.1%; P=0.003) (34.6% vs. 22.8%); P=0.004) Conclusion: When patency and amputation rates are evaluated in diabetic and non-diabetic patient groups with limb-threatening chronic leg ischemia after endovascular treatment, good clinical results were reported in these two groups. Current results suggest that endovascular treatment can be used safely and effectively in both patient groups.

Do Pre-Operative Transcutaneous Oxygen Perfusion Measurements Predict Atraumatic Major Lower Extremity Amputation Wound Healing?

Category:OtherIntroduction/Purpose:Determining appropriate amputation level is a challenging task requiring clinical, laboratory, and imaging data. However, there is no validated consensus on the method with the most prognostic accuracy. Transcutaneous oxygen perfusion measurement (TcPO2) is a noninvasive means of measuring tissue oxygenation. A TcPO2 > 30-40mm Hg is widely cited as a positive predictor of post-operative wound healing, but its validity has not been well defined. We hypothesized that TcPO2 levels positively correlate with the success of amputation wound healing. Additionally, we secondarily investigated the correlation between other preoperative demographics and clinical variables and their impact on post-operative amputation wound healing.Methods:A retrospective chart review was performed on patients who underwent lower extremity above, through, or below knee amputations at a single institution with documented preoperative TcPO2 values between January 1, 2012 and December 1, 2018 and a minimum 30 days post-operative clinical follow up. Amputations performed for oncologic pathology, infected arthroplasty, osteomyelitis and traumatic amputations were excluded in order to isolate TcPO2 as a decision-making test for amputation level. This yielded one hundred and forty-one total amputations. Of these ninety-three were below knee amputations (BKA), six through knee amputations, and forty-two above knee amputations (AKA). Chi-square and t-tests were used to compare successful and failed amputations where appropriate.Results:Eighty-six of the amputations were successful and fifty-five failed, as defined by post-operative wound dehiscence or infection. Of these, thirty-seven were BKAs, four were through knee amputations and fourteen were AKAs. There was a significant difference in preoperative TcPO2 levels between the successful and failure groups at 46.2 and 38.3 respectively (p = 0.02). A TcPO2 of 30-40mm Hg had a success rate of 68.8%, and a TcPO2 < 20mm Hg a success rate of 18.2%. A receiver operating characteristic curve for TcPO2 levels predicting amputation success elucidated that with an area under the curve of 0.53 for the AKA cohort and 0.61 for the BKA cohort, the diagnostic ability is far from prognostic.Conclusion:Our results provide new insight into the predictive accuracy of preoperative TcPO2 levels. There is not a linear association between TcPO2 and success rate. A TcPO2 < 20mm Hg has a high positive predictive value for failure, but higher TcPO2 levels are not 100% predictive of amputation wound healing as reported by prior studies. Multiple factors should be considered when selecting amputation level.

Penectomia total para tratamento de parafimose crônica em cão: relato de caso

Disorders that affect the reproductive system generate a lot of problems for animals and become a source of concern for tutors. Paraphimosis is one of the most common diseases that affect the genital organ, because it affects dogs of different breeds and ages, and it has a congenital or acquired causes. The disease is characterized by permanent exposure of the canine penis, which does not return to the preputial cavity. However, its evolution may be in stages, such as that the treatment of choice will depend on the severity of the case, and may be both clinical and surgical. Diagnosis is made through visual inspection associated with the tutor's report. In cases of long-term paraphymoses, which are accompanied by tissue involvement, total or partial penile amputation becomes necessary. Therefore, this paper has the objective of report a case of paraphimosis in a dog, which was treated at a private clinic in the city of Crateús-Ce, presenting a story of penile exposure over a period of approximately 10 days. Among the other symptoms that the animal had on physical examination, an extensive fibrous lesion, which a proliferative aspect was observed, affecting the entire mucosa of the glans and external urethral orifice. Giving the definitive diagnosis for paraphimosis, and considering the current stage, the real choice was consisted of total penectomy surgery associated with scrotal urethrostomy, which provided a great recovery and a great patient response.

Amputation of Penis Due To Electrocution- A Case Report

Electricity is an integral part of modern society. Without electricity the existence of human life seems difficult, but it has the capacity to stand life and destroyed the life up to the death. The most fatalities caused due to electricity are accidental and result from passage of an electric current [both low & high voltage] through the body. Penile trauma presents a difficult physical and psychological problem and is rare. The causes of penile trauma are varied; it can be iatrogenic or caused by traffic accidents, thermal and electric burns, ritual circumcision, animal bites, gunshots or self?mutilation. The type and extent of penile trauma varies from mild to severe injuries, sometimes even with total amputation. In the present case, a 24 year old young male from Palwal (Haryana) sustained electric burn injuries while he was standing in the balcony and came in contact with high voltage electric wires passing in front of the balcony. He was admitted in Safdarjung hospital, Delhi and expired on the same day. During autopsy electric contact burn marks were present on unusual sites of the body like head, neck, abdomen, pubic region and root of penis with amputation of penis. Electric flash burns were also present on different parts of the body along with fracture of cervical vertebra.

Epidemiological investigation of 169 inpatients with high-voltage electrical burns on the wrist

Objective: To analyze the epidemiological characteristics of inpatients with high-voltage electrical burns on the wrist in Beijing Jishuitan Hospital (hereinafter referred to as the author's unit), so as to provide reference for the prevention and treatment of high-voltage electrical burns on the wrist. Methods: The medical records of inpatients suffered from high-voltage electrical burns on the wrist in the author's unit from January 2008 to December 2019 were collected. The patients' gender, age, population category, injury situation, injury season, total burn area, electrical burn type on the wrist of the affected limbs, the time from injury to first flap/myocutaneous flap transplantation, vascular reconstruction and flap/myocutaneous flap transplantation of the affected limbs, the total amputation rate of the affected limbs and the amputation rate of the affected limbs with type Ⅲelectrical burns on the wrist, the number of operation, postoperative infection rate of flap/myocutaneous flap, length of hospital stay, hospitalization expense, and treatment outcome were retrospectively analyzed. Comparison of the aforementioned statistical items between patients admitted from January 2008 to December 2013 (hereinafter referred to as the pre-stage) and January 2014 to December 2019 (hereinafter referred to as the post-stage) except gender, the total amputation rate of the affected limbs, treatment outcome were performed. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and Wilcoxon rank-sum test. Results: During the 12 years, a total of 169 patients with high-voltage electrical burns on the wrist were admitted to the author's unit, including 162 males and 7 females, aged (35±13) years, and 75.15% (127/169) of patients were 21-50 years old. The top three groups in population category from high to low were workers, migrant workers, and primary and secondary school students, accounting for 48.52% (82/169), 28.99% (49/169), and 9.47% (16/169), respectively. At work of non-electric power accounted for 47.93% (81/169) and ranked the first in the proportion of injury situation. The injury occurred mostly in summer and autumn, accounting for 39.05% (66/169) and 28.99% (49/169), respectively. About 65.09% (110/169) of the patients were with total burn area less than 10% total body surface area. There were totally 216 affected limbs with high-voltage electrical burns on the wrist, of which the numbers of wrist with type Ⅲ and type Ⅳ injury were 25 (11.57%) and 21 (9.72%), respectively. The time from injury to first flap/myocutaneous flap transplantation was 6.00 (3.75, 8.00) d. There were 45 affected limbs operated with vascular reconstruction, 75 affected limbs transplanted with pedicled axial flap, and 86 affected limbs transplanted with free flap/myocutaneous flap. The total amputation rate of affected limbs was 12.96% (28/216), and the amputation rate of the affected limbs with type Ⅲ electrical burns on the wrist was 28% (7/25). The number of operation was 4 (3, 5) times, the postoperative infection rate of flap/myocutaneous flap was 7.18% (13/181), the hospitalization time was 39.00 (25.00, 50.00) d, and the hospitalization cost was 123 553.00 (50 656.50, 216 003.00) yuan. Compared with those of the pre-stage, the time from injury to first flap/myocutaneous flap transplantation was significantly shortened (Z=-4.038, P<0.01), the ratio of free flap/myocutaneous flap transplantation on affected limbs was significantly increased (χ(2)=13.478, P<0.01), the ratio of pedicled axial flap transplantation on affected limbs was significantly decreased (χ(2)=10.242, P<0.01), the number of operation was significantly reduced (Z=-5.903, P<0.01), the postoperative infection rate of flap/myocutaneous flap was significantly decreased (χ(2)=4.492, P<0.05), the length of hospital stay was significantly shortened (Z=-2.723, P<0.01), and the hospitalization expense was significantly decreased among patients hospitalized in the post-stage (Z=-2.121, P<0.05). The other items were close between patients hospitalized in the pre-stage and those in the post-stage. Conclusions: Men were more likely than women to suffer from high-voltage electrical burns on the wrist in the author's unit. Young workers and migrant workers may be the key groups for the prevention of high-voltage electrical burns on the wrist. It is very important to strengthen the management of high voltage safety education for non-electric power staff, warn and protect the surrounding area of high voltage environment, and prohibit non staff for entering the high voltage environment, especially in summer and autumn. In the last 6 years, the patients with high-voltage electrical burns on the wrist may benefit from the active vascular reconstruction at early stage and free flap/myocutaneous flap repair in the author's unit.

Clinical Profile of Diabetic Foot Amputation in Hasan Sadikin Hospital, Bandung, Indonesia

Diabetes mellitus related to foot ulcers is common. Most studies use amputation rates as a measure of foot management in diabetics. The aim of this study was to determine the description of diabetic foot clinical profile at Hasan Sadikin Hospital, Bandung, Indonesia. The study was conducted on diabetic foot who came to Hasan Sadikin Hospital, Bandung from January 2014 to December 2018, retrospectively. There are 243 diabetic foot patients at Hasan Sadikin Hospital in this study. There are 112 males (46.1%) and 131 females (53.9%). There are more patients with the duration of diabetes was more than 10 years than the shorter duration of diabetes. The 51-60 year age group is the group with the largest percentage (41.6%). Based on the Wagner classification group, patients with grade 2 Wagner diabetic foot became the most group (28.4%). Total amputations were 91 patients (37.5%). The most diabetic foot management is debridement, which is 110 patients (45.3%). The most common type of amputation is below knee amputation, which is 45 patients (49.5%).

Mangled finger salvage using cross-finger revascularization

BackgroundMangled finger with impaired arteria digitalis communis remains to be a challenge for replantation surgery due to the limited amount of tissue to work with.MethodsOut of 554 hands with total finger amputations treated by replantation of finger/fingers from July 2012 to June 2018, there were 7 cases of damaged arteria digitalis communis, all of which were replanted by anastomosing distal adjacent radial/ulnar digital artery to distal end of ulnar/radial digital artery of amputation finger, and 2 veins were anastomosed for each finger. A skin pedicle was made by suturing both dorsal and palmar skin of adjacent fingers, and detachment was performed 4 weeks postoperatively.ResultsThe survival rate was 100%. Mean total active motion was 191.4° (ranging from 170 to 220°). Mean 2-point discrimination was 8 mm static (ranging from 6 to 11 mm), and mean grip strength was 35.3 kg (range, 29 to 40 kg).ConclusionsBased on our experience, cross-finger revascularization is an effective and safe alternative for mangled finger salvage when arteria digitalis communis is damaged, and good functional prognosis can be expected.

Optimization of the antibiotic management of diabetic foot infections: protocol for two randomized controlled trials

BackgroundFew studies have addressed the appropriate duration of antibiotic therapy for diabetic foot infections (DFI) with or without amputation. We will perform two randomized clinical trials (RCTs) to reduce the antibiotic use and associated adverse events in DFI.MethodsWe hypothesize that shorter durations of postdebridement systemic antibiotic therapy are noninferior (10% margin, 80% power, alpha 5%) to existing (long) durations and we will perform two unblinded RCTs with a total of 400 DFI episodes (randomization 1:1) from 2019 to 2022. The primary outcome for both RCTs is remission of infection after a minimal follow-up of 2 months. The secondary outcomes for both RCTs are the incidence of adverse events and the overall treatment costs. The first RCT will allocate the total therapeutic amputations in two arms of 50 patients each: 1 versus 3 weeks of antibiotic therapy for residual osteomyelitis (positive microbiological samples of the residual bone stump); or 1 versus 4 days for remaining soft tissue infection. The second RCT will randomize the conservative approach (only surgical debridement without in toto amputation) in two arms with 50 patients each: 10 versus 20 days of antibiotic therapy for soft tissue infections; and 3 versus 6 weeks for osteomyelitis. All participants will have professional wound debridement, adequate off-loading, angiology evaluation, and a concomitant surgical, re-educational, podiatric, internist and infectiology care. During the surgeries, we will collect tissues for BioBanking and future laboratory studies.DiscussionBoth parallel RCTs will respond to frequent questions regarding the duration of antibiotic use in the both major subsets of DFIs, to ensure the quality of care, and to avoid unnecessary excesses in terms of surgery and antibiotic use.Trial registrationClinicalTrials.gov, NCT04081792. Registered on 4 September 2019.

Cancer of the Penis: Clinical Features and Therapeutic Modalities in Senegalese Hospitals

Background: Penile cancer is a rare malignancy in Senegal. This rarity is probably related to the fact that circumcision, which has a protective effect, is a common practice in childhood. Some of the known risk factors include uncircumcised status, chronic inflammatory conditions, and a history of condyloma acuminata, smoking, and possibly human papillomavirus exposure. It is a pathology in adults with a maximum incidence after the age of 50. In our practice penile cancer is most often diagnosed at an advanced stage or only a radical and mutilating treatment may be proposed. Aims: To describe the clinical and therapeutic features of penis cancer in Senegal. Patients and methods: we carried out a retrospective, descriptive, bicentric study, collecting the records of patients with penis cancer in the Urology-Andrology department of the Aristide Le Dantec University hospital and the military hospital of Ouakam between January 2010 and December 2019. Results: fourteen cases of penile cancer were diagnosed. The mean age was 53.2 years with extremes of 29 and 84 years, the average consultation time was 21 months. All patients were circumcised in childhood. The tumor was limited to the glans in 2 cases and involved the entire penis in 5 cases. Six patients had bilateral inguinal adenopathies. The histological type was squamous cell carcinoma in all cases with a predominance of grade 2 (8 cases). Patients were classified as cT3 (7 cases), cT2 (5 cases), cT4 (1 case) and cT1 (1 case). Treatment consisted of partial amputation of the penis (5 cases), emasculation and perineal urethrostomy (4 cases) total amputation and perineal urethrostomy (2 cases). Three patients had refused total penis amputation. The average length of follow-up was 26 months (4 and 72 months), 3 lymph nodes recurrences and 2 local recurrences were observed. Two patients died among the operated patients. Conclusion: Cancer of the penis is rare in Senegal. The delay in diagnosis explains the frequency of advanced forms which can only be treated by radical surgery.

Successful total scalp replantation using the retromandibular vein as a recipient vessel

Replantation is the first treatment in scalp amputations. Venous insufficiency is the most common cause of failure. There may be difficulties caused by venous anastomosis, especially in cases with cranial bone fractures. There is no agreement about the number of vessels that should be used for replantation. Depending on the severity of the injury, there may be concurrent injuries such as spinal fractures and other system pathologies, such as cranial bone fractures. In this article, we describe and discuss the surgical treatment of a patient with a temporal bone fracture concurrent with a total hairy skin amputation, which extended from both eyebrows anteriorly, in front of the ear laterally, to the hairline posteriorly. Single-artery and single-vein anastomoses were performed. The retromandibular vein was used as the recipient vein because an alternative appropriate vein was not available. Complete improvement was achieved in our patient, both aesthetically and functionally.

Penile strangulation injury in children — Reconstructive procedure and outcome

BackgroundPenile strangulation injury (PSI) is rare and is usually reported in circumcised children. Damage to Corpus Spongiosum (encasing urethra) and Corpus Spongiosum by hidden constricting material (e.g. hair or thread) in penile groove can cause Urethral Fistula (UF) and near total glans amputation. We report varied grades of PSI in children with emphasis on surgical procedure and its outcome. Patients and methodsFifteen children were treated from August 1991 to December 2018 for PSI inflicted by encircling hair (n = 4) and cotton or polyester thread (n = 11). Twelve patients with Grade 1 and 2 injury had a single stage reconstructive procedure. ResultsAge of patients ranged from 6 months to 11 years (mean 5.8 years). All the patients including two who have attained sexual maturity stated satisfactory outcomes, e.g., urinary stream on follow up (range: 1.1 to 13 years; mean 6.5 years). One patient developed urethrocutaneous fistula (UF) and had repair as a daycare procedure. ConclusionOne stage surgical repair is appropriate to manage varied damage to urethra and corpora associated with PSI. Immediate and long-term results are reasonable. Level of evidenceLevel IV.

Surgical outcomes in HIV positive patients following major surgery at two tertiary institutions in Harare, Zimbabwe

BackgroundHuman Immunodeficiency Virus (HIV) traditionally has been associated with poorer outcomes among the critically ill. Recent evidence suggests that the outcomes of surgical patients have improved with increased use of antiretroviral regimens. We set out to find if this is true for major surgical procedures in Zimbabwe. MethodsA prospective cohort study was done on 215 patients who underwent major surgical procedures at the two main tertiary hospitals in Harare between June 2015 and April 2016. Dependent variables considered were surgical outcomes and length of hospital stay (LOS). Independent parameters which were studied included patient's demographics, HIV status, clinical features, diagnosis, investigations, and procedures carried out. The data was analysed using STATA statistical package version (STATA 13). ResultsThe mean age was 47.1years (SD = 18.1) and 43% were males. The HIV prevalence was 28%. Of the HIV positive patients, 16% had CD4 count <200 cells/mm3, 42% with CD4 counts between 200 and 400 cells/mm3 and 42% with CD4 counts >500 cells/mm. In HIV positive patients the common major operations performed were total abdominal hysterectomies (19%), amputations (16%) and perforated viscus (8%). The length of hospital stay in HIV positive patients was 14.4 days (SD = 10.8) compared to 10.9 days (SD = 6.7) in HIV negative patients. Surgical site infections and pneumonia were the most common postoperative complications seen. There was no difference in LOS in HIV positive patients on HAART (LOS = 15.2 days) and those not on HAART (LOS = 14.2 days) and the post operative complications were comparable between the two groups. Mortality was 3%. ConclusionSurgical site infections (25%) and pneumonia (32%) are the most common short term postoperative complications in HIV positive patients. Low CD4 count was associated with higher rates of surgical site infections (64%) and pneumonia (72%) in HIV positive patients. There was high prevalence (28%) of HIV positivity in patients undergoing major operations at the two tertiary hospitals compared to HIV prevalence in the general adult population in Zimbabwe.

Salvage of a Finger Near Total Avulsion Amputation: A Simpler Alternative Technique.

Crush avulsion amputation of fingers are the most severe injuries due to the involvement of rotational, pulling, and crushing forces.[1] Sometimes, it is challenging to assess the extent of damage to the neurovascular structures. However, it was proven beyond doubt that salvage of avulsion amputations results in better functional outcomes.[2]

Long-Term Quality of Life after Free Flap Upper Extremity Reconstruction for Traumatic Injuries.

Microsurgical reconstruction of upper extremity injuries is often challenging, and the resulting impact on the quality of life (QoL) may be significant. However, there is a lack of knowledge on long-term patient-reported QoL. In a retrospective long-term follow-up study, all consecutive patients with an upper extremity injury who had undergone a free flap reconstruction were identified and categorized into three groups based on the type of injury. Patient-reported upper extremity function and QoL were assessed using three validated questionnaires: the 36-item Short Form Health Survey (SF-36), the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Michigan Hand Outcomes Questionnaire (MHQ). A total of 61 patients were identified, of whom 10% had undergone a free flap reconstruction for soft tissue loss only, 62% for an injury accompanied by a fracture, and 28% for a (sub) total amputation. Twenty-one (44%) patients responded to the questionnaires, with a mean follow-up time of 9.7 ± 6.2 years. Patients, on average, reported poorer SF-36 "physical component score" and "role limitations due to physical health" scores compared with Dutch norms. Also, they reported poorer mean DASH scores compared with the general population, indicating worse upper extremity function. Mean MQH scores were lower for the injured side compared with the noninjured side. Pain correlated negatively with the total scores of DASH, MHQ, and SF-36. Free flap upper extremity reconstruction is challenging. At 10 years of follow-up, the injury and its treatment continued to have a significant impact on the upper extremity function and daily QoL, with chronic pain being an important factor negatively affecting these outcomes.

Prehospital amputation: An experimental comparison of techniques

ObjectivePrehospital limb amputation is a rare but potentially life-saving intervention. When patients cannot be extricated due to limb entrapment or have hemodynamic compromise that precludes a prolonged extrication, they may benefit from an emergent prehospital amputation. The objective was to experimentally compare three prehospital amputation techniques on porcine legs. MethodsThe three techniques studied were a scalpel with a Gigli saw, a hacksaw, and a reciprocating saw. For the first technique, a scalpel was used to make a circumferential incision in the soft tissue and a Gigli wire saw to cut through the bone. The second and third techniques only used a saw and did not require soft tissue incision with a scalpel. Three providers including an emergency medicine physician, a paramedic, and a medical student performed three amputations of each technique, resulting in twenty-seven total amputations. The primary outcome was amputation time. Secondary outcomes were rate of instrument malfunction and cleanliness of cut. ResultsThe primary outcome of amputation time was different between techniques. The Gigli saw technique took 32.86 ± 16.53 s (mean ± SD), hacksaw technique 6.28 ± 0.76 s, and reciprocating saw technique 2.84 ± 0.40 s. There were no differences in amputation time between participants for a given amputation technique. The Gigli saw technique had an instrument malfunction on 3/9 trials which was distinct from the other techniques. Differences in cleanliness of cut were nonsignificant. ConclusionsPrehospital limb amputation with a hacksaw or reciprocating saw may result in faster completion of the time-sensitive procedure with fewer instrument malfunctions.