Amputação primária no trauma: perfil de um hospital da região centro-oeste do Brasil

Comparative study of angiographic changes in diabetic and non-diabetic patients with peripheral arterial disease

Background

Diabetics are at 5-15 times greater risk of developing peripheral arterial disease (PAD) and few studies have compared risk factors and distribution and severity of arterial changes in diabetics compared with non-diabetics.

Objectives

To compare angiographic changes between diabetic and non-diabetic patients with advanced PAD and correlate them with risk factors.

Methods

A retrospective cross-sectional study was conducted of consecutive patients undergoing lower limb arteriography for PAD (Rutherford 3-6) using TASC II and Bollinger et al. angiographic scores. Exclusion criteria were upper limb angiographies, unclear images, incomplete laboratory test results, and previous arterial surgeries. Statistical analyses included chi-square tests, Fisher's test for discrete data, and Student's t test for continuous data (significance level: p < 0.05).

Results

We studied 153 patients with a mean age of 67 years, 50.9% female and 58.2% diabetics. A total of 91 patients (59%) had trophic lesions (Rutherford 5 or 6) and 62 (41%) had resting pain or limiting claudication (Rutherford 3 and 4). Among diabetics, 81.7% were hypertensive, 29.4% had never smoked, and 14% had a history of acute myocardial infarction. According to the Bollinger et al. score, infra-popliteal arteries were more affected in diabetics, especially the anterior tibial artery (p = 0.005), while the superficial femoral artery was more affected in non-diabetics (p = 0.008). According to TASC II, the most severe angiographic changes in the femoral-popliteal segment occurred in non-diabetic patients (p = 0.019).

Conclusions

The most frequently affected sectors were the infra-popliteal sectors in diabetics and the femoral sector in non-diabetics.

Comparative study of angiographic changes in diabetic and non-diabetic patients with peripheral arterial disease

Abstract Background Diabetics are at 5-15 times greater risk of developing peripheral arterial disease (PAD) and few studies have compared risk factors and distribution and severity of arterial changes in diabetics compared with non-diabetics. Objectives To compare angiographic changes between diabetic and non-diabetic patients with advanced PAD and correlate them with risk factors. Methods A retrospective cross-sectional study was conducted of consecutive patients undergoing lower limb arteriography for PAD (Rutherford 3-6) using TASC II and Bollinger et al. angiographic scores. Exclusion criteria were upper limb angiographies, unclear images, incomplete laboratory test results, and previous arterial surgeries. Statistical analyses included chi-square tests, Fisher's test for discrete data, and Student’s t test for continuous data (significance level: p < 0.05). Results We studied 153 patients with a mean age of 67 years, 50.9% female and 58.2% diabetics. A total of 91 patients (59%) had trophic lesions (Rutherford 5 or 6) and 62 (41%) had resting pain or limiting claudication (Rutherford 3 and 4). Among diabetics, 81.7% were hypertensive, 29.4% had never smoked, and 14% had a history of acute myocardial infarction. According to the Bollinger et al. score, infra-popliteal arteries were more affected in diabetics, especially the anterior tibial artery (p = 0.005), while the superficial femoral artery was more affected in non-diabetics (p = 0.008). According to TASC II, the most severe angiographic changes in the femoral-popliteal segment occurred in non-diabetic patients (p = 0.019). Conclusions The most frequently affected sectors were the infra-popliteal sectors in diabetics and the femoral sector in non-diabetics.

Prognostic factors in treatment of traumatic femoropopliteal arterial injuries at a Brazilian trauma center

Background

Despite significant improvements in outcomes, traumatic arterial limb injuries remain a significant cause of limb loss and mortality.

Objectives

This study sought to identify predictors of mortality and major amputation in patients undergoing revascularization after femoropopliteal arterial trauma.

Methods

This was a retrospective review of a trauma registry from an urban trauma center in Brazil. All patients admitted to our hospital with a femoropopliteal arterial injury from November 2012 to December 2017 who underwent vascular reconstruction were included. Univariate analyses and logistic regression analyses were conducted to identify factors independently associated with the primary outcome of amputation and the secondary outcome of mortality.

Results

Ninety-six patients were included. Eleven patients (11.5%) had an amputation and 14 (14.6%) died. In the logistic regression model for amputation, patients with ischemia duration greater than 6 hours were approximately 10 times more likely to undergo an amputation compared to those with ischemia duration less than or equal to 6 hours (adjusted odds ratio (AOR) [95% confidence interval (CI)]: 9.6 [1.2-79.9]). The logistic regression model for mortality revealed that patients with ischemia duration greater than 6 hours were approximately 6 times more likely to die compared to those with ischemia duration less than or equal to 6 hours (AOR [95% CI]: 5.6 [1.3 to 24.7).

Conclusions

Ischemia duration remains the most important factor independently associated with limb loss and mortality for patients undergoing femoropopliteal arterial revascularization after traumatic injuries. Physiological status on admission and trauma scores are also important.

Physical therapy evaluation in the immediate post-operative period of patients with lower limbs amputation assisted at the hospital bedside

Abstract Lower limb (LL) amputation compromises the individual's quality of life and functionality, requiring immediate rehabilitation through the assistance of a multi-professional team. This research describes the sociodemographic and physical-functional profile of the LL amputee, evaluated at the hospital bedside in the immediate postoperative period. This is a descriptive and cross-sectional study in which patients from the Unified Health System were evaluated, who underwent LL of any etiology in a public hospital. The collection was designated through notifications from the hospital staff regarding cases of newly amputees, totaling fourteen subjects. The average age of the participants was 44 years old, being 86% male. The etiology of the predominant amputation was automobile trauma due to motorcycle accidents and transtibial level. From the perimetry, it was found that 43% of the individuals presented edema in the stump when compared to the contralateral limb. Regarding stump pain, 93% of subjects reported feeling, while 78% reported feeling phantom pain and phantom sensation. Concerning normal muscle strength in the amputated limb, it was present in only 1% of patients, in contrast to the intact limb was present in 48% of individuals for any muscle group. In bed mobility, 32% of individuals had complete independence. In unipodal orthostatism, no patient was able to stand independently. From the collected data it was possible to conclude that the physical therapist should pay attention to the muscular strength, bed mobility, and static balance of the amputee to avoid muscle contractures and facilitate prosthesis.

Characterization of amputees at a large hospital in Recife, PE, Brazil

BACKGROUND

Limb amputation can be defined as a procedure that consists of separating a limb or a segment of a limb from the body.

OBJECTIVES

To describe the profile of limb amputation procedures performed at a large hospital run by the state of Pernambuco (Brazil).

METHODS

Cross-sectional descriptive and retrospective study conducted at a large hospital in the city of Recife, PE. Data were collected from the records of patients who underwent amputations during 2017. Records from patients who had had a limb amputation during 2017 were included, unless data were illegible or missing.

RESULTS

A total of 328 procedures were performed on 274 patients, the majority of whom were male (57.7%). There was a predominance of lower limb amputations (64.2%), of non-traumatic causes (86.5%), and urgent treatment (96.4%). The majority of patients who underwent amputations remained in hospital for 11 to 25 days (32.1%). The study found that the majority of amputees were discharged (69.7%), although a proportion died. Deaths of lower limb amputees were primarily among elderly women in the age range of 60 to 90 years (76%), females (55%), and patients subjected to a single amputation (91%).

CONCLUSIONS

The data observed in this study are alarming, particularly considering that many of these amputations could have been avoided, since they were caused by complications of diseases that can be prevented and controlled at healthcare services of a lower level of complexity and at a relatively low cost.

Prevalência de amputações de membros superiores e inferiores no estado de Alagoas atendidos pelo SUS entre 2008 e 2015

RESUMO A amputação é um recurso terapêutico utilizado para realizar a remoção de um membro, outro apêndice ou saliência do corpo, na ocorrência de lesões graves de nervos, artérias, partes moles e ossos. O objetivo desta pesquisa foi verificar a prevalência de amputações de membros no estado de Alagoas. Tratou-se de um estudo de dados secundários, com abordagem epidemiológica e observacional, no período de 2008 a 2015. As informações foram coletadas do banco de dados do SIHSUS. Foram registrados 361.585 procedimentos de amputações de membros no Brasil, com predominância nas regiões Sudeste, Nordeste e Sul, responsáveis por 88,13% desse total. Alagoas ocupou o 21º lugar em número de amputações entre os estados brasileiros: seus procedimentos ocorreram em seis microrregiões, destas, 3 foram responsáveis por 95% dos casos. A prevalência de amputação em Alagoas foi de 19,05 amputações/100 mil habitantes. Três tipos de procedimentos apresentam maior predominância: amputação de membros inferiores, dedos, pé e tarso, o que representa 95% das amputações.

Adaptive Foot in Lower-Limb Prostheses

The human foot consists of complex sets of joints. The adaptive nature of the human foot enables it to be stable on any uneven surface. It is important to have such adaptive capabilities in the artificial prosthesis to achieve most of the essential movements for lower-limb amputees. However, many existing lower-limb prostheses lack the adaptive nature. This paper reviews lower-limb adaptive foot prostheses. In order to understand the design concepts of adaptive foot prostheses, the biomechanics of human foot have been explained. Additionally, the requirements and design challenges are investigated and presented. In this review, adaptive foot prostheses are classified according to actuation method. Furthermore, merits and demerits of present-day adaptive foot prostheses are presented based on the hardware construction. The hardware configurations of recent adaptive foot prostheses are analyzed and compared. At the end, potential future developments are highlighted.

Vascular injuries in the state of Pará, Brazil, 2011-2013 and their relation with demographic and clinical variables

BACKGROUND:Vascular traumas are associated with high morbidity rates.OBJECTIVE: To report the characteristics of vascular traumas in the Brazilian state of Pará, in trauma victims treated at the Hospital Metropolitano de Urgência e Emergência (HMUE), from 2011 to 2013.METHOD: This was a descriptive, cross-sectional, retrospective and quantitative study that analyzed data on sex, age group, geographical origin, time waiting for care, mechanism of trauma, clinical status, anatomic site of injury, prevalence of associated fractures, vascular structures injured, types of vascular injury, principal types of surgery, early postoperative outcomes, level of amputation, number of deaths, length of hospital stay and multidisciplinary care for 264 medical records.RESULTS: The majority of victims were male and the most common age group was from 16 to 30 years. The majority of cases were from towns other than the state capital, accounting for 169 cases (64.02%). The principal mechanism of injury was firearm wounding - 110 (41.67%) followed by cold weapon wounds - 65 (24.62%) and traffic accidents - 42 (15.91%). The segments of the body and the vascular structures most often injured were lower limbs - 120 (45.45%) and injuries to the popliteal and femoral arteries and veins. The most common clinical presentation at admission was hemorrhage - 154 (58.33%). The most common surgeries were ligatures of veins and arteries. There were 163 (61.74%) hospital discharges and 33 (12.5%) deaths.CONCLUSIONS: The greatest prevalence observed was related to traumas caused by urban violence. Victims were most frequently male, of working age and from towns other than the capital of the state of Pará.