Pattern of upper limb amputation associated with lower limb amputation: the UK military experience from Iraq and Afghanistan

2021 ◽  
pp. bmjmilitary-2021-001783
Author(s):  
Louise McMenemy ◽  
V Mondini ◽  
D C Roberts ◽  
A Kedgley ◽  
J C Clasper ◽  
...  
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Limb Amputation ◽  
Life Outcomes ◽  
Manual Search ◽  
Large Numbers ◽  
Significant Difference ◽  
Extremity Injuries ◽  
The Uk ◽  
The Right

IntroductionThe conflicts in Iraq and Afghanistan resulted in large numbers of personnel sustaining extremity injuries. In the context of polytrauma, partial hand amputation is often unrecorded. The aim of this work was to quantify the burden of upper limb (UL) amputation at any level occurring concurrently with a major (ankle and proximal) lower limb (LL) amputation. Knowledge of this cohort could aid in prosthetic modification to further improve quality of life outcomes in a population with dexterity loss.MethodA trauma database search was undertaken for all UK military LL amputees from the conflicts in Iraq and Afghanistan. A manual search method was employed to identify from the major LL amputees those who had a concurrent UL amputation at any level (including isolated finger amputation). Demographics, level of amputation, and injury profile data were recorded.ResultsSixty-eight individuals were identified; the most prevalent population was bilateral LL with a unilateral UL amputation (60%). Most UL amputations were partial hand (75%). The was no statistically significant difference between left or right side (p=0.13). On the left side, correlation was found between amputation of the thumb and third digit (rho=0.34; p=0.005) not seen on the right.ConclusionWe have determined the rate of UL amputation at any level, in combination with LL amputation as a result of blast injury. Knowledge of these combinations enables further research to support anecdotal evidence that there is a need for tailored prosthetics in the context of potential dexterity loss making donning and doffing problematic.

scholarly journals Avaliação postural de sujeitos com amputação de membro inferior

2019 ◽  
Vol 29 (1) ◽  
pp. 33103
Author(s):  
Viviane Leite ◽  
Lisiane Piazza Luza ◽  
Sara Maria Soffiatti Dias ◽  
Thamara Caviquioni ◽  
Ediane Roberge Fernandes Zampirolo ◽  
...  
Keyword(s):  
Lower Limb ◽  
T Test ◽  
Limb Amputation ◽  
Postural Asymmetry ◽  
Significance Level ◽  
Below The Knee ◽  
Significant Difference ◽  
Ankle Angle ◽  
The Right ◽  
Left Scapula

AIMS: To evaluate the posture of subjects with lower limb amputee.METHODS: Ten subjects participated in the study, males, with 38,2 ± 8,2 years, with unilateral lower limb amputation and prosthesis users. For the postural evaluation, the Postural Evaluation Software (SAPO) was used, and the images were evaluated according to the software protocol. Data were analyzed through descriptive and inferential statistics (independent t test), with a significance level of p ≤ 0,05.RESULTS: The main alterations observed were: rearfoot valgus enlargement, flexed ankle, head tilted to the right and trunk in flexion. When compared the posture according to time of amputation, was observed a statistically significant difference in the horizontal asymmetry of scapula in relation to T3 (p = 0,004), being that subjects with amputation time of up to six years presented the left scapula higher than the right one (-5,28 ± 8,16°) and those with more than six years of amputation had the right upper right scapula (19,42 ± 11°). In the comparison between amputation levels, there was a statistically significant difference in the ankle angle (p = 0,008), with subjects with amputation below the knee presenting greater ankle flexion (81,97 ± 1,72°) than those with amputation at the level of the knee and above this (87,30 ± 2,65°).CONCLUSIONS: The findings of the present study demonstrate that all the evaluated subjects presented some postural alteration, however, it cannot be affirmed that the postural asymmetry of these is due to the amputation.

Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

scholarly journals Co-relation of functional mobility with anxiety in traumatic below knee amputees

2021 ◽  
Vol 9 (5) ◽  
pp. 4013-4018
Author(s):  
Lavanya R Ayyer ◽  
◽  
Asmita C Moharkar ◽  
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Holistic Approach ◽  
The Body ◽  
Functional Mobility ◽  
Mental Wellbeing ◽  
Limb Amputation ◽  
Surgical Removal ◽  
Institutional Ethics ◽  
Restricted Mobility

Background: Amputation is defined as the surgical removal of one or more parts of the body. It causes great stress to the physical and mental wellbeing of an individual. The incidence of lower limb amputation is greater as compared to upper limb amputation. Also lower limb amputees experience more restricted mobility than upper limb amputee patients. Rehabilitation is an important to the recovery of an amputee. In cases of planned amputation, rehabilitation starts before the surgery. It involves physiotherapy, occupational therapy and recreational training. There is little to no studies on the co-relation of anxiety with functional mobility in amputees. This study focusses on the same. Context and purpose: Amputation causes restricted mobility and decreased quality of life. A study on the relation between anxiety and mobility will indicate a different outlook of a holistic approach while treating mobility issues in below knee amputees. Materials and methods: This is a one group co-relational study design. Study was conducted after taking approval from the institutional ethics committee and all the subjects gave their written informed consent. The study was conducted at Yashwantrao Chavan Memorial Hospital, Pune. Result: Statistical analysis of the data was done using the Pearson’s co-relation co-efficient and a co-relation was found between anxiety and functional mobility in below knee amputee patients. Conclusion: There is a co-relation between functional mobility and anxiety. Patients with anxiety showed a reduced performance on the functional mobility scale than the patients without anxiety. KEY WORDS: Amputation, Anxiety, below knee amputation, functional mobility, rehabilitation.

Clinical Features and Outcomes Following Bilateral Lower Limb Amputation in Korea

2006 ◽  
Vol 30 (2) ◽  
pp. 155-164 ◽  
Author(s):  
Ji Cheol Shin ◽  
Eun Joo Kim ◽  
Chang Il Park ◽  
Eun Sook Park ◽  
Kyoo-Ho Shin
Keyword(s):  
Clinical Features ◽  
Lower Limb ◽  
Daily Living ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Medical Problems ◽  
Amputation Level ◽  
Significant Difference ◽  
Bilateral Lower Limb ◽  
Lower Limb Amputees

The objectives of this study were to evaluate the clinical features and outcomes of 43 bilateral lower limb amputees. The clinical features obtained included the causes of amputation, level of amputation, concurrent medical problems, and stump condition. Outcome measures were obtained using the activities of daily living (ADL) index, the Frenchay Activities Index (FAI), and mobility grading with prostheses or wheelchair. Of 33 amputees who were prosthetic ambulators, 22 (67%), mainly bilateral trans-tibial (TT) amputees, were community ambulators, and participated in activities which included stair-walking, and six of 11 household ambulators were combination trans-femoral (TF) and TT amputees. Of 10 amputees who were wheelchair ambulators, only one was able to perform wheelchair transfers independently and five were independent wheelchair ambulators. Using the ADL index and FAI, there was no significant difference in scores according to the level of amputation ( p > 0.05), but the scores of community prosthetic ambulators were significantly higher than those of wheelchair ambulators ( p < 0.05). Age was found to be negatively correlated with ADL index and FAI scores ( r = −0.518 vs. r = −0.550) ( p < 0.01). This study concludes that overall independence in ADL after bilateral lower limb amputation improved with young age and prosthetic mobility.

Thermoregulatory responses in persons with lower-limb amputation during upper-limb endurance exercise in a hot and humid environment

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kouki Fukuhara ◽  
Yukio Mikami ◽  
Hiroshi Hasegawa ◽  
Daigo Nakashima ◽  
Yasunari Ikuta ◽  
...  
Keyword(s):  
Upper Limb ◽  
Endurance Exercise ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Humid Environment ◽  
Thermoregulatory Responses

scholarly journals Benign monomelic amyotrophy with proximal upper limb involvement: case report

2007 ◽  
Vol 65 (2b) ◽  
pp. 524-527 ◽  
Author(s):  
Marco Antonio Orsini Neves ◽  
Marcos R.G. de Freitas ◽  
Mariana Pimentel de Mello ◽  
Carlos Henrique Dumard ◽  
Gabriel R. de Freitas ◽  
...  
Keyword(s):  
Case Report ◽  
Upper Limb ◽  
Lower Limb ◽  
Clinical Manifestations ◽  
Rare Condition ◽  
Insidious Onset ◽  
Rare Location ◽  
Muscle Groups ◽  
Clinical Stabilization ◽  
The Right

Monomelic amyotrophy (MA) is a rare condition in which neurogenic amyotrophy is restricted to an upper or lower limb. Usually sporadic, it usually has an insidious onset with a mean evolution of 2 to 4 years following first clinical manifestations, which is, in turned, followed by stabilization. We report a case of 20-years-old man who presented slowly progressive amyotrophy associated with proximal paresis of the right upper limb, which was followed by clinical stabilization 4 years later. Eletroneuromyography revealed denervation along with myofasciculations in various muscle groups of the right upper limb. We call atention to this rare location of MA, as well as describe some theories concerning its pathophysiology .

scholarly journals Prognostic Risk Modelling for Patients Undergoing Major Lower Limb Amputation: An Analysis of the UK National Vascular Registry

2020 ◽  
Vol 59 (4) ◽  
pp. 606-613
Author(s):  
Graeme K. Ambler ◽  
Emma Thomas-Jones ◽  
Adrian G.K. Edwards ◽  
Christopher P. Twine
Keyword(s):  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Risk Modelling ◽  
The Uk

scholarly journals Acute Parotitis after Lower Limb Amputation: A Case Report of a Rare Complication

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Konstantinos Ioannis Avgerinos ◽  
Nikolaos Degermetzoglou ◽  
Sofia Theofanidou ◽  
Georgia Kritikou ◽  
Ioannis Bountouris
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
General Anesthesia ◽  
Lower Limb ◽  
Rare Complication ◽  
Head Tilt ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
The Right ◽  
Type Of Surgery

Background. Postoperative parotitis is a rare complication that occurs usually after abdominal surgery. Parotitis has never been described as a complication of vascular operations, in literature. In the present article, we describe a case of a postamputation parotitis along with its management and its possible pathogenesis. Case Report. An 83-year-old diabetic man was emergently admitted to hospital because of gangrene below the right ankle and sepsis. The patient underwent a lower limb amputation above the knee. On the 5th postoperative day, he was diagnosed with right parotitis probably because of dehydration, general anesthesia, and immunocompromisation. A CT scan confirmed the diagnosis. He received treatment with antibiotics and fluids. His condition gradually improved, and he was finally discharged on 15th postoperative day. Conclusions. Postoperative parotitis can possibly occur after any type of surgery including vascular. Clinicians should be aware of this complication although it is rare. Several risk factors such as dehydration, general anesthesia, drugs, immunocompromisation, head tilt during surgery, and stones in Stensen’s duct may predispose to postoperative parotitis. Treatment consists of antibiotics and hydration.

scholarly journals CURRENT PROCEDURES IN HAND REPLANTATIONS - PARTICULAR LEVEL OF TRAUMATIC UPPER LIMB AMPUTATION

2018 ◽  
Vol 1 (3) ◽  
Author(s):  
Roxana Pătulea ◽  
B. Măciuceanu ◽  
D. Cinteză ◽  
Iulia Perșinaru ◽  
Madalina Iordache ◽  
...  
Keyword(s):  
Upper Limb ◽  
Limb Amputation ◽  
Pinch Strength ◽  
Significant Disabilities ◽  
Active Range Of Motion ◽  
Radiocarpal Joint ◽  
Reconstructive Microsurgery ◽  
Vascular Structures ◽  
Hand Amputation ◽  
The Right

Amputations in the upper extremity due to trauma are, by definition, devastating injuries that involve multiple critical structures of the fingers, hand, arm, or any combination of the three and nearly always lead to significant disabilities, both directly and through their psychosocial impact. Replantation is defined as the reattachment of a part that has been completely cut off and the reconnection of the damaged vascular structures. Chances of viability depend on the degree of vascular, bone, muscle and nerve lesions, the level of amputation, the trauma mechanism, the pacient’s age and comorbidities, the ischemia time while the functional recovery is assessed according to the following criteria: the active range of motion, the two-point discrimination sensibility ratings, the grip and pinch strength, the cold intolerance, and the return to previous employment. We report a case of a man D.V., aged 51, with a non-pathological personal history, admitted in April 2014 in the Emergency Hospital of Bucharest with the diagnostic “Severe injury by circular right upper limb. Hand amputation from radiocarpal joint, 3 hours old”. The pacient was urgently transported in the operating room, where the right hand replantation was performed. He was first hospitalized in the Intensive Care Unit, then he was transferred in the Plastic Surgery and Reconstructive Microsurgery Clinic. Post-operatively, the results were favorable, our patient achieved at 6 months evaluation S3+ and M4 on British Medical Research Council‘s scale.

Sign in / Sign up

Export Citation Format

Share Document