Introduction: Foot amputation in a diabetic patient is a real public health problem due to its functional and psychological repercussions. The objective was to study the factors associated with amputation in patients ...Introduction: Foot amputation in a diabetic patient is a real public health problem due to its functional and psychological repercussions. The objective was to study the factors associated with amputation in patients monitored for a diabetic foot in the internal medicine hospitalization of the Abass Ndao University Hospital Center (CHU) in Dakar. Methods: This was a retrospective, descriptive and analytical study conducted from the records of hospitalized patients over a 24-month period. The analysis included a descriptive phase, followed by a bivariate phase completed by logistic modeling following a descending procedure. Results: Of 1499 hospitalized patients, 224 cases had diabetic foot (14.9%). Among the cases of diabetic foot, 198 patients met the inclusion criteria. Their mean age was 61.7 ± 11.3 years, the sex ratio (M/F) was 1.2. Other associated cardiovascular risk factors were high blood pressure (54.0% 107 cases), and smoking (10.9% 21 cases). A history of lower limb amputation was found in 21.2% (42 cases). It was type 2 diabetes in 184 cases (92.9%) and the mean blood sugar was 2.7 ± 1.3 g/l. Chronic complications included neuropathy in 112 cases (78.3%), arteriopathy in 172 cases (86.9%), and chronic kidney disease in 167 cases (84.4%). The mean consultation time was 47.6 days. The main lesions were gangrene (64.6%), ulcer (24.7%), phlegmon (5.6%), and necrotizing fasciitis (5.1%). According to the University of Texas classification, patients presented with a stage D lesion (86.4%), grade 3 (51.0%). The hospital prevalence of amputation was 57.6% (114 cases), including major amputation in 55.1% (109 cases). The mortality rate was 36.4% (72 cases). Risk factors for amputation were peripheral arterial disease (ORa = 4.96 [1.33 - 18.43] p = 0.017), foot gangrene (Ora = 3.16 [1.24 - 8.04] p = 0.016) and Texas classification grade 3 (ORa = 17.49 [1.67 - 190] p = 0.019). Conclusion: The prevalence of foot and amputations remains a health problem. Reducing amputations will necessarily require strengthening prevention through education and early monitoring of diabetic patients.展开更多
BACKGROUNDDiabetes mellitus causes a large majority of non-traumatic major and minoramputations globally. Patients with diabetes are clinically complex with amultifactorial association between diabetic foot ulcers (DF...BACKGROUNDDiabetes mellitus causes a large majority of non-traumatic major and minoramputations globally. Patients with diabetes are clinically complex with amultifactorial association between diabetic foot ulcers (DFU) and subsequentlower extremity amputations (LEA). Few studies show the long-term outcomeswithin the cohort of DFU-associated LEA.AIMTo highlight the long-term outcomes of LEA as a result of DFU.METHODSPubMed/MEDLINE and Google Scholar were searched for key terms, “diabetes”,“foot ulcers”, “amputations” and “outcomes”. Outcomes such as mortality, reamputation,re-ulceration and functional impact were recorded. Peer-reviewedstudies with adult patients who had DFU, subsequent amputation and follow upof at least 1 year were included. Non-English language articles or studiesinvolving children were excluded.RESULTSA total of 22 publications with a total of 2334 patients were selected against theinclusion criteria for review. The weighted mean of re-amputation was 20.14%,29.63% and 45.72% at 1, 3 and 5 years respectively. The weighted mean of mortality at 1, 3 and 5 years were 13.62%, 30.25% and 50.55% respectively withsignificantly higher rates associated with major amputation, re-amputation andischemic cardiomyopathy.CONCLUSIONPrevious LEA, level of the LEA and patient comorbidities were significant riskfactors contributing to re-ulceration, re-amputation, mortality and depreciatedfunctional status.展开更多
Included: •Description of a health system problem;•Possible options for addressing this problem;•Strategies for implementing these options. Not included: recommendations This policy brief do...Included: •Description of a health system problem;•Possible options for addressing this problem;•Strategies for implementing these options. Not included: recommendations This policy brief does not make recommendations regarding which policy to choose. Who is this policy brief for? Policymakers, healthcare professionals, training institutions and other stakeholders that have an interest in the problem addressed in this evidence-based policy brief, Community leaders, non-governmental organizations. Why was this policy brief prepared? To inform discussions about health policies and programmes in relation to diabetic foot care by summarising relevant literature available on foot care in diabetic patients and possible solutions to reduce amputations. What is an evidence-based policy brief? Evidence based policy briefs bring together global research evidence (from systematic/literature reviews) and local evidence to inform discussions about health policies and programmes. Systematic review: A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyze data from this research. Executive Summary: The evidence presented in this executive summary is summarized from a full brief.展开更多
AIM To investigate the total blood loss(TBL) and the safety with respect to the re-amputation rate after transtibial amputation(TTA) conducted with and without a tourniquet. METHODS The study was a single-centre retro...AIM To investigate the total blood loss(TBL) and the safety with respect to the re-amputation rate after transtibial amputation(TTA) conducted with and without a tourniquet. METHODS The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between January 2013 and April 2015. All patients with a primary TTA were assessed for inclusion if the amputation was performed because of arteriosclerosis or diabetic complications. All patients underwent a standardized TTA procedure that was performed approximately 10 cm below the knee joint and performed with sagittalflaps. The pneumatic tourniquet, when used, was inflated around the femur to a pressure of 100 mmH g above the systolic blood pressure. The number of blood transfusions within the first four postoperative days was recorded. The intraoperative blood loss(OBL), which is defined as the volume of blood lost during surgery, was determined from the suction volume and by the weight difference of the surgical dressings. The trigger for a blood transfusion was set at a decrease in the Hgb level < 9.67 g/dL(6 mmol/L). Transfusions were performed with pooled red blood cells containing 245 m L per portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d. RESULTS Seventy-four out of 86 consecutive patients who underwent TTA within the two-year study period were included in the analysis. Of these, 38 were operated on using a tourniquet and 36 were operated on without using a tourniquet. There were no significant preoperative differences between the groups. The patients in both groups had a postoperative decrease in their Hgb level compared with preoperative baseline values. The patients operated on using a tourniquet received approximately three millilitres less blood transfusion per kilogram body weight compared with patients operated on without a tourniquet. The duration of surgery was shorter and the OBL was less for the tourniquet group than the non-tourniquet group, whereas no significant difference was observed for the TBL. The TBL median was 859 mL(IQR: 383-1315) in the non-tourniquet group vs 737 mL(IQR: 331-1218) in the tourniquet group(P = 0.754). Within the 30-d follow-up period, 9 patients in the tourniquet group and 11 in the non-tourniquet group underwent a reamputation at the trans-femoral level. The use of a tourniquet showed no statistically significant association with the 30-d re-amputation at the femur level in the multiple logistic regression model(P = 0.78). The only variable with a significant association with re-amputation was age(OR = 1.07; P = 0.02).CONCLUSION The results indicate that tourniquets do not cause severe vascular damage with an increased postoperative bleeding or failure rate as the result.展开更多
AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,re...AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P < 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.展开更多
Background: In combat operations, patients with traumatic injuries require expeditious evacuation to improve survival. Studies have shown that long transport times are associated with increased morbidity and mortality...Background: In combat operations, patients with traumatic injuries require expeditious evacuation to improve survival. Studies have shown that long transport times are associated with increased morbidity and mortality. Limited data exist on the influence of transport time on patient outcomes with specific injury types. The objective of this study was to determine the impact of the duration of time from the initial request for medical evacuation to arrival at a medical treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and noncompressible torso injury(NCTI).Methods: We completed a retrospective review of MEDEVAC patient care records for United States military personnel who sustained traumatic amputations and NCTI during Operation Enduring Freedom between January 2011 and March 2014. We grouped patients as traumatic amputation and NCTI(AMP+NCTI), traumatic amputation only(AMP),and neither AMP nor NCTI(Non-AMP/NCTI). Analysis was performed using chi-squared tests, Fisher's exact tests,Cochran-Armitage Trend tests, Shapiro-Wilks tests, Wilcoxon and Kruskal-Wallis techniques and Cox proportional hazards regression modeling.Results: We reviewed 1267 records, of which 669 had an injury severity score(ISS) of 10 or greater and were included in the analysis. In the study population, 15.5% sustained only amputation injuries(n=104, AMP only), 10.8% sustained amputation and NCTI(n=72, AMP+NCTI), and 73.7% did not sustain either an amputation or an NCTI(n=493,Non-AMP/NCTI). AMP+NCTI had the highest mortality(16.7%) with transport time greater than 60 min. While the AMP+NCTI group had decreasing survival with longer transport times, AMP and Non-AMP/NCTI did not exhibit the same trend.Conclusions: A decreased transport time from the point of injury to a medical treatment facility was associated with decreased mortality in patients who suffered a combination of amputation injury and NCTI. No significant association between transport time and outcomes was found in patients who did not sustain NCTI. Priority for rapid evacuation of combat casualties should be given to those with NCTI.展开更多
Background: To identify health concerns of veterans with high-level lower extremity amputations.Methods: Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists,p...Background: To identify health concerns of veterans with high-level lower extremity amputations.Methods: Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists,physiotherapist and prosthetists examined 100 veterans using a short-form health-related quality of life questionnaire(SF-36) that assessed their ability to perform activities of daily living(ADL), instrumental activities of daily living(IADL) and life satisfaction(SWLS) after hip disarticulation or hemi-pelvectomy amputations. The assessment tool was designed to gather statistically useful information about their health needs.Results: The means of the Physical Component Summary(PCS), Mental Component Summary(MCS), SWLS, ADL and IADL were 48.58±29.6, 33.33±22.0, 19.30±7.7, 48.10±10.5 and 5.08±1.8, respectively. Somatization, depression, and anxiety were the most prevalent disorders;among the veterans who were visited by psychiatrists, 11.6% had a history of hospitalization in a psychiatry section, and 53.2% had a psychiatric visit. Regardless of their injury in battle, 34% of veterans were hospitalized. Hearing problems were common, and about four-fifths of the participants suffered from at least one orthopedic condition. Neuroma(49%) was the most common stump-related complication during orthopedic evaluations, though the prevalence of phantom pain was 81% during the pain assessment. A total of 87% of the participants had a history of wearing a prosthesis, but only 29% wore a prosthesis at the time of the present study.The Canadian-type of prosthesis was uncomfortable and not useful(27%) and excessively heavy(10%) according to the amputees.Conclusions: Understanding veterans’ characteristics and special needs are important to make sure that enough facilities and services are afforded to them. These findings emphasize the importance of paying close attention to different dimensions of health in veterans and can help health providers identify health needs and make regular assessments.展开更多
Introduction: Amputation is the removal of a body part through a bone, while disarticulation is a removal of a part through a joint. This common procedure has different causes depending on the geographical locations a...Introduction: Amputation is the removal of a body part through a bone, while disarticulation is a removal of a part through a joint. This common procedure has different causes depending on the geographical locations and cultural practices. These ranges from dead body part to malignancy. Our study focused on the profile of the amputees including the biodata, causes and the financial consequences of the procedure. Material and Methods: The case notes of all patients who had amputation from 1998-2012 (15 years) were collected and the biodata, intra-operative diagnosis, parts amputated and duration of hospital stay were retrospectively analysed. Results: One hundred and ninety six patients had various types of amputations for the duration of our study. 159 (81.12%) were males while 37 (18.88%) were females. 68 (34.69%) patients had below knee amputation. 54 (27.55%) had above knee amputation. 27 (13.78%) had above elbow amputation. 18 (9.18%) patients had below elbow amputation, while 30 (15.30%) patients had other forms of amputations. The highest number of amputees (72 patients) was within the age range of 21 - 30 yr and the least number (5 patients) was within the age range of 51 - 60 yr. The highest number of amputation (71 patients) was due to complications from by traditional bone setters intervention. Conclusion: In our study, we found that most cases were males with a mean age of 35 years and majority (34.69%) had below knee amputation, and that most cases suffered vascular occlusion leading to gangrene.展开更多
<b><span>Introduction: </span></b><span>During the 19</span><sup><span style="vertical-align:super;">th</span></sup><span> and 20</sp...<b><span>Introduction: </span></b><span>During the 19</span><sup><span style="vertical-align:super;">th</span></sup><span> and 20</span><sup><span style="vertical-align:super;">th</span></sup><span> centuries, the Wars were the cause of many amputations among military and civilians.</span><span> </span><span>Despite the absence of armed conflict in our country, we notice a high frequency of major amputations in our activity.</span><span> </span><b><span>Objective: </span></b><span>The aim of this work was to study the causes of major amputations observed in our practice in order to develop preventive measures.</span><span> </span><b><span>Materials and Method</span></b><b><span>: </span></b><span>This was a descriptive retrospective study over a 6-year period, from January 1, 2008 to December 31, 2014.</span><span> </span><span>The following parameters were studied: epidemiological aspects (age according to WHO age groups and gender of patients), type of amputation, level of amputation and causes.</span><span> </span><b><span>Results</span></b><b><span>: </span></b><span>Two hundred and fifty-two patients were included. The distribution of amputations by cause and age group showed two distinct entities:</span><span> </span><span>The forms of the young subject where there was a predominance of tumour and traumatic causes;and the forms of the elderly person caused by vascular infections and conditions.</span><span> </span><span>Infections were the main cause of amputation in both sexes. </span><b><span>Conclusion</span></b><b><span>: </span></b><span>The causes of major limb amputations vary according to age and limb: tumor and trauma in young people and for the upper limb, infectious and vascular in the elderly and for the lower limb.</span>展开更多
Background: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with pr...Background: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with profound economic, social, and psychological effects on the patients. The aim of this study is to evaluate the quality of life of major limb amputees in a rural setting in western Cameroon. Methods: This was a cross-sectional descriptive and analytical study carried out at the BATSENGLA-DSCHANG community in the West Region of Cameroon. Participants were interviewed and data collected using a pre-defined accredited questionnaire of the WHOQOL-BREF to assess the quality of life. Results: There were 63 participants, and a majority (60.32%) reported trauma as the cause of amputation. Participants with prostheses had a better quality of life. Conclusion: The age range of the study participants was 18 to 85 years with a mean of 46.73 ± 18.31 years. The majority were males (74.6%). Most of them (41.27%) had attained at least a secondary level of education, a majority (80.95%) were unemployed and more than half (55.56%) have less than the guaranteed inter-professional minimum wage. Major limb amputations were mostly due to traumatic causes (72%) and involved the lower limbs. Only a few (12.70%) used prostheses. Almost all of them (90.48%) had symptoms consistent with a phantom limb. The quality of life after major limb amputation in this study was generally fair according to the WHO quality of life tool.展开更多
Dear Editor,We present this case report which discusses a patient who underwent flap amputation after repeated attempts to resolve persistent and severe epithelial ingrowth following laser-assisted in situ keratomileu...Dear Editor,We present this case report which discusses a patient who underwent flap amputation after repeated attempts to resolve persistent and severe epithelial ingrowth following laser-assisted in situ keratomileusis(LASIK)surgery.Epithelial ingrowth is a known complication of LASIK surgery,typically manageable with minimal measures.However,severe cases may necessitate more aggressive interventions,such as flap amputation[1].LASIK is a widely performed refractive surgery with high success rates and excellent visual outcome[2].展开更多
Purpose： Distal finger amputations pose a therapeutic problem with the distal fragment quality. Reimplantation remains the reference treatment for functional and aesthetic recovery of the hand. The interest of this s...Purpose： Distal finger amputations pose a therapeutic problem with the distal fragment quality. Reimplantation remains the reference treatment for functional and aesthetic recovery of the hand. The interest of this study is to propose the reposition flap as an alternative to different hedging techniques in the proximal stump, in many situations where revascularization is impossible. It consists in osteosynthesis of the bone fragment and its coverage by a pedicled local flap. Methods： The technique of reposition flap was evaluated retrospectively between 2003 and 2016 through a study of 13 patients compiled in Nabeul orthopedic department. For each patient, the sensitivity, the pulp trophicity, the interphalangeal mobility, the digital length, the appearance of the nail and radiological consolidation were evaluated. Results： The reposition flap keeps more than 80% of the length of p3. This procedure improves nail aesthetics in comparison with the regularizations. There is no significant difference in sensitivity of the pulp or of the mobility of the distal inter-phalangeal （DIP） joint as a function of the technique studied. However there is a significant difference in average test of the Quick Dash （350 against 500 for regularizations）. Conclusion： The reposition flap seems to be a good alternative to regularization in the context of trans-p3 fingers amputations, in which the distal fragment is not revascularizable. It allows better aesthetic and functional results.展开更多
Innervated full thickness graft will be presented as an option to reconstruct a fingertip defect which might result in better sensibility than standard reconstruction using a full thickness graft without innervation. ...Innervated full thickness graft will be presented as an option to reconstruct a fingertip defect which might result in better sensibility than standard reconstruction using a full thickness graft without innervation. Also, anastomosing the nerve stumps can decrease the chance of developing neuroma.展开更多
Objective：Ectopic tissue transplantation is not a new idea.Godina and his colleagues pioneered this method in the 1980s.This method is a last resort method of preserving an amputated body part,which consists of banki...Objective：Ectopic tissue transplantation is not a new idea.Godina and his colleagues pioneered this method in the 1980s.This method is a last resort method of preserving an amputated body part,which consists of banking the amputated segment in an ectopic area and returning it to its native place at a later date.In this article we present our experience with this demanding procedure.Methods：Debridement was the mainstay of this procedure.The stump and amputated part are carefully debrided and the stump was either closed primarily or covered by a flap.The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting.Results：Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study.The overall success rate was about 70%,lower than expected but these are cases of severe crush injury.Although the functional recovery of these patients are very low,all of the successful cases except one could find a job as a janitor or light manual worker.No patient could return to his previous job.Conclusion：Ectopic transplantation of body parts is an accepted method of treatment of severely crushed extremity or finger injuries.In our country an amputee has very little chance of finding a job instead a disabled person can.In addition in Iran cultures amputation is seen as punishment of either the God or the society,so it is not well accepted and many patients persist on saving the limb even with no functional recovery.None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers.展开更多
BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of t...BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)are a significant challenge in diabetic care,and the efficacy of negative pressure wound therapy(NPWT)in treating them remains a subject of continuous investigation.AIM To provide ...BACKGROUND Diabetic foot ulcers(DFUs)are a significant challenge in diabetic care,and the efficacy of negative pressure wound therapy(NPWT)in treating them remains a subject of continuous investigation.AIM To provide a comprehensive meta-analysis of the role of NPWT in the manage-ment of DFUs.METHODS A systematic review was performed based on Preferred Reporting Items for Sys-tematic Reviews and Meta-Analyses guidelines,searching databases like PubMed,Embase,Web of Science,and the Cochrane Library.Randomized clinical trials(RCTs)were included to compare NPWT to other dressings for DFUs.Outcomes measured were wound healing time and rate,granulation tissue formation time,amputation rate,and adverse events.Study quality was evaluated using Coch-rane's risk of bias tool.Analyses utilizedχ2,I2,fixed or random-effects models via Stata v17.RESULTS Of the 1101 identified articles,9 RCTs were selected for meta-analysis.Studies spanned from 2005 to 2020 and originated from countries including the United States,Chile,Pakistan,Italy,India,and Germany.Meta-analysis demonstrated a significant improvement in wound healing rate[risk ratio(RR)=1.46,95%CI:1.22-1.76,P<0.01]and a reduction in amputation rate(RR=0.69,95%CI:0.50-0.96,P=0.006)with NPWT.Furthermore,the time for granulation tissue formation was significantly reduced by an average of 19.54 days.However,the incidence of adverse events did not significantly differ between NPWT and control treatments.CONCLUSION NPWT significantly improves wound healing rates and reduces amputation rates in DFUs.It also hastens the formation of granulation tissue.However,the therapy does not significantly alter the risk of adverse events compared to alternate treatments.展开更多
Finger reimplantation is a pivotal technique in microsurgery,playing an irreplaceable role in restoring the functional integrity of fingers,maintaining the aesthetic appearance of the hand,ensuring the patient’s abil...Finger reimplantation is a pivotal technique in microsurgery,playing an irreplaceable role in restoring the functional integrity of fingers,maintaining the aesthetic appearance of the hand,ensuring the patient’s ability to perform delicate hand operations,and enhancing their social participation and quality of life.This paper reports on the perioperative nursing approach employed in a successful case of replantation involving a single hand with a multi-planar,20-segment amputation of four fingers.By establishing a specialized nursing team,conducting a comprehensive assessment of the patient’s condition,formulating a personalized nursing plan,and implementing precise nursing care,we achieved successful outcomes.After nearly four weeks of meticulous diagnosis,treatment,and nursing,17 segments of the replanted fingers survived,preserving the functional length of the amputated fingers and maximizing the restoration of hand function.This nursing method provides valuable insights and approaches for effectively managing vascular crises following digital replantation,improving the replantation survival rate,and enhancing patient satisfaction.展开更多
BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,whil...BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.展开更多
This study highlights the importance of identifying and addressing risk factors associated with wound complications following transtibial amputation in diabetic patients.These amputations,often necessitated by severe ...This study highlights the importance of identifying and addressing risk factors associated with wound complications following transtibial amputation in diabetic patients.These amputations,often necessitated by severe diabetic foot ulcers,carry significant risks of postoperative complications such as infection and delayed wound healing.Elevated hemoglobin A1c levels,indicative of poor glycemic control,and a history of kidney transplantation,due to required immunosuppressive therapy,are key factors influencing these outcomes.This paper emphasizes the need for enhanced glycemic management and personalized postoperative care,particularly for immunocompromised individuals,to minimize complications and improve patient prognosis.Future research should focus on prospective studies to validate targeted interventions and optimize care strategies,ultimately aiming to reduce the healthcare burden associated with diabetic foot complications.展开更多
BACKGROUND Diabetic foot ulcer(DFU)is a serious and destructive complication of diabetes,which has a high amputation rate and carries a huge social burden.Early detection of risk factors and intervention are essential...BACKGROUND Diabetic foot ulcer(DFU)is a serious and destructive complication of diabetes,which has a high amputation rate and carries a huge social burden.Early detection of risk factors and intervention are essential to reduce amputation rates.With the development of artificial intelligence technology,efficient interpretable predictive models can be generated in clinical practice to improve DFU care.AIM To develop and validate an interpretable model for predicting amputation risk in DFU patients.METHODS This retrospective study collected basic data from 599 patients with DFU in Beijing Shijitan Hospital between January 2015 and June 2024.The data set was randomly divided into a training set and test set with fivefold cross-validation.Three binary variable models were built with the eXtreme Gradient Boosting(XGBoost)algorithm to input risk factors that predict amputation probability.The model performance was optimized by adjusting the super parameters.The pre-dictive performance of the three models was expressed by sensitivity,specificity,positive predictive value,negative predictive value and area under the curve(AUC).Visualization of the prediction results was realized through SHapley Additive exPlanation(SHAP).RESULTS A total of 157(26.2%)patients underwent minor amputation during hospitalization and 50(8.3%)had major amputation.All three XGBoost models demonstrated good discriminative ability,with AUC values>0.7.The model for predicting major amputation achieved the highest performance[AUC=0.977,95%confidence interval(CI):0.956-0.998],followed by the minor amputation model(AUC=0.800,95%CI:0.762-0.838)and the non-amputation model(AUC=0.772,95%CI:0.730-0.814).Feature importance ranking of the three models revealed the risk factors for minor and major amputation.Wagner grade 4/5,osteomyelitis,and high C-reactive protein were all considered important predictive variables.CONCLUSION XGBoost effectively predicts diabetic foot amputation risk and provides interpretable insights to support person-alized treatment decisions.展开更多
文摘Introduction: Foot amputation in a diabetic patient is a real public health problem due to its functional and psychological repercussions. The objective was to study the factors associated with amputation in patients monitored for a diabetic foot in the internal medicine hospitalization of the Abass Ndao University Hospital Center (CHU) in Dakar. Methods: This was a retrospective, descriptive and analytical study conducted from the records of hospitalized patients over a 24-month period. The analysis included a descriptive phase, followed by a bivariate phase completed by logistic modeling following a descending procedure. Results: Of 1499 hospitalized patients, 224 cases had diabetic foot (14.9%). Among the cases of diabetic foot, 198 patients met the inclusion criteria. Their mean age was 61.7 ± 11.3 years, the sex ratio (M/F) was 1.2. Other associated cardiovascular risk factors were high blood pressure (54.0% 107 cases), and smoking (10.9% 21 cases). A history of lower limb amputation was found in 21.2% (42 cases). It was type 2 diabetes in 184 cases (92.9%) and the mean blood sugar was 2.7 ± 1.3 g/l. Chronic complications included neuropathy in 112 cases (78.3%), arteriopathy in 172 cases (86.9%), and chronic kidney disease in 167 cases (84.4%). The mean consultation time was 47.6 days. The main lesions were gangrene (64.6%), ulcer (24.7%), phlegmon (5.6%), and necrotizing fasciitis (5.1%). According to the University of Texas classification, patients presented with a stage D lesion (86.4%), grade 3 (51.0%). The hospital prevalence of amputation was 57.6% (114 cases), including major amputation in 55.1% (109 cases). The mortality rate was 36.4% (72 cases). Risk factors for amputation were peripheral arterial disease (ORa = 4.96 [1.33 - 18.43] p = 0.017), foot gangrene (Ora = 3.16 [1.24 - 8.04] p = 0.016) and Texas classification grade 3 (ORa = 17.49 [1.67 - 190] p = 0.019). Conclusion: The prevalence of foot and amputations remains a health problem. Reducing amputations will necessarily require strengthening prevention through education and early monitoring of diabetic patients.
文摘BACKGROUNDDiabetes mellitus causes a large majority of non-traumatic major and minoramputations globally. Patients with diabetes are clinically complex with amultifactorial association between diabetic foot ulcers (DFU) and subsequentlower extremity amputations (LEA). Few studies show the long-term outcomeswithin the cohort of DFU-associated LEA.AIMTo highlight the long-term outcomes of LEA as a result of DFU.METHODSPubMed/MEDLINE and Google Scholar were searched for key terms, “diabetes”,“foot ulcers”, “amputations” and “outcomes”. Outcomes such as mortality, reamputation,re-ulceration and functional impact were recorded. Peer-reviewedstudies with adult patients who had DFU, subsequent amputation and follow upof at least 1 year were included. Non-English language articles or studiesinvolving children were excluded.RESULTSA total of 22 publications with a total of 2334 patients were selected against theinclusion criteria for review. The weighted mean of re-amputation was 20.14%,29.63% and 45.72% at 1, 3 and 5 years respectively. The weighted mean of mortality at 1, 3 and 5 years were 13.62%, 30.25% and 50.55% respectively withsignificantly higher rates associated with major amputation, re-amputation andischemic cardiomyopathy.CONCLUSIONPrevious LEA, level of the LEA and patient comorbidities were significant riskfactors contributing to re-ulceration, re-amputation, mortality and depreciatedfunctional status.
文摘Included: •Description of a health system problem;•Possible options for addressing this problem;•Strategies for implementing these options. Not included: recommendations This policy brief does not make recommendations regarding which policy to choose. Who is this policy brief for? Policymakers, healthcare professionals, training institutions and other stakeholders that have an interest in the problem addressed in this evidence-based policy brief, Community leaders, non-governmental organizations. Why was this policy brief prepared? To inform discussions about health policies and programmes in relation to diabetic foot care by summarising relevant literature available on foot care in diabetic patients and possible solutions to reduce amputations. What is an evidence-based policy brief? Evidence based policy briefs bring together global research evidence (from systematic/literature reviews) and local evidence to inform discussions about health policies and programmes. Systematic review: A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyze data from this research. Executive Summary: The evidence presented in this executive summary is summarized from a full brief.
文摘AIM To investigate the total blood loss(TBL) and the safety with respect to the re-amputation rate after transtibial amputation(TTA) conducted with and without a tourniquet. METHODS The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between January 2013 and April 2015. All patients with a primary TTA were assessed for inclusion if the amputation was performed because of arteriosclerosis or diabetic complications. All patients underwent a standardized TTA procedure that was performed approximately 10 cm below the knee joint and performed with sagittalflaps. The pneumatic tourniquet, when used, was inflated around the femur to a pressure of 100 mmH g above the systolic blood pressure. The number of blood transfusions within the first four postoperative days was recorded. The intraoperative blood loss(OBL), which is defined as the volume of blood lost during surgery, was determined from the suction volume and by the weight difference of the surgical dressings. The trigger for a blood transfusion was set at a decrease in the Hgb level < 9.67 g/dL(6 mmol/L). Transfusions were performed with pooled red blood cells containing 245 m L per portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d. RESULTS Seventy-four out of 86 consecutive patients who underwent TTA within the two-year study period were included in the analysis. Of these, 38 were operated on using a tourniquet and 36 were operated on without using a tourniquet. There were no significant preoperative differences between the groups. The patients in both groups had a postoperative decrease in their Hgb level compared with preoperative baseline values. The patients operated on using a tourniquet received approximately three millilitres less blood transfusion per kilogram body weight compared with patients operated on without a tourniquet. The duration of surgery was shorter and the OBL was less for the tourniquet group than the non-tourniquet group, whereas no significant difference was observed for the TBL. The TBL median was 859 mL(IQR: 383-1315) in the non-tourniquet group vs 737 mL(IQR: 331-1218) in the tourniquet group(P = 0.754). Within the 30-d follow-up period, 9 patients in the tourniquet group and 11 in the non-tourniquet group underwent a reamputation at the trans-femoral level. The use of a tourniquet showed no statistically significant association with the 30-d re-amputation at the femur level in the multiple logistic regression model(P = 0.78). The only variable with a significant association with re-amputation was age(OR = 1.07; P = 0.02).CONCLUSION The results indicate that tourniquets do not cause severe vascular damage with an increased postoperative bleeding or failure rate as the result.
文摘AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P < 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.
基金Department of Defense Joint Program Committee(JPC-6)
文摘Background: In combat operations, patients with traumatic injuries require expeditious evacuation to improve survival. Studies have shown that long transport times are associated with increased morbidity and mortality. Limited data exist on the influence of transport time on patient outcomes with specific injury types. The objective of this study was to determine the impact of the duration of time from the initial request for medical evacuation to arrival at a medical treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and noncompressible torso injury(NCTI).Methods: We completed a retrospective review of MEDEVAC patient care records for United States military personnel who sustained traumatic amputations and NCTI during Operation Enduring Freedom between January 2011 and March 2014. We grouped patients as traumatic amputation and NCTI(AMP+NCTI), traumatic amputation only(AMP),and neither AMP nor NCTI(Non-AMP/NCTI). Analysis was performed using chi-squared tests, Fisher's exact tests,Cochran-Armitage Trend tests, Shapiro-Wilks tests, Wilcoxon and Kruskal-Wallis techniques and Cox proportional hazards regression modeling.Results: We reviewed 1267 records, of which 669 had an injury severity score(ISS) of 10 or greater and were included in the analysis. In the study population, 15.5% sustained only amputation injuries(n=104, AMP only), 10.8% sustained amputation and NCTI(n=72, AMP+NCTI), and 73.7% did not sustain either an amputation or an NCTI(n=493,Non-AMP/NCTI). AMP+NCTI had the highest mortality(16.7%) with transport time greater than 60 min. While the AMP+NCTI group had decreasing survival with longer transport times, AMP and Non-AMP/NCTI did not exhibit the same trend.Conclusions: A decreased transport time from the point of injury to a medical treatment facility was associated with decreased mortality in patients who suffered a combination of amputation injury and NCTI. No significant association between transport time and outcomes was found in patients who did not sustain NCTI. Priority for rapid evacuation of combat casualties should be given to those with NCTI.
基金financially supported by Janbazan Medical and Engineering Research Center(JMERC)
文摘Background: To identify health concerns of veterans with high-level lower extremity amputations.Methods: Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists,physiotherapist and prosthetists examined 100 veterans using a short-form health-related quality of life questionnaire(SF-36) that assessed their ability to perform activities of daily living(ADL), instrumental activities of daily living(IADL) and life satisfaction(SWLS) after hip disarticulation or hemi-pelvectomy amputations. The assessment tool was designed to gather statistically useful information about their health needs.Results: The means of the Physical Component Summary(PCS), Mental Component Summary(MCS), SWLS, ADL and IADL were 48.58±29.6, 33.33±22.0, 19.30±7.7, 48.10±10.5 and 5.08±1.8, respectively. Somatization, depression, and anxiety were the most prevalent disorders;among the veterans who were visited by psychiatrists, 11.6% had a history of hospitalization in a psychiatry section, and 53.2% had a psychiatric visit. Regardless of their injury in battle, 34% of veterans were hospitalized. Hearing problems were common, and about four-fifths of the participants suffered from at least one orthopedic condition. Neuroma(49%) was the most common stump-related complication during orthopedic evaluations, though the prevalence of phantom pain was 81% during the pain assessment. A total of 87% of the participants had a history of wearing a prosthesis, but only 29% wore a prosthesis at the time of the present study.The Canadian-type of prosthesis was uncomfortable and not useful(27%) and excessively heavy(10%) according to the amputees.Conclusions: Understanding veterans’ characteristics and special needs are important to make sure that enough facilities and services are afforded to them. These findings emphasize the importance of paying close attention to different dimensions of health in veterans and can help health providers identify health needs and make regular assessments.
文摘Introduction: Amputation is the removal of a body part through a bone, while disarticulation is a removal of a part through a joint. This common procedure has different causes depending on the geographical locations and cultural practices. These ranges from dead body part to malignancy. Our study focused on the profile of the amputees including the biodata, causes and the financial consequences of the procedure. Material and Methods: The case notes of all patients who had amputation from 1998-2012 (15 years) were collected and the biodata, intra-operative diagnosis, parts amputated and duration of hospital stay were retrospectively analysed. Results: One hundred and ninety six patients had various types of amputations for the duration of our study. 159 (81.12%) were males while 37 (18.88%) were females. 68 (34.69%) patients had below knee amputation. 54 (27.55%) had above knee amputation. 27 (13.78%) had above elbow amputation. 18 (9.18%) patients had below elbow amputation, while 30 (15.30%) patients had other forms of amputations. The highest number of amputees (72 patients) was within the age range of 21 - 30 yr and the least number (5 patients) was within the age range of 51 - 60 yr. The highest number of amputation (71 patients) was due to complications from by traditional bone setters intervention. Conclusion: In our study, we found that most cases were males with a mean age of 35 years and majority (34.69%) had below knee amputation, and that most cases suffered vascular occlusion leading to gangrene.
文摘<b><span>Introduction: </span></b><span>During the 19</span><sup><span style="vertical-align:super;">th</span></sup><span> and 20</span><sup><span style="vertical-align:super;">th</span></sup><span> centuries, the Wars were the cause of many amputations among military and civilians.</span><span> </span><span>Despite the absence of armed conflict in our country, we notice a high frequency of major amputations in our activity.</span><span> </span><b><span>Objective: </span></b><span>The aim of this work was to study the causes of major amputations observed in our practice in order to develop preventive measures.</span><span> </span><b><span>Materials and Method</span></b><b><span>: </span></b><span>This was a descriptive retrospective study over a 6-year period, from January 1, 2008 to December 31, 2014.</span><span> </span><span>The following parameters were studied: epidemiological aspects (age according to WHO age groups and gender of patients), type of amputation, level of amputation and causes.</span><span> </span><b><span>Results</span></b><b><span>: </span></b><span>Two hundred and fifty-two patients were included. The distribution of amputations by cause and age group showed two distinct entities:</span><span> </span><span>The forms of the young subject where there was a predominance of tumour and traumatic causes;and the forms of the elderly person caused by vascular infections and conditions.</span><span> </span><span>Infections were the main cause of amputation in both sexes. </span><b><span>Conclusion</span></b><b><span>: </span></b><span>The causes of major limb amputations vary according to age and limb: tumor and trauma in young people and for the upper limb, infectious and vascular in the elderly and for the lower limb.</span>
文摘Background: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with profound economic, social, and psychological effects on the patients. The aim of this study is to evaluate the quality of life of major limb amputees in a rural setting in western Cameroon. Methods: This was a cross-sectional descriptive and analytical study carried out at the BATSENGLA-DSCHANG community in the West Region of Cameroon. Participants were interviewed and data collected using a pre-defined accredited questionnaire of the WHOQOL-BREF to assess the quality of life. Results: There were 63 participants, and a majority (60.32%) reported trauma as the cause of amputation. Participants with prostheses had a better quality of life. Conclusion: The age range of the study participants was 18 to 85 years with a mean of 46.73 ± 18.31 years. The majority were males (74.6%). Most of them (41.27%) had attained at least a secondary level of education, a majority (80.95%) were unemployed and more than half (55.56%) have less than the guaranteed inter-professional minimum wage. Major limb amputations were mostly due to traumatic causes (72%) and involved the lower limbs. Only a few (12.70%) used prostheses. Almost all of them (90.48%) had symptoms consistent with a phantom limb. The quality of life after major limb amputation in this study was generally fair according to the WHO quality of life tool.
文摘Dear Editor,We present this case report which discusses a patient who underwent flap amputation after repeated attempts to resolve persistent and severe epithelial ingrowth following laser-assisted in situ keratomileusis(LASIK)surgery.Epithelial ingrowth is a known complication of LASIK surgery,typically manageable with minimal measures.However,severe cases may necessitate more aggressive interventions,such as flap amputation[1].LASIK is a widely performed refractive surgery with high success rates and excellent visual outcome[2].
文摘Purpose： Distal finger amputations pose a therapeutic problem with the distal fragment quality. Reimplantation remains the reference treatment for functional and aesthetic recovery of the hand. The interest of this study is to propose the reposition flap as an alternative to different hedging techniques in the proximal stump, in many situations where revascularization is impossible. It consists in osteosynthesis of the bone fragment and its coverage by a pedicled local flap. Methods： The technique of reposition flap was evaluated retrospectively between 2003 and 2016 through a study of 13 patients compiled in Nabeul orthopedic department. For each patient, the sensitivity, the pulp trophicity, the interphalangeal mobility, the digital length, the appearance of the nail and radiological consolidation were evaluated. Results： The reposition flap keeps more than 80% of the length of p3. This procedure improves nail aesthetics in comparison with the regularizations. There is no significant difference in sensitivity of the pulp or of the mobility of the distal inter-phalangeal （DIP） joint as a function of the technique studied. However there is a significant difference in average test of the Quick Dash （350 against 500 for regularizations）. Conclusion： The reposition flap seems to be a good alternative to regularization in the context of trans-p3 fingers amputations, in which the distal fragment is not revascularizable. It allows better aesthetic and functional results.
文摘Innervated full thickness graft will be presented as an option to reconstruct a fingertip defect which might result in better sensibility than standard reconstruction using a full thickness graft without innervation. Also, anastomosing the nerve stumps can decrease the chance of developing neuroma.
文摘Objective：Ectopic tissue transplantation is not a new idea.Godina and his colleagues pioneered this method in the 1980s.This method is a last resort method of preserving an amputated body part,which consists of banking the amputated segment in an ectopic area and returning it to its native place at a later date.In this article we present our experience with this demanding procedure.Methods：Debridement was the mainstay of this procedure.The stump and amputated part are carefully debrided and the stump was either closed primarily or covered by a flap.The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting.Results：Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study.The overall success rate was about 70%,lower than expected but these are cases of severe crush injury.Although the functional recovery of these patients are very low,all of the successful cases except one could find a job as a janitor or light manual worker.No patient could return to his previous job.Conclusion：Ectopic transplantation of body parts is an accepted method of treatment of severely crushed extremity or finger injuries.In our country an amputee has very little chance of finding a job instead a disabled person can.In addition in Iran cultures amputation is seen as punishment of either the God or the society,so it is not well accepted and many patients persist on saving the limb even with no functional recovery.None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers.
文摘BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.
基金Supported by the National Natural Science Foundation of China,No.82202454 and No.81873934the Wang Zhengguo Trauma Medicine Fund(Growth Factor Revival Plan)No.SZYZ-TR-09+1 种基金the Shandong Provincial Natural Science Foundation Youth Fund,No.ZR2020QH168the Jinan Science and Technology Plan Project,No.202225065。
文摘BACKGROUND Diabetic foot ulcers(DFUs)are a significant challenge in diabetic care,and the efficacy of negative pressure wound therapy(NPWT)in treating them remains a subject of continuous investigation.AIM To provide a comprehensive meta-analysis of the role of NPWT in the manage-ment of DFUs.METHODS A systematic review was performed based on Preferred Reporting Items for Sys-tematic Reviews and Meta-Analyses guidelines,searching databases like PubMed,Embase,Web of Science,and the Cochrane Library.Randomized clinical trials(RCTs)were included to compare NPWT to other dressings for DFUs.Outcomes measured were wound healing time and rate,granulation tissue formation time,amputation rate,and adverse events.Study quality was evaluated using Coch-rane's risk of bias tool.Analyses utilizedχ2,I2,fixed or random-effects models via Stata v17.RESULTS Of the 1101 identified articles,9 RCTs were selected for meta-analysis.Studies spanned from 2005 to 2020 and originated from countries including the United States,Chile,Pakistan,Italy,India,and Germany.Meta-analysis demonstrated a significant improvement in wound healing rate[risk ratio(RR)=1.46,95%CI:1.22-1.76,P<0.01]and a reduction in amputation rate(RR=0.69,95%CI:0.50-0.96,P=0.006)with NPWT.Furthermore,the time for granulation tissue formation was significantly reduced by an average of 19.54 days.However,the incidence of adverse events did not significantly differ between NPWT and control treatments.CONCLUSION NPWT significantly improves wound healing rates and reduces amputation rates in DFUs.It also hastens the formation of granulation tissue.However,the therapy does not significantly alter the risk of adverse events compared to alternate treatments.
文摘Finger reimplantation is a pivotal technique in microsurgery,playing an irreplaceable role in restoring the functional integrity of fingers,maintaining the aesthetic appearance of the hand,ensuring the patient’s ability to perform delicate hand operations,and enhancing their social participation and quality of life.This paper reports on the perioperative nursing approach employed in a successful case of replantation involving a single hand with a multi-planar,20-segment amputation of four fingers.By establishing a specialized nursing team,conducting a comprehensive assessment of the patient’s condition,formulating a personalized nursing plan,and implementing precise nursing care,we achieved successful outcomes.After nearly four weeks of meticulous diagnosis,treatment,and nursing,17 segments of the replanted fingers survived,preserving the functional length of the amputated fingers and maximizing the restoration of hand function.This nursing method provides valuable insights and approaches for effectively managing vascular crises following digital replantation,improving the replantation survival rate,and enhancing patient satisfaction.
文摘BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.
基金Supported by Henan Province Key Research and Development Program,No.231111311000Henan Provincial Science and Technology Research Project,No.232102310411+2 种基金Henan Province Medical Science and Technology Key Project,No.LHGJ20220566 and No.LHGJ20240365Henan Province Medical Education Research Project,No.WJLX2023079Zhengzhou Medical and Health Technology Innovation Guidance Program,No.2024YLZDJH022.
文摘This study highlights the importance of identifying and addressing risk factors associated with wound complications following transtibial amputation in diabetic patients.These amputations,often necessitated by severe diabetic foot ulcers,carry significant risks of postoperative complications such as infection and delayed wound healing.Elevated hemoglobin A1c levels,indicative of poor glycemic control,and a history of kidney transplantation,due to required immunosuppressive therapy,are key factors influencing these outcomes.This paper emphasizes the need for enhanced glycemic management and personalized postoperative care,particularly for immunocompromised individuals,to minimize complications and improve patient prognosis.Future research should focus on prospective studies to validate targeted interventions and optimize care strategies,ultimately aiming to reduce the healthcare burden associated with diabetic foot complications.
文摘BACKGROUND Diabetic foot ulcer(DFU)is a serious and destructive complication of diabetes,which has a high amputation rate and carries a huge social burden.Early detection of risk factors and intervention are essential to reduce amputation rates.With the development of artificial intelligence technology,efficient interpretable predictive models can be generated in clinical practice to improve DFU care.AIM To develop and validate an interpretable model for predicting amputation risk in DFU patients.METHODS This retrospective study collected basic data from 599 patients with DFU in Beijing Shijitan Hospital between January 2015 and June 2024.The data set was randomly divided into a training set and test set with fivefold cross-validation.Three binary variable models were built with the eXtreme Gradient Boosting(XGBoost)algorithm to input risk factors that predict amputation probability.The model performance was optimized by adjusting the super parameters.The pre-dictive performance of the three models was expressed by sensitivity,specificity,positive predictive value,negative predictive value and area under the curve(AUC).Visualization of the prediction results was realized through SHapley Additive exPlanation(SHAP).RESULTS A total of 157(26.2%)patients underwent minor amputation during hospitalization and 50(8.3%)had major amputation.All three XGBoost models demonstrated good discriminative ability,with AUC values>0.7.The model for predicting major amputation achieved the highest performance[AUC=0.977,95%confidence interval(CI):0.956-0.998],followed by the minor amputation model(AUC=0.800,95%CI:0.762-0.838)and the non-amputation model(AUC=0.772,95%CI:0.730-0.814).Feature importance ranking of the three models revealed the risk factors for minor and major amputation.Wagner grade 4/5,osteomyelitis,and high C-reactive protein were all considered important predictive variables.CONCLUSION XGBoost effectively predicts diabetic foot amputation risk and provides interpretable insights to support person-alized treatment decisions.
