Partial traumatic amputation of an upper limb with excellent functional recovery: A 13-year follow-up clinical case (original) (raw)
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Traumatic and trauma-related amputations: Part II: Upper extremity and future directions
The Journal of bone and joint surgery. American volume, 2010
Trauma is the most common reason for amputation of the upper extremity. The morphologic and functional distinctions between the upper and lower extremities render the surgical techniques and decision-making different in many key respects. Acceptance of the prosthesis and the outcomes are improved by performing a transradial rather than a more proximal amputation. Substantial efforts, including free tissue transfers when necessary, should be made to salvage the elbow. Careful management of the peripheral nerves is critical to minimize painful neuroma formation while preserving options for possible future utilization in targeted muscle reinnervation and use of a myoelectric prosthesis. Rapid developments with targeted muscle reinnervation, myoelectric prostheses, and composite tissue allotransplantation may dramatically alter surgical treatment algorithms in the near future for patients with severe upper-extremity trauma.
Severe complex injuries to the upper extremity: Revascularization and replantation
The Journal of Hand Surgery, 1991
Twenty-nine patients with an incomplete (26) or a complete (3) amputation of the upper extremity proximal to the wrist with revascularization or replantation were reviewed. Limb survival rates were very high (93%) despite the severity of the injuries. All patients regained some useful hand function, with 76% attaining a group I or group II (Chen criteria) functional result. Bone shortening osteotomies are a helpful way to reduce the soft tissue defect size. In contrast to earlier studies, clear correlations between the level of injury, degree of nerve lesion, bone pathology, and the number of major nerves involved, and the functional outcome achieved were not found. There was a weak correlation between the type of wound and the functional recovery ultimately obtained. (J HAND SURC 1991;16A:574-84.)
Current Trauma Reports
Purpose of Review To provide an overview of patient management and surgical technique regarded as best practice in optimising outcome following primary and secondary amputation in trauma patients. This is supported by evidence where available. Recent Findings There is increasing evidence that primary amputation may offer superior outcome to reconstruction in severe open lower limb injuries, particularly segmental trauma involving the foot and tibia. Similarly, patients considering complex reconstructive procedures for failed trauma management should be counselled that reported outcomes are equivalent or better following amputation and are achieved faster and with less complications. Patients should be fully informed of this when making decisions about management, though this needs to be individualised. Various surgical techniques have been associated with improved outcome and these are described herein. Careful peri-operative pain management has been associated with faster rehabilitation, better psychological response and a reduced risk of chronic pain. On discharge, patients should be linked to rehabilitation, prosthetic and clinical psychology services and these should be integrated where possible. Summary A holistic, multidisciplinary approach is recommended in all aspects of care and should be available from the outset. Patients should be optimised medically and functionally, where possible pre-operatively. Psychological assessment and early information sharing are recommended. Where this is not possible due to acuity, these issues should be addressed as soon as possible post-amputation. Particularly where the limb is severely injured, careful planning and joint operating by senior Orthopaedic, Plastic and Vascular surgeons can achieve the best results.
Trends in the Management of Traumatic Upper Extremity Amputations
The Journal of Hand Surgery, 2020
Purpose Treatment for upper extremity amputations includes revision amputation or attempted replantation. The rate of digital replantation has been declining in the United States. Prior studies discovered the presence of socioeconomic disparities associated with these injuries. The goals of this study were to investigate yearly trends of traumatic upper extremity amputations and evaluate the presence of disparities with access to care in these injuries. Methods The 2008 to 2014 New York Statewide Planning and Research Cooperative System (SPARCS) inpatient and outpatient databases were utilized to identify patients who had traumatic upper extremity amputations. We queried the database for patient characteristics, resource utilization characteristics, insurance status, major in-hospital complications, and mortality. Patients at low-, medium-, and high-volume institutions were compared. We performed multivariable logistic regressions for the binary variable replantation (yes/no) controlling for age, sex, race, insurance status, amputation level, admission hour, and comorbidities. Results A total of 2,492 patients met our inclusion criteria: 92.1% sustained digital amputations and 7.9% sustained arm amputations. The annual rate of inpatient finger amputations decreased significantly (1.9 per 100,000 people in 2008 vs 1.4 per 100,000 people in 2014) during the study period while that of outpatient finger amputations increased significantly (12.0 per 100,000 people in 2008 vs 15.5 per 100,000 people in 2014). Multivariable analysis demonstrated incrementally lower odds for replantation with increasing age and increased odds for replantation in patients with private insurance (odds ratio, 1.64; 95% confidence interval, 1.08e2.50). The number of replantation surgeries at medium-volume institutions decreased by 45% while remaining steady in low-and high-volume institutions. Conclusions Our findings corroborate the findings of other studies that underscore the existence of disparities with respect to insurance status in these injuries. Replantations occur more frequently at high-volume hospitals and are more common in younger patients with private insurance. This finding suggests that patients with traumatic amputations may benefit from treatment at high-volume institutions. Further research to help improve access to such institutions is warranted.
Lower limb amputation in trauma sequelae: choice of level and techniques
Lo Scalpello - Otodi Educational
The main purpose of amputation is to bring a specific patient, regardless of the initial scenario, to a new normality, characterized by the absence of pain and functional potential of the stump in terms of wearability and power. It is therefore implicit that the strategy is played on the choice of the level, using both analysis of the scenario of the patient and the perspective of the prosthetic project. Hence the delicacy of the choice of the moment and the level of amputation, considering multiple possibilities arising from evolution of surgical techniques, interdigitation of skills between traumatologist and plastic surgeon, translation of some techniques initially used for amputations of the upper limb to amputations of the lower limb, to substantial innovations in limb prostheses.
Factors affecting outcome after traumatic limb amputation
British Journal of Surgery, 2012
Background: Traumatic leg amputation commonly affects young, active people and leads to poor longterm outcomes. The aim of this review was to describe common causes of disability and highlight therapeutic interventions that may optimize outcome after traumatic leg amputation.
Rehabilitation of Individuals with Limb Loss due to Trauma
Current Trauma Reports, 2020
Purpose of the Review To provide a comprehensive overview of care and rehabilitation of those with traumatic limb loss, from preoperative to lifelong care. Recent Findings Comprehensive care including peer support and monitoring for the development of secondary conditions which compound disability is essential after traumatic amputation. Conditions that commonly develop after traumatic limb loss include heterotopic ossification, intact limb knee osteoarthritis, low back pain, and reduction in cardiopulmonary reserve. Summary Optimal care for people after traumatic limb loss requires a multidisciplinary team to provide perioperative and lifelong care. In addition to ensuring optimal rehabilitation based on the individual's vocational and avocational goals, current function, concomitant injuries, and amputation level, their psychological recovery must not be overlooked. To optimize quality of life and independence, lifelong follow-up with a physiatrist is essential to care for complications and secondary conditions, as well as to promote an active lifestyle.