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Kontopodis N, Tosounidis T, Kehagias E, Kouraki A, Tzirakis K, Ioannou CV. Concomitant vascular and orthopedic trauma: 10 points to consider. J Clin Orthop Trauma 2024; 51:102407. [PMID: 38681997 PMCID: PMC11053217 DOI: 10.1016/j.jcot.2024.102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Although vascular injuries complicate only 1-2% of patients with orthopedic trauma, they may be encountered in a much higher rate of around 10 % in injuries around the knee and elbow joints following both fractures and dislocations. In case of vascular involvement, specific diagnostic and therapeutic challenges arise and there is a higher risk for significant morbidity (i.e. limb loss) or mortality. In the absence of randomized data, diagnostic and therapeutic algorithms are not always straightforward and clinical practice may be based on experience and local protocols rather than firm evidence. With this article we intend to review available literature regarding concomitant skeletal and vascular trauma in order to provide concise information and clear guidelines of when to operate with least investigations and when to go for a full spectrum of investigations in the absence of hard clinical signs. Additionally, other aspects concerning the manipulation of these patients are discussed, such as the indications of primary amputation, the potential role of endovascular techniques and the value of the Resuscitative Endovascular Balloon Occlusion of the Aorta. In summary, this scoping review summarizes current practices in the diagnostic and therapeutic management of patients with concomitant orthopedic and vascular injuries, discusses different treatment strategies and gives a practical perspective for implementation on every day practice.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Department, University of Crete-Medical School, Heraklion, Crete, Greece
| | - Theodoros Tosounidis
- Orthopedic Department, University of Crete-Medical School, Heraklion, Crete, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, University of Crete-Medical School, Heraklion, Crete, Greece
| | | | - Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Christos V. Ioannou
- Vascular Surgery Department, University of Crete-Medical School, Heraklion, Crete, Greece
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Hanwright PJ, Suresh V, Shores JT, Souza JM, Tuffaha SH. Current Concepts in Lower Extremity Amputation: A Primer for Plastic Surgeons. Plast Reconstr Surg 2023; 152:724e-736e. [PMID: 37768220 DOI: 10.1097/prs.0000000000010664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the goals of lower extremity reconstruction and identify clinical scenarios favoring amputation. 2. Understand lower extremity amputation physiology and biomechanics. 3. Review soft-tissue considerations to achieve durable coverage. 4. Appreciate the evolving management of transected nerves. 5. Highlight emerging applications of osseointegration and strategies to improve myoelectric prosthetic control. SUMMARY Plastic surgeons are well versed in lower extremity reconstruction for traumatic, oncologic, and ischemic causes. Limb amputation is an increasingly sophisticated component of the reconstructive algorithm and is indicated when the residual limb is predicted to be more functional than a salvaged limb. Although plastic surgeons have traditionally focused on limb salvage, they play an increasingly vital role in optimizing outcomes from amputation. This warrants a review of core concepts and an update on emerging reconstructive techniques in amputee care.
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Affiliation(s)
- Philip J Hanwright
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Visakha Suresh
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Jaimie T Shores
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Jason M Souza
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center
| | - Sami H Tuffaha
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
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Harrington CJ, Wade SM, Hoyt BW, Tintle SM, Potter BK, Souza JM. A Longitudinal Perspective on Conversion to Amputation for Combat-Related Extremity Injuries Treated With Flap-Based Limb Salvage. J Orthop Trauma 2023; 37:361-365. [PMID: 36750445 DOI: 10.1097/bot.0000000000002582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To define the rate and primary drivers behind early and late amputation after flap-based limb salvage in the setting of combat extremity trauma. DESIGN Retrospective review. SETTING Level II trauma center. PATIENTS 307 (303 men, 4 women) patients who underwent flap-based limb salvage treatment between 2003 and 2014. INTERVENTION We reviewed patient medical records, radiographs, and clinical photographs. MAIN OUTCOME MEASUREMENTS Early and late amputation rates, time to amputation, reason for amputation. RESULTS 307 patients accounted for 323 limbs that underwent flap-based limb salvage treatment (187 lower extremities, 136 upper extremities). A total of 58 extremities (18%) initially treated with flap-based limb salvage ultimately underwent amputation at a median of 480 days (IQR, 285-715 days) from injury. Periarticular fractures and lower extremity injuries were risk factors for early and late amputation. Other independent risk factors for early amputation were flap complications and vascular injuries, whereas risk factors for late amputation were fractures that went on to nonunion. CONCLUSIONS This study highlights that a subset of patients ultimately require major limb amputation despite having achieved what is initially considered "successful" limb salvage. Flap-related complications, vascular injury, and lower extremity site of injury were associated with early amputation after successful expeditionary efforts at limb preservation. Conversion to late amputation was associated with lower extremity periarticular fractures and fracture nonunion. Chronic pain and persistent limb dysfunction were the most common reasons for late amputation. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Colin J Harrington
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
| | - Sean M Wade
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
| | - Benjamin W Hoyt
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
| | - Scott M Tintle
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
| | - Benjamin K Potter
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
- Uniformed Services University-Walter Reed Department of Surgery, 4301 Jones Bridge Road, Bethesda, MD; and
| | - Jason M Souza
- Departments of Plastic and Reconstructive Surgery and Orthopedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43212
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Wade SM, Harrington CJ, Hoyt BW, Melendez-Munoz AM, Potter BK, Souza JM. Beyond Limb Salvage: Limb Restoration Efforts Following Remote Combat-Related Extremity Injuries Optimize Outcomes and Support Sustained Surgical Readiness. Mil Med 2023; 188:e584-e590. [PMID: 34591089 DOI: 10.1093/milmed/usab403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/29/2021] [Accepted: 09/20/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION As the combat operational tempo of the military conflicts in Iraq and Afghanistan has declined over the last decade, there has been a decrease in the number of patients requiring acute limb salvage. In their place, a growing population of patients with persistent functional deficits, pain, and inadequate soft tissue coverage stemming from prior limb salvage strategies have returned to our institution seeking revision surgery. Herein, we examine our institution's evolving surgical approach to extremity reconstruction from 2011 through 2019, culminating in the development of our limb restoration concept. We also discuss the impact of this orthoplastic approach on the acute management of complex extremity trauma and its role in providing sustained surgical readiness during interwar years. MATERIALS AND METHODS We retrospectively reviewed all limb reconstructive procedures performed at our tertiary care military treatment facility between September 1, 2011 to December 31, 2019 to characterize the trends in extremity reconstruction procedures performed at our institution. Cases were identified as limb restoration procedures if they involved secondary/revision reconstructive procedures designed to optimize function, treat pain, or improve the durability of the injured extremity following initial reconstruction efforts. RESULTS Nearly 500 limb restoration procedures were performed during the study period. These procedures steadily increased since 2011, reaching a maximum of 120 in 2018. Orthoplastic procedures such as osseointegration, targeted muscle reinnervation, regenerative peripheral nerve interface, agonist-antagonist myoneural interface, and soft tissue resurfacing flap reconstruction accounted for the rise in secondary/revision reconstruction performed during this time period. CONCLUSION Limb restoration is a collaborative orthoplastic approach that utilizes state-of-the-art surgical techniques for treating complex extremity trauma. Although limb restoration originally developed in response to managing the long-term sequelae of combat extremity trauma, the concept can be adapted to the acute management setting. Moreover, limb restoration provides military surgeons with a means for maintaining critical war-time surgical skills during the current low casualty rate era. Level of Evidence: V, therapeutic.
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Affiliation(s)
- Sean M Wade
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Colin J Harrington
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Benjamin W Hoyt
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | | | - Benjamin K Potter
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Jason M Souza
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
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Management of the Mangled Extremity. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Behr B, Lotzien S, Flecke M, Wallner C, Wagner JM, Dadras M, Daigeler A, Schildhauer TA, Lehnhardt M, Geßmann J. Comparative analysis of clinical outcome and quality of life between amputations and combined bone and flap reconstructions at the lower leg. Disabil Rehabil 2022; 44:6744-6748. [PMID: 34546826 DOI: 10.1080/09638288.2021.1971309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE At the lower leg, soft tissue defects with exposed bones, tendons, or hardware require flap coverage. In this retrospective study, we analyzed combined bone and soft tissue reconstructions compared to amputations of the lower leg in a civilian setting. MATERIALS AND METHODS Patients who underwent combined bone and flap reconstruction (LR) or amputation (LA) of the lower leg were eligible for the study. Bone conditions included fractures and bony defects due to posttraumatic osteomyelitis and non-union. Besides the analysis of the medical history, the study included clinical examination including extremity functional scale (LEFS) and SF-36-questionnaire. RESULTS LEFS score was significantly higher in the LR group compared to the LA group. Importantly, 42% in the LR group as opposed to 80% in the LA group could not return to their occupation. Mean hospitalization was 119 in the LR and 49 days in the LA group. SF-36 body item scores were significantly higher in the LR group as compared to LA. CONCLUSIONS Patients undergoing complex extremity reconstructions, including flap transfer to the lower leg have better functionality and higher quality of life than amputated patients. These data emphasize the advantages of these procedures and justify reconstructive efforts for limb salvage. Level of Evidence III.Implications for RehabilitationAmputation and combined bone and flap reconstruction in severe injuries of the lower leg can imply functional disabilities even after successful treatment.Albeit longer hospitalizations, patients with complex reconstructions showed better functional outcomes and had a higher quality of life.Limb salvage showed better functional outcomes and a higher rate in reintegration to work as compared to limb amputation.These data emphasize the importance of complex bone and soft tissue reconstruction in this patient cohort.
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Affiliation(s)
- Björn Behr
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Sebastian Lotzien
- Department of General and Trauma surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Marcel Flecke
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - J Maximillian Wagner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Mehran Dadras
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Jan Geßmann
- Department of General and Trauma surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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Cao Z, Zhang Y, Lipa K, Qing L, Wu P, Tang J. Ilizarov Bone Transfer for Treatment of Large Tibial Bone Defects: Clinical Results and Management of Complications. J Pers Med 2022; 12:jpm12111774. [PMID: 36579496 PMCID: PMC9692871 DOI: 10.3390/jpm12111774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUNDS The purpose of this study is to present our clinical experience using the Ilizarov bone transfer technique and free-flap technique in the reconstruction of large tibial bone and soft tissue defects, including an evaluation of both the management of postoperative complications and long-term outcomes. METHODS From January 2010 to May 2020, 72 patients with tibia bone and soft tissue defects were retrospectively evaluated. Either an anterolateral thigh perforator flaps (ALTP) or latissimus dorsi musculocutaneous flaps (LD), solely or in combination, were used to cover soft tissue defects. Once the flap was stabilized, an Ilizarov external fixator was applied to the limb. Follow-up was postoperatively performed at 1, 3, 6, 9, and 12 months. RESULTS Postoperatively, there were two cases of total and five of partial flap necrosis, and two cases of subcutaneous ulcers, which were caused by vascular crisis, infection, and hematoma, respectively. All the patients underwent Ilizarov external fixator surgery after flap recovery. A total of 16 complications occurred, including 3 cases of simple needle tract infection (antibiotic treatment) and 13 cases of complications requiring reoperation. A correlation factor analysis revealed that the main factors affecting the healing time were the defect length and operative complications. All patients with complications treated with the vascularized iliac flap eventually healed completely. CONCLUSIONS The Ilizarov method used together with an ALTP, LD, or a combination thereof yields good clinical results for repairing large bone and soft tissue defects of the tibia, thus reducing the incidence of amputations. However, longer treatment times may be involved, and postoperative complications can occur. The vascularized iliac flap may be a suitable choice for the treatment of postoperative complications of this type of Ilizarov bone transport.
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Affiliation(s)
- Zheming Cao
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Yiqian Zhang
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Katelyn Lipa
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Liming Qing
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Panfeng Wu
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Juyu Tang
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Correspondence:
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A modified passive-dynamic ankle-foot orthosis: can it prevent amputation and arthrodesis in patients with ankle-foot trauma? Arch Orthop Trauma Surg 2022; 142:2719-2726. [PMID: 34319472 DOI: 10.1007/s00402-021-04083-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION High-energy lower extremity trauma (HELET) may cause severe damage within the foot-ankle complex. Occasionally, arthrodesis or amputation are the only remaining options to increase activity levels. The modified passive dynamic ankle-foot orthosis (PDAFO) may prove to be a nonsurgical alternative. This study evaluated the effect of a modified PDAFO with a 6-week training program on pain and performance in patients after HELET. MATERIALS AND METHODS A retrospective cohort study was conducted on seventeen patients who considered an arthrodesis or an amputation after HELET. In an attempt to avoid surgery, the modified PDAFO with a 6-week training program was provided. Pain scores was measured with the Numeric Rating Scale and administered at the start of testing, immediately after the two performance tests and at the end of the day of testing. Performance was evaluated with the 6-min walk test (6MWT) and the Comprehensive high-level activity mobility predictor (CHAMP). RESULTS A significant pain reduction was achieved after the treatment procedure. At the start of the test days (p = 0.002), after the 6MWT (p = 0.001), after the CHAMP (p < 0.001) and at the end of the day (p < 0.001). In addition, a significant improvement on performance was observed in the 6MWT (p < 0.001) and the CHAMP (p = 0.01). None of the patients considered a surgical intervention anymore. CONCLUSIONS Patients after HELET show a decrease in pain and an improvement in performance after a 6-week training program with modified PD-AFO. The results suggest that the modified PDAFO is an effective alternative for a surgical approach.
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Godwin Y, Ahmed A, Shaat HY. A review of the first wave of lower limb amputees from the Great March of Return in Gaza: Taking stock and preparing for the task ahead. Injury 2022; 53:2541-2549. [PMID: 35643556 DOI: 10.1016/j.injury.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 02/02/2023]
Abstract
AIM Ballistic injuries during the Great March of Return (GMR) protests in Gaza have resulted in young, civilian amputees. This article defines this unique population, their injuries and clinical variables that impacted on amputation. METHOD A multidisciplinary team (MDT) assessed 103 lower limb amputees (104 stumps). Individualized prescriptions of care were formulated and applied for both stump and prosthesis management. The cohort's health state was assessed at screening by applying the EQ-5D-L5 questionnaire. The EQ-5D-L5 will be repeated on completion of the prescription of care. RESULTS The population is predominantly young, male, suffering unilateral amputation with an equal ratio of above knee (AKA) to below knee (BKA) amputations. 18% were amputated immediately and 82% with delay. Most amputations occur within 15 days of gunshot wound (GSW). All tissue elements were affected by the severe, ballistic injury. Division, gapping and tissue loss consolidated the decision for amputation rather than limb salvage. Knee zone injury was common, influencing the high numbers AKAs. Primary injury ramified beyond the amputated leg: 38% have contralateral leg injuries. 20% had physiological challenges requiring Intensive care unit (ICU) admissions. Infection was reported in 49% of amputees with 12% reporting acute sepsis. Psychologically, 49% reported severe, or extreme, anxiety and depression. AKAs were associated with greater morbidity: amputees are significantly younger, have more proximal vascular injuries, receive delayed amputations and experience longer time intervals to stump healing. ICU care and contralateral leg injuries were more frequent. One third of amputees used their prostheses', one third did not and one third do not have a prosthesis yet. The limiting factor for repair was supply of materials. 11% of amputees needed no adjustment to stump or prosthesis. Surgical stump revision was recommended in 26% of stumps and prosthetic management in 41%. A further 22%, subject to the success or failure of prescribed prosthetic adjustment, could require stump revision. CONCLUSION Youth, proximal injury, high numbers of AKA, psychosocial issues and the need for stump and prosthetic support define this group of amputees. Unifying expertise within a National MDT will promote continuity of care necessary for decades to come. The ultimate aim is an evidence-based amputee care system in Gaza, with lower limb specialists promoting best outcomes, judicious allocation of funds and maximising amputee quality of life.
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Affiliation(s)
- Yvette Godwin
- Department of Plastic Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Almaqadma Ahmed
- Department of Orthopaedic and Plastic Surgery, Al-Awda Hospital, Gaza strip, Tal al-Zatar, Palestine
| | - Hammad Yousef Shaat
- Al Shifa Hospital, Department of Orthopaedics, Ezden Qassam Street, Rimal District, Gaza City, Palestine
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Qian Z, Wang M, Xu T. Application of Emergency Specialist Nursing Combined with Green Channel Mode in Patients with Limb Amputation. Appl Bionics Biomech 2022; 2022:3838928. [PMID: 35498146 PMCID: PMC9042639 DOI: 10.1155/2022/3838928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background The treatment of limb amputation is always a challenge to emergency medical staff. The success of replantation of severed limbs requires not only emergency professional nursing measures but also rapid transport against time. We that found emergency specialist nursing combined with green channel mode can effectively improve the success rate of amputated limb replantation surgery. Methods From September 2017 to August 2020, the medical records of 80 patients with severed limb replantation treated by the emergency department of our hospital were collected and divided into the control group and the experimental group. 36 patients in the control group were emergency patients treated from September 2017 to May 2019. These patients did not take appropriate emergency specialist nursing measures and opened green channels at that time; the other 44 patients were in the experimental group, for emergency patients treated from June 2019 to August 2020. These patients have received emergency specialist care and opened a green channel. We recorded the gender, age, preoperative examination time, and success rate of amputated limb replantation surgery of the two groups of patients. Results The age of the patients in the control group was 41.17 ± 8.00 years old, and the age of the patients in the experimental group was 41.07 ± 7.31 years old (P > 0.05). The preoperative examination time of the patients in the control group was 46.53 ± 4.11 min, and the preoperative examination time of the patients in the experimental group was 40.34 ± 5.85 min (P < 0.05); the replantation success rate of the control group was 72.2%, and the replantation success rate of the experimental group was 81.8% (P < 0.05). Conclusion Standardized emergency specialist nursing measures combined with green channel mode can effectively shorten the preoperative examination time and help improve the success rate of amputated limb replantation surgery.
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Affiliation(s)
- Zaiyun Qian
- Wuxi 9th People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Min Wang
- Wuxi 9th People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Tonglong Xu
- Wuxi 9th People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
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Sharrock M. The mangled extremity: assessment, decision making and outcomes. Acta Orthop Belg 2021; 87:755-760. [PMID: 35172444 DOI: 10.52628/87.4.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The management of the mangled extremity continues to pose a significant challenge for ortho- paedic trauma surgeons. This article provides a comprehensive, up-to-date literature review on the assessment of complex limb injuries, and the variables that affect decision-making and outcomes in both limb salvage and amputation. Initial assessment involves using a systematic approach, saving life before limb, with early involvement of the relevant surgical specialities and multidisciplinary team. The decision to attempt limb salvage or perform amputation can be extremely difficult. Scoring systems can be used as a guide but should not be wholly relied upon; instead more emphasis should be placed on the surgeon's experience, extent of soft tissue damage, and patient factors and wishes. Outcomes following amputation versus limb salvage are comparable, with some studies suggesting amputation may be favourable. It is important to advise patients and families on what treatment is in their best interest so they can make an informed decision, and this must utilise a multidisciplinary approach.
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Pottecher J, Lefort H, Adam P, Barbier O, Bouzat P, Charbit J, Galinski M, Garrigue D, Gauss T, Georg Y, Hamada S, Harrois A, Kedzierewicz R, Pasquier P, Prunet B, Roger C, Tazarourte K, Travers S, Velly L, Gil-Jardiné C, Quintard H. Guidelines for the acute care of severe limb trauma patients. Anaesth Crit Care Pain Med 2021; 40:100862. [PMID: 34059492 DOI: 10.1016/j.accpm.2021.100862] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOAL To provide healthcare professionals with comprehensive multidisciplinary expert recommendations for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre. DESIGN A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded. METHODS The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient's prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10) What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain? Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/-) and 12 had a low level of evidence (GRADE 2+/-). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. CONCLUSIONS There was significant agreement among experts on strong recommendations to improve practices for severe limb trauma patients.
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Affiliation(s)
- Julien Pottecher
- Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg Cedex, France; Université de Strasbourg, FMTS, France.
| | - Hugues Lefort
- Structure des urgences, Hôpital d'Instruction des Armées Legouest, BP 9000, 57077 Metz Cédex 03, France
| | - Philippe Adam
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg Cedex, France
| | - Olivier Barbier
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital d'Instruction des Armées Sainte Anne, 2 boulevard Sainte Anne, 83000 Toulon, France; Ecole du Val de Grace, 2 place Alphonse Laveran, 75005 Paris, France
| | - Pierre Bouzat
- Université Grenoble Alpes, Pôle Anesthésie-Réanimation, Centre Hospitalo-Universitaire Grenoble-Alpes, Grenoble, France
| | - Jonathan Charbit
- Soins critiques DAR Lapeyronie, CHU Montpellier, France; Réseau OcciTRAUMA, Réseau Régional Occitanie de prise en charge des traumatisés sévères, France
| | - Michel Galinski
- Pôle urgences adultes - SAMU 33, Hôpital Pellegrin, CHU de Bordeaux 3300 Bordeaux, France; INSERM U1219, ISPED, Bordeaux Population Health Research Center INSERM U1219-"Injury Epidemiology Transport Occupation" Team, F-33076 Bordeaux Cedex, France
| | - Delphine Garrigue
- Pôle d'Anesthésie Réanimation, Pôle de l'Urgence, CHU Lille, F-59000 Lille, France
| | - Tobias Gauss
- Service d'Anesthésie-Réanimation, Hôpital Beaujon, DMU PARABOL, AP-HP Nord, Clichy, France; Université de Paris, Paris, France
| | - Yannick Georg
- Service de Chirurgie Vasculaire et Transplantation Rénale, Hôpitaux Universitaire de Strasbourg, Strasbourg, France
| | - Sophie Hamada
- Département d'Anesthésie Réanimation, Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France
| | - Anatole Harrois
- Département d'anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Romain Kedzierewicz
- Ecole du Val de Grace, 2 place Alphonse Laveran, 75005 Paris, France; Bureau de Médecine d'Urgence, Division Santé, Brigade de Sapeurs-Pompiers de Paris, 1 place Jules Renard, 75017 Paris, France
| | - Pierre Pasquier
- Département anesthésie-réanimation, Hôpital d'instruction des armées Percy, Clamart, France; Brigade de Sapeurs-Pompiers de Paris, Paris, France
| | - Bertrand Prunet
- Ecole du Val de Grace, 2 place Alphonse Laveran, 75005 Paris, France; Brigade de Sapeurs-Pompiers de Paris, Paris, France
| | - Claire Roger
- Service de Réanimation Chirurgicale, Pôle Anesthésie Réanimation Douleur Urgence, CHU Carémeau, 30000 Nîmes, France
| | - Karim Tazarourte
- Service SAMU-Urgences, CHU Edouard Herriot, Hospices civils de Lyon, Lyon, France; Université Lyon 1 Hesper EA 7425, Lyon, France
| | - Stéphane Travers
- Ecole du Val de Grace, 2 place Alphonse Laveran, 75005 Paris, France; 1ère Chefferie du Service de Santé, Villacoublay, France
| | - Lionel Velly
- Service d'Anesthésie Réanimation, CHU Timone Adultes, 264 rue St Pierre 13005 Marseille, France; MeCA, Institut de Neurosciences de la Timone - UMR 7289, Aix Marseille Université, Marseille, France
| | - Cédric Gil-Jardiné
- Pôle Urgences adultes SAMU-SMUR, CHU Bordeaux, Bordeaux Population Health - INSERM U1219 Université de Bordeaux, Equipe IETO, Bordeaux, France
| | - Hervé Quintard
- Soins Intensifs, Hôpitaux Universitaires de Genève, Genève, Suisse
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Zeiderman MR, Pu LLQ. Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma. BURNS & TRAUMA 2021; 9:tkab024. [PMID: 34345630 PMCID: PMC8324213 DOI: 10.1093/burnst/tkab024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/22/2021] [Indexed: 11/29/2022]
Abstract
The complex lower extremity wound is frequently encountered by orthopedic and plastic surgeons. Innovations in wound care, soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid injuries. In this review, the principles of reconstruction of complex lower extremity traumatic wounds are outlined. These principles include appropriate initial evaluation of the patient and mangled extremity, as well as appropriate patient selection for limb salvage. The authors emphasize proper planning for reconstruction, timing of reconstruction and the importance of an understanding of the most appropriate reconstructive option. The role of different reconstructive and wound care modalities is discussed, notably negative pressure wound therapy and dermal substitutes. The role of pedicled flaps and microvascular free-tissue transfer are discussed, as are innovations in understanding of perforator anatomy and perforator flap surgery that have broadened the reconstruction surgeon’s armamentarium. Finally, the importance of a multidisciplinary team is highlighted via the principle of the orthoplastic approach to management of complex lower extremity wounds. Upon completion of this review, the reader should have a thorough understanding of the principles of contemporary lower extremity reconstruction.
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Affiliation(s)
- Matthew R Zeiderman
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Lee L Q Pu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, Davis, Sacramento, CA, USA
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Functional Limb Restoration Through Amputation: Minimizing Pain and Optimizing Function With the Use of Advanced Amputation Techniques. Ann Surg 2021; 273:e108-e113. [PMID: 33378296 DOI: 10.1097/sla.0000000000003942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To demonstrate the role of advanced orthoplastic techniques in harnessing the full potential of elective amputation as a functionally restorative procedure. SUMMARY OF BACKGROUND DATA Once considered the unfortunate consequence of failed reconstructive efforts, recent outcomes studies have prompted a re-evaluation of the role of amputation in the management of complex extremity trauma. However, even as amputation is appropriately afforded greater consideration as part of the reconstructive algorithm, reconstructive techniques that are commonly utilized in pursuit of limb salvage are rarely applied to amputation. METHODS The following case demonstrates the successful application of orthoplastic reconstructive techniques to achieve optimal pain and functional outcomes in a 41-year-old active duty soldier who underwent an elective transtibial amputation after prolonged, limb salvage. RESULTS The patient presented with a large osteocutaneous proximal tibial defect secondary to trauma and subsequent osteomyelitis. The patient underwent a free scapular-parascapular fasciocutaneous flap to provide soft tissue coverage and facilitate the skeletal reconstruction necessary for either continued limb salvage or amputation. Due to tibial allodynia and severely limited ankle function, the patient subsequently elected for amputation in favor of continued limb salvage. Thus, a transtibial amputation was performed concurrently with a pedicled vascularized fibula to address the proximal tibial defect. A modified agonist-antagonist myoneural interface procedure was used to maximize post-amputation function, with creation of regenerative peripheral nerve interface constructs to prophylax against neurogenic pain. After the operation, the patient achieved improved function of the extremity with the use of a prosthesis and reported substantially improved pain while remaining on active duty in a warfighting military occupational specialty. CONCLUSIONS By addressing all of the reconstructive components commonly considered in limb salvage, an orthoplastic approach to amputation surgery can minimize pain and maximize the rehabilitative potential of the amputee.
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Baus A, Bich CS, Grosset A, de Rousiers A, Duhoux A, Brachet M, Duhamel P, Thomas M, Rogez D, Mathieu L, Bey E. Medical and surgical management of lower extremity war-related injuries. Experience of the French Military Health Service (FMHS). ANN CHIR PLAST ESTH 2020; 65:447-478. [DOI: 10.1016/j.anplas.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/13/2020] [Indexed: 01/27/2023]
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Cai G, Liu W, Xiong J, Liu L, Wang D, Yang J. Functional Reconstruction of Hindfoot With Total Calcaneus and Talus Loss by Ilizarov Technique: A Case Report. J Foot Ankle Surg 2020; 59:142-148. [PMID: 31882137 DOI: 10.1053/j.jfas.2019.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/08/2018] [Accepted: 03/11/2019] [Indexed: 02/03/2023]
Abstract
Total calcaneus and talus loss in the hindfoot is an unusual but severe condition encountered in clinical settings. This condition affects lower-extremity function and poses a significant challenge to limb salvage. We present a case of a 43-year-old man with total calcaneus and talus loss in the right foot treated by Ilizarov technique. A staged treatment protocol was planned to reconstruct and optimize the heel for weightbearing and walking. During the 15-month postoperative follow-up, the patient reported no significant discomfort in the targeted foot and regained satisfactory function, including shoe wearing, walking, driving, and climbing stairs. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score was 71, which was an improvement from a preoperative score of 40. This case is the first reported on the functional reconstruction by Ilizarov technique of hindfoot with total calcaneus and talus loss. This treatment protocol provides an effective approach to reconstructing the hindfoot with massive bone loss, although the long-term outcome remains unknown.
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Affiliation(s)
- Gaorui Cai
- Surgeon, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Wei Liu
- Surgeon, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Jianyi Xiong
- Professor, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Lijun Liu
- Professor, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Daping Wang
- Professor, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Jinxing Yang
- Professor, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China.
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Progress on combat damage control resuscitation/surgery and its application in the Chinese People's Liberation Army. J Trauma Acute Care Surg 2020; 87:954-960. [PMID: 31574061 DOI: 10.1097/ta.0000000000002344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Damage control resuscitation (DCR) and damage control surgery (DCS) has now been developed as a well-established standard of care for severely injured civilian patients worldwide. On the other hand, the application of combat DCR/DCS has saved the lives of thousands of severely injured casualties in several wars during the last two decades. This article describes the great progress on DCR/DCS in the last two decades and its application in the Chinese People's Liberation Army (PLA). The main development of the advanced theories of combat DCR/DCS including the global integration of DCR/DCS, application of remote battlefield DCR, balanced hemostatic resuscitation in combat hospitals and enhancement of en route DCR. There are two key factors that determine the feasibility of combat DCR: one is the availability of resources and supplies to implement the advanced theories of combat DCR/DCS, the other is the availability of qualified personnel who master the skills needed for the implementation of DCR/DCS. In the PLA, the advanced theories of combat DCR/DCS have now been widely accepted, and some of related advanced products, such as fresh-frozen plasma, packed red blood cells, and platelets, have been available in Level III medical facilities. In conclusion, great progress in combat DCR/DCS has been achieved in recent years, and the Chinese PLA is keeping good pace with this development, although there is still room for improvement.
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Hohenberger GM, Konstantiniuk P, Cambiaso-Daniel J, Matzi V, Schwarz AM, Lumenta DB, Cohnert TU. The Mangled Extremity Severity Score Fails to be a Good Predictor for Secondary Limb Amputation After Trauma with Vascular Injury in Central Europe. World J Surg 2019; 44:773-779. [DOI: 10.1007/s00268-019-05263-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Buchheit T, Hsia HLJ, Cooter M, Shortell C, Kent M, McDuffie M, Shaw A, Buckenmaier CT, Van de Ven T. The Impact of Surgical Amputation and Valproic Acid on Pain and Functional Trajectory: Results from the Veterans Integrated Pain Evaluation Research (VIPER) Randomized, Double-Blinded Placebo-Controlled Trial. PAIN MEDICINE 2019; 20:2004-2017. [PMID: 31045229 DOI: 10.1093/pm/pnz067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine if the perioperative administration of valproic acid reduces the incidence of chronic pain three months after amputation or revision surgery. DESIGN Multicenter, randomized, double-blind, placebo-controlled trial. SETTING Academic, military, and veteran medical centers. SUBJECTS One hundred twenty-eight patients undergoing amputation or amputation revision surgery at Duke University Hospital, Walter Reed National Military Medical Center, or the Durham Veterans Affairs Medical Center for either medical disease or trauma. METHODS Patients were randomized to placebo or valproic acid for the duration of hospitalization and treated with multimodal analgesic care, including regional anesthetic blockade. Primary outcome was the proportion of patients with chronic pain at three months (average numeric pain score intensity of 3/10 or greater). Secondary outcomes included functional trajectories (assessed with the Brief Pain Inventory short form and the Defense and Veterans Pain Rating Scale). RESULTS The overall rate of chronic pain was 68.2% in the 107 patients who completed the end point assessment. There was no significant effect of perioperative valproic acid administration, with a rate of 65.45% (N = 36) in the treatment group and a rate of 71.15% (N = 37) in the placebo group. Overall, pain scores decreased from baseline to follow-up (median = -2 on the numeric pain scale). Patients additionally experienced improvements in self-perceived function. CONCLUSIONS The rate of chronic pain after amputation surgery is not significantly improved with the perioperative administration of valproic acid. In this cohort treated with multimodal perioperative analgesia and regional anesthetic blockade, we observed improvements in both pain severity and function.
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Affiliation(s)
- Thomas Buchheit
- Department of Anesthesiology, Duke University Medical Center, Durham VA Medical Center, Durham, North Carolina
| | - Hung-Lun John Hsia
- Department of Anesthesiology, Duke University Medical Center, Durham VA Medical Center, Durham, North Carolina
| | | | - Cynthia Shortell
- Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Mary McDuffie
- Walter Reed National Military Medical Center, Defense and Veterans Center for Integrative Pain Management, Rockville, MD, USA
| | - Andrew Shaw
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Chester Trip Buckenmaier
- Department of Military Emergency Medicine, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, MD, USA
| | - Thomas Van de Ven
- Department of Anesthesiology, Duke University Medical Center, Durham VA Medical Center, Durham, North Carolina
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Black CK, Ormiston LD, Fan KL, Kotha VS, Attinger C, Evans KK. Amputations versus Salvage: Reconciling the Differences. J Reconstr Microsurg 2019; 37:32-41. [PMID: 31499559 DOI: 10.1055/s-0039-1696733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND There are many factors to consider when choosing between amputations versus salvage in lower extremity reconstructive surgery. Postoperative functionality and survival benefit are critical factors when deciding between limb salvage and amputation. METHODS In this review, we present the evidence and the risks and benefits between these two options in the setting of the acute, trauma population and the chronic, diabetes population. RESULTS The trauma population is on average young without significant comorbidities and with robust vasculature and core strength for recovery. Therefore, these patients can often recover significant function with anamputation and prosthesis. Amputation can therefore be the more desirable in this patient population, especially in the case of complete traumatic disruption, unstable patients, high risk of extensive infection, and significant nerve injury. However, traumatic lower extremity reconstruction is also a viable option, especially in the case of young patients and those with intact plantar sensation and sufficient available tissue coverage. The diabetic population with lower extremity insult has on average a higher comorbidity profile and often lower core strength. These patients therefore often benefit most from reconstruction to preserve limb length and improve survival. However, amputation may be favored for diabetics that have no blood flow to the lower extremity, recalcitrant infection, high-risk comorbidities that preclude multiple operations, and those with end stage renal disease. CONCLUSION Many patient-specific factors should be considered when deciding between amputation vs. salvage in the lower extremity reconstruction population.
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Affiliation(s)
- Cara K Black
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC
| | - Laurel D Ormiston
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC
| | - Kenneth L Fan
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC
| | - Vikas S Kotha
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC
| | - Christopher Attinger
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC
| | - Karen Kim Evans
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC
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Noblet T, Lineham B, Wiper J, Harwood P. Amputation in Trauma—How to Achieve a Good Result from Lower Extremity Amputation Irrespective of the Level. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-0159-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Readability, Suitability, and Complexity of Online Resources for Lower Extremity Reconstruction. Ann Plast Surg 2019; 82:2-6. [DOI: 10.1097/sap.0000000000001636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herrera-Moreno D, Carvajal-Ovalle D, Cueva-Nuñez MA, Acevedo C, Riveros-Munévar F, Camacho K, Fajardo-Tejada DM, Clavijo-Moreno MN, Lara-Correa DL, Vinaccia-Alpi S. Body image, perceived stress, and resilience in military amputees of the internal armed conflict in Colombia. Int J Psychol Res (Medellin) 2018; 11:56-62. [PMID: 32612779 PMCID: PMC7110278 DOI: 10.21500/20112084.3487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The objective of this study was to determine the levels and the relationship between body image satisfaction, perceived stress and resilience in soldier amputee victims of the internal armed conflict in Colombia. It was a quantitative, cross-sectional study of correlational scope, with the participation of 22 Colombian soldiers who were victims of the internal armed conflict and with some degree of amputation. For each soldier, the Multidimensional Body Self-relations Questionnaire (MBSRQ), Perceived Stress (EEP-14) and the Connor-Davidson Resilience Scale (CD-RISC 10) were applied. The results show high scores in behaviors aimed at maintaining physical fitness, self-assessed physical attractiveness and physical appearance, low scores in stress and scores with high trends in resilience, as well as a negative correlation between stress and conducts aimed to maintain physical fitness.
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Affiliation(s)
- Daniela Herrera-Moreno
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - Diego Carvajal-Ovalle
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - María Angélica Cueva-Nuñez
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - Camila Acevedo
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - Fernando Riveros-Munévar
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - Katherin Camacho
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - Diana Milena Fajardo-Tejada
- Ministerio de defensa-Dirección Centro de Rehabilitación Inclusiva, Colombia. Ministerio de defensa-Dirección Centro de Rehabilitación Inclusiva Colombia
| | - Mauricio Noel Clavijo-Moreno
- Ministerio de defensa-Dirección Centro de Rehabilitación Inclusiva, Colombia. Ministerio de defensa-Dirección Centro de Rehabilitación Inclusiva Colombia
| | - Dary Luz Lara-Correa
- Ministerio de defensa-Dirección Centro de Rehabilitación Inclusiva, Colombia. Ministerio de defensa-Dirección Centro de Rehabilitación Inclusiva Colombia
| | - Stefano Vinaccia-Alpi
- Universidad del Sinú, Montería, Colombia. Universidad del Sinú Universidad del Sinú Montería Colombia
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de Kruijff LGM, Prins M, van der Krans A, Hoencamp R, van der Wurff P. Combat-related foot injuries: impact on gait and functional outcome. J ROY ARMY MED CORPS 2018; 164:322-327. [DOI: 10.1136/jramc-2017-000870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/04/2022]
Abstract
IntroductionPrior to deployment of the Netherlands Army Task Force Urozgan in Afghanistan, the Dutch Military and civilian healthcare systems had limited experience in treating blast injuries and their long-term consequences. This meant that guidelines for treatment and rehabilitation were lacking. The aim of this cohort study was to quantify kinematic and kinetic abnormalities in service members with foot injuries in relation to functional outcome using gait analysis.MethodIn nine service members with combat-related talus, calcaneus and/or navicular bone (TCN) fractures and nine controls, gait parameters were measured using Gait Real-Time Analysis Interactive Lab system. High-level mobility was evaluated by the Comprehensive High-Level Activity Mobility Predictor (CHAMP), and functional ability was assessed by Lower Extremity Functional Scale (LEFS) questionnaire.ResultsSignificant differences were found for LEFS and CHAMP scores (P<0.01), comfortable walking speed and ankle joint range of motion (ROM) (P<0.05), all lower in the group with TCN fractures. For this group, a trend (0.1>P>0.05) for higher step width and lower stride duration and peak power was found. A strong correlation (0.6>r>0.79) is shown between LEFS and comfortable walking speed and CHAMP and ankle joint ROM. The correlations between LEFS and stride duration, step width, ankle joint ROM and peak power, and between CHAMP and comfortable walking speed and stride duration, were moderate (0.4>r>0.59).ConclusionsThis study demonstrated that service members with TCN fractures, compared with healthy controls, have altered gait characteristics, specifically lower walking speed and ankle joint ROM, both related to lower physical functioning. Patients with bilateral depressed Böhler’s angle had the worse functional performance, and further research is recommended to evaluate the relationship between Böhler’s angle and physical performance.Clinical TrialThe Dutch Ministry of Defence (MOD) and the Institutional Review Board and Medical Ethics Review Committee Brabant, The Netherlands, approved this study (P1550).
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Affiliation(s)
- Jowan G Penn-Barwell
- Orthopaedic Trauma Surgeon, Institute of Naval Medicine, Gosport, Hampshire, UK.
| | - Philippa M Bennett
- Orthopaedic Trauma Surgeon, Institute of Naval Medicine, Gosport, Hampshire, UK
| | - Andrew C Gray
- Orthopaedic Trauma Surgeon, Institute of Naval Medicine, Gosport, Hampshire, UK
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