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AIMS: Risk factors for lower limb amputation (LLA) in individuals with diabetes have been under-studied. We examined how 1/demographic and socioeconomic, 2/medical, and 3/lifestyle risk factors may be associated with LLA in people with newly diagnosed diabetes. METHODS: Using the Swedish national diabetes register from 2007 to 2016, we identified all individuals ≥18 years with an incident diabetes diagnosis and no previous amputation. These individuals were followed from the date of diabetes diagnosis to amputation, emigration, death, or the end of the study in 2017 using data from the In-Patient Register and the Total Population Register. The cohort consisted of 66,569 individuals. Information about demographic, socioeconomic, medical, and lifestyle risk factors was ascertained around the time of the first recorded diabetes diagnosis, derived from the above-mentioned registers. Cox proportional hazard models were used to obtain hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: During the median follow-up time of 4 years, there were 133 individuals with LLA. The model adjusting for all variables showed a higher risk for LLA with higher age, HR 1.08 (95% CI 1.05-1.10), male sex, HR 1.57 (1.06-2.34), being divorced, HR 1.67 (1.07-2.60), smokers HR 1.99 (1.28-3.09), insulin treated persons HR 2.03 (1.10-3.74), people with low physical activity (PA) HR 2.05 (1.10-3.74), and people with an increased foot risk at baseline HR > 4.12. People with obesity had lower risk, HR 0.46 (0.29-0.75). CONCLUSIONS: This study found a higher risk for LLA among people with higher age, male sex, who were divorced, had a higher foot risk group, were on insulin treatment, had lower PA levels, and were smokers. No significant association was found between risk for LLA and education level, country of origin, type of diabetes, blood glucose level, hypertension, hyperlipidemia, creatinine level, or glomerular filtration rate. Obesity was associated with lower risk for LLA. Identified variables may have important roles in LLA risk among people with diabetes.
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Amputación Quirúrgica , Extremidad Inferior , Humanos , Masculino , Femenino , Amputación Quirúrgica/estadística & datos numéricos , Suecia/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Anciano , Adulto , Extremidad Inferior/cirugía , Pie Diabético/cirugía , Pie Diabético/epidemiología , Pie Diabético/etiología , Sistema de Registros , Estilo de Vida , Estudios de Cohortes , Modelos de Riesgos Proporcionales , Diabetes Mellitus/epidemiologíaRESUMEN
BACKGROUND: Although femoropopliteal-specific stents have durable patency, stent thrombosis (ST) may occur, which can lead to acute limb ischaemia (ALI). AIMS: We aimed to investigate the clinical features and outcomes of ALI caused by femoropopliteal ST in patients with lower extremity artery disease. METHODS: This multicentre retrospective study included 499 patients with ALI - of whom 108 patients had ALI caused by femoropopliteal ST (ST-ALI) and 391 patients had ALI caused by other aetiologies (de novo ALI) - who underwent treatment between September 2011 and March 2023. Clinical features and outcomes were compared between the two groups. The primary outcome measure was 12-month amputation-free survival; factors associated with amputation or death were investigated using multivariate Cox proportional hazards regression analysis. RESULTS: Patients with ST-ALI were significantly more likely to exhibit conventional atherosclerotic risk factors, including diabetes mellitus (63% vs 26%) and haemodialysis (51% vs 10%) compared to patients with de novo ALI, whereas patients with de novo ALI were older (80 years vs 74 years) and more likely to have atrial fibrillation (49% vs 18%) than patients with ST-ALI. The 12-month amputation-free survival rate was significantly lower in the ST-ALI group than that in the de novo ALI group (51% vs 76%; p<0.001). Multivariate analysis revealed that ST-ALI, older age, haemodialysis, atrial fibrillation, the presence of a wound, peak C-reactive protein level, and non-ambulatory status all have an independent, positive association with death or major amputation. CONCLUSIONS: The current study revealed that patients with ST-ALI had worse clinical outcomes than those with de novo ALI, highlighting the need to maximise ST prevention.
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Amputación Quirúrgica , Arteria Femoral , Isquemia , Enfermedad Arterial Periférica , Arteria Poplítea , Stents , Trombosis , Humanos , Masculino , Anciano , Femenino , Estudios Retrospectivos , Arteria Poplítea/cirugía , Isquemia/terapia , Isquemia/mortalidad , Isquemia/etiología , Isquemia/cirugía , Arteria Femoral/cirugía , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/cirugía , Enfermedad Arterial Periférica/mortalidad , Anciano de 80 o más Años , Persona de Mediana Edad , Trombosis/etiología , Trombosis/mortalidad , Resultado del Tratamiento , Factores de Riesgo , Recuperación del Miembro , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Extremidad Inferior/irrigación sanguínea , Enfermedad Aguda , Grado de Desobstrucción VascularRESUMEN
Objective: This study aimed to comprehensively analyze the incidence of amputation in Chinese patients with diabetic foot ulcers (DFUs). Methods: The Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were used. The CNKI, Wanfang Data, VIP, PubMed, Web of Science, and Embase databases were searched to collect relevant literature on the incidence of amputation in Chinese patients with DFUs. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias. The data were systematically analyzed using Stata 17.0 software to determine the incidence of amputation in this patient population. Results: A total of 25 papers were included in the study, revealing an incidence of amputation in Chinese patients with DFUs of 22.4% (95% confidence interval: 18.3-26.5%). The subgroup analysis revealed that a history of ulcers, Wagner grade >3, and diabetic peripheral vascular disease were the primary risk factors associated with a higher incidence of amputation in Chinese patients with DFUs (P<0.05). Among Chinese patients with DFUs, the amputation group and the non-amputation group showed significant differences in body mass index, duration of DFUs, total cholesterol, triglyceride, fasting blood glucose, white blood cell count, hemoglobin A1c, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and uric acid (P<0.05). Conclusion: The high incidence of amputation among Chinese patients with DFUs indicates that interventions should be implemented to prevent or minimize amputations. Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42023463976.
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Amputación Quirúrgica , Pie Diabético , Humanos , Pie Diabético/cirugía , Pie Diabético/epidemiología , Amputación Quirúrgica/estadística & datos numéricos , Factores de Riesgo , Incidencia , China/epidemiología , Pueblos del Este de AsiaRESUMEN
The amputation rate resulting from electrical burn injuries remains high, yet no study has investigated whether early fasciotomy may reduce the amputation rate. The aim of this study was to analyze the success rate of fasciotomy in preventing amputation and determine the optimal timing for fasciotomy in electrical burn injuries. This study was conducted at Dr. Soetomo Hospital from January 2020 to July 2023. Total sampling was employed to recruit the patients. Clinical data, voltage characteristics, burn location, affected total body surface area, burn depth, hospital arrival time, and time interval from incident to fasciotomy were assessed. Chi-squared test was used to assess factors associated with the fasciotomy incidence and factors associated with amputation after fasciotomy. A total of 45 patients were included, of which 97.8% were male, with a mean age of 37.60 years old. Approximately 73% of patients had full-thickness burn injuries, with the left upper extremity being the most affected (80%). There are seven patients (15.6%) had fasciotomy and five (11.1%) patients had an amputation. Our data indicated a significant association between voltage characteristics and fasciotomy incidence (p=0.034). Additionally, our data indicated that earlier arrival to the hospital (p=0.002) and timely fasciotomy conducted upon arrival (p<0.001) were associated with a reduced rate of amputation. This study highlights that prompt arrival to the hospital and early fasciotomy may prevent amputation in patients with electrical burn injuries.
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Amputación Quirúrgica , Quemaduras por Electricidad , Fasciotomía , Humanos , Masculino , Quemaduras por Electricidad/cirugía , Quemaduras por Electricidad/epidemiología , Indonesia/epidemiología , Femenino , Adulto , Estudios Transversales , Amputación Quirúrgica/estadística & datos numéricos , Amputación Quirúrgica/efectos adversos , Persona de Mediana EdadRESUMEN
BACKGROUND: The potential preventive effect of fenofibrate on lower extremity amputation (LEA) and peripheral arterial disease (PAD) in patients with type 2 diabetes (T2D) is not fully elucidated. METHODS: We selected adult patients ≥ 20 years of age with T2D from the Korean National Health Insurance Service Database (2009-2012). The fenofibrate users were matched in a 1:4 ratio with non-users using propensity scores (PS). The outcome variables were a composite of LEA and PAD and the individual components. The risks of outcomes were implemented as hazard ratio (HR) with 95% confidence intervals (CI). For safety issues, the risks of acute kidney injury, rhabdomyolysis and resulting hospitalization were analyzed. RESULTS: A total of 114,920 patients was included in the analysis with a median follow-up duration of 7.6 years (22,984 and 91,936 patients for the fenofibrate user and non-user groups, respectively). After PS matching, both groups were well balanced. The fenofibrate group was associated with significantly lower risks of composite outcome of LEA and PAD (HR 0.81; 95% CI 0.70-0.94), LEA (HR 0.76; 95% CI 0.60-0.96), and PAD (HR 0.81; 95% CI 0.68-0.96). The risk of acute kidney injury, rhabdomyolysis, or hospitalization for these events showed no significant difference between the two groups. Subgroup analyses revealed consistent benefits across age groups, genders, and baseline lipid profiles. CONCLUSIONS: This nationwide population-based retrospective observational study suggests that fenofibrate can prevent LEA and PAD in patients with T2D who are on statin therapy.
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Amputación Quirúrgica , Diabetes Mellitus Tipo 2 , Fenofibrato , Hipolipemiantes , Enfermedad Arterial Periférica , Humanos , Fenofibrato/uso terapéutico , Fenofibrato/efectos adversos , Masculino , Femenino , Amputación Quirúrgica/efectos adversos , Persona de Mediana Edad , Anciano , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/epidemiología , Enfermedad Arterial Periférica/cirugía , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Hipolipemiantes/uso terapéutico , Hipolipemiantes/efectos adversos , Factores de Riesgo , Resultado del Tratamiento , República de Corea/epidemiología , Estudios Retrospectivos , Rabdomiólisis/diagnóstico , Rabdomiólisis/epidemiología , Rabdomiólisis/inducido químicamente , Bases de Datos Factuales , Factores de Tiempo , Lesión Renal Aguda/prevención & control , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/diagnóstico , Adulto , Angiopatías Diabéticas/diagnóstico , Angiopatías Diabéticas/prevención & control , Angiopatías Diabéticas/epidemiologíaRESUMEN
BACKGROUND: Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. METHODS: The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. RESULTS: From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. CONCLUSION: The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.
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Amputación Quirúrgica , Carga Global de Enfermedades , Extremidad Inferior , Humanos , Medio Oriente/epidemiología , África del Norte/epidemiología , Amputación Quirúrgica/estadística & datos numéricos , Amputación Quirúrgica/tendencias , Masculino , Femenino , Extremidad Inferior/cirugía , Carga Global de Enfermedades/tendencias , Prevalencia , Incidencia , Persona de Mediana Edad , Años de Vida Ajustados por Discapacidad/tendencias , AdultoRESUMEN
BACKGROUND: Our goal was to develop and validate the Severe Lower-Extremity Trauma decision aid (SLETRA) to help patients make treatment decisions aligned with their values regarding amputation versus reconstruction. METHODS: We recruited 62 adults (41 women) from a foot and ankle practice at a US academic hospital from June to August 2020. We excluded patients who could not read in English and who lacked internet service access. Patients completed an 8-question knowledge test regarding the risks, benefits, and outcomes of treatment options before and after reviewing SLETRA. The survey presented a hypothetical case of severe lower-extremity trauma. Respondents, imagining themselves as patients, indicated whether they would choose amputation or reconstruction. We evaluated knowledge scores (maximum, 8 points); decisional conflict scores (maximum, 400 points, with higher scores indicating greater respondent difficulty in decision making); ratings of factors influencing the decision; and SLETRA helpfulness (maximum, 7 points). Pre- and post-test knowledge scores were compared using paired Student's t-tests; Alpha = 0.05. RESULTS: Mean and standard deviation knowledge scores improved from 5.2 ± 1.6 (pre-test) to 6.7 ± 1.6 (post-test) (p < 0.001). Mean decisional conflict score was 223 ± 16, reflecting moderate difficulty. Factors affecting treatment choice were risk of complications (n = 29), recovery time (n = 27), and future prosthesis use (n = 27). No respondent had difficulty understanding SLETRA. Mean helpfulness score was 5.6 ± 0.16, reflecting considerable benefit. CONCLUSION: The SLETRA decision aid is a helpful, understandable tool that significantly improves patient knowledge regarding treatment options for severe lower-extremity trauma.
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Amputación Quirúrgica , Técnicas de Apoyo para la Decisión , Humanos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Conocimientos, Actitudes y Práctica en Salud , Traumatismos de la Pierna/cirugía , Traumatismos de la Pierna/diagnóstico , Traumatismos de la Pierna/fisiopatología , Traumatismos de la Pierna/psicología , Participación del Paciente , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Melanoma is the most malignant skin tumor, with a high metastatic potential. Spitzoid melanoma is a subtype of melanoma requiring rapid management and extensive tumor resection. We have set the goal to recognize anatomical peculiarities and difficulties diagnoses posed by this type of tumor, as well as to recognize the management modalities, especially the surgical one, of malignant spitzoid melanoma. CASE PRESENTATION: A 25-year-old Tunisian male patient had consulted for nodular lesion of the right index, evolving for 4 years. A malignant tumor was strongly suspected, then confirmed as a melanoma by a biopsy excision. Initially, the excision was incomplete in depth, suggesting a complementary surgery, but the patient refused it; 3 years later, the patient again consulted after the appearance of an axillary lymphadenopathy and worsening of the skin lesion. A supplement of tumor removal with lymph node biopsy were performed. It was decided to perform an amputation of the second ray and the first commissure with cheiroplasty, reconstructing a four-finger hand. An homolateral axillary cleaning was performed at the same time. The postoperative result is considered esthetically and functionally satisfying. The evolution was marked by the appearance of pulmonary metastases, requiring adjuvant chemotherapy. A regression of the nodule under the mammary skin and total disappearance of axillary nodes have been marked; but the patient's condition rapidly deteriorated, and he died after a 2-month decline. CONCLUSION: Spitzoid melanoma is exceptional, posing difficulties in diagnostics, and it should not be underestimated, considering that it may involve the vital prognosis. Knowledge of this rare form of melanoma is important to avoid misdiagnosis, which delays diagnosis and subsequent therapy.
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Dedos , Melanoma , Neoplasias Cutáneas , Humanos , Masculino , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Melanoma/patología , Melanoma/cirugía , Melanoma/diagnóstico , Adulto , Dedos/patología , Dedos/cirugía , Amputación Quirúrgica , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/secundario , AxilaRESUMEN
For endovascular treatment of below-the-knee (BTK) peripheral artery disease (PAD), independently adjudicated real-world outcomes comparing non-stent-based balloon angioplasty (percutaneous transluminal angioplasty) and adjunctive treatments with or without a concomitant ipsilateral femoropopliteal (FP) artery intervention are scarce. A total of 1,060 patients from the multicenter XLPAD registry who underwent non-stent-based BTK PAD intervention between 2006 and 2021 were included. The primary outcome was the 1-year incidence of major adverse limb events (MALEs), a composite of all-cause death, any amputation, or clinically driven repeat revascularization. A total of 566 patients underwent BTK and 494 BTK + FP interventions; 72% were men, with a mean age of 68.4 ± 10.9 years. Diabetes mellitus was more prevalent in the BTK-only group (76.5% vs 69%, p = 0.006). Mean Rutherford class was 4.2 ± 1.18; chronic limb-threatening ischemia was more frequent in the BTK group (55.3% vs 49%, p = 0.040). Moderate to severe calcification was more frequent in the BTK + FP group (21.2% vs 27.1%, p = 0.024), as was lesion length (110.6 ± 77.3 vs 135.4 ± 86.3 mm, p <0.001). Nearly 81% of lesions were treated with percutaneous transluminal angioplasty. Drug-coated balloon (1.6% vs 14%, p <0.001) and atherectomy (38% vs 58.5%, p <0.001) use was more frequent in the BTK + FP group. The rate of procedural success was higher in the BTK + FP group (86% vs 91%, p = 0.009), with amputation being the most common complication at 3.3% within 30 days after the procedure. The rates of 1-year MALE (21.2% vs 22.3%, p = 0.675) and mortality (4.6% vs 3.4%, p = 0.3) were similar between the BTK and BTK + FP groups. Nonstent treatment for BTK PAD with concomitant FP intervention leads to high procedural success and similar rates of 1-year MALE compared with isolated BTK intervention. Condensed Abstract: The vast majority of below-the-knee (BTK) peripheral artery disease (PAD) interventions are performed with balloon angioplasty. Presence of inflow femoropopliteal PAD in patients who undergo BTK interventions can affect the outcome of the procedure. This report explores immediate procedural success and major adverse limb events at 1 year after balloon angioplasty treatment for isolated BTK PAD and in patients who underwent an additional femoropopliteal PAD intervention.
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Angioplastia de Balón , Enfermedad Arterial Periférica , Arteria Poplítea , Sistema de Registros , Humanos , Masculino , Femenino , Enfermedad Arterial Periférica/terapia , Anciano , Angioplastia de Balón/métodos , Persona de Mediana Edad , Resultado del Tratamiento , Amputación Quirúrgica , Arteria Femoral , Recuperación del MiembroRESUMEN
A 1-year-old male neutered ferret (Mustela putorius furo) was evaluated for an abnormal left cubital joint. Radiographs demonstrated a proliferative osseous lesion of the left proximal antebrachium. Computed tomography confirmed a large thin-walled expansile osseous lesion of the left proximal radius and identified multifocal proliferative lesions of the axial spine, two of which caused spinal cord compression. A left forelimb amputation with total scapulectomy was performed. Histopathology revealed a well-demarcated mass with a thin rim of mature lamellar bone and a discontinuous cartilage cap covered by a perichondrial/periosteal membrane continuous with the adjacent bone. Findings were most consistent with an osteochondroma or osteochondromatosis (i.e., multiple cartilaginous exostoses, hereditary multiple exostoses). No evidence of malignant transformation was observed within this specimen. Three months post-surgery, verbal correspondence with the owner confirmed return to normal activity level and no emergence of neurological signs. Repeat examination and imaging were recommended.
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Neoplasias Óseas , Hurones , Miembro Anterior , Osteocondroma , Animales , Masculino , Miembro Anterior/patología , Miembro Anterior/cirugía , Neoplasias Óseas/veterinaria , Neoplasias Óseas/cirugía , Neoplasias Óseas/patología , Osteocondroma/veterinaria , Osteocondroma/cirugía , Osteocondroma/patología , Osteocondroma/diagnóstico por imagen , Amputación Quirúrgica/veterinaria , Tomografía Computarizada por Rayos X/veterinaria , Resultado del TratamientoRESUMEN
INTRODUCTION: In the evaluation of an internal analysis of data on the increased effort for nursing during rehabilitation of patients with amputations in the Baumrainklinik of the HELIOS Rehabilitation Center Bad Berleberg, the number of patients with transfemoral amputations (TFA) due to uncontrollable multiple infections after implantation of a total knee endoprosthesis (total knee arthroplasty, TKA) was clearly emphasized. OBJECTIVE: This article discusses the results of a retrospective, patient-controlled trial (PCT) and compares these with the data of the German Endoprosthesis Registry (EPRD). The study concentrated on patients who were admitted to rehabilitation after a TFA due to an uncontrollable infection after implantation of a knee TKA. The primary aims were the identification of patients who developed an uncontrollable infection after TKA with subsequent TFA and the comparison with national and international revision and amputation rates after TKA. METHOD: An analysis of the medical history questionnaire was carried out for all 787 patients with amputation of the lower extremities who underwent rehabilitation in the time period from 1st January 2007 to 31st December 2015. The patient records were systematically analyzed based on the standardized documentation methods of the medical and nursing personnel using the Barthel index, the activity/function classes, phantom pain and length of stay, including demography, infection history and insurance company. RESULTS: The analysis showed that 10 patients, 2.29% of all TFA, suffered the loss of a lower extremity due to an uncontrollable TKA infection. The revision rate 3 years after primary TKA in Germany is 3.0% (EPRD annual report 2023), whereas values of 1-4% are given in the international literature (status 2020). In the patient group of the EPRD, in 2022 revision surgery was necessary due to an infection in 15.0% of the cases. The current statistics of the EPRD (annual report 2023) show that 3 years after the initial revision surgery due to an infected TKA another revision was necessary in 23.5-30% of cases. CONCLUSION: These numbers are alarming and should be critically evaluated and monitored. The future aim is to identify the causes of infections, systematic errors in the TKA and the pathogens that lead to infections after TKA and to correlate the associations.
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Amputación Quirúrgica , Artroplastia de Reemplazo de Rodilla , Infecciones Relacionadas con Prótesis , Humanos , Amputación Quirúrgica/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Masculino , Alemania/epidemiología , Anciano , Femenino , Estudios Retrospectivos , Infecciones Relacionadas con Prótesis/etiología , Persona de Mediana Edad , Prótesis de la Rodilla/efectos adversos , Anciano de 80 o más Años , Reoperación , Sistema de Registros , Fémur/cirugíaRESUMEN
Despite intensive research and development of systems for restoration of sensory information, these have so far only been the subject of study protocols. A new noninvasive feedback system translates pressure loads on the forefoot and hindfoot into gait-synchronized vibrotactile stimulation of a defined skin area. To increase the authenticity, this treatment can be supplemented by a surgical procedure. Targeted sensory reinnervation (TSR) describes a microsurgical procedure in which a defined skin area on the amputated stump of the residual limb is first denervated and then reinnervated by a specific, transposed sensory nerve harvested from the amputated part of the limb. This creates a sensory interface at the residual stump. This article presents the clinical and orthopedic technical treatment pathway with this innovative vibrotactile feedback system and explains in detail the surgical procedure of TSR after amputation of the lower limb.
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Marcha , Tacto , Vibración , Humanos , Vibración/uso terapéutico , Marcha/fisiología , Tacto/fisiología , Caminata/fisiología , Retroalimentación Sensorial/fisiología , Diseño de Equipo , Amputación Quirúrgica/rehabilitaciónRESUMEN
OBJECTIVE: To evaluate presentations, aetiologies, interventions, and outcomes of patients presenting with acute limb ischaemia (ALI). STUDY DESIGN: An observational study. Place and Duration of the Study: Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan, from January 2000 to December 2020. METHODOLOGY: Record of 104 patients who underwent surgical interventions for ALI was retrospectively evaluated. The diagnosis was confirmed on imaging (ultrasound / CTA / conventional angiography). Demographic characteristics, co-morbidities, aetiologies, and outcomes were analysed using descriptive statistics and logistic regression. RESULTS: The cohort's mean age was 58.89 ± 12.6 years, with (54.8%, n = 57) females and (45.2%, n = 47) males. Hypertension (54.8%, n = 57), diabetes (46.2%, n = 48), and atrial fibrillation (34.6%, n = 36) were common comorbidities. Thromboembolism (67.3%, n = 70) and thrombotic occlusion (32.7%, n = 34) were primary aetiologies, predominantly affecting the lower limb (66.3%, n = 58) and femoral artery (51.9%, n = 54). The majority of cases were classified as Rutherford classification 2A (53.8%; 56 cases) and 2B (44.2%; 46 cases); 58 (55.8%) patients were classified as ASA Class III, while 36 (34.6%) patients were categorised as ASA Class IV. Embolectomy (80.8%, n = 84) was the prevailing intervention, with an amputation rate (17.3%, n = 18) and a mortality rate (5.8%, n = 6). CONCLUSION: Most patients with ALI presented with Rutherford Class II and had thromboembolism aetiology. Embolectomy was the most commonly performed procedure with a high amputation rate and mortality. KEY WORDS: Acute limb ischaemia, Embolectomy, Amputation, Thromboembolism.
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Amputación Quirúrgica , Isquemia , Humanos , Femenino , Masculino , Persona de Mediana Edad , Isquemia/cirugía , Estudios Retrospectivos , Pakistán/epidemiología , Anciano , Enfermedad Aguda , Amputación Quirúrgica/estadística & datos numéricos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/cirugía , Embolectomía/métodos , Recuperación del Miembro/métodos , AdultoRESUMEN
OBJECTIVE: To explore cognitive load in people with transfemoral amputations fitted with socket or bone-anchored prostheses by describing activity in the left and right dorsolateral prefrontal cortices during single- and dual-task walking. DESIGN: Cross-sectional pilot study. PATIENTS: 8 socket prosthesis users and 8 bone-anchored prosthesis users. All were fitted with microprocessor-controlled prosthetic knees. METHODS: Participants answered self-report questionnaires and performed gait tests during 1 single-task walking condition and 2 dual-task walking conditions. While walking, activity in the dorsolateral prefrontal cortex was measured using functional near-infrared spectroscopy. Cognitive load was investigated for each participant by exploring the relative concentration of oxygenated haemoglobin in the left and right dorsolateral prefrontal cortex. Symmetry of brain activity was investigated by calculating a laterality index. RESULTS: Self-report measures and basic gait variables did not show differences between the groups. No obvious between-group differences were observed in the relative concentration of oxygenated haemoglobin for any walking condition. There was a tendency towards more right-side brain activity for participants using a socket prosthesis during dual-task conditions. CONCLUSIONS: This pilot study did not identify substantial differences in cognitive load or lateralization between socket prosthesis users and bone-anchored prosthesis users.
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Miembros Artificiales , Cognición , Caminata , Humanos , Proyectos Piloto , Masculino , Persona de Mediana Edad , Estudios Transversales , Femenino , Caminata/fisiología , Cognición/fisiología , Adulto , Anciano , Fémur/cirugía , Amputación Quirúrgica/rehabilitación , Diseño de Prótesis , Prótesis Anclada al Hueso , Corteza Prefrontal/fisiopatología , Amputados/rehabilitación , Amputados/psicología , Espectroscopía Infrarroja Corta , Marcha/fisiologíaRESUMEN
BACKGROUND: High-energy casualties such as firearm injuries may result in extensive loss of soft tissue and bone in the lower extremities. Although the primary aim in these types of injuries is the preservation of the extremity, repeated surgical procedures for extremity salvage and subsequent restoration of function could have detrimental effects on the patient both physically and psychologically. The main aim of this study is to evaluate the physical and psychological outcomes of patients who underwent lower extremity amputation in the early period after a firearm injury compared with the results of patients who underwent amputation in the late period. We also evaluated the factors affecting the prognosis in patients undergoing late below-knee amputation (BKA). METHODS: This retrospective study included patients who underwent BKA following a lower extremity injury caused by firearms between March 2016 and March 2022. Patients who underwent emergency BKA at the first center they were taken to immediately after the injury constituted the early amputation (EA) group. Patients who were transferred to our tertiary-level referral center for continuation of treatment after the first intervention at another center and later underwent BKA constituted the late amputation (LA) group. The patients were evaluated regarding age, gender, amputation side, presence of phantom limb pain (PLP), and post-traumatic stress disorder (PTSD). RESULTS: Information was available from hospital records for a total of 35 patients; 16 in the EA group and 19 in the LA group. All patients were male. The mean age at the time of injury was 25.5±5.3 years (range, 20-45 years), and the mean follow-up period was 37±17 months (range, 25-84 months). In the comparison of PLP experienced, the difference between the groups was statistically significant, with PLP experienced by 1 (10%) patient in the EA group and by 9 (90%) in the LA group (p=0.010). PTSD was diagnosed in 3 (23%) patients in the EA group and 10 (77%) patients in the LA group (p=0.039). CONCLUSION: Patients who underwent late BKA were found to be affected by PLP and PTSD at a higher rate. When deciding on extremity-preserving surgery for patients with severe open injuries to the lower extremity, it is crucial to consider the poor outcomes associated with late BKA. Patients should be thoroughly informed about these negative outcomes.
Asunto(s)
Amputación Quirúrgica , Heridas por Arma de Fuego , Humanos , Heridas por Arma de Fuego/cirugía , Heridas por Arma de Fuego/complicaciones , Masculino , Estudios Retrospectivos , Adulto , Femenino , Estudios de Seguimiento , Persona de Mediana Edad , Traumatismos de la Pierna/cirugía , Extremidad Inferior/lesiones , Extremidad Inferior/cirugía , Factores de Tiempo , Adulto Joven , Resultado del TratamientoRESUMEN
OBJECTIVE: To assess the effects of colchicine, which has been shown to reduce the risks of coronary artery disease but scarcely studied in peripheral artery disease (PAD), on major adverse limb events (MALE) in patients with PAD. METHODS: This is a retrospective study based on a nationwide database. Patients who were diagnosed with PAD between 2010 and 2020 and prescribed with colchicine after the diagnosis of PAD were identified. Patients were then categorized into the colchicine or the control group according to drug use. Propensity score matching was performed to mitigate selection bias. Risks of MALE (including lower limb revascularization and nontraumatic amputation) and major adverse cardiovascular events were compared between the two groups. RESULTS: After patient selection and propensity score matching, there were 60,219 patients in both colchicine and control groups. After a mean follow-up of 4.5 years, the risk of MALE was significantly lower in the colchicine group compared with control (subdistribution HR, 0.75; 95% CI, 0.71 to 0.80), as were the incidence of both components of MALE, lower limb revascularization and major amputations. Colchicine treatment was also associated with lower risk of cardiovascular death. The lower risk of MALE observed with colchicine therapy was accentuated in the subgroup of patients receiving concomitant urate-lowering medications. CONCLUSION: In patients diagnosed with PAD, the use of colchicine is associated with lower risks of MALE and cardiovascular death. Anti-inflammatory therapy with colchicine may provide benefits in vascular beds beyond the coronary arteries.
Asunto(s)
Colchicina , Enfermedad Arterial Periférica , Humanos , Colchicina/uso terapéutico , Enfermedad Arterial Periférica/tratamiento farmacológico , Enfermedad Arterial Periférica/epidemiología , Masculino , Estudios Retrospectivos , Anciano , Femenino , Persona de Mediana Edad , Puntaje de Propensión , Amputación Quirúrgica/estadística & datos numéricos , Extremidad Inferior/irrigación sanguínea , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiologíaRESUMEN
Individuals with transtibial amputation can activate residual limb muscles to volitionally control robotic ankle prostheses for walking and postural control. Most continuous myoelectric ankle prostheses have used a tethered, pneumatic device. The Open Source Leg allows for myoelectric control on an untethered electromechanically actuated ankle. To evaluate continuous proportional myoelectric control on the Open Source Ankle, we recruited five individuals with transtibial amputation. Participants walked over ground with an experimental powered prosthesis and their prescribed passive prosthesis before and after multiple powered device practice sessions. Participants averaged five hours of total walking time. After the final testing session, participants indicated their prosthesis preference via questionnaire. Participants tended to increase peak ankle power after practice (powered 0.80 ± 1.02 W/kg and passive 0.39 ± 0.31 W/kg). Additionally, participants tended to generate greater ankle work with the powered prosthesis compared to their passive device ( 0.13 ± .15 J/kg increase). Although work and peak power generation were not statistically different between the two prostheses, participants preferred walking with the prosthesis under myoelectric control compared to the passive prosthesis. These results indicate individuals with transtibial amputation learned to walk with an untethered powered prosthesis under continuous myoelectric control. Four out 5 participants generated larger magnitudes in peak power compared to their passive prosthesis after practice sessions. An additional important finding was participants chose to walk with peak ankle powers about half of what the powered prosthesis was capable of based on mechanical testing.
Asunto(s)
Amputación Quirúrgica , Miembros Artificiales , Biónica , Electromiografía , Diseño de Prótesis , Caminata , Humanos , Masculino , Caminata/fisiología , Femenino , Fenómenos Biomecánicos , Adulto , Persona de Mediana Edad , Amputación Quirúrgica/rehabilitación , Tobillo , Tibia/cirugía , Robótica , Amputados/rehabilitación , Articulación del TobilloRESUMEN
Upper extremity amputation can lead to significant functional morbidity. The main goals after amputation are to minimize pain and maintain or improve functional status while optimizing the quality of life. Postamputation pain is common and can be addressed with regenerative peripheral nerve interface surgery or targeted muscle reinnervation surgery. Both modalities are effective in treating residual limb pain and phantom limb pain, as well as improving prosthetic use. Differences in surgical technique between the 2 approaches need to be weighed when deciding what strategy may be most appropriate for the patient.