Immunomodulation to Optimize Vascularized Composite Allograft Integration in Limb Loss Therapy

2013 ◽  
Author(s):  
Linda C. Cendales
Keyword(s):  
Limb Loss ◽  
Vascularized Composite Allograft

Is Vascularized Composite Allograft Transplantation Experimental or an Accepted Surgical Procedure: Results from a National Survey

2020 ◽  
Vol 36 (04) ◽  
pp. 276-280
Author(s):  
Salih Colakoglu ◽  
Seth Tebockhorst ◽  
David Woodbridge Mathes
Keyword(s):  
Clinical Investigation ◽  
The United States ◽  
Representative Sampling ◽  
Electronic Survey ◽  
Internal Review ◽  
Vascularized Composite Allograft ◽  
American Society ◽  
Question Survey ◽  
Internal Review Board

Abstract Background More than 85 patients have received over 100 hand/arm transplants and more than 35 patients have received full or partial face transplants at institutions around the world. Given over two decades of experience in the field and in the light of successful outcomes with up to 17 years follow up time, should we still consider vascularized composite allograft (VCA) as a research/clinical investigation? We present the results of a nationwide electronic survey whose intent was to gather institutional bias with regard to this question. Methods An 11 question survey that was developed by VCA advisory committee of American Society of Transplantation was sent to all identified Internal Review Board chairs or directors in the United States. Results We received a total of 54 responses (25.3%) to the survey. The majority (78%) of responses came from either the chairperson, director, or someone who is administratively responsible for an IRB. Conclusion Though certainly not an exhaustive investigation into each institution's preference, we present a representative sampling. The results of which favor VCA as an accepted clinical procedure given the appropriate setting. Further research is needed to fully ascertain practices at each individual institution.

scholarly journals Medial knee joint contact force in the intact limb during walking in recently ambulatory service members with unilateral limb loss: a cross-sectional study

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e2960 ◽  
Author(s):  
Ross H. Miller ◽  
Rebecca L. Krupenevich ◽  
Alison L. Pruziner ◽  
Erik J. Wolf ◽  
Barri L. Schnall
Keyword(s):  
Knee Joint ◽  
Limb Loss ◽  
Service Members ◽  
Model Parameters ◽  
Joint Loading ◽  
Cross Sectional ◽  
Medial Knee ◽  
Knee Oa ◽  
Joint Contact ◽  
Intact Limb

BackgroundIndividuals with unilateral lower limb amputation have a high risk of developing knee osteoarthritis (OA) in their intact limb as they age. This risk may be related to joint loading experienced earlier in life. We hypothesized that loading during walking would be greater in the intact limb of young US military service members with limb loss than in controls with no limb loss.MethodsCross-sectional instrumented gait analysis at self-selected walking speeds with a limb loss group (N = 10, age 27 ± 5 years, 170 ± 36 days since last surgery) including five service members with transtibial limb loss and five with transfemoral limb loss, all walking independently with their first prosthesis for approximately two months. Controls (N = 10, age 30 ± 4 years) were service members with no overt demographical risk factors for knee OA. 3D inverse dynamics modeling was performed to calculate joint moments and medial knee joint contact forces (JCF) were calculated using a reduction-based musculoskeletal modeling method and expressed relative to body weight (BW).ResultsPeak JCF and maximum JCF loading rate were significantly greater in limb loss (184% BW, 2,469% BW/s) vs. controls (157% BW, 1,985% BW/s), with large effect sizes. Results were robust to probabilistic perturbations to the knee model parameters.DiscussionAssuming these data are reflective of joint loading experienced in daily life, they support a “mechanical overloading” hypothesis for the risk of developing knee OA in the intact limb of limb loss subjects. Examination of the evolution of gait mechanics, joint loading, and joint health over time, as well as interventions to reduce load or strengthen the ability of the joint to withstand loads, is warranted.

Limitations of body mass index for counseling individuals with unilateral lower extremity amputation

2016 ◽  
Vol 41 (2) ◽  
pp. 186-193 ◽  
Author(s):  
Alexandra P Frost ◽  
Tracy Norman Giest ◽  
Allison A Ruta ◽  
Teresa K Snow ◽  
Mindy Millard-Stafford
Keyword(s):  
Body Mass Index ◽  
Lower Extremity ◽  
Health Risk ◽  
Body Mass ◽  
Body Fat ◽  
Lower Limb ◽  
Dual Energy ◽  
Limb Loss ◽  
Percent Body Fat ◽  
X Ray

Background: Body composition is important for health screening, but appropriate methods for unilateral lower extremity amputees have not been validated. Objectives: To compare body mass index adjusted using Amputee Coalition equations (body mass index–Amputee Coalition) to dual-energy X-ray absorptiometry in unilateral lower limb amputees. Study design: Cross-sectional, experimental. Methods: Thirty-eight men and women with lower limb amputations (transfemoral, transtibial, hip disarticulation, Symes) participated. Body mass index (mass/height2) was compared to body mass index corrected for limb loss (body mass index–Amputee Coalition). Accuracy of classification and extrapolation of percent body fat with body mass index was compared to dual-energy X-ray absorptiometry. Results: Body mass index–Amputee Coalition increased body mass index (by ~ 1.1 kg/m2) but underestimated and mis-classified 60% of obese and overestimated 100% of lean individuals according to dual-energy X-ray absorptiometry. Estimated mean percent body fat (95% confidence interval) from body mass index–Amputee Coalition (28.3% (24.9%, 31.7%)) was similar to dual-energy X-ray absorptiometry percent body fat (29.5% (25.2%, 33.7%)) but both were significantly higher ( p < 0.05) than percent body fat estimated from uncorrected body mass index (23.6% (20.4%, 26.8%)). However, total errors for body mass index and body mass index–Amputee Coalition converted to percent body fat were unacceptably large (standard error of the estimate = 6.8%, 6.2% body fat) and the discrepancy between both methods and dual-energy X-ray absorptiometry was inversely related ( r = −0.59 and r = −0.66, p < 0.05) to the individual’s level of body fatness. Conclusions: Body mass index (despite correction) underestimates health risk for obese patients and overestimates lean, muscular individuals with lower limb amputation. Clinical relevance Clinical recommendations for an ideal body mass based on body mass index–Amputee Coalition should not be relied upon in lower extremity amputees. This is of particular concern for obese lower extremity amputees whose health risk might be significantly underestimated based on body mass index despite a “correction” formula for limb loss.

A Molecular Footprint of Limb Loss: Sequence Variation of the Autopodial Identity Gene Hoxa-13

2008 ◽  
Vol 67 (6) ◽  
pp. 581-593 ◽  
Author(s):  
Tiana Kohlsdorf ◽  
Michael P. Cummings ◽  
Vincent J. Lynch ◽  
Geffrey F. Stopper ◽  
Kazuhiko Takahashi ◽  
...  
Keyword(s):  
Sequence Variation ◽  
Limb Loss

scholarly journals 2523: Vascularized composite allograft tolerance with transient high-dose tacrolimus across a full MHC mismatch in a large animal model

2016 ◽  
Vol 3 (1-2) ◽  
pp. 8-8 ◽  
Author(s):  
Howard D. Wang ◽  
Edward W. Swanson ◽  
Hsu-Tang Cheng ◽  
Jeffrey Walch ◽  
Jose C. Alonso-Escalante ◽  
...  
Keyword(s):  
Animal Model ◽  
Large Animal Model ◽  
High Dose ◽  
Large Animal ◽  
Vascularized Composite Allograft

A Content Analysis on the Media Portrayal of Characters with Limb Loss

2017 ◽  
Vol 29 (4) ◽  
pp. 170-176 ◽  
Author(s):  
Lisa Abernethy ◽  
John Chad Duncan ◽  
Walter Lee Childers
Keyword(s):  
Content Analysis ◽  
Limb Loss ◽  
Media Portrayal ◽  
The Media

Necrotizing Soft-Tissue Infections in the Feet of Patients With Diabetes: Outcome of Surgical Treatment and Factors Associated With Limb Loss and Mortality

2009 ◽  
Vol 8 (3) ◽  
pp. 141-146 ◽  
Author(s):  
Javier Aragón-Sánchez ◽  
Yurena Quintana-Marrero ◽  
Jose L. Lázaro-Martínez ◽  
Maria J. Hernández-Herrero ◽  
Esther García-Morales ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Limb Loss ◽  
Soft Tissue Infections ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
Necrotizing Soft Tissue Infections ◽  
Diabetes Outcome

scholarly journals Ageing, limb-loss and military veterans: a systematic review of the literature

2018 ◽  
Vol 39 (8) ◽  
pp. 1582-1610 ◽  
Author(s):  
NICK CADDICK ◽  
HELEN CULLEN ◽  
AMANDA CLARKE ◽  
MATT FOSSEY ◽  
MICHAEL HILL ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Military Service ◽  
Military Veterans ◽  
Limb Loss ◽  
Cochrane Library ◽  
Term Care ◽  
Long Term Impact ◽  
The Impact

ABSTRACTThe impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.

Sign in / Sign up

Export Citation Format

Share Document