Traumatic Limb Amputation Research Articles

Tactile, thermal, and electrical thresholds in patients with and without phantom limb pain after traumatic lower limb amputation.

PurposeTo examine whether there is central sensitization in patients with phantom limb pain (PLP) after traumatic limb amputation.MethodsSeventeen patients after unilateral lower limb amputation secondary to trauma were enrolled. Ten patients had chronic PLP, while the other seven patients had no PLP. Tactile-sensation threshold, cold- and warm-sensation thresholds, cold- and heat-pain thresholds, electrical-sensation threshold (EST), and electrical-pain threshold on the distal residual limb and the symmetrical site on the sound limb were measured in all tested patients. Their thresholds were compared within the PLP and non-PLP group, and between the groups.ResultsThe novel findings included: 1) electrical-pain threshold was only decreased in the sound limb in the PLP group and there was no difference between two limbs in the non-PLP group, suggesting central sensitization in patients with PLP; and 2) EST was increased on the affected limb as compared to the sound limb within the PLP group, but there were no significant differences in EST between the PLP and non-PLP group. There were in general no significant differences in other tested thresholds within the groups and between groups.ConclusionOur results demonstrate central sensitization in the patients with PLP after traumatic limb amputation.

Surgical revision for stump problems after traumatic above-ankle amputations of the lower extremity.

BackgroundStump problems (SPs) secondary to traumatic lower limb amputation had a crucial influence on amputees’ ability to return to living and work. The purpose of this study was to investigate the surgical management strategies of the SPs after above-ankle amputation of the lower limb secondary to trauma.MethodA cohort of clinical cases, who were troubled by SPs after above-ankle amputation following trauma, had undergone revision surgery of the stump and was analyzed retrospectively. Various factors were noted like sex, unilateral or bilateral, amputation type, and causes of trauma. Different SPs like excess soft tissue (where a considerable amount of soft tissue interposed between the rigid elements which hindered the fitting of a prosthesis), scar, ulcers, neuromas, and bone spurs were taken as dependent variables. The relationship between factors and SPs was analyzed.ResultsA total of 80 stumps were treated surgically. The frequency of excess soft tissue in above-knee amputation cases was higher than that in below-knee amputation (p = 0.007). Bone spur occurred more frequently in the unilateral amputation than in bilateral ones (p = 0.018). There was a significant difference in the ADL scores between admission and discharge (p = 0.000).ConclusionStump problems secondary to traumatic lower limb amputation had crucial influence on amputees’ ability to return to living and work, appropriate evaluation and timely surgical revision showed excellent results.

Complete major amputation of the upper extremity: Early results and initial treatment algorithm.

Traumatic major amputations of the upper extremity are devastating injuries. These injuries have a profound impact on patient's quality of life and pose a burden on social economy. The aims of the current study were to report about the initial management of isolated traumatic major upper limb amputation from the time of admission to definitive soft tissue closure and to establish a distinct initial management algorithm. We recorded data concerning the initial management of the patient and the amputated body part in the emergency department (ED) (time from admission to the operation, Injury Severity Score [ISS], cold ischemia time from injury to ED, and total cold ischemia time). The duration, amount of surgical procedures, the time to definitive soft tissue coverage, and the choice of flap were part of the documentation. All intraoperative and postoperative complications were recorded. All patients were successfully replanted (time from injury to ED, 59 ± 4 minutes; ISS16; time from admission to operating room 57 ± 10 minutes; total cold ischemia time 203 ± 20 minutes; total number of procedures 7.3 ± 2.5); definitive soft tissue coverage could be achieved 23 ± 14 days after injury. Two thromboembolic complications occurred, which could be treated by embolectomy during revision surgery, and we saw one early infection, which could be successfully managed by serial debridements in our series. The management of complete major amputations of the upper extremity should be reserved for large trauma centers with enough resources concerning technical, structural, and personnel infrastructure to meet the demands of surgical reconstruction as well as the postoperative care. Following a distinct treatment algorithm is mandatory to increase the rate of successful major replantations, thus laying the foundation for promising secondary functional reconstructive efforts. Therapeutic study, level V.

Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations.

Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hyperhidrosis treatment after traumatic limb amputation. Articles discussing hyperhidrosis treatment for amputations secondary to chronic medical conditions were excluded. Seven case studies published over the last 12 years have demonstrated positive outcomes of this treatment strategy. Overall, there is little data examining this topic and current publications focus primarily on small case series. A larger, double-blind, placebo-controlled study would likely benefit veterans, service members, and civilians.

Importância da reavaliação primária seriada na condução do politraumatizado – relato de caso e revisão da literatura

O estudo traz o relato de uma experiência de um paciente vítima de trauma carro versus bicicleta, que sofreu amputação traumática bilateral de membros inferiores. Para isso foram coletadas informações no banco de dados PubMed em 8 artigos, juntamente com informações da nova edição do livro ATLS®, além de informações do paciente, do atendimento pré hospitalar e hopitalar, conduta e evolução. No caso exposto foi realizada correta avaliação primária e sua reavalição seriada, permitindo precoce identificação das lesões e conduta terapêutica, com boa evolução do paciente pós operatório. Afirma-se que a implementação do protocolo ATLS® é grande responsável pela diminuição da mortalidade do paciente politraumatizado. A reavaliação seriada se mostrou imprescindível para detecção do sangramento do paciente, estabilização e tratamento definitivo.

Prevalence and pattern of traumatic limb amputations in female population of Bhimber District, Azad Jammu and Kashmir, Pakistan.

Objective:Traumatic limb amputations (TLA) are structural defects that cause mild-to-severe disabilities and have significant impact on the quality of life of subjects. A recent epidemiological study in Bhimber District, AJK, Pakistan, revealed that TLA had a very high incidence among the young/adult females. The present study aimed at determining the prevalence, pattern, causes and risk factors associated with TLA in that female sample. Methods:In a prospective door-to-door survey, 1731 females were randomly enrolled, and clinico-etiological investigations on 19 subjects with TLA were carried out in a follow-up study. Affected subjects were physically examined and phenotypic detail and restriction to normal function were documented. Results:There were 19 subjects with TLA, hence the prevalence was estimated to be 10.98/1,000 (0.011%; CI=0.0061-0.0159). TLA mostly involved the upper limbs and right hand. Transphalangeal amputations were most frequent, followed by involvements of middle/upper arm and leg segments. These analyses further revealed that agriculture tools were the leading cause of trauma. TLA were witnessed to be higher in subjects originating from Samahni tehsil (OR:2.71), rural areas (OR:3.33), those who were illiterate (OR:2.65), married, spoke Pahari language (OR:1.73), those who fall in higher age category (OR:16.74), and had certain professions. Conclusion:Limb amputations had heavy bearings on the lives of subjects. Curiously, majority of these traumas could be avoided by adopting certain safety measures. Prevalence and risk estimate of TLA across various socio-demographic variables of Bhimber population would be useful in guiding further studies and the public health policy to mitigate the impact of these anomalies.

The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices

A frequently-seen injury pattern in current military experience is traumatic lower limb amputation as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb amputation. A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb amputation in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures. Of 77 consecutive patients with traumatic lower limb amputations, 17 (22%) had an associated pelvic fracture (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). Unilateral amputees (n = 31) had a 10% incidence of associated pelvic fracture, whilst 30 % of bilateral amputees (n = 46) had a concurrent pelvic fracture. However, in bilateral, trans-femoral amputations (n = 28) the incidence of pelvic fracture was 39%. The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group.

The relationship of prosthesis usage, phantom pain and psychiatric symptoms in male traumatic limb amputees

The relationship of prosthesis usage, phantom pain and psychiatric symptoms in male traumatic limb amputees

Intraosseous access in the military operational setting

In an operational military environment, circulatory access can prove difficult for a variety of reasons including profound hypovolaemia, and limited first responder experience. With many injuries that cause catastrophic haemorrhage, such as traumatic limb amputations, circulatory access is needed as quickly as possible. Since 2006, the Defence Medical Services have been using the EZ-IO and FAST1 devices as a means of obtaining circulatory access. A prospective observational study was conducted between March and July 2011 at the Emergency Department, Camp Bastion, Afghanistan. All patients with an intraosseous device had data recorded that included if the device successfully flushed (functionality) and if any problems were encountered. 117 patients presented with a total of 195 devices: 149 were EZ-IO (76%) and 46 were FAST1 (24%). Functionality was recorded for 111 (57%), with 17 failing to function, yielding an overall success rate of 84.7%. Device failure was observed to be more prevalent in the humerus; inability to flush the device was the leading cause, followed by mechanical failure. There were 2 complications, device breaking on removal being the reason for both. The devices in the study were tested for a period of time following insertion (median 32 minutes), and still the success rates mirror those found in the literature. Observed differences between sites were not found to be significant with confidence intervals overlapping. Further work is proposed to investigate the long-term complications of intraosseous devices.

Service user involvement in nurse education

Service user involvement is now recognised as an integral component of nurse education. This article describes the involvement of one service user, who experienced a traumatic limb amputation, in an educational session for second-year nursing students at De Montfort University. The aim of the initiative was to use the patient's experience to improve care delivery.

Diabetic Foot Ulcers: A Prospective Study Of 100 Patients Based On Wound Based Severity Score.

The Diabetic foot is the commonest complication of Diabetes and is a leading cause of Hospitalization and prolonged in - patient treatment. Diabetic foot ulcer is far and away the most frequent indication for non traumatic lower limb amputations. Appropriate preventive measures as well as patient education will markedly reduce ulcer formation and the frequency of amputations in addition to cutting down on healthcare costs. Here we studied 100 diabetic patients on the basis of new wound based severity scoring system given by Beckert et al. AIMS & OBJECTIVES

Quality of Life in Patients with Lower Limb Amputation: Does It Affect Post-amputation Pain, Functional Status, Emotional Status and Perception of Body Image?

Objective: Comparison of quality of life [QOL] and emotional status in male patients with traumatic lower limb amputation [LLA] and controls and evaluation of the relationship between these outcomes and post-amputation pain, functional status and perception of body image.Methods: Thirty male patients aged between 20 and 45 years, with traumatic LLA and 30 healthy normal controls were enrolled. The Nottingham Health Profile [NHP], Beck Depression Inventory [BDI], Beck Anxiety Inventory [BAI], visual analog scale [VAS], Locomotor Capabilities Index [LCI] and Amputee Body Image Scale [ABIS] were used.Results: There were significantly higher NHP, BDI and BAI scores in patients with LLA than control subjects [p < 0.05]. In patients with LLA, all subgroups of NHP were positively correlated with BDI, BAI and ABIS scores [p < 0.05]. The NHP energy and physical disability subgroups scores were negatively correlated with LCI scores. The positive correlation was found between the NHP pain subgroup score and post-amputation pain VAS score [p < 0.05]. There was no correlation between NHP scores and age and time since amputation [p > 0.05]. The positive correlation was found between BDI, BAI and ABIS score [p < 0.05].Conclusion: It was found that QOL and emotional status deteriorated in male patients with LLA. According to the results of this study, depression, anxiety and body image disturbances may be the determinants of QOL. Having lower functional status were higher post-amputation pain were associated with the poor QOL for some domain. Emotional status of LLA patients may be linked to perception of body image.

Paravalvular aortic regurgitation as the reason for second CoreValve bioprosthesis implantation in a patient with native bicuspid valve

We present the case of a 70-year-old male patient who was admitted to our centre with severe symptomatic aortic stenosis. His medical history included: hypertension, stroke (1998 and 2013) with subsequent left-sided paraparesis and status after traumatic upper right limb amputation in his youth. Patient’s logistic EuroSCORE was 18.1%, EuroSCORE II 5.7% and the Society of Thoracic Surgeons Score 2.7%. Transthoracic echocardiography showed impaired left ventricular ejection fraction of 27%, mean aortic pressure gradient of 70.5 mm Hg, aortic valve area of 0.6 cm2, and peak velocity of 6.3 m/s. For precise aortic annulus measurement, transoesophageal echocardiography (TEE) and a computed tomography scan were performed and revealed a heavily calcified bicuspid valve with mean annulus diameter of 24 mm. Angiography demonstrated a significant lesion in the 3rd segment of right coronary artery (RCA). Due to the high operative risk, the patient was referred by the Heart Team for percutaneous coronary intervention of RCA and transcatheter aortic valve implantation (TAVI) via the femoral route (considering the absence of atherosclerotic lesions in ilio-femoral arteries). Native valve was predilated with a 22 mm Numed balloon catheteter (Fig. 1A). On the basis of pre-procedural imaging, a 29 mm Medtronic CoreValveTM bioprosthesis was implanted at the annulus level. However, control angio and TEE showed low implantation accompanied by significant paravalvular aortic regurgitation (Fig. 1B). Haemodynamic measurement also confirmed a suboptimal effect with low diastolic aortic pressure (DAP) and high left-ventricular end-diastolic pressure (LVEDP) (Fig. 2A). Therefore, the decision was made to implant a second bioprosthesis — another 29 mm CoreValve was placed and deployed 8–10 mm higher than the first one (Fig. 1C). Implantation of the second valve significantly decreased the magnitude of regurgitation from severe to no or mild, both in angiography and pressure recordings (Figs. 1D and 2A, respectively). It has been shown in several observational and randomised trials that even mild paravalvular regurgitation after TAVI is an independent predictor of long-term mortality. It is therefore of crucial importance to diagnose early and minimise the grade of regurgitation by post-dilatation or second valve deployment. This case demonstrates that apart from imaging modalities, direct pressure measurement is an easy, reliable and reproducible method of paravalvular leak detection. Recently, it has been shown in a non-selected population of TAVI procedures that pressure gradient DDAP-LVEDP is a powerful predictor of mortality.

Phantom Limb Pain: Treatment Strategies

421 ISSN 1758-1869 10.2217/PMT.13.51 © 2013 Future Medicine Ltd Pain Manage. (2013) 3(6), 421–424 Phantom pain following limb amputation represents a challenge for medical science. Recent wars in Afghanistan and Iraq, combined with civil wars in Syria and other nations, have led to an increase in the number of traumatic limb amputations being carried out on otherwise healthy people. In addition to this, it has been estimated that the number of amputees in the USA will double by the year 2050 to 3.6 million [1]. In western countries few amputations are performed as a result of trauma, the majority occur in elderly patients with vascular disease and a comorbid diagnosis of diabetes mellitus. However, whether the cause is traumatic or medical, amputations are an increasingly prevalent part of the clinician’s reality, and it is for this reason that the problem of phantom limb pain should not be overlooked. Regardless of the reason for amputation, the prevalence of phantom limb pain is reported to be as high as 85%. In most amputees, the frequency and intensity of pain attacks decrease over the years; however, approximately 5–10% of amputees continue to have severe, intractable and disabling phantom limb pain for many years after an amputation [2,3]. Unfortunately, the current treatment available for chronic phantom limb pain is far from satisfactory, and this represents a major challenge for the clinician. There is little evidence from randomized controlled trials to guide clinicians with treatment, and many studies are hindered by major methodological limitations [4]. The current editorial will include a brief discussion of preventive measures, but its primary focus will be on the treatment of phantom limb pain. The opinions expressed in the editorial are based on evidence where available and supported by the authors’ own research on phantom limb pain and their daily practice as pain clinicians. Although only partly supported by the literature, it seems that an effective analgesic treatment of early postoperative stump pain may delay the onset of phantom pain, or at least temporarily decrease its severity. At Aarhus University Hospital (Denmark), epidural or peripheral regional blocks are used, and these are most often

下肢外傷性切断後の皮膚欠損に対するV.A.C.ATS®治療システムの使用経験

下肢外傷性切断後の皮膚欠損に対するV.A.C.ATS®治療システムの使用経験

The psychological challenge of genital injury

IntroductionInjuries sustained from Improvised Explosive Devices (IEDs) can have a devastating impact on bodily integrity; physical injuries can be severe and include traumatic amputation of limbs, pelvic fracture, abdominal trauma,...

Development of Perfusate for Composite Tissue Allograft: New Maneuvers for Ischemic Golden Period

Objective: In the management of traumatic limb amputation, it is important to consider ischemic time and reperfusion injury by free radicals when blood supply is reestablished. These considerations must be weighed even more seriously in macroreplantation cases. To have the greatest chance for success, replantation operations require a minimizing unnecessary ischemic injury. This abstract reports a successful case of hand replantation after long ischemia time and the development of perfusate for Composite Tissue Allograft. Design and method: A 55-year-old man suffered complete amputation of his left hand 0.5 inches distal from the wrist. He arrived at our hospital 4 hours and 20 minutes after his accident. We performed three simple maneuvers before hand replantation to shorten the warm ischemia time and minimize muscle necrosis. 1. Blood was aspirated from the femoral artery and infused through the radial artery. 2. The dorsalis pedis artery and vein were then anastomosed to the radial artery and vein. 3. One hour prior to replantation, University of Wisconsin solution was used to flush the hand vasculature. The aim of these maneuvers was maintain blood pH and electrolyte stability. Microsurgical replantation started 10 hours after injury. Reperfusion was achieved approximately 12 hours after injury. Results: The amputated hand survived completely. There was no evidence of reperfusion injury. Conclusions: We achieved a successful microsurgical complete hand replantation despite 12 hours of ischemic time. This illustrates that it is possible to extend the ischemic golden period. After this experience, we develop “Dynamic Preservation Method” which focuses the oxygen supply. This is a special combination of ET-kyoto solution (existing organ storage solution), artificial hemoglobin and oxygen nanobubble. This persusate may overcome an ischemic time limit which is the one of the problems of the allotransplantation.

The heterotopic ossifications in the traumatic limb amputation by war wounds: Case report

The heterotopic ossifications in the traumatic limb amputation by war wounds: Case report

Complete trunk severance of a motorcyclist by a traffic sign post at a comparably low collision speed

Traumatic limb amputations and transections of the trunk generally indicate high impact velocities. Complete traumatic severances of the trunk in road accidents however are rarely reported in literature. We describe a case where the trunk of a motorcyclist was completely severed as he hit the post of a traffic sign. Based on the documented end position and damage of the motorcycle, an impact velocity range of 52–80km/h could be determined for the motorcyclist. To our knowledge, this is the first report on the type and mechanism of injury at this comparatively low collision speed range.

Pattern and mechanism of traumatic limb amputations after explosive blast

Pattern and mechanism of traumatic limb amputations after explosive blast