Upper-limb Amputees Research Articles

Intact peritoneum in a child with ileal perforation from a firearm injury

Introduction Indirect intra-abdominal injury with an intact peritoneum following close passage of highly energized projectiles is an uncommon but clearly described phenomenon; likewise delayed gastrointestinal perforation hours or days after passage of a high-energy stress wave from primary blast injury is uncommon. Awareness of these two rare occurrences is required to ensure delayed perforations are diagnosed and managed in a timely manner. Case report An 8-year-old male child sustained a shotgun injury to the right elbow and the abdominal wall only of the right hypochondrium. Due to a non-salvageable joint injury, he underwent amputation of the right upper limb above the elbow, but on the third day of admission, he developed peritonitis and an X-ray revealed pneumoperitoneum. On abdominal exploration, two small ileal perforations were found without penetration of the peritoneum or diaphragm. The ileal injuries were primarily repaired and the postoperative course was uneventful. Conclusion Indirect injury to abdominal viscera from the primary blast effect of close passage of high-energy projectiles resulting is rare and can have significant consequences if not diagnosed and managed early.

Enhancing Upper Limb Prosthetic Control in Amputees Using Non-invasive EEG and EMG Signals with Machine Learning Techniques

Amputation of the upper limb significantly hinders the ability of patients to perform activities of daily living. To address this challenge, this paper introduces a novel approach that combines non-invasive methods, specifically Electroencephalography (EEG) and Electromyography (EMG) signals, with advanced machine learning techniques to recognize upper limb movements. The objective is to improve the control and functionality of prosthetic upper limbs through effective pattern recognition. The proposed methodology involves the fusion of EMG and EEG signals, which are processed using time-frequency domain feature extraction techniques. This enables the classification of seven distinct hand and wrist movements. The experiments conducted in this study utilized the Binary Grey Wolf Optimization (BGWO) algorithm to select optimal features for the proposed classification model. The results demonstrate promising outcomes, with an average classification accuracy of 93.6% for three amputees and five individuals with intact limbs. The accuracy achieved in classifying the seven types of hand and wrist movements further validates the effectiveness of the proposed approach. By offering a non-invasive and reliable means of recognizing upper limb movements, this research represents a significant step forward in biotechnical engineering for upper limb amputees. The findings hold considerable potential for enhancing the control and usability of prosthetic devices, ultimately contributing to the overall quality of life for individuals with upper limb amputations.

Intracortical and interhemispheric excitability changes in arm amputees: A TMS study

ObjectiveTo evaluate cortical circuits and excitability of the motor cortex in the hemisphere contralateral to the affected (AH) and to the unaffected arm (UH), in upper limb amputees. MethodsMotor evoked potentials (MEP) were recorded in 17 subjects who had upper limb amputation: 11 trans-radial (TR) and 6 trans-humeral (TH). Motor thresholds (MT), short interval intracortical inhibition (SICI), and interhemispheric inhibition (IHI) in the available arm muscles of the stump were evaluated. ResultsThere was no significant difference in MT between hemispheres. SICI was preserved in TR but not in TH group. Additionally, in the TR group, the MEP amplitudes in AH were higher than in UH. A significant IHI was observed in the whole sample but not in each hemisphere or patient group. ConclusionsIn our population of TR amputees, we found increased corticospinal excitability in the AH with preserved intracortical inhibition. This finding was not observed in the TH population. SignificanceUnderstanding the changes in intracortical excitability in amputees may enhance knowledge of the functional reorganization of the brain in the post-amputation phase, bringing useful information for prosthetic rehabilitation.

Development of a baby cot with temperature and weight monitoring features: Focus on parents with phocomelia and upper limb amputation

Caring for an infant is a tough and demanding task that presents various challenges for parents. This is especially true for parents who have physical disabilities, as they face unique obstacles in their caregiving journey. For parents with limited movement in their upper limbs, keeping track of important aspects of their baby's health, like weight and temperature, can be a difficult and exhausting task, necessitating innovative solutions to ensure that these parents can provide the best possible care for their child while also promoting their independence. While previous studies have established technology that enhance baby's comfort and safety in cradles and cots, and in contrast to existing products that may require separate monitoring devices or manual interventions, this work presents a significant shift by focusing on the specific needs of parents with phocomelia and upper limb amputation, to enable them to provide independent and attentive infant care. We developed a voice recognition-controlled smart baby cot equipped with real-time temperature and weight monitoring features, and a liquid-crystal display (LCD) feedback, to assist such parents in predicting their baby's well-being. We conducted both finite element analysis (FEA) and ten experimental performance evaluations on the prototype, with and without a load (baby) to assess the cot's load-bearing capacity across different positions, its sensitivity to household noise, and consistency in temperature and weight reading. Our findings demonstrated consistent load-bearing capability and precise weight and temperature measurements, with an overall standard error of 0.03. The voice activation system also performed effectively in environments with noise levels below 80 dB. This work promotes parental autonomy and has the potential to benefit infants and parents in various contexts, including resource-constrained settings. Additionally, it aligns with the global discourse on inclusive healthcare and technology, contributing to the objectives of Africa's Agenda 2063 and Sustainable Development Goal (SDG) 3.

Barriers and facilitators to community reintegration in adults following traumatic upper limb amputation: an exploratory study

Purpose To explore barriers and facilitators to community reintegration experienced by people following traumatic upper limb amputation (ULA). Methods An exploratory qualitative study was conducted with ten adults with major ULA due to trauma. Data from individual, semi-structured interviews was analysed using Braun and Clarke’s reflexive thematic analysis. Results Underlying and influencing community reintegration for participants, was a process of adjustment to the impacts of amputation on everyday function and re-establishing their identity. Participants felt social networks and peer support facilitated the return to social and community activities, as did drawing on personal attributes such as positivity, resilience and self-belief. Prosthetic devices were facilitative for community reintegration by minimising visible differences and unwanted attention through restored cosmesis and in the performance of functional tasks to fulfil social norms and meaningful roles despite issues with comfort and function. Despite the adaptation and evolution of abilities, perspectives and identities, the functional impact of ULA on everyday community activities was an ongoing challenge for all participants. Conclusion ULA has a significant and lifelong impact on an individual’s ability to complete tasks and fulfil meaningful roles in the community. Recommendations based on the study’s findings will inform clinicians to support community reintegration for people following traumatic ULA.

A content comparison of 4 commonly used adult upper limb amputee outcome measurements with application of the refinements of International Classification of Functioning, Disability, and Health linking rules.

The application of the refinements of linking rules to the outcome measurement methods provides an opportunity to obtain information concerning what the available instruments actually measure and how the instrument measures certain outcomes. The purpose of the study was to analyze the content of 4 commonly used upper limb amputee scales using the refined International Classification of Functioning, Disability, and Health (ICF) linking rules. The Upper Extremity Functional Status module of the Orthotics and Prosthetics User Survey (OPUS-UEFS), Trinity Amputation and Prosthesis Experience Scales, Southampton Hand Assessment Procedure (SHAP), and Quick Disability of the Arm, Shoulder, and Hand were analyzed by 2 health professionals for a content comparison based on ICF categories. The Kappa statistic was used to calculate the degree of agreement between 2 professionals. The scale questions were linked with 43 different ICF codes in this study. Trinity Amputation and Prosthesis Experience Scale addresses all ICF domains. All items of SHAP and most items of OPUS-UEFS were linked to the activity-participation domain. Quick Disability of the Arm, Shoulder, and Hand items were linked with activity-participation and body function domains. The perspectives of OPUS-UEFS and SHAP are descriptive. The perspectives of Quick Disability of the Arm, Shoulder, and Hand were descriptive and appraisal. The perspectives of Trinity Amputation and Prosthesis Experience Scale subscales were descriptive, appraisal, and needs or dependency. Estimated kappa values ranged from 0.44 to 0.91 for ICF codes. Most concepts in the scales were frequently linked to the activity-participation domain. We think that the results of this study will be a useful guide to clinicians and researchers in selecting relevant and appropriate outcome measurements for upper limb amputee rehabilitation.

DL-AMPUT-EEG: Design and development of the low-cost prosthesis for rehabilitation of upper limb amputees using deep-learning-based techniques

Upper limb amputation is a widespread problem worldwide, leading to massive loss of functionality for the victims. While a few solutions exist, these are often very expensive and involve expensive and dangerous surgical procedures. In this paper, we propose a low-cost, highly functional upper limb prosthesis controlled via Electroencephalogram (EEG) signals captured in real-time, classified into upper limb motion intention using a novel Genetic Algorithm (GA) optimized Long Short-Term Memory (LSTM) deep learning model to rehabilitate amputees. The proposed 3D-printed prosthetic arm has 3 Degrees-of-Freedom (DOF), which allows it to perform complex movements that can accurately emulate an actual human arm. The results discussed later in this paper conclude that our approach, while being low-cost, is highly accurate and functional.

Outcomes Associated with Concomitant Lower-Limb Amputation in Persons with Major Upper-Limb Amputation: Results of a National Study

ABSTRACT Introduction The challenges faced by persons with amputations are amplified for those with multiple limb loss, compared with single limb loss. However, there is limited research describing the functional outcomes of mixed upper and lower limb loss or the long-term psychosocial and health-related quality of life (HRQoL) outcomes among this group. Materials and Methods A cross-sectional, national telephone survey of 808 US veterans with major upper-limb amputation (ULA) with and without concomitant lower-limb amputation (LLA) who received care at US Veterans Affairs Medical Centers between 2010 and 2015 was conducted. T-tests and χ2 tests identified any significant differences in characteristics and outcomes of groups with and without LLA. Linear regressions examined the association between amputation laterality and outcomes. Results In comparison to those with no LLA, respondents with concomitant LLA were slightly younger (60.0 vs. 63.7) and had similar mean time in years from initial amputation (31.5 vs. 31.4). Transfemoral was the most common level of LLA (67.7%), and there was no significant difference in the distribution of ULA levels between the 2 groups. Phantom pain was less common among those with concomitant LLA compared with ULA only (64.4% vs. 74.5%, P < 0.05). No significant differences were found in prevalence of residual limb, neck, or back pain; measures of disability (QuickDASH); HRQoL; or need for activities of daily living help across the two groups. Conclusions In veterans with concomitant LLA and ULA, transfemoral amputation was the most common level of LLA. Those with concomitant LLA were less likely to report phantom limb pain. No statistically significant differences were found by group in need for ADL help, disability, or HRQoL. Clinical Relevance These results provide clinicians with a greater appreciation of the similarities and differences between the two groups in relation to amputation characteristics, pain, prosthesis utilization, prosthesis satisfaction, and functional outcomes.

Epidemiology of Limb Amputations and Prosthetic Use During COVID-19 Pandemic in the Netherlands

ObjectiveTo evaluate the trends in the incidence of major limb amputations and the prevalence of Dutch prosthetic users at the national level in The Netherlands between 2012 and 2021 (during the COVID-19 pandemic). Local hospitals in The Netherlands reported a doubling of major lower limb amputations during COVID-19, information about a change in the incidence of major upper limb amputations was not reported. We could not confirm this remarkable increase in major lower limb amputations in our institution, nor did we observe a change in the incidence of major upper limb amputations. We hypothesize that the COVID-19 pandemic had no effect on the number of major limb amputations. DesignObservational retrospective study analyzing national open-access databases of health insurance claims. SettingThe Dutch national opensource database www.opendisdata.nl was used to retrieve the incidence of limb amputations in the period 2012-2021, stratified by the level of amputation and the cause of amputation. The results were verified using the www.gipdatabank.nl databank. This period included 4 intervals of nationwide COVID-19 lockdowns. Participants60,848 patients who underwent limb amputations at the upper or lower extremity in the Netherlands from 2012 to 2021 (N=60,848) were included in this study. InterventionNot applicable. Main Outcome MeasuresUpper- and lower-limb amputation and prosthetic use. ResultsData were retrieved for a total of 60,848 patients in the Netherlands, who underwent 68,180 amputations of the upper and lower extremities at any level from 2012 to 2021, including 22,095 major amputations of the lower extremities. The ongoing trend of stable numbers of major lower-limb amputations from 2012 to 2019 continued in 2020 and 2021. The verification of these data at the level of prosthetic users confirmed that the annual trends were unchanged. ConclusionThe reported increased numbers of major lower-limb amputations during the COVID-19 pandemic in the Netherlands could not be confirmed using nationwide epidemiologic data.

A Rare Presentation of Acute Coronary Syndrome, in a Patient of Amputation of Right Forearm: A Case Study.

A patient presented with sudden onset right-sided chest pain in the emergency department. He had a past history of amputation of his right forearm due to trauma 25 years back. Phantom limb pain was suspected, but on investigations, he was diagnosed with acute coronary syndrome with unstable angina. The patient was treated in ICCU ECG and ECHO were done.ECG report showed T wave inversion in V3-V6 precordial leads with ST elevation (fixed change). A coronary angiogram was done and minor CAD was detected(LAD minor blockage). ECHO report showed mild tricuspid regurgitation, concentric LVH, EF-64%. Blood pressure was 150/90mm Hg, pulse rate-103/minute and Trop T was negative on admission in iccu. The patient’s lipid profile, thyroid function test, kidney function tests, FBS, and PPBS was done and reports were normal.. Patient on discharge was advised oral medications like aspirin. clopidogrel, atorvastatin, angiotensin receptor blocker and nitroglycerine tablets. On discharge salt-restricted diet and two weeks of bed rest were advised. The theory of past experiences, denervation hypersensitivity and cortical plasticity might be the contributors of such atypical angina pain presentation which overruled the dermatomal rule. The study highlighted on atypical presentation of ACS as cardiac pain radiated in the right side in a special scenario of amputation of the right upper limb below the elbow. Differential diagnosis : Costochondral chest pain, Dextrocardia, Pericarditis, pneumonia, esophageal disease. The phantom limb component of referred pain radiates to the right side

Reassessing referral of touch following peripheral deafferentation: The role of contextual bias

Some amputees have been famously reported to perceive facial touch as arising from their phantom hand. These referred sensations have since been replicated across multiple neurological disorders and were classically interpreted as a perceptual correlate of cortical plasticity. Common to all these and related studies is that participants might have been influenced in their self-reports by the experimental design or related contextual biases. Here, we investigated whether referred sensations reports might be confounded by demand characteristics (e.g., compliance, expectation, suggestion). Unilateral upper-limb amputees (N = 18), congenital one-handers (N = 19), and two-handers (N = 22) were repeatedly stimulated with computer-controlled vibrations on 10 body-parts and asked to report the occurrence of any concurrent sensations on their hand(s). To further manipulate expectations, we gave participants the suggestion that some of these vibrations had a higher probability to evoke referred sensations. We also assessed similarity between (phantom) hand and face representation in primary somatosensory cortex (S1), using functional Magnetic Resonance Imaging (fMRI) multivariate representational similarity analysis. We replicated robust reports of referred sensations in amputees towards their phantom hand; however, the frequency and distribution of reported referred sensations were similar across groups. Moreover, referred sensations were evoked by stimulation of multiple body-parts and similarly reported on both the intact and phantom hand in amputees. Face-to-phantom-hand representational similarity was not different in amputees' missing hand region, compared with controls. These findings weaken the interpretation of referred sensations as a perceptual correlate of S1 plasticity and reveal the need to account for contextual biases when evaluating anomalous perceptual phenomena.

Prevalence and predictors of unmet need for upper limb prostheses: An observational cohort study.

ABSTRACT Introduction No prior studies have examined the prevalence of unmet prosthesis need among prosthesis nonusers. Objectives The aim of this study was to describe the prevalence of unmet need for an upper-limb prosthesis and identify independent covariates associated with unmet need for a prosthesis. Study Design This study is a telephone survey of 742 persons with upper-limb amputation (ULA). Methods Differences between users and nonusers and between nonusers with and without an unmet need were compared statistically. Covariates associated with unmet need P ≤ 0.2 in bivariate analyses were included in a multivariate logistic regression model predicting unmet need. Results Odds of unmet need were higher for those who stopped using a prosthesis within the past year compared with 20 years or more ago (odds ratio [OR], 4.30; 95% confidence interval [CI], 1.28–14.51) and those on disability (OR, 4.01; 95% CI, 0.95–16.85). Odds of unmet need were lower for those with higher upper-limb function scores (OR, 0.94; 95% CI, 0.96–1.00), who were unemployed versus employed/student (OR, 0.15; 95% CI, 0.02–0.98), and those who had abandoned a prior prosthesis because it was “too much fuss” (OR, 0.41; 95% CI, 0.18–0.92). Conclusions Unmet need was prevalent, impacting approximately 50% of persons with upper-limb amputation who were not using a device and 14% who reported never having used a prosthesis. Independent correlates of greater unmet included worse upper-limb function, prosthesis use within the prior year, and disability status. Correlates of lesser unmet need included being unemployed and having abandoned a prosthesis because it was perceived as an undue burden. Further studies are needed to understand barriers to prosthesis use among nonusers with an unmet need. Clinical Relevance Persons with ULA who do not use a prosthesis should be reevaluated regularly to identify unmet needs. Our findings suggest recent prosthesis users, those with poorer upper-limb function, and those who are employed or on disability are more likely to have unmet needs.

Stent thrombectomy for acute upper limb ischemia associated with thrombosis or thromboembolism: a case series

Objective: To evaluate the effectiveness of endovascular stent thrombectomy for acute upper limb ischemia caused by thrombosis or thromboembolism of the major arteries of the upper limb.Methods: We evaluated the effectiveness and safety of this technique in 18 patients with acute upper limb ischemia. The mean age was 72 (38‐93) years; 66.7% of the patients were women. Arterial hypertension was observed in 94.4% of the patients, and 38.9% of the patients had confirmed atrial fibrillation.Results: The primary success rate (complete revascularization according to angiography findings) was 83.3% (15 of 18 cases). We used this technique as a stand-alone procedure in 15 cases. Two patients received self-expanding stents, and 1 patient had selective thrombolytic therapy. In 3 cases we did not relieve symptoms of acute ischemia and perform any upper limb amputations during hospitalization, nor did we have any conversions to open surgery. Two patients died during hospitalization: one patient died of acute myocardial infarction, and another died of multiple organ dysfunction syndrome in the postoperative period.Conclusion: This endovascular thrombectomy technique in combination with other endovascular techniques is highly effective and has a number of benefits, such as low trauma, no need for general anesthesia, accurate intra- and postoperative patency control, timely detection of emboli with the possibility of their removal from arteries comparable in diameter to a stent delivery system (up to 1.8 mm). Received 15 February 2023. Revised 29 March 2023. Accepted 6 April 2023. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsLiterature review: A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan, A.D. KiselevDrafting the article: A.N. Kazantsev, A.N. Ivanenko, G.A. SobolevCritical revision of the article: I.S. SeminSurgical treatment: A.N. Ivanenko, G.A. SobolevFinal approval of the version to be published: I.S. Semin, A.N. Ivanenko, G.A. Sobolev, A.D. Kiselev, A.N. Kazantsev, A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan

Recognition of Upper Limb Movements Based on Hybrid EEG and EMG Signals for Human-Robot Interaction

Upper limb amputation is a condition that severely limits the amputee’s movement. Patients who have lost the use of one or more of their upper extremities have difficulty performing activities of daily living. To help improve the control of upper limb prosthesis with pattern recognition, non-invasive approaches (EEG and EMG signals) is proposed in this paper and are integrated with machine learning techniques to recognize the upper-limb motions of subjects. EMG and EEG signals are combined, and five features are utilized to classify seven hand movements such as (wrist flexion (WF), outward part of the wrist (WE), hand open (HO), hand close (HC), pronation (PRO), supination (SUP), and rest (RST)). Experiments demonstrate that using mean absolute value (MAV), waveform length (WL), Wilson Amplitude (WAMP), Sine Slope Changes (SSC), and Cardinality features of the proposed algorithm achieves a classification accuracy of 89.6% when classifying seven distinct types of hand and wrist movement. Index Terms— Human Robot Interaction, Bio-signals Analysis, LDA classifier.

Developing a Program forAdvanced Physical Therapist Practice inAmputation Care.

Over the past 20 years, military medicine made greatstrides in the medical management of traumatically injured patients. Significant advancements were made in the treatment and rehabilitation after limb loss. These advancements can be attributed to the large number of complex patients presenting to military treatment facilities and the demand for medical professionals to provide care to patients with complex injuries and multiple traumatic amputations. The concern now is to maintain the skills needed to be prepared for the next conflict. To meet this demand, the Extremity Trauma and Amputation Center of Excellence (EACE) initiated the documentation of knowledge, skills, and abilities (KSAs) to ensure that the skill sets needed to treat this unique population are not lost. The EACE developed KSAs to sustain advanced clinical practice for physical therapists, occupational therapists, and prosthetists and is in the process of developing KSAs for orthotists and physical medicine physicians. The learning objectives [terminal and enabling learning objectives (TLOs and ELOs)] derived from each set of KSAs will drive curricula development for enduring education, residencies, and fellowships. This article describes the KSAs and learning objectives for advanced physical therapist competencies in amputation care. Clinical subject matter experts (SMEs) convened from the Department of Defense (DoD) Advanced Rehabilitation Centers (ARCs) to draft the initial KSAs. All experts had specific expertise in treating individuals with highly complex lower and upper limb amputation. In a quasi-Delphi methodology, the initial draft KSAs underwent five cycles of review and comment by an additional 15 DoD, Veterans Affairs, and civilian institution experts from clinical practice, education, and research. The consensus KSAs were then transcribed into learning objectives with collaboration between clinical subject matter experts and doctoral-level educators. The final program document has 21 instructional modules with 30 TLOs and 157 ELOs. The KSAs and the learning objectives describe the skills expected of an advanced practice physical therapist treating patients with traumatic limb loss. Weaknesses of this document include the focus on traumatic amputation and military specific needs. However, many of the central advanced practices are universal to all physical therapists working in amputation. Thus, this document should serve as a starting point and can evolve to include dysvascular, oncology, and other etiologies. To our knowledge, this is the first paper to describe the KSAs for the advanced practice physical therapist working with traumatic limb loss population. This work will form the framework for physical therapist advanced practice training programs.

A 3D Printed, Bionic Hand Powered by EMG Signals and Controlled by an Online Neural Network.

About 8% of the Ecuadorian population suffers some type of amputation of upper or lower limbs. Due to the high cost of a prosthesis and the fact that the salary of an average worker in the country reached 248 USD in August 2021, they experience a great labor disadvantage and only 17% of them are employed. Thanks to advances in 3D printing and the accessibility of bioelectric sensors, it is now possible to create economically accessible proposals. This work proposes the design of a hand prosthesis that uses electromyography (EMG) signals and neural networks for real-time control. The integrated system has a mechanical and electronic design, and the latter integrates artificial intelligence for control. To train the algorithm, an experimental methodology was developed to record muscle activity in upper extremities associated with specific tasks, using three EMG surface sensors. These data were used to train a five-layer neural network. the trained model was compressed and exported using TensorflowLite. The prosthesis consisted of a gripper and a pivot base, which were designed in Fusion 360 considering the movement restrictions and the maximum loads. It was actuated in real time thanks to the design of an electronic circuit that used an ESP32 development board, which was responsible for recording, processing and classifying the EMG signals associated with a motor intention, and to actuate the hand prosthesis. As a result of this work, a database with 60 electromyographic activity records from three tasks was released. The classification algorithm was able to detect the three muscle tasks with an accuracy of 78.67% and a response time of 80 ms. Finally, the 3D printed prosthesis was able to support a weight of 500 g with a safety factor equal to 15.

Prosthesis nonuse and discontinuation in United States veterans with major limb amputation: Results of a national survey.

Prosthesis use in persons with amputation can improve mobility and functional independence. Better understanding of the reasons for and outcomes associated with prosthesis nonuse is important to optimize function and long-term health in persons with amputation. Study objectives were to describe the rate, reasons for, and factors associated with never using or discontinuing prosthesis use in United States (US) veterans with amputation. Cross-sectional study design. The study used an online survey to assess prosthesis use and satisfaction in veterans with upper-limb and lower-limb amputation. Survey participation invitations were distributed by email, text message, and mail to 46,613 potential participants. The survey response rate was 11.4%. After exclusions, an analytic sample of 3,959 respondents with a major limb amputation was identified. The sample was 96.4% male; 78.3% White, with mean age of 66.9; and mean of 18.2 years since amputation. The rate of never using a prosthesis was 8.2%, and the rate of prosthesis discontinuation was 10.5%. Functionality (62.0%), undesirable prosthesis characteristics (56.9%), and comfort (53.4%) were the most common reasons for discontinuation. After controlling for the amputation subgroup, the odds of prosthesis discontinuation were higher for those with unilateral upper-limb amputation, female gender, White race (compared with Black race), diabetes, above-knee amputation, and lower prosthesis satisfaction. Prosthesis satisfaction and quality of life were highest for current prosthesis users. This study adds new understanding regarding the rate and reasons for prosthesis nonuse in veterans and highlights the important relationship between prosthesis discontinuation and prosthesis satisfaction, quality of life, and satisfaction with life.

Improving the Early Outcome of Digital Replantation: Technical Tricks Learned in a US Fellowship

Abstract Background Despite stable numbers of upper limb amputations there is a decline in replantation in Europe. This results in lacking experience, decreasing success rates, and fewer attempts. Training in high-volume centers is crucial for hand surgeons performing upper extremity replantation. Aims This abstract highlights the experience in a US microsurgery fellowship. Methods Upper extremity revascularization and replantation cases during a 10 month - period were retrospectively reviewed. Overall, the fellow was exposed to 29 cases: 2 hand, 5 thumb and 9 digitial replantations as well as 13 thumb and digital revascularizations. Primary outcome was the survival of the injured body part. Secondary outcomes were total case time, number of repaired arteries/veins, the use of vein grafts, and early free flap coverage. Whenever possible, all microsurgical steps including vessel debridement and anastomosis were performed under tourniquet. Results Success rate was 21/29 (72%). Failure was limited to avulsion or crush injuries. Mean surgery time for revascularization was 92 min (range, 45-134 min) per digit. Mean surgery time for thumb and single digit replantation was 133 min (range, 62-270 min) and for the two hand replantations 180 min and 300 min, respectively. Routinely, only 1 dominant artery was repaired. Forearm or saphenous vein grafts were used in 14/29 cases. Only in 3/23 cases > 1 vein was repaired and in 3 cases interpositional vein grafts were used for dorsal vein reconstruction. One venous flow-through flap was used and a dorsal hand soft tissue defect was covered with a fascio-cutaneous free flap 5 days after replantation. Conclusions Replantation remains a challenge for hand surgeons. The thoughtful use of a tourniquet with vessel debridement in a bloodless field is key to maximize the efficiency of replantation. Furthermore, the liberate use of vein grafts and venous flow-through flaps helps moving outside the trauma zone, thus increasing the likelihood of upper limb salvage.

ID: 200598 Targeted Muscle Re-Innervation for Management of Terminal Neuroma in Traumatic Upper Limb Amputation

The patient is a 49-year-old male with a left wrist disarticulation in the setting of work-related trauma complicated by thrombosis and osteomyelitis (Figure 1). His case was complicated by severe constant grabbing pain in his distal residual limb, refractory to conservative treatments, functionally limiting his ability to use his prosthesis for more than 30 minutes at a time. His examination revealed significant allodynia with palpation of the left distal forearm with an intact integumentary exam.

X-reality for phantom limb management for amputees: A systematic review and meta-analysis

Phantom limb is a disabling neuropsychiatric condition among amputees resulting in pain and disturbance that impact their functions, quality of life, and autonomy. While pharmacological approaches appeared to be ineffective, the emergence and integration of X-reality, including virtual reality, augmented reality, and mixed reality, might elevate the effectiveness of mirror therapy in managing phantom limb. The objective of this study is to review X-reality for managing phantom pain. A systematic search was conducted on PubMed, Scopus, Web of Science, PsycINFO, Embase, and CINAHL. Sixteen (n = 16) studies containing 66 lower-limb and 53 upper-limb amputees were included for the review over the thematic framework of amputee characteristics and intervention designs, while thirteen (n = 13) studies were further proceeded for the meta-analysis. We found eleven studies on virtual reality (n = 11), four studies on marker-based augmented reality (n = 4) and one study on mixed reality (n = 1) with a total of 40 game/task themes involving, motor skills, motor control, and stimulus-sensing. Regardless, all these interventions adopted the movement representation strategies with different techniques. Overall, the X-reality interventions reduced the pain level of the amputees (mean difference: -2.30, 95% CI, -3.38 to -1.22), especially the virtual reality subgroup (mean difference: -2.83, 95% CI, -4.43 to -1.22). However, there were substantial heterogeneity and partially explained by the subgroup analysis on publication year. The strength of evidence was limited by case reports and case series in this review.