Four limb amputations due to electrical burn caused by TV antenna contact with overhead electric cables

Traumatic quadruple amputee rehabilitation: from amputation to prosthetic functionality: a case report

INTRODUCTION

Traumatic quadruple amputations limit daily living activities; however, the current literature regarding rehabilitation treatment for multi-limb amputations is scant. The patient showed adaptation to prosthetic fittings, acquiring a level of functional independence that enabled the patient to lead a nearly independent life.

METHODS

The patient's therapeutic intervention was divided into a pre-prosthetic phase, which consisted of functional physical adaptation to the amputation and preparation for the prostheses, and a prosthetic phase, in which different myoelectric and microprocessor limb prostheses were integrated to be used functionally. Its functional use was favored by the training with contact electromyography feedback carried out with the Biometrics E-Link System^® for the upper extremities that has made it possible to obtain many grip options in a natural way, for the lower extremities the use of the intelligent passive prostheses has overcome the functional capacity achieved in this type of patients referenced in the literature who had used prostheses of previous generations such as mechanical passive prostheses.

RESULTS

With rehabilitation, the patient showed improvements in the following scales and questionnaires (initial vs. final values): Disabilities of the Arm, Shoulder, and Hand Questionnaire; Functional Independence Measure; Berg Balance Scale; Locomotor Capabilities Index in Amputees (an assessment of overall motor capacity); and Special Interest Group in Amputee Medicine scale (an assessment of the degree of mobility).

CONCLUSIONS

The patient's age, psychological status, and family and personal support, in addition to technical and economic resources used for next-generation prostheses adapted to this clinical case, were crucial for his progress. IMPLICATIONS FOR REHABILITATION The use of next-generation myoelectric and microprocessor prostheses makes it possible to achieve greater end functionality in quadruple amputees. Proximal amputation levels present greater difficulty in achieving good functionality. Early and intensive rehabilitation could favour and contribute towards improving psychological states. Age, psychological status, and pain management are aspects to take into account during the rehabilitation process.

Etiology and Outcome of Burns in Tabriz, Iran an Analysis of 2963 Cases

Background and aims:

Burn injuries still produce a significant morbidity and mortality in Iran. A 3-year retrospective review of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of patients in Tabriz.

Material and Methods:

Two thousand nine hundred sixty + three patients were iden tified and stratified by age, sex, burn size, presence or absence of inhalation injury, cause of burn. There is one burn center in the East Azarbygan province serving 3.3 million people over an area of 47,830 sq.km.

Results:

The overall incidence rates of hospitalization and death were 30.5 % and 5.6 % per 100000 person years. The mean patient age was 22 years, and the male: female ratio was 1.275. There were 555 deaths altogether (18.7 %). The highest incidence of burns was in the 1–9 age group (29.2 %). Patients with less than 40 percent of burned surface constituted 79.8 % of injuries. The most common cause of burns was kerosene accident in adults and scald injuries in children. The mean length of hospitalization was 13 days. The mean body surface area burned was larger with higher mortality in females than in males (p < 0.001). Inhalation injuries were strongly associated with large burns and were present in all flame-burn fatalities.

Conclusion:

In our opinion, social factors are the main drive leading to an unacceptably high rate of burn injuries in our societies. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable; educational programs might reduce the incidence of burn injuries.

Four limb amputations due to peripheral gangrene from inotrope use - Case report and review of the literature

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Rare case of 4 limb amputations due to peripheral gangrene from inotrope use.

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Contributing factors include disseminated intravascular coagulation and septic shock.

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Differential diagnoses include symmetrical peripheral gangrene and purpura fulminans.

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Some therapeutic agents are beneficial for peripheral ischemia with dopamine use.

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Single-stage elective amputations led to satisfactory rehabilitation with prosthesis.

INTRODUCTION

We present a rare case of 4 limb amputations due to peripheral gangrene which resulted from the use of inotropes for septic shock.

PRESENTATION OF CASE

A 72-year-old woman with no past medical history presented with fever and pain in bilateral big toes. She was diagnosed with Streptococcal pneumoniae septicaemia and was started on broad spectrum antibiotics, dopamine and noradrenaline in the medical intensive care unit. She developed peripheral gangrene of all 4 extremities due to microvascular spasm from inotrope use and 4 limb amputations were performed electively in a single stage.

DISCUSSION

The gangrene was contributed by the presence of disseminated intravascular coagulation and septic shock. There was no evidence of an autoimmune disorder or vasculitis on laboratory investigations and tissue histology.

CONCLUSION

Microvascular spasm is a rare complication of inotrope use which may lead to extensive peripheral gangrene. Anecdotal reports of reversal agents have been discussed. Four limb amputations are a reasonable option especially if done in an elective setting after the gangrene has demarcated itself. Rehabilitation with prosthesis after 4 limb amputations can result in good functional outcome.

Limb fitting for quadruple amputees: report of two cases of symmetrical peripheral gangrene caused by pneumococcal purpura fulminans

BACKGROUND

We report our experiences of prosthetic fitting in quadruple amputees. Two patients underwent quadruple amputation after suffering from disseminated intravascular coagulation in conjunction with pneumococcemia with purpura fulminans.

CASE DESCRIPTION AND METHODS

The first patient, a 52-year-old man, underwent bilateral transradial, left transtibial, and right transfemoral amputation, and the second patient, a 62-year-old man, underwent bilateral transradial and bilateral transfemoral amputation, both for symmetrical peripheral gangrene subsequent to septic shock.

FINDINGS AND OUTCOMES

The amputations were accompanied by skin damage due to ischemic tissue changes both on the stumps and on the nose and/or lips. The combination of the intensive prosthetic rehabilitation program and supportive medical care led to completely independent functioning, including driving a car, with the use of four prosthetic limbs and a wheelchair in both cases.

CONCLUSION

Early initiation of a multidisciplinary approach can properly address impairments and minimize future disability.

A patient with an electrical burn treated by modified bilateral hemipelvectomy and disarticulation of the right arm

A 23-year-old Hispanic worker sustained an electrical injury to 45% of his body when a crane hit a power line. Amputations of both legs, with bilateral partial hemipelvectomies, were required. A disarticulation of the right arm at the shoulder was also preformed. Resection of necrotic bowel, debridement of 95% of the abdominal wall, and resection of the genitalia was eventually required, with later reconstruction of the abdominal wall. After wound healing was complete, the patient was fitted with Jobst garments. A customized bucket prosthesis with a temperature control, to allow sitting upright, was provided. An electric wheel chair and a myoelectronic prosthetic arm were supplied. Rehabilitation was begun early.

High tension electrical injury from a telephone receiver

A high tension (13000 V) electrical injury to a young man from telephone receiver is described. The current entered the telephone circuit due to contact with a high tension live wire running close to the telephone wire 2 km away from the site of incidence.

A small contact burn injury requiring upper limb amputation

An elderly, demented, man was referred with a fairly small contact burn to the medial side of his left arm and forearm. The thermal injury had caused ischaemia of the forearm and hand. Thrombosis of the underlying brachial artery was suspected, and the only surgical option was amputation. This is an unusual but devastating complication of a contact burn. Those particularly at risk of this injury include the demented, elderly, epileptics and neuropathics, who may lie helpless or unaware of prolonged contact with warm objects.

The changing needs of patients after primary rehabilitation: an overlooked entity

PURPOSE

The need for rehabilitation should not be viewed as a single event that may occur during a lifetime. This theme is explored.

METHOD

A case of a man who lost the distal portions of all four limbs, is reported.

RESULTS

He was rehabilitated and spent many years as an active member of the community. The physical changes, owing to advancing age, were overlooked.

CONCLUSIONS

Attention is drawn to the fact that long term re-evaluation of function is periodically required.

Electrocution due to contact of industrial equipment with power lines

Electrocution due to contact of construction equipment with power lines is not uncommon as a source of industrial injury. We report seven such cases. Two patients sustained cardiac arrest and were successfully resuscitated at the scene. Four patients lost consciousness and in two cases, amnesia for the event was encountered. No long-term cardiac or neurologic effects were noted. Surgery including amputation was sometimes required. In all cases, the patient was on the ground touching the machinery or touching cables connected to the machinery at the time of injury. The importance of exercising due care in industrial safety measures is stressed. Prompt CPR was life saving in two cases.

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the first, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0-10 years old (40 per cent) and moderate to major burns in the age group 21-30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.