scholarly journals The cost of major lower limb amputation: a 12-year experience

2012 ◽  
Vol 36 (4) ◽  
pp. 430-434 ◽  
Author(s):  
Robert Warner Jordan ◽  
Avi Marks ◽  
Daniel Higman
Keyword(s):  
Average Length ◽  
Case Series ◽  
Limb Amputation ◽  
Valuable Insight ◽  
Retrospective Case ◽  
Perioperative Mortality ◽  
Initial Procedure ◽  
Transfemoral Amputees ◽  
Critical Ischaemia ◽  
The Cost

Background:The amputee population is elderly, has significant medical co-morbidities and perioperative mortality leading to high financial implications. Commonly used outcomes in the literature are survival, prosthetic use and mobility.Objectives:Our study aims to share our 12-year experience of amputee care, concentrating on perioperative mortality and patient rehabilitation.Study Design:Observational study in the form of a retrospective case series.Methods:In total, 130 amputations, performed between January 1998 and December 2009, were followed up for a mean of three and a half years and analyzed for demographics, vascular history, operation details, prosthetic use, mobility and mortality.Results:The population was 59.2% male, had a mean age of 73 and the most common indication for amputation was critical ischaemia (78.5%). The average length of acute inpatient stay was 63 days with a 30-day mortality rate of 15.3% and inpatient mortality of 29.3%. In total, 63.3% of patients were issued with a prosthesis with 48.2% of all patients achieving at least indoor mobility, transtibial (49.9%) rehabilitated better than transfemoral amputees (24.3%).Conclusions:Our data support the urgent need for action to improve perioperative mortality in the amputee population, with the added advantage of reducing its financial impact.Clinical relevanceOur study gives an overview of the clinical journey taken by a 12-year amputee population. By following this cohort from initial procedure through to rehabilitation or mortality we provide the reader with a valuable insight into the difficulties of managing this population and the likely outcomes for these patients.

Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review

2021 ◽  
pp. 194338752110264
Author(s):  
Sean A. Knudson ◽  
Kristopher M. Day ◽  
Patrick Kelley ◽  
Pablo Padilla ◽  
Ian X. Collier ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Planning ◽  
Average Length ◽  
Case Series ◽  
Retrospective Case ◽  
Oral Nutrition ◽  
Microsurgical Reconstruction ◽  
Virtual Surgical Planning ◽  
And Function ◽  
Ballistic Trauma

Study Design: Retrospective case series; systematic review. Objective: It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods: A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results: Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions: Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.

scholarly journals Blood loss following medial unicondylar knee replacements without a tourniquet: is there a need to group and save?

2018 ◽  
Vol 5 (1) ◽  
pp. 65
Author(s):  
Sayyied J. Kirmani ◽  
Mark Middleton ◽  
Andreas Fontalis ◽  
Raka Srivastava ◽  
Feroz Dinah
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Case Series ◽  
Operative Blood Loss ◽  
Retrospective Case ◽  
Current Trends ◽  
Knee Replacements ◽  
Total Knee ◽  
Topical Tranexamic Acid ◽  
The Cost

<p class="abstract"><strong>Background:</strong> There are current trends towards not using a tourniquet in total knee replacement (TKR), but there is nothing published on what the effects of not using a tourniquet on unicondylar knee replacements (UKR) may be in terms of blood loss.</p><p class="abstract"><strong>Methods:</strong> A retrospective case series of 36 consecutive UKR from our institution were analysed. All procedures were carried out without a tourniquet and also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, administration of periarticular local anaesthetic and adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion.<strong></strong></p><p class="abstract"><strong>Results:</strong> Most patients (61.1%) experienced an estimated intra-operative blood loss of less than100 mls. There was a mean haemoglobin drop of 16.1 g/l (range 1–26, SD ±5.9), with a mean post operatively haemoglobin level of 125.1 g/l (range 107-142, SD ±8.7). No patients required a blood transfusion.</p><p class="abstract"><strong>Conclusions:</strong> A low level of blood loss is encountered when UKR is undertaken without a tourniquet and with our standard interventions to reduce bleeding. The level of post-operative haemoglobin and absence of requirement for blood transfusion suggests that this operation can be undertaken without the need for a group and save. It is our hope that surgeons will be encouraged to perform this procedure without a tourniquet and benefit from the cost-saving opportunity of not performing a group and save.</p>

scholarly journals Critical Care Admissions following Total Laryngectomy: Is It Time to Change Our Practice?

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Hussein Walijee ◽  
Alexandria Morgan ◽  
Bethan Gibson ◽  
Sandeep Berry ◽  
Ali Jaffery
Keyword(s):  
Critical Care ◽  
Total Laryngectomy ◽  
Average Length ◽  
Case Series ◽  
Limited Resource ◽  
District General Hospital ◽  
Close Monitoring ◽  
Retrospective Case ◽  
Potential Cost ◽  
Average Length Of Stay

Critical Care Unit (CCU) beds are a limited resource and in increasing demand. Studies have shown that complex head and neck patients can be safely managed on a ward setting given the appropriate staffing and support. This retrospective case series aims to quantify the CCU care received by patients following total laryngectomy (TL) at a District General Hospital (DGH) and compare patient outcomes in an attempt to inform current practice. Data relating to TL were collected over a 5-year period from 1st January 2010 to 31st December 2015. A total of 22 patients were included. All patients were admitted to CCU postoperatively for an average length of stay of 25.5 hours. 95% of these patients were admitted to CCU for the purpose of close monitoring only, not requiring any active treatment prior to discharge to the ward. 73% of total complications were encountered after the first 24 hours postoperatively at which point patients had been stepped down to ward care. Avoiding the use of CCU beds and instead providing the appropriate level of care on the ward would result in a potential cost saving of approximately £8,000 with no influence on patient morbidity and mortality.

Spina bifida and lower limb amputation in Northern Ireland: A retrospective study of demographics and outcome

2017 ◽  
Vol 41 (5) ◽  
pp. 503-506 ◽  
Author(s):  
Lorraine Graham
Keyword(s):  
Spina Bifida ◽  
Lower Limb ◽  
Chart Review ◽  
Case Series ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Retrospective Case ◽  
Younger Age ◽  
Chronic Skin ◽  
Almost All

Background: Spina bifida is an uncommon cause for lower limb amputation. The causes and level of amputation and mobility outcome for these patients have not been reported previously. Case description: To identify the causes and level of amputation and the mobility outcome for amputee patients with spina bifida. Study design: Retrospective case series. Methods: Chart review of patients identified by computer as having an amputation secondary to neurological or congenital cause. Additional patients identified from the Regional Spina Bifida Medical Clinic. Demographics, cause and level of mobility pre- and post-amputation recorded from the prosthetic notes. Findings: In total, 16 patients were identified who had a diagnosis of spina bifida and a lower limb amputation. Mean age at the time of amputation was 28.5 years. In total, 15 patients had a transtibial amputation. In total, 14 patients post-amputation were able to maintain their mobility, wheelchair or walking, without any change in type of aid needed. Conclusion: Patients with spina bifida appear to require lower limb amputation at a younger age than patients with peripheral vascular disease. Almost all patients had prior chronic skin infection/osteomyelitis as precursors for amputation. The most common level for amputation was transtibial. Mobility was maintained for all patients, albeit for two in a more supported way. Clinical relevance Spina bifida is an uncommon reason for amputation. Patients, are often younger and medically complicated. Chronic skin ulceration, was the most common indication for amputation. Wheelchair or walking ambulance was maintained at the same level for most patients.

Structural Fat Grafting to Improve Reconstructive Outcomes in Secondary Cleft Lip Deformity

2017 ◽  
Vol 54 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Christine M. Jones ◽  
Brad T. Morrow ◽  
William B. Albright ◽  
Ross E. Long ◽  
Thomas D. Samson ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Cleft Lip ◽  
Rating Scale ◽  
Average Length ◽  
Care Center ◽  
Case Series ◽  
Fat Grafting ◽  
Retrospective Case ◽  
Student’S T

Objective To describe the technique and results of structural fat grafting in cleft lip revision, including patient satisfaction and aesthetic outcome. Design Retrospective case series Setting Multidisciplinary cleft care center. Patients All patients who underwent structural fat grafting between June 2006 and September 2012 for cleft lip revision, with appropriate photographic follow-up included. Twenty-two cases were reviewed; 18 had sufficient data to be included. Interventions Patients underwent structural fat grafting for cleft lip revision, most commonly injecting fat under deficient philtral columns, the nostril base, and upper lip. Main Outcome Measures Blinded observers rated outcomes using the Asher-McDade nasolabial appearance rating scale. Patients completed questionnaires assessing their satisfaction. A paired Student's t-test was used to test outcomes for significance (alpha = 0.05). Results Patients were an average of 16 years old (range 6-43); average length of follow up was 11.7 months. Overall symmetry and aesthetics were improved based on the nasal form ( P = 0.006) and vermillion border (P - 0.04) when rated using the Asher-McDade scale. No complications were recorded. Patients were significantly happier with their appearance after fat grafting (P < 0.001) and were uniformly positive when questioned about the ease of the surgery and rate of recovery. Conclusions Structural fat grafting is a safe and effective way to improve symmetry and enhance facial proportions in patients with cleft lip. Given the high degree of patient satisfaction, few complications, and durable results, fat grafting offers many advantages in cleft lip revision.

Results of External Fixation and Metatarsophalangeal Joint Fixation With K-Wire in Brachymetatarsia

2018 ◽  
Vol 39 (8) ◽  
pp. 942-948 ◽  
Author(s):  
Víctor Manuel Peña-Martínez ◽  
Dionisio Palacios-Barajas ◽  
Juan Carlos Blanco-Rivera ◽  
Ángel Arnaud-Franco ◽  
Jorge Alberto Elizondo-Rodríguez ◽  
...  
Keyword(s):  
External Fixator ◽  
Average Length ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Healing Time ◽  
Bone Lengthening ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Number Of Patients ◽  
The Mean

Background: Brachymetatarsia is a rare foot deformity caused by the premature closure of the metatarsal physis. It may result in functional as well as cosmetic alterations, which may require operative management. Methods: A prospective study examining outcomes of 48 cases of brachymetatarsia with gradual bone lengthening at a rate of 1 mm/d using an external fixator and metatarsophalangeal joint fixation was performed. The difference between the length before treatment and after external fixator removal was measured. The patients were assessed at 2, 4, 6, and 8 weeks postoperatively; at the end of the period of distraction; and 1 year after surgery. The total number of patients was 26, and surgery was performed in 48 metatarsals. The mean age was 17.0 ± 4.1 (range, 11-24) years, and all were female. Results: The fourth metatarsal was the most frequently affected, representing 98% of the cases; the third metatarsal represented the other 2%. The average length gained was 18.6 ± 6.7 mm, and the average length gained as a proportion of the original metatarsal length was 38.2% ± 3.1% (range, 13%-24%). The mean healing time was 71.0 (range, 64-104) days, and the mean healing index (healing time divided by centimeters of length gained [d/cm]) was 38.4 (range, 38.2-50.1) d/cm. Conclusion: Gradual bone lengthening at a rate of 1 mm/d using an external fixator and intramedullary nailing was a safe and efficient method, representing a minimally invasive procedure with a low incidence of complications and satisfactory results for the patient. Level of Evidence: Level IV, retrospective case series.

scholarly journals Role of oral sildenafil in neonates with persistent pulmonary hypertension of newborn

2019 ◽  
Vol 6 (5) ◽  
pp. 2222
Author(s):  
Arohi Gupta ◽  
Mala Kumar ◽  
Tarun Anand
Keyword(s):  
Pulmonary Hypertension ◽  
Average Length ◽  
Case Series ◽  
Phosphodiesterase Inhibitors ◽  
Persistent Pulmonary Hypertension ◽  
Treatment Modalities ◽  
Retrospective Case ◽  
Average Length Of Stay ◽  
Resource Limited

Persistent pulmonary hypertension of newborn is a devastating condition and leads to morbidity and mortality. Even after the increasing use of  NO, ECMO and HFO many patients succumb to death. About 50% of the patients either have rebound hypertension or do not respond to the treatment. Hence the role of phosphodiesterase inhibitors (sildenafil) need to be evaluated. Methods is authors report a retrospective case series of 24 patients with PPHN admitted in NICU and treated with oral sildenafil. Results sildenafil was started on all patients on a mean of 1.46 days and stopped on mean of 3.8 days. Initial fio2 was 100%, which after starting sildenafil decreased gradually to 50% on mean of 10 days. Average length of stay in NICU was 20 days. 17(70.8%) patients survived whereas 7 (29%) expired No improvement in oxygen Index after 48 hours (p<0.05) was the independent predicting risk factor for PPHN related mortality in the expired patients.Conclusion are oral sildenafil can be a used in conjunction with other treatment modalities for PPHN especially in resource limited settings.

scholarly journals 12 `Risk feeding’ for Older People: a Retrospective Case Series to Review the Decision Making Process

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Niamh O'Loughlin ◽  
Oonagh McCarthy
Keyword(s):  
Decision Making ◽  
Average Length ◽  
Hospital Setting ◽  
Case Series ◽  
Oral Intake ◽  
Acute Hospital ◽  
Best Interests ◽  
Retrospective Case ◽  
The Individual ◽  
Acute Hospital Setting

Abstract Background `Risk feeding' is a term commonly used when an individual continues to eat and drink despite a perceived risk of choking or aspiration. It is suspected that there is significant variability around how a decision of ‘risk feeding’ is made for older people in the acute hospital setting, particularly whether or not the individual and his/her family are involved. This is of particular interest under the Assisted Decision Making (Capacity) Act 2015. Aims To investigate individuals' participation in decision-making regarding `risk feeding' To investigate the duration individuals are kept NPO pending `risk feeding' decisions Methods A retrospective case series was completed. 18 medical charts were reviewed for collection of the following data: Average length an individual was NPO pending decision regarding oral intakeDiscussion between individual and medical team regarding oral intakeThe individual's capacity for decision making regarding oral intakeDiscussion of what is in the best interests of the individualDiscussion with family/NOKExplicit plan regarding oral intake Results Average length NPO: 1 day (range 0-4 days) Discussion with patient: 17% Patient capacity for decision making: 17% Best interests discussion: 66% Discussion with family/NOK: 77% Explicit plan: 66% Conclusion There is significant variability in decision making for `risk feeding' with older adults in the acute hospital setting. Individuals are not consistently involved in their plan to `risk feed'. In some cases there was reliance on family members to decide on `risk feeding', in others the medical team made decision in the best interests of the individual. Individuals are being kept NPO for a period of time to allow decision making, without knowledge of why this is so. The review highlights the need for individual involvement in decision regarding dysphagia and oral intake. Multidisciplinary education and guidance is recommended to ensure consistent ethical decision making.

scholarly journals ULTRASOUND-GUIDED CONTINUOUS RADIOFREQUENCY ABLATION OF PAINFUL RESIDUAL LIMB NEUROMA IN INDIVIDUALS WITH LIMB AMPUTATION- A RETROSPECTIVE CASE SERIES

2019 ◽  
Author(s):  
Shigong Guo ◽  
Ramy Mansour ◽  
David Henderson Slater
Keyword(s):  
Radiofrequency Ablation ◽  
Steroid Injection ◽  
Case Series ◽  
Limb Amputation ◽  
Residual Limb ◽  
Ultrasound Guided ◽  
Retrospective Case ◽  
Prosthetic Limb ◽  
Pain Scores ◽  
Retrospective Case Series

BACKGROUND: Residual limb neuromas are a significant cause of post-amputation pain. There is little knowledge concerning ultrasound-guided (US) radiofrequency ablation (RFA) as treatment. OBJECTIVE: To investigate US-guided RFA for neuroma associated pain in individuals with limb amputation. METHODOLOGY: The notes of nine consecutive patients were retrospectively reviewed. Information obtained included neuroma size and nerve, RFA duration/temperature, pain scores, analgesic requirements and ease/comfort of prosthetic use. Eight patients had lower-limb amputations and one had a trans-radial amputation.  All except one, underwent diagnostic US-guided steroid injection to confirm the neuroma as the source of pain, prior to RFA. RESULTS: Six patients reported significant reduction in pain scores (defined as at least 50% reduction) and an improvement in comfort/ease of wearing their prosthetic limb, with no adverse effects. Three of these six patients also reported a reduction in analgesic requirements. Of the three remaining patients – one had a large sciatic nerve neuroma that was eventually surgically excised, another had confounding pain from an adjacent bony spur, whilst the third patient did not receive a routine diagnostic steroid injection prior to RFA.   CONCLUSIONS: Our findings suggest that US-guided RFA is safe and effective for small to medium-sized residual limb neuroma associated pain in individuals with limb amputation. It can reduce pain and analgesic requirements, improve comfort/ease of wearing the prosthesis and potentially avoid surgical excision. We recommend patients should undergo a diagnostic steroid injection prior to RFA to confirm that the neuroma is the source of pain. LAYMAN’S ABSTRACTAfter amputation, many patients can get a neuroma which can cause significant pain leading to discomfort wearing the prosthetic limb. Ultrasound-guided radiofrequency ablation can successfully treat painful residual limb neuromas in individuals with limb amputation which in turn can reduce the patient’s pain medications and improve the comfort of wearing the prosthetic limb. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33061/25509 How to Cite: Guo S, Mansour R, Henderson Slater D. Ultrasound-guided continuous radiofrequency ablation of painful residual limb neuroma in individuals with limb amputation- A retrospective case series. Canadian Prosthetics & Orthotics Journal. 2019; volume2, Issue1, No.4. https://doi.org/10.33137/cpoj.v2i1.33061 CORRESPONDING AUTHOR:Shigong Guo,LLM MSc(Orth Eng) MRCS, Specialty Registrar in Rehabilitation MedicineOxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK.Email: [email protected]

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