Pie diabético tratados con injerto obtenido por bioimpresora, a propósito de una serie de casos / Diabetic foot treated with graft obtained by bioprinter, about a series of cases

El riesgo de amputaciones en pacientes con diabetes es 10 a 20 veces más frecuente en comparación con no diabéticos. El equipo biotecnológico desarrollado por ROKIT Healthcare, Inc., de procedencia surcoreana: Dr. INVIVO, es un equipo de biotecnología que ofrece una terapia eficaz para el tratamiento del pie diabético, con una plataforma de regeneración de órganos hiperpersonalizados que mediante la inteligencia artificial, escanea la lesión para así, fabricar un parche que contiene células madres autólogas, matriz extracelular y materiales específicos de tejido, para posteriormente aplicarla a la herida, y con esto, lograr la cicatrización y regeneración completa. El propósito del presente reporte apunta a demostrar la efectividad del tratamiento en úlceras en pie diabético y exponer los resultados de 3 casos clínicos con extensas lesiones posteriores a amputaciones de miembros inferiores, atendidos en el Hospital Distrital de Ñemby, Paraguay, utilizando esta tecnología.

The risk of amputations in patients with diabetes is 10 to 20 times more frequent compared to non-diabetics. The biotechnological team developed by ROKIT Healthcare, Inc., of South Korean origin: Dr. INVIVO, is a biotechnology team that offers an effective therapy for the treatment of diabetic foot, with a hyper-personalized organ regeneration platform that, through artificial intelligence, scan the injury in order to manufacture a patch that contains autologous stem cells, extracellular matrix and specific tissue materials, to later apply it to the wound, and with this, achieve complete healing and regeneration. The purpose of this report aims to demonstrate the effectiveness of treatment in diabetic foot ulcers and present the results of 3 clinical cases with extensive injuries after lower limb amputations, treated at the District Hospital of Ñemby, Paraguay, using this technology.

Aspects médico-légaux de la réparation des amputations traumatiques de membres en milieu professionnel reçues au Centre des Urgences de Yaoundé / Medico-legal aspects of the repair of traumatic limb amputations in the workplace received at the Yaoundé Emergency Center

Objectif : Décrire les aspects médico-légaux de la réparation des amputations traumatiques de membres en milieu professionnel. Méthodologie : Etude descriptive retrospective réalisée au centre des urgences de Yaoundé (CURY) de Janvier 2017 à Decembre 2022. Etait inclus, tout patient consentant ayant subi une amputation de membre consécutive à un accident de travail durant la période d'étude. Résultats : Au total, 96 patients amputes de membres ont ete colliges. Les victimes étaient majoritairement de sexe masculin soit 70.8%, la tranche d'âge la plus representee était celle de 30 à 35 ans. La categorie professionnelle la plus representee etait la categorie H (transport et entreposage) soit 34.5%. L'ecrasement a constitué le type lésionnel le plus pourvoyeur d'amputation soit 46,9 %, les membres inferieurs etaient le plus souvent atteint (66,6%). La duree moyenne d'arrêt de travail etait de 90,5 jours et l'incapacité permanent partielle (IPP) moyen etait de 47.9 %. Des patients amputes, 47.9 % avaient beneficies d'un changement de poste de travail. Conclusion: Les amputations traumatiques de membres en milieu professionnel sont relativement fréquentes. Toutes les catégories socioprofessionnelles peuvent être concernees. Elles sont source de prejudices importants.

Objective : To describe the medico-legal aspects of repairing traumatic limb amputations in the workplace. Methodology : Retrospective descriptive study conducted at the Yaounde emergency centre (YEC) from January 2017 to December 2022. All consenting patients who underwent a limb amputation following a work-related accident during the study period were included. Results : A total of 96 patients with limb amputations were enrolled. The victims were predominantly male (70.8%), and the most common age group was between 30 and 35 years. The most common occupational category was H (transport and storage), at 34.5%. Crushing was the most common type of injury causing amputations (46.9%), with the lower limbs most often affected (66.6%). The average length of time off work was 90.5 days, and the average permanent partial disability (PPD) was 47.9%. Of the amputated patients, 47.9% had benefited from a change of workstation. Conclusion : Traumatic limb amputations in the workplace are relatively common. All socioprofessional categories may be affected. They are a source of significant prejudice

Bone reconstruction in the treatment of tibial hemimelia: an alternative to amputation? / Reconstrução óssea no tratamento da hemimelia tibial: uma alternativa para amputação?

ABSTRACT Objective: To evaluate the advantages and disadvantages of bone reconstruction and lengthening compared to amputation in the treatment of tibial hemimelia for patients and their families. Methods: Systematic review of articles published in English and Portuguese between 1982 and 2022 in the MEDLINE, PubMed, Cochrane and SciELO databases. The variables of interest were: year of publication, sample characteristics, classification of tibial hemimelia according to Jones, treatment outcome and follow-up time. Results: A total of eleven articles were included in the scope of this review. The studies involved 131 patients, 53.4% male and 46.6% female. The age of the patients who underwent a surgical procedure ranged from 1 year and 10 months to 15 years. The most common type was Jones' I (40.9%). The most recurrent complications in the reconstruction treatment were: infection of the external fixator path, flexion contracture (mainly of the knee), reduction in the range of motion of the knee and ankle. Conclusion: We did not find enough relevant studies in the literature to prove the superiority of reconstruction. Amputation remains the gold standard treatment for tibial hemimelia to this day. Level of Evidence III, systematic review of level III studies

RESUMO Objetivo: Avaliar as vantagens e desvantagens da reconstrução óssea e alongamento comparada à amputação no tratamento da hemimelia tibial para pacientes e familiares. Métodos: Revisão sistemática, com análise de artigos publicados nas línguas inglesa e portuguesa entre 1982 e 2022, nas bases de dados MEDLINE, PubMed, Cochrane e SciELO. As variáveis de interesse foram: ano de publicação, característica da amostra, classificação da hemimelia tibial segundo Jones, desfecho do tratamento e tempo de seguimento. Resultados: Fizeram parte do escopo desta revisão onze artigos. Os estudos envolveram 131 pacientes, 53,4% do sexo masculino e 46,6% do feminino. A idade dos pacientes submetidos a algum procedimento cirúrgico variou de 1 ano e 10 meses a 15 anos. O tipo mais comum foi o I de Jones (40,9%). As complicações mais recorrentes no tratamento pela reconstrução foram: infecção do trajeto de pinos do fixador externo, contratura em flexão (principalmente do joelho), redução do arco de movimento de joelho e tornozelo. Conclusão: Não encontramos na literatura estudos suficientemente relevantes para comprovar a superioridade da reconstrução. A amputação se mantém até os dias de hoje o tratamento padrão-ouro para hemimelia tibial. Nível de evidência III; revisão sistemática de estudos de nível III.

Nursing interventions to empower the family caregiver of person with lower limb amputation: scoping review / Intervenções de Enfermagem para capacitar o cuidador familiar de uma pessoa com amputação de membro inferior: revisão de escopo / Intervenciones de enfermería para capacitar al cuidador familiar de una persona con amputación de miembro inferior: revisión de alcance

ABSTRACT Objectives: to map nursing interventions that empower the Family caregiver of the person with lower limb amputation for is role. Methods: scoping review guided by Joanna Briggs Institute methodology conducted in different databases (including gray literature). Results: six studies published between 2009 and 2021 were included. Interventions of counselling and support for patients and family; peer support interventions performed by a certified pair; involvement of caregivers or family members in support groups; and key interventions for patient and family caregiver psychological balance. Two studies discussed the importance of caregiver and amputee training and development of coping skills. Another study recommended Interventions of informative support for caregivers regarding care for the amputee and adaptation to home. Conclusions: results of this review allow the identification of recommendations (guidelines) for practice and recommendations/suggestions for interventions according with identified needs of family caregivers of patients with lower limb amputation.

RESUMO Objetivos: mapear intervenções de enfermagem que capacitem o cuidador familiar da pessoa com amputação de membro inferior para seu papel. Métodos: revisão de escopo orientada pela metodologia do Joanna Briggs Institute realizada em diferentes bases de dados (incluindo literatura cinzenta). Resultados: foram incluídos seis estudos publicados entre 2009 e 2021. Intervenções de aconselhamento e apoio para pacientes e familiares; intervenções de apoio de pares realizadas por uma dupla certificada; envolvimento de cuidadores ou membros da família em grupos de apoio; e intervenções-chave para o equilíbrio psicológico do paciente e do cuidador familiar. Dois estudos discutiram a importância do treinamento do cuidador e do amputado e do desenvolvimento de habilidades de enfrentamento. Outro estudo recomendou intervenções de suporte informativo para os cuidadores com relação aos cuidados com o amputado e à adaptação ao lar. Conclusões: os resultados dessa revisão permitem a identificação de recomendações (diretrizes) para a prática e recomendações/sugestões para intervenções de acordo com as necessidades identificadas dos cuidadores familiares de pacientes com amputação de membros inferiores.

RESUMEN Objetivos: mapear intervenciones de enfermería que capaciten al cuidador familiar de la persona con amputación de miembro inferior para su rol. Métodos: es una revisión de alcance guiada por la metodología del Instituto Joanna Briggs, llevada a cabo en diferentes bases de datos (incluyendo literatura gris). Resultados: se tuvieron en cuenta seis estudios publicados entre 2009 y 2021, a saber: intervenciones de asesoramiento y apoyo para pacientes y familiares; intervenciones de apoyo entre iguales realizadas por un par de profesionales certificados; participación de cuidadores o familiares en grupos de apoyo e intervenciones clave para el equilibrio psicológico del paciente y del cuidador familiar. Dos estudios analizaron la importancia de la formación del cuidador y del amputado y del desarrollo de habilidades de afrontamiento. Otro estudio recomendó intervenciones de apoyo informativo para los cuidadores en relación con el cuidado del amputado y su adaptación a la vida hogareña. Conclusiones: los resultados de esta revisión permiten identificar recomendaciones/directrices para la práctica y recomendaciones/sugerencias de intervenciones según las necesidades identificadas de los cuidadores familiares de pacientes con amputación de miembros inferiores.

Costos directos en el tratamiento del pie diabético Unidad de Pie Diabético. Hospital de Clínicas. Universidad de la República

En el mundo un paciente diabético gasta entre dos y tres veces más que el no diabético. El pie diabético disminuye la calidad de vida, aumenta la morbimortalidad y la carga económica del sistema de salud. Objetivo: comunicar la investigación realizada sobre costos directos en el tratamiento de la úlcera del pie diabético. Material y método: estudio observacional, descriptivo, retrospectivo de pacientes asistidos en la Unidad de Pie del Hospital de Clínicas, Universidad de la República, entre octubre de 2014 y septiembre de 2016. Se estimaron gastos directos del tratamiento ambulatorio e internación a través de información de la historia clínica. El horizonte de tratamiento fue de tres meses. Se calcularon los gastos en unidades reajustables (UR), pesos y dólares. Los gastos se actualizaron a octubre del 2022 utilizando el índice de precios al consumo (IPC), ajustado a la tasa de inflación acumulada. Resultados: incluimos 49 pacientes, 11 mujeres y 38 hombres, edad promedio 61,5 años. El gasto general fue mayor a 400.000 dólares, con el mayor costo en gastos de internación. El gasto total promedio por paciente fue de 8.799 dólares. El tratamiento convencional fue 3.707,93 dólares, la amputación mayor 32.003,61 dólares y amputación menor 12.385,34 dólares. El gasto en internación fue muy superior al del paciente ambulatorio. En emergencia, 28 pacientes gastaron 4.396 dólares. El incremento de costos al año 2022 fue de 37,45%, suponiendo un gasto general de 16.682.993,4 pesos o 410.830,2 dólares. Conclusión: primera evaluación en nuestro país de estimación de gastos en pie diabético. El costo de la úlcera genera una carga económica notoria y en aumento. La gravedad inicial de la úlcera determina ingresos con elevados costes. Los gastos de internación y amputaciones representan la mayor erogación económica.

On a global scale, a diabetic patient incurs healthcare expenses that are 2 to 3 times higher than those of a non-diabetic individual. Diabetic foot syndrome reduces the quality of life, increases morbidity and mortality, and places an economic burden on the healthcare system. Objective: Communicating the research conducted on direct costs in the treatment of diabetic foot ulcers. Method: Observational, descriptive, retrospective study of patients treated at the Foot Unit of the Hospital de Clínicas (UDELAR) between October 2014 and September 2016. Direct treatment costs for outpatient care and hospitalization were estimated using information from the medical records. The treatment horizon extended over a period of 3 months. Expenses were calculated in readjustable units, Uruguayan pesos (UYU), and United States dollars (USD). Expenses were updated to October 2022 using the Consumer Price Index (IPC) adjusted for the cumulative inflation rate. Results: 49 patients were included in the study: 11 women and 38 men, average age was 61.5 years old. The overall expenditure exceeded 400,000 USD, with the highest cost attributed to hospitalization expenses. The average total expenditure per patient amounted to 8,799 USD. The cost of conventional treatment was 3,707.93 USD, major amputation represented USD 32,003.61, and minor amputation USD 12,385.34. Hospitalization expenses significantly exceeded those of outpatient care. In the emergency department, 28 patients spent USD 4,396. The increase in costs by the year 2022 amounted to 37.45%, resulting in a total expenditure of UYU 16,682,993.4 (Uruguayan pesos) or USD 410,830.2. Conclusions: It was the first assessment in our country to estimate diabetic foot costs. The cost of ulcer management imposes a significant and increasing economic burden. The initial severity of the ulcer results in hospitalization which implies high associated costs. Hospitalization and amputation costs constitute the most substantial economic expenditure.

Em todo o mundo, um paciente diabético gasta entre 2 e 3 vezes mais do que um paciente não diabético. O pé diabético reduz a qualidade de vida, aumenta a morbimortalidade e a carga económica no sistema de saúde. Objetivos: Comunicar os resultados da pesquisa realizada sobre os custos diretos no tratamento das úlceras do pé diabético. Materiais e métodos: Estudo observacional, descritivo e retrospectivo de pacientes atendidos na Unidade de Pie do Hospital de Clínicas (UDELAR), entre outubro de 2014 e setembro de 2016. Foram estimados gastos diretos com tratamento ambulatorial e internação, por meio de informações do prontuário do paciente. O período de tratamento estudado foi de 3 meses. As despesas foram calculadas em Unidades Ajustáveis, em pesos uruguaios (UYU) e em dólares norte-americanos (USD). As despesas foram atualizadas para outubro de 2022 pelo Índice de Preços ao Consumidor (IPC) ajustado à inflação acumulada. Resultados: Foram incluídos 49 pacientes: 11 mulheres e 38 homens com idade média de 61,5 anos. A despesa global foi superior a US$ 400.000, com o maior custo em despesas de hospitalização. A despesa total média por paciente foi de US$ 8.799. Os custos por tratamento foram: Tratamento convencional US$ 3.707,93 USD, amputação maior US$ 32.003,61 e amputação menor US$ 12.385,34. O gasto com internação foi muito superior ao do ambulatório. No atendimento de emergência 28 pacientes gastaram US$ 4.396. O aumento dos custos até 2022 foi de 37,45%, assumindo uma despesa geral de UY$ 16.682.993,4 ou US$ 410.830,2 USD. Conclusão: Esta é a primeira avaliação de estimativa de gastos com pé diabético realizada no Uruguai. O custo das úlceras gera uma carga económica notável e crescente. A gravidade inicial da úlcera determina internações com custos elevados. As despesas com hospitalização e amputação representam o maior gasto financeiro.

Tratamiento rehabilitador como alternativa en paciente amputado. Presentación de un caso y revisión de la literatura

La amputación o separación de una parte del cuerpo, de un miembro inferior o superior, es un procedimiento quirúrgico que conlleva importantes consecuencias anatómicas, funcionales, psicológicas y sociales. Los autores se motivaron a presentar un caso del Centro Especializado Ambulatorio de la provincia Cienfuegos, con el objetivo de describir la experiencia durante la combinación del tratamiento rehabilitador y de medicina natural y tradicional en un paciente con amputación del miembro inferior izquierdo. Se presenta el caso de un paciente de sexo masculino, de 52 años, con antecedentes de diabetes mellitus tipo 2 e hipertensión arterial controladas por tratamiento, además de padecer trombopatía hereditaria tratada con anticoagulantes, motivo por el cual, llevó procedimiento quirúrgico. La combinación del tratamiento rehabilitador y de medicina natural y tradicional en pacientes con enfermedades crónicas con amputación del miembro inferior izquierdo, constituye una acción de acondicionamiento motor y funcional para lograr su reincorporación a la vida diaria. Se presenta el caso porque resulta interesante la combinación de tratamiento rehabilitador y de medicina natural y tradicional en un paciente que padece varias enfermedades crónicas.

The amputation or separation of a part of the body, of a lower or upper limb, is a surgical procedure that entails important anatomical, functional, psychological and social consequences. The authors were motivated to present a case from the Specialized Outpatient Center of the Cienfuegos province, with the objective of describing the experience during the combination of rehabilitative treatment and natural and traditional medicine in a patient with amputation of the left lower limb. The case of a 52-year-old male patient is presented, with a history of type 2 diabetes mellitus and arterial hypertension controlled by treatment, in addition to suffering from hereditary thrombopathy treated with anticoagulants, which is why he underwent surgical treatment. The combination of rehabilitative treatment and natural and traditional medicine in patients with chronic diseases with amputation of the left lower limb is an action of motor and functional conditioning to achieve their return to daily life. The case is presented because the combination of rehabilitative treatment and natural and traditional medicine in a patient who suffers from several chronic diseases is interesting.

Evaluación de aspectos clínicos relacionados con la amputación de miembros inferiores en personas que viven con diabetes mellitus tipo 2 en México / Evaluation of clinical aspects related to lower limb amputation among individuals living with type 2 diabetes mellitus in Mexico

RESUMEN Introducción: La diabetes continúa siendo una de las principales causas de discapacidad y muerte en la población mundial. Alrededor del 25% de las personas con diabetes desarrollarán una úlcera en alguno de sus miembros pélvicos inferiores. Objetivo: El presente estudio evalúa los aspectos clínicos relacionados con la amputación del miembro inferior pélvico en una cohorte de pacientes con diabetes mellitus. Métodos: Estudio retrospectivo, transversal, realizado en colaboración entre el Instituto Mexicano del Seguro Social y la Facultad de Farmacia de la Universidad Autónoma del Estado de Morelos, implicó una revisión de expedientes de pacientes con diabetes mellitus tipo 2 en el Hospital General Regional "Ignacio García Téllez". Se seleccionaron 100 expedientes clínicos y Electrónicos basados en criterios de inclusión, que incluían edad mayor de 18 años, afiliación en el sitio del estudio, evolución de la diabetes de al menos 10 años, tratamiento farmacológico para la diabetes y diagnóstico de pie diabético con curación completa o amputación como resultado. Los análisis estadísticos se realizaron mediante STATA y se obtuvo aprobación ética. Resultados: Los pacientes con un control glucémico óptimo cuantificando sus niveles de glucosa en ayunas (<130 mg/dl) así como sus valores de hemoglobina glicosilada (< 7%) tuvieron una menor frecuencia de amputaciones (p˂0,001; Chi2) en comparación con aquellos pacientes sin un control glucémico adecuado. Conclusión: Se encontró que ser hombre, valores de hemoglobina glucosilada superiores al 7% y valores promedio de glucosa en ayunas superiores a 130 mg/L aumentan la probabilidad de presentar una amputación de extremidad inferior.

ABSTRACT Introduction: Diabetes continues to be a leading cause of disability and death in the world's population. About 25% of people with diabetes will develop an ulcer in one of their lower pelvic limbs. Objective: The present study evaluates the clinical aspects related to lower pelvic limb amputation in a cohort of patients with diabetes mellitus. Lazarte Echegaray Hospital during the period 2017-2020. Methods: Retrospective, cross-sectional study, conducted in collaboration between the Mexican Institute of Social Security and the School of Pharmacy of the Autonomous University of Morelos State, involved a review of records of patients with type 2 diabetes mellitus at the Regional General Hospital "Ignacio García Téllez". One hundred clinical and electronic records were selected based on inclusion criteria, which included age over 18 years, affiliation at the study site, diabetes evolution of at least 10 years, pharmacological treatment for diabetes and diagnosis of diabetic foot with complete healing or amputation as an outcome. Statistical analyses were performed using STATA and ethical approval was obtained. Results: Patients with optimal glycemic control by quantifying their fasting glucose levels (<130 mg/dl) as well as their glycated hemoglobin values (< 7%) had a lower frequency of amputations (p˂0.001; Chi2) compared to those patients without adequate glycemic control. Conclusion: Being male, glycosylated hemoglobin values greater than 7% and mean fasting glucose values greater than 130 mg/L were found to increase the likelihood of having a lower extremity amputation.

Validación de clasificaciones de pie diabético en Argentina / Validation of diabetic foot classifications in Argentina

Introducción: las clasificaciones de pie diabético (PD) son una herramienta que tienen el objetivo de mejorar la comunicación entre los profesionales, la referencia y contrarreferencia; proporcionar un pronóstico; ayudar en la valoración de las lesiones, y contribuir con fines estadísticos. Objetivos: describir las características de los pacientes que se presentaron al consultorio o a la guardia con un PD durante un período de 3 meses, determinar el riesgo según cinco clasificaciones (Texas, IDSA, San Elián, WIfI y SINBAD) y evaluar su evolución a 6 meses en relación con el grado de gravedad determinada por cada clasificación. Materiales y métodos: se analizaron 312 pacientes de 15 instituciones en Argentina. Para el análisis se utilizó la calculadora de clasificaciones de pie diabético/score de riesgo del Comité de Pie Diabético de la Sociedad Argentina de Diabetes. Resultados: el 43% de los pacientes (n=133) requirió internación al momento de la primera consulta y el 61% (n=189) había consultado previamente. El porcentaje de amputación mayor total fue de 8,33% (IC 95%; 5,5-11,9) (n=26) y el de amputación menor de 29,17% (IC 95%; 24,2-34,6) (n=91). A los 6 meses, el porcentaje de muerte fue de 4,49% (IC 95%; 2,5-7,4) (n=14), el 24,3% (IC 95%;19,6-29,5) presentaba la herida aún abierta (n=76), el 58,0% (IC 95%; 52,3-66,5) (n=181) cicatrizó y el 7,37% se perdió del seguimiento (n=23). Las clasificaciones de San Elián y WIfI se relacionaron con amputación mayor, cicatrización y muerte. En relación a la clasificación de Texas, el 49% de los pacientes presentó herida penetrante a hueso o articulación (Texas 3), con o sin infección. El 65,3% de las amputaciones mayores y el 78,6% de las muertes se produjeron en pacientes con isquemia. El punto de corte de San Elián para amputación mayor fue 20. Conclusiones: conocer los datos locales permite organizar los recursos para mejorar la atención de los pacientes.

Introduction: the classifications of diabetic foot (DF) are a tool that aims to improve communication between professionals, referral and counter-referral, provide a prognosis, help in the assessment of lesions, and contribute to statistical purposes. Objectives: to describe the characteristics of patients who presented to the clinic or emergency department with DF over a period of 3 months, determine the risk according to 5 classifications (Texas, IDSA, SEWSS, WIfI, and SINBAD), and evaluate their evolution at 6 months in relation to the severity degree determined by each classification. Materials and methods: 312 patients from 15 institutions in Argentina were analyzed. The Diabetic Foot Classification Calculator/Risk Score from the Diabetic Foot Committee of the Argentina Argentina Diabetes Society was used for the analysis. Results: 43% of patients (n=133) required hospitalization at the time of the first consultation and 61% (n=189) had previously consulted. The total major amputation percentage was 8.33% (95%CI; 5.5-11.9) (n=26), and the minor amputation percentage was 29.17% (95% CI; 24.2-34.6) (n=91). At 6 months, the death rate was 4.49% (95% CI; 2.5-7.4) (n=14), 24.3% (95% CI; 19.629.5) had an open wound (n=76), 58.0% (95% CI; 52.3-66.5) (n=181) had healed, and 7.37% were lost to follow-up (n=23). The SEWSS and WIfI classifications were related to major amputation, healing, and death. Regarding the Texas classification, 49% of patients had a penetrating wound to bone or joint (Texas 3), with or without infection. 65.3% of major amputations and 78.6% of deaths occurred in patients with ischemia. The SEWSS cut-off point for major amputation was 20. Conclusions: knowing local data allows organizing resources to improve patient care.

Impacto del manejo multidisciplinario del pie diabético

Objetivo: Estudiar el efecto del manejo multidisciplinario (MMD) de úlcera de PD (UPD) en un Hospital de Chile durante el período 2017-2020. Materiales y Métodos: Estudio comparativo, observacional y retrospectivo, se analizó una base de datos disociada compuesta por 111 pacientes atendidos en el periodo 2017-2020 y se comparó con los datos de 121 pacientes con UPD atendidos en el mismo Hospital sin MMD en periodo 1998-2005. Para los estudios analíticos se usó prueba de Chi cuadrado, prueba exacta de Fisher, U de Mann Whitney y Kruskal Wallis. Resultados: La tasa de reamputaciones mayores con MMD fue de un 2,7%, el 91,2% de los pacientes atendidos con MMD lograron mejorar la condición clínica de la herida, sin embargo, en pandemia por SARCOV-2 la mejoría se redujo a un 78,2%. La tasa de cicatrización completa de la herida con MMD fue de 77,8% v/s 31,4% sin MMD (p < 0,0001) y la tasa de reamputación general sin MMD fue de 47,1% v/s 12,6% con MMD (< 0,0001). La recidiva fue de un 11,7% con MMD v/s 100% a los cuatro años sin MMD (p < 0,0001). Discusión y Conclusión: Observamos que el MMD de la UPD logra mejores tasas de efectividad de la intervención que pacientes sin MMD, mostrándose mejores tasas de cicatrización de la herida, tasa de reamputación mayor, y tasa de recidiva. Por lo tanto, un MMD podría contribuir, significativamente, al rescate de la extremidad afectada.

Objective: To assess the effect of a multidisciplinary approach on patients with diabetic foot ulcer (DFU) in a Hospital in Chile from 2017 to 2020. Material and Method: The study is observational, comparative, and retrospective. The data from 111 patients were analyzed anonymously during 2017-2020. It was compared with old data from a group of121 patients treated in the same hospital but without a multidisciplinary approach. To gather the data the Chi-square test, Fisher's exact test, the U of Mann Whitney, and the Kruskal Wallis were used. Results: It was found that the rate of major re-amputations in patients undergoing treatment with a multidisciplinary approach was 2.7%. Furthermore, 91.2% of patients treated with a multidisciplinary approach improved the clinical condition of the wound. However, During the SARCOV-2 pandemic, the improvement rate was reduced to 78.2%. The complete wound healing rate was 77.8% in patients treated with a multidisciplinary approach versus 31.4% without a multidisciplinary approach (p < 0.0001). The overall re-amputation rate on patients without a multidisciplinary approach was 47.1% versus 12.6% on patients with a multidisciplinary approach (< 0.0001). The recurrence rate was 11.7% in patients with a multidisciplinary approach versus 100% in patients without a multidisciplinary approach (p < 0.0001). Conclusion: We observed finally, we observed that a multidisciplinary approach helped the DFU patients to achieve better intervention effectiveness rates, showing better rates of wound healing, higher re-amputation rate, and recurrence rate. Therefore, a multidisciplinary approach could contribute significantly to the improvement of the affected limb.

Bloqueo del tobillo con lidocaína y bupivacaina para amputación de los radios del pie. Hospital General del Sur "Dr. Pedro Iturbe" / Ankle block with lidocaine and bupivacaine for foot rays amputation. Hospital General del Sur "Dr. Pedro Iturbe"

El objetivo de este trabajo es determinar la utilidad del bloqueo del tobillo con lidocaína y Bupivacaína para amputación de los radios del pie en pacientes atendidos en el Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Venezuela, desde mayo 2019 hasta mayo 2021. Se realizó un estudio pre-experimental, prospectivo y longitudinal. Se incluyeron pacientes de ambos sexos, entre 18 a 90 años, con amputaciones traumáticas, pie diabético e insuficiencia vascular periférica. Se incluyeron 50 pacientes, con edad promedio de 50,76 ± 25,0 años, 35(70,0%) de sexo masculino. Con antecedente de diabetes 13(26,0%) pacientes, fumadores 4(8,0%), cardiópatas 4(8,0%), hipertensos/diabéticos 6(12,0%), obesidad 5(10,0%), trauma 6(12,0%), nefrópatas 2(4,0%), drogas 1(2,0%) y sin antecedentes 9(18,0%). Diagnóstico preoperatorio predominante: amputación traumática 19 pacientes (38,0%), El promedio de tiempo de inicio del bloqueo fue 5-15min en 21(42,0%) casos. El bloqueo fue satisfactorio en 46(92,0%) pacientes. La duración del bloqueo en 22(44,0%) pacientes fue prolongada. Según la EVA del dolor en 19(38,0%) casos fue leve. No se evidenciaron complicaciones asociadas al procedimiento en 50(100,0%) pacientes. El bloqueo con lidocaína y bupivacaína es una técnica útil en la amputación de los radios del pie, inmediata, ambulatoria, a bajo costo, de duración prolongada y satisfactoria, de bajo dolor postoperatorio, poco requerimiento de analgésicos y con bajas complicaciones(AU)

The objective to determine the usefulness of the ankle block with lidocaine and Bupivacaine for amputation of the foot rays in patients treated at the Hospital General del Sur Dr. Pedro Iturbe during the period May 2019 to May 2021. A pre-experiment, prospective and longitudinal study was made. Patients of both sexes, between 18 and 90 years old, with traumatic amputations, diabetic foot and peripheral vascular Insufficiency were included. A descriptive statistical analysis was applied. Mean age 50,76±25,0 years, 35(70,0%) male patients. Patients history: Diabetes 13(26,0%), smokers 4(8,0%), heart patients 4(8,0%), hypertensive/diabetics 6(12,0%) patients, obesity 5(10,0%), trauma 6(12,0%), kidney disease 2(4,0%), drugs 1(2,0%), no history 9(18,0%). Predominant preoperative diagnosis: traumatic amputation 19(38,0%) patients, Block onset time: medium (5-15min) 21(42,0%) patients. The blockade was satisfactory in 46 patients (92.0%). Block duration in 22(44,0%) patients was prolonged. Pain scale 19(38,0%) patients mild pain. There were no complications associated with the procedure in 50(100,0%) patients. Conclusions: The blockade with lidocaine and bupivacaine is useful in the amputation of the foot rays since it is performed immediately, on an outpatient basis, at low cost, with a long and satisfactory duration, presenting mild postoperative pain, little need for analgesics and they do not represent a risk for the patient since there were no complications related to the technique(AU)

Isquemia arterial aguda trombótica de los miembros inferiores / Acute thrombotic arterial ischemia of the lower limbs

Introducción: La enfermedad arterial periférica es una de las afecciones más prevalentes. Resulta habitual su coexistencia con la enfermedad vascular en otras localizaciones. El diagnóstico precoz tiene importancia para mejorar la calidad de vida del paciente y reducir el riesgo de eventos secundarios mayores, como el infarto agudo de miocardio o el ictus. Objetivo: Caracterizar el comportamiento de la isquemia arterial aguda trombótica en miembros inferiores en pacientes que ingresaron en el Instituto Nacional de Angiología y Cirugía Vascular. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo, con el fin de determinar factores pronósticos en la evolución final del tratamiento quirúrgico de la isquemia arterial aguda trombótica en miembros inferiores, en pacientes que ingresaron en los servicios de Arteriología y Angiopatía Diabética del Instituto Nacional de Angiología y Cirugía Vascular durante un período de cuatro años. Resultados: El grupo de edades más afectado estuvo entre 40 y 59 años, con un predomino del sexo masculino. El hábito de fumar fue el factor de riesgo vascular más frecuente; y la amputación mayor, el procedimiento quirúrgico más empleado, por lo que el patrón oclusivo femoropoplíteo resultó el más prevalente. Conclusiones: Predominaron el sexo masculino, el hábito de fumar, la amputación mayor y el patrón oclusivo femoropoplíteo(AU)

Introduction: Peripheral arterial disease is one of the most prevalent conditions. Its coexistence with vascular disease in other locations is common. Early diagnosis is important to improve the patient's quality of life and reduce the risk of major secondary events, such as acute myocardial infarction or stroke. Objective: To characterize the behavior of acute thrombotic arterial ischemia in lower limbs in patients admitted to the National Institute of Angiology and Vascular Surgery. Methods: An observational, descriptive and retrospective study was conducted in order to determine prognostic factors in the final evolution of surgical treatment of acute thrombotic arterial ischemia in the lower limbs in patients admitted to the Arteriology and Diabetic Angiopathy services of the National Institute of Angiology and Vascular Surgery for a period of four years. Results: The most affected age group was the one of 40 to 59 years, with a predominance of males. Smoking was the most frequent vascular risk factor; and major amputation, the most used surgical procedure, so the femoropopliteal occlusive pattern was the most prevalent. Conclusions: Male sex, smoking habit, major amputation and femoropopliteal occlusive pattern predominated(AU)

Heberprot-P® en el tratamiento de trauma vascular distal / Heberprot-P® in the treatment of distal vascular trauma

Introducción: Los traumatismos constituyen causa frecuente de consulta. Entre sus localizaciones más comunes se encuentran las extremidades inferiores. El Heberprot-P® resulta un factor de crecimiento epidérmico que se ha utilizado durante más de una década para la cicatrización de las úlceras del pie diabético con excelentes resultados. Ampliar su utilización a otras patologías, incluso de etiología traumática, permitiría expandir las posibilidades terapéuticas para la cicatrización de las heridas. Objetivo: Exponer el resultado de la aplicación del Heberprot-P® en una amputación transtarsiana en un paciente portador de un trauma vascular distal. Presentación del caso: Paciente masculino de 23 años con antecedentes de salud. Luego de traumatismo por accidente de tránsito presentó fractura de huesos del metatarso y la sección total de la arteria pedia del pie izquierdo, lo cual provocó una gangrena húmeda de la extremidad. Por este motivo se realizó una amputación transtarsiana del pie. Se usó el Heberprot-P® como terapia para acortar el tiempo de cicatrización. Conclusiones: El Heberprot-P® resultó útil para la evolución de la herida como consecuencia de un trauma vascular, al evitar una amputación mayor, acelerar el proceso de cicatrización y conservar una extremidad funcional, lo que demostró que puede constituir una terapia eficaz para las heridas de difícil cicatrización, independientemente de su etiología(AU)

Introduction: Trauma is a frequent cause of consultation. Among its most common locations are the lower extremities. Heberprot-P® is an epidermal growth factor that has been used for more than a decade for the healing of diabetic foot ulcers with excellent results. Extending its use to other pathologies, including traumatic etiology ones, would expand the therapeutic possibilities for wound healing. Objective: To present the result of the application of Heberprot-P® in a Chopart´s amputation in a patient with distal vascular trauma. Case presentation: A 23-year-old male patient with a health history. After trauma from a traffic accident, he presented a fracture of the bones of the metatarsus and the whole section of the left foot´s pedis artery, which caused a wet gangrene of the extremity. For this reason, a Chopart´s amputation of the foot was performed. Heberprot-P® was used as therapy to shorten healing time. Conclusions: Heberprot-P® was useful for wound evolution as a result of vascular trauma, avoiding major amputation, accelerating the healing process and preserving a functional limb, which showed that it can be an effective therapy for wounds that are difficult to heal, regardless of their etiology(AU)

Instrumentos de avaliação do ajuste psicossocial à amputação, uso e satisfação com a prótese: uma revisão sistemática da literatura / Instruments for evaluation of psychosocial adjustment to amputation, use and satisfaction with the prosthesis: a systematic review of literature

O ajuste à amputação envolve tanto questões físicas quanto psicossociais e a satisfação com o membro artificial. Objetivo: Revisar sistematicamente a literatura acerca dos instrumentos que avaliam o ajuste psicossocial à amputação e uso da prótese e a satisfação com a prótese em pessoas com amputação de membro inferior. Métodos: Fonte de dados: Medline via Pubmed, Web of Science e Scopus. Critérios de elegibilidade: estudos originais que utilizaram questionários para avaliar o ajustamento psicossocial a amputação e uso da prótese e a satisfação com a prótese. Participantes: pessoas com amputação de membro inferior. Métodos de avaliação e síntese dos estudos: todas as análises foram realizadas por três avaliadores, de forma independente, sendo os resultados apresentados de forma descritiva, em tabelas. Resultados: Foram encontrados 239 artigos na busca inicial, sendo incluídos 12 artigos ao final da revisão. Nestes, foram identificados 14 questionários que avaliam o ajuste psicossocial e a satisfação com a prótese, porém, somente 5 são validados especificamente para a população amputada. Conclusão: A Trinity Amputation and Prosthesis Experience Scale (TAPES) e o Prosthesis Evaluation Questionnaire (PEQ) são os instrumentos mais utilizados, sendo sempre importante uma seleção criteriosa dos instrumentos a serem utilizados nas pesquisas e intervenções a fim de se obter dados válidos, confiáveis e comparáveis. Número de registro da revisão sistemática: CRD42019097279

The adjustment to amputation involves physical and psychosocial issues and the satisfaction with the artificial limb. Objective: To systematically review the literature about the instruments that assess psychosocial adjustment to amputation and use of the prosthesis and satisfaction with the prosthesis in people with lower limb amputation. Methods: Data sources: Medline via Pubmed, Web of Science and Scopus. Study eligibility criteria: Original studies that using questionnaires to evaluated the psychosocial adjustment to amputation and prosthesis use and about prosthesis satisfaction. Participants: people with lower limb amputation. Study appraisal and synthesis methods: all analyzes were performed independently by three evaluators, and the results were presented descriptively, in tables. Results: Were found 239 articles in the initial search, with 12 articles included at the end of the review. In these, 16 questionnaires were identified that assess the psychosocial adjustment and satisfaction with the prosthesis, however, only five are validated specifically for the amputated population. Conclusion: The Trinity Amputation and Prosthesis Experience Scale (TAPES) and the Prosthesis Evaluation Questionnaire (PEQ) are the most used instruments, being always important to carefully select the instruments to be used in research and interventions in order to obtain valid, reliable and comparable data. Systematic review registration number: CRD42019097279

Preliminary analysis of mRNA and microRNA differential expression profiles in spinal cord regeneration of Gekko japonicus after tail amputation / 解剖学报

Objective To analyze the expression changes of related mRNA and microRNA(miRNA)during spinal cord regeneration after tail amputation of Gekko japonicus, and to explore the biological effects of differentially expressed mRNA and miRNA during spinal cord regeneration. Methods Fifty Gekko japonicus, the tail amputation model of Gekko japonicus was constructed, divided into normal group, 15 days tail amputation group, and 25 days tail amputation group, 5 in each group, repeat the experiment 3 times, 5 spare. Samples of each group were collected, RNA of each group was extracted and high-throughput sequencing. Bioinformatics analysis identifies differentially expressed mRNA and miRNA between groups, Gene Ontology(GO) enrichment analysis of differentially expressed mRNA functional annotations, and construction of miRNA and mRNA gene regulatory networks related to spinal cord regeneration. Results The differential expression of mRNA and miRNA in the normal and newborn spinal cords of Gekko japonicus was analyzed by sequencing. The 15 days and 25 days tail amputation groups identified 538 and 510 differential mRNA expressions and 446, 127 differential miRNA expressions, respectively. GO analysis found that the differentially expressed mRNA aggregated in biological processes related to cell proliferation and neurodevelopment. In the spinal cord regeneration-related miRNA and its target gene regulatory network, 21 mRNA expression was down-regulated in the 15 days tail amputation group, which was regulated negatively by 41 up-regulated miRNAs; 12 mRNA expression was up-regulated and was regulated by 29 down-regulated miRNAs. In the 25 days tail amputation group, 8 mRNA expression was down-regulated and regulated negatively by 10 up-regulated miRNAs; 20 mRNA expression was up-regulated and regulated by 32 down-regulated miRNAs. Conclusion Through the analysis of the differential expression of miRNA and mRNA in the regenerated spinal cord of Gekko japonicus, the expression changes of mRNA and miRNA in spinal cord regeneration were initially revealed, which provided experimental data for elucidating the molecular mechanism of spinal cord regeneration.

Study of the improvement effect of "DuZhong-DangGui" on osteoarthritis rats via regulating NLPR3 inflammasome / 中国临床药理学与治疗学

AIM: To investigate the protective effect of "DuZhong-DangGui" (DZ-DG) on the knee tissue of rats with osteoarthritis (OA) and its regulation role on NLPR3 inflammasome. METHODS: Twenty-four SPF male SD rats, eighteen rats were randomly selected to establish OA model by anteri- or cruciate ligament amputation (ACLT) method, and rats were divided into control group, OA model group, DZ-DG group and positive drug group, 6 in each group, treatment for 8 weeks. The peripheral blood were collected, ELISA was used to detect the levels of IL-1β, IL-6, IL-18, and TNF-α; cartilage tissue of knee joint were collected, HE staining was used to observe pathology changes, OARSI staining was used to observe cartilage calcification and preform quantitative OARSI scoring; immunohistochemistry and TUNEL staining were used to detect the contents of Caspase1 and Collagen II and the number of apoptosis in the tissue, respectively, and western blot was used to detect the protein expressions of matrix metalloproteinase-13 (MMP-13), tissue inhibitor of metalloproteinase-1 (TIMP-1), p53, p21, NLPR3, apoptosis-associated speck-like protein containing a CARD (ASC) and Pro-Caspase-1. RESULTS: Compared to control group, OA model group rats serum levels of IL-1β, IL-6, IL-18, and TNF - α significantly increased (P<0.01), OARSI scores significantly increased (P<0.01), chondrocyte apoptosis was increased (P<0.01), Caspase-1 content and MMP-13, p53, p21, NLPR3, ASC, Pro-Caspase-1 protein expressions significantly increased (P <0.01), while Collagen II content and TIMP-1 protein expression significantly decreased (P<0.01). Compared with the OA model group, DZ-DG group and positive drug group rats serum levels of IL-1β, IL-6, IL -18 and TNF - α significantly decreased (P< 0.05), chondrocyte apoptosis were significantly decreased (P<0.01), Caspase1 content, MMP-13, p53, NLPR3, Pro-Caspase-1 significantly decreased (P< 0.05), Collagen Ⅱ content and TIMP- 1 protein expression (P<0.01); DZ-DG group rats protein expression of p21 and ASC were decreased (P<0.01). CONCLUSION: The DZ-DG have protection role on cartilage of OA rats, its effect may related to mediation of NLPR3/ASC/Pro-Caspase-1 pathway, to decrease of IL-1β, and inhibition of cell apoptosis.

A Case Report of a Patient who Achieved Recovery of Walking Independence with the Adjustment of the Prosthesis after Bilateral Leg Amputation and Spinal Cord Injury / The Japanese Journal of Rehabilitation Medicine

This report describes a case of an amputee with a lumber spinal cord injury who successfully recovered ambulation with the use of prosthesis.A 30-year-old man with schizophrenia underwent amputation of the lower legs and concurrently developed lumbar spinal cord injury from of a suicide attempt. After the treatment of stump plasty and posterior fusion, the patient was transferred to our facility. Lower-extremity prostheses for both legs were fitted, and orthostatic training was commenced following admission. During the initial evaluation, the patient could not maintain a stable standing position because of weakness in the hip extensor muscle. An inflexion angle of the prosthesis was set to 0° to extend the knee joint and achieve standing stability. Appropriate adjustments of the prosthesis were made as required, specifically addressing the paraplegia caused by his lumbar spinal cord injury. Thus, the patient successfully regained ambulation with the treatment.Recovering walking independence after bilateral lower leg amputations or paraplegia caused by lumber spinal cord injury is not uncommon. However, this case is unique in that the muscle weakness caused by lumbar spinal cord injury presented unforeseen difficulties for the patient to achieve ambulation, which is not ordinarily observed in amputation rehabilitation cases. No similar cases have been reported in which patients concurrently suffered from both these conditions in Japan；therefore, this case is extremely rare.

A Case Report of a Patient who Achieved Recovery of Walking Independence with the Adjustment of the Prosthesis after Bilateral Leg Amputation and Spinal Cord Injury / The Japanese Journal of Rehabilitation Medicine

This report describes a case of an amputee with a lumber spinal cord injury who successfully recovered ambulation with the use of prosthesis.A 30-year-old man with schizophrenia underwent amputation of the lower legs and concurrently developed lumbar spinal cord injury from of a suicide attempt. After the treatment of stump plasty and posterior fusion, the patient was transferred to our facility. Lower-extremity prostheses for both legs were fitted, and orthostatic training was commenced following admission. During the initial evaluation, the patient could not maintain a stable standing position because of weakness in the hip extensor muscle. An inflexion angle of the prosthesis was set to 0° to extend the knee joint and achieve standing stability. Appropriate adjustments of the prosthesis were made as required, specifically addressing the paraplegia caused by his lumbar spinal cord injury. Thus, the patient successfully regained ambulation with the treatment.Recovering walking independence after bilateral lower leg amputations or paraplegia caused by lumber spinal cord injury is not uncommon. However, this case is unique in that the muscle weakness caused by lumbar spinal cord injury presented unforeseen difficulties for the patient to achieve ambulation, which is not ordinarily observed in amputation rehabilitation cases. No similar cases have been reported in which patients concurrently suffered from both these conditions in Japan；therefore, this case is extremely rare.

The Osseous Pathology of Purpura Fulminans in a TwoYear-Old Child: A Case Report

@#Purpura fulminans (PF) is a severe clinical manifestation of Neisseria meningitides infection that is associated with high mortality rates in children. Survivors are frequently left with debilitating musculoskeletal sequelae. There is a paucity of reports on the musculoskeletal pathology of purpura fulminans. We report on a 2-year-old boy with purpura fulminans due to meningococcemia. The child developed distal gangrene in both the upper and lower limbs. Amputations were done for both lower limbs. Histological examination of the amputated specimens showed an inflammatory process and features of osteonecrosis. The latest follow-up at the age of 6 years showed a right knee valgus due to asymmetrical growth arrest of the proximal tibia. PF and its complications are challenging to treat and may require a multidisciplinary approach to improve patient’s functional ability.

A Case of Thromboembolism and Deep Venous Thrombosis after Transfemoral Amputation with Short Stump / The Japanese Journal of Rehabilitation Medicine

An 82-year-old patient underwent a left transfemoral amputation due to a malignant soft tissue tumor. He developed symptoms of chest pain and hypoxia on the 32nd day after the operation. These symptoms were caused by deep venous thrombosis (DVT) of the stump and acute pulmonary thromboembolism (PTE), for which he was treated with anticoagulant therapy. Shortly after treatment he could resume a rehabilitation therapy. Patients with a lower extremity amputation have a higher risk of developing a DVT because of immobility and increased venous pooling in the residual limb. Even with a short stump as in this case, it is important to actively train the range of motion of the joint and try to prevent DVT.

A Case of Thromboembolism and Deep Venous Thrombosis after Transfemoral Amputation with Short Stump / The Japanese Journal of Rehabilitation Medicine

An 82-year-old patient underwent a left transfemoral amputation due to a malignant soft tissue tumor. He developed symptoms of chest pain and hypoxia on the 32nd day after the operation. These symptoms were caused by deep venous thrombosis (DVT) of the stump and acute pulmonary thromboembolism (PTE), for which he was treated with anticoagulant therapy. Shortly after treatment he could resume a rehabilitation therapy. Patients with a lower extremity amputation have a higher risk of developing a DVT because of immobility and increased venous pooling in the residual limb. Even with a short stump as in this case, it is important to actively train the range of motion of the joint and try to prevent DVT.