Five-year mortality rate for patients with diabetic hand gangrene who undergo upper extremity amputation

Non-traumatic upper extremity amputations are an increasing concern with the rising prevalence of diabetes mellitus. To ascertain the risk factors and mortality rates for these amputations, the demographic information, amputation history, comorbidities and clinical outcomes of 140 patients who underwent non-traumatic upper extremity amputations between 1 January 2004 and 31 October 2017 were studied. Correlations were assessed using Cochran-Armitage chi-squared tests, odds ratios and multivariate binomial logistic regression as appropriate. Diabetes mellitus, coronary artery disease, end-stage renal failure, peripheral arterial disease and prior lower extremity amputation were significant risk factors for multiple upper extremity amputations. One-year, 2-year and 5-year mortality rates were 12%, 15% and 38%, respectively, following first upper extremity amputation. The risk factors for upper extremity amputations correspond with those for lower extremity amputations, comprising mainly diabetes mellitus and its related comorbidities. The mortality rates for non-traumatic upper extremity amputations highlight their significant burden on patients. Level of evidence: III

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Impact of traumatic upper-extremity amputation on the outcome of injury caused by an antipersonnel improvised explosive device

Canadian Journal of Surgery ◽

10.1503/cjs.014518 ◽

2018 ◽

Vol 61 (6 Suppl 1) ◽

pp. S203-S207

Author(s):

Shane A. Smith ◽

Mark P. DaCambra ◽

Vivian C. McAlister

Keyword(s):

Upper Extremity ◽

Improvised Explosive Device ◽

Explosive Device ◽

Improvised Explosive ◽

Extremity Amputation

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Major Upper Extremity Amputation

Plastic & Reconstructive Surgery ◽

10.1097/01.prs.0000435956.12599.95 ◽

2013 ◽

Vol 132 ◽

pp. 84

Author(s):

John V. Larson ◽

Theodore A. Kung ◽

Erika D. Sears ◽

Paul S. Cederna ◽

Melanie G. Urbanchek ◽

...

Keyword(s):

Upper Extremity ◽

Extremity Amputation

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Neurorehabilitation in Adults With Traumatic Upper Extremity Amputation: A Scoping Review

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211070277 ◽

2021 ◽

pp. 154596832110702

Author(s):

Jake Rydland ◽

Stephanie Spiegel ◽

Olivia Wolfe ◽

Bennett Alterman ◽

John T Johnson ◽

...

Keyword(s):

Upper Extremity ◽

Upper Limb ◽

Current Literature ◽

Scoping Review ◽

Neural Mechanisms ◽

Limb Amputation ◽

Future Research ◽

Prosthetic Devices ◽

Scoping Reviews ◽

Extremity Amputation

Background Most of the current literature around amputation focuses on lower extremity amputation or engineering aspects of prosthetic devices. There is a need to more clearly understand neurobehavioral mechanisms related to upper extremity amputation and how such mechanisms might influence recovery and utilization of prostheses. Objective This scoping review aims to identify and summarize the current literature on adult traumatic upper limb amputation in regard to recovery and functional outcomes and how neuroplasticity might influence these findings. Methods We identified appropriate articles using Academic Search Complete EBSCO, OVID Medline, and Cochrane databases. The resulting articles were then exported, screened, and reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. Results Eleven (11) studies met the study criteria. Of these studies, 7 focused on sensory involvement, 3 focused on neuroplastic changes post-amputation related to functional impact, and 1 study focused on motor control and learning post-amputation. Overall, these studies revealed an incomplete understanding of the neural mechanisms involved in motor rehabilitation in the central and peripheral nervous systems, while also demonstrating the value of an individualized approach to neurorehabilitation in upper limb loss. Conclusions There is a gap in our understanding of the role of neurorehabilitation following amputation. Overall, focused rehabilitation parameters, demographic information, and clarity around central and peripheral neural mechanisms are needed in future research to address neurobehavioral mechanisms to promote functional recovery following traumatic upper extremity amputation.

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Rehabilitation for Persons with Upper-Extremity Amputation

Orthotics and Prosthetics in Rehabilitation ◽

10.1016/b978-1-4377-1936-9.00031-x ◽

2013 ◽

pp. 814-829

Author(s):

Margaret Wise

Keyword(s):

Upper Extremity ◽

Extremity Amputation

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Factors Associated with Mortality and Amputation Caused by Necrotizing Soft Tissue Infections of the Upper Extremity: A Retrospective Cohort Study

World Journal of Surgery ◽

10.1007/s00268-019-05256-9 ◽

2019 ◽

Vol 44 (3) ◽

pp. 730-740 ◽

Cited By ~ 1

Author(s):

Femke Nawijn ◽

Svenna H.W.L. Verhiel ◽

Kiera N. Lunn ◽

Kyle R. Eberlin ◽

Falco Hietbrink ◽

...

Keyword(s):

Risk Factor ◽

Soft Tissue ◽

Mortality Rate ◽

Upper Extremity ◽

Base Deficit ◽

Amputation Rate ◽

Soft Tissue Infections ◽

Factors Associated ◽

Asa Classification ◽

Necrotizing Soft Tissue Infections

Abstract Background It is unclear what the exact short-term outcomes of necrotizing soft tissue infections (NSTIs), also known and necrotizing fasciitis of the upper extremity, are and whether these are comparable to other anatomical regions. Therefore, the aim of this study is to assess factors associated with mortality within 30-days and amputation in patients with upper extremity NSTIs. Methods A retrospective study over a 20-year time period of all patients treated for NSTIs of the upper extremity was carried out. The primary outcomes were the 30-day mortality rate and the amputation rate in patients admitted to the hospital for upper extremity NSTIs. Results Within 20 years, 122 patients with NSTIs of the upper extremity were identified. Thirteen patients (11%) died and 17 patients (14%) underwent amputation. Independent risk factors for mortality were an American Society of Anesthesiologists (ASA) classification of 3 or higher (OR 9.26, 95% CI 1.64–52.31) and a base deficit of 3 meq/L or greater (OR 10.53, 95% CI 1.14–96.98). The independent risk factor for amputation was a NSTI of the non-dominant arm (OR 3.78, 95% CI 1.07–13.35). Length of hospital stay was 15 (IQR 9–21) days. Conclusion Upper extremity NSTIs have a relatively low mortality rate, but a relatively high amputation rate compared to studies assessing NSTIs of all anatomical regions. ASA classification and base deficit at admission predict the prognosis of patients with upper extremity NSTIs, while a NSTI of the non-dominant side is a risk factor for limb loss.

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