Cirugías ablativas por causas oncológicas. 17 años de experiencia en una Unidad Especializada del Estado Monagas, Venezuela / Ablative surgeries for oncological causes. 17 years experience in a Monagas specialized unit

Estudio retrospectivo, sobre pacientes a quienes se les practicó cirugías ablativas por causas oncológicas: un total de 76 casos, predominando en la serie: el sexo masculino, la segunda década de la vida y como motivo de consulta: aumento de volumen con un 73,5%, el osteosarcoma fue la neoplasia más frecuente con un 34%, la fractura patológica acompañó a los tumores en el 50% de los casos, el hueso más afectado fue el fémur, los estadios según Enneking predominantes fueron los II b y III. Se practicaron más cirugías en miembros inferiores, siendo la amputación transfemoral la más frecuente. La intención de los procedimientos fue predominantemente curativa con un 69% sobre las intenciones paliativas, se practicaron más amputaciones en niveles oncológicos radicales que amplias. Se obtuvo una sobrevida global de 53,4% a los dos años de seguimiento, el miembro fantasma estuvo presente como complicación por encima del 77% de los casos operados(AU)

Retrospective study on patients who underwent ablative surgeries for oncological causes: a total of 76 cases, predominantly in the series: male sex, second decade of life and as a reason for consultation: volume increase with 73,5%. Osteosarcoma was the most frequent neoplasm with 34%, pathological fracture accompanied the tumors in 50% of cases, the most affected bone was the femur, the predominant Enneking stages were IIb and III. More surgeries were performed on the lower limbs, with transfemoral amputation being the most frequent. The intention of the procedures was predominantly curative with 69% of the palliative intentions, more amputations were performed at radical oncological levels than extensive ones. An overall survival of 53.4% was obtained at two years of follow-up, the phantom limb was present as a complication in over 77% of operated cases.

Gait Analysis of Hip Disarticulation Amputees Based on Kinematic Parameters and Plantar Pressure Measurement / 医用生物力学

Objective To analyze the gait characteristics of hip disarticulation amputees, and analyze the reasons for their differences from normal gait, so as to assist clinical diagnosis and evaluation. Methods Through the portable human motion capture device and plantar pressure analysis system, the kinematics and plantar pressure information of 5 hip amputees were collected and compared with 15 healthy volunteers in control group. Gait differences between the amputees and normal subjects and between the affected leg side and the healthy leg side of the amputees were compared. Results The proportion of double-support period for hip amuptees was higher than that of normal gait. Step length, step time, loading response period, mid support period, pre-swing period, proportion of the swing period for the affected leg side and healthy leg side of hip amputees showed significant differences with those of control group. The relative symmetry index of the gait for hip amputees was 0.60±0.05. Compared with the affected leg side, the support period of the healthy leg side was extended, the step length was shortened, the ground reaction force was greater than that of the affected leg side, and the center of pressure trajectory shifted to the affected leg side. Conclusions The gait of hip amputees is significantly different from that of normal people. Hip amputees have weak walking ability, poor gait symmetry, and they lack of continuity in the body’s center of gravity. The results provide experimental basis and theoretical analysis for the design of mechanical structure and control system of novel hip prosthesis.

Thoracic-weight-bearing Socket and Reciprocating Gait Prosthesis for Pelvis Disarticulation Amputee: A Case Report / 中国康复理论与实践

Objective:To design, fit and use a thoracic-weight-bearing socket and reciprocating gait prosthesis for amputee pelvis disarticulation. Methods:A case after pelvis disarticulation amputation was reported. The main weight of the socket bore on lower thorax, and the socket suspended with the pressure from anterior-posterior sides. Walking prosthesis was consisted of the socket, reciprocating hip joint, prosthetic knee joint and SACH foot. The prosthesis was adjusted alignment, and the patient was trained to walk with the prosthesis. Results:The patient could stand for four hours a time with the socket, and walk 200 meters in 30 minutes assisted with axillary crutches. The score of modified Barthel Index improved from 41.5 admitted to hospital to 93 (with socket) or 83 (with prosthesis) as discharged. Conclusion:Pelvis disarticulation amputees could stand up with socket with reasonable weight bearing and suspension and walk in reciprocating gait with reasonable components and joints, right alignment and gait training, to improve activities of daily living.

Static Finite Element Analysis on Hip Disarticulation Prosthesis Socket-Residual Limb in Stance Phase / 医用生物力学

Objective To study mechanical properties of the interface between hip residual limb and hip socket during the stance phase by using the finite element analysis (FEA) method, so as to provide the theoretical basis for structure optimization and design of hip socket, as well as the research basis for comfort evaluation of hip socket. Methods According to CT scan images of the patient’s residual limb, the model of bone, soft tissues and socket was reconstructed by reverse modeling. The distribution of normal stress and shear stress on the interface between hip residual limb and hip socket was analyzed and a pressure acquisition module system was designed to verify the stress distribution condition. Results The interfacial stress between hip residual limb and hip socket was mainly distributed in the waist and the bottom of the residual limb, and the interfacial stress was more evenly distributed in the rest of the residual limb. The results of finite element calculation were in good agreement with the system measurement results of pressure acquisition module. Conclusions In order to improve force transfer and safety and comfort of the hip socket, it is necessary to fully consider stress condition of the waist and bottom of the residual limb, as well as the coordination degree between residual limb and hip socket.

Design and simulation of dynamic hip prosthesis based on remote motion center mechanism / 生物医学工程学杂志

The rotation center of traditional hip disarticulation prosthesis is often placed in the front and lower part of the socket, which is asymmetric with the rotation center of the healthy hip joint, resulting in poor symmetry between the prosthesis movement and the healthy lower limb movement. Besides, most of the prosthesis are passive joints, which need to rely on the amputee's compensatory hip lifting movement to realize the prosthesis movement, and the same walking movement needs to consume 2-3 times of energy compared with normal people. This paper presents a dynamic hip disarticulation prosthesis (HDPs) based on remote center of mechanism (RCM). Using the double parallelogram design method, taking the minimum size of the mechanism as the objective, the genetic algorithm was used to optimize the size, and the rotation center of the prosthesis was symmetrical with the rotation center of the healthy lower limb. By analyzing the relationship between the torque and angle of hip joint in the process of human walking, the control system mirrored the motion parameters of the lower on the healthy side, and used the parallel drive system to provide assistance for the prosthesis. Based on the established virtual prototype simulation platform of solid works and Adams, the motion simulation of hip disarticulation prosthesis was carried out and the change curve was obtained. Through quantitative comparison with healthy lower limb and traditional prosthesis, the scientificity of the design scheme was analyzed. The results show that the design can achieve the desired effect, and the design scheme is feasible.

Forequarter amputation in a patient with locally advanced recurrent breast carcinoma

Forequarter amputation (FQA) involves the removal of the upper limb, clavicle, and scapula and is indicated for the resection of primary or metastatic tumors invading the axillary neurovascular bundle. Reports on breast cancer have associated FQA with the primary resection of a locally advanced tumor, resection of recurrent disease, brachial plexus injury, Stewart-Treves syndrome, or sarcoma secondary to breast cancer irradiation. We described a case of recurrent breast carcinoma with curative-intent surgery. The surgery aimed at locoregional control and improvement in the quality of life. The literature is scarce on the topic, discussing the multiple aspects related to the indication of FQA for breast cancer patients. This report presents the first case described in Latin American literature.

Caracterização das pessoas amputadas de um hospital de grande porte em Recife (PE, Brasil) / Characterization of amputees at a large hospital in Recife, PE, Brazil

A amputação de membros pode ser definida como um procedimento que consiste em separar do corpo um membro ou segmento dele. Objetivos Descrever o perfil dos procedimentos de amputações de membros realizados em um hospital estadual de grande porte. Métodos Estudo transversal do tipo descritivo e retrospectivo realizado em um hospital de grande porte da cidade de Recife (PE). Os dados foram coletados em registros de pacientes que foram submetidos à amputação no ano de 2017. Foram incluídos pacientes que tiveram seu membro amputado em 2017 e excluídos aqueles com informações ilegíveis ou incompletas. Resultados Foram realizados 328 procedimentos em 274 pacientes, a maioria do gênero masculino (57,7%). Houve predominância de amputações em membros inferiores (64,2%), de causa não traumática (86,5%) e atendimentos de urgência (96,4%). A maioria dos pacientes submetidos a amputações ficaram internados por um período de 11 a 25 dias (32,1%). Este estudo mostrou que a maioria das pessoas amputadas recebeu alta (69,7%) e uma parte foi a óbito, sendo os óbitos, no caso das amputações de membros inferiores, principalmente de pessoas idosas na faixa etária de 60 a 90 anos (76%), do sexo feminino (55%), e submetidas a uma amputação (91%). Conclusões Os dados apresentados neste estudo são alarmantes, principalmente ao se considerar que muitas das amputações poderiam ter sido evitadas, visto que foram decorrentes de complicações de doenças cuja prevenção e controle podem ser realizados em outros níveis de complexidade do sistema e com custo relativamente baixo

Limb amputation can be defined as a procedure that consists of separating a limb or a segment of a limb from the body. Objectives To describe the profile of limb amputation procedures performed at a large hospital run by the state of Pernambuco (Brazil). Methods Cross-sectional descriptive and retrospective study conducted at a large hospital in the city of Recife, PE. Data were collected from the records of patients who underwent amputations during 2017. Records from patients who had had a limb amputation during 2017 were included, unless data were illegible or missing. Results A total of 328 procedures were performed on 274 patients, the majority of whom were male (57.7%). There was a predominance of lower limb amputations (64.2%), of non-traumatic causes (86.5%), and urgent treatment (96.4%). The majority of patients who underwent amputations remained in hospital for 11 to 25 days (32.1%). The study found that the majority of amputees were discharged (69.7%), although a proportion died. Deaths of lower limb amputees were primarily among elderly women in the age range of 60 to 90 years (76%), females (55%), and patients subjected to a single amputation (91%). Conclusions The data observed in this study are alarming, particularly considering that many of these amputations could have been avoided, since they were caused by complications of diseases that can be prevented and controlled at healthcare services of a lower level of complexity and at a relatively low cost

Prevalência de amputações de membros superiores e inferiores no estado de Alagoas atendidos pelo SUS entre 2008 e 2015 / Prevalencia de amputaciones de miembros superiores e inferiores en el estado de Alagoas atendidos por el SUS entre 2008 y 2015 / Prevalence of upper and lower limb amputations of SUS patients in the state of Alagoas between 2008 and 2015

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

RESUMEN La amputación es un recurso terapéutico utilizado para realizar la remoción de un miembro, otro apéndice o prominencia del cuerpo, en la ocurrencia de lesiones graves de nervios, arterias, partes blandas y huesos. El objetivo de esta investigación fue verificar la prevalencia de amputaciones de miembros en el estado de Alagoas. Se trató de un estudio de datos secundarios, con abordaje epidemiológico y observacional, en el período de 2008 a 2015. Se recolectaron las informaciones de la base de datos de SIHSUS. Se registraron 361.585 procedimientos de amputaciones de miembros en Brasil, con predominancia en las regiones Sudeste, Nordeste y Sul, responsables por el 88.13% de ese total. Alagoas ocupó el 21º lugar en número de amputaciones entre los estados brasileños: sus procedimientos ocurrieron en seis microrregiones, de las cuales 3 son responsables por el 95% de los casos. La prevalencia de amputación en Alagoas ha sido de 19.05 amputaciones/100 mil habitantes. Tres tipos de procedimientos presentan mayor predominio: amputación de miembros inferiores, dedos, pie y tarso, lo que representa el 95% de las amputaciones.

ABSTRACT Amputation is a therapeutic resource used to remove a limb, an appendage of lump from the body, in case of serious injury to nerves, arteries, soft tissues and bones. The objective of this research was to verify the prevalence of limb amputations in the state of Alagoas. This was a study of secondary data, epidemiological and observational approach, conducted from 2008 to 2015. Data were collected from SIHSUS Database. The number of 361,585 limb amputation procedures were registered in Brazil, mainly in the Southeast, Northeast and South regions, accounting for 88.13% of the total of these procedures. Alagoas occupied the 21st place in the number of amputations among Brazilian states, its procedures occurred in six microregions, of these, three were responsible for 95% of cases. The prevalence of amputation in the state of Alagoas was 19.05 amputations/100,000 inhabitants. Three types of procedures have greater predominance: amputation of lower limbs, fingers, foot and tarsus, which represents 95% of the procedures.

Hip disarticulation - case series analysis and literature review / Desarticulação da anca - Análise de uma série e revisão da literatura

ABSTRACT OBJECTIVE: To present a retrospective study of 16 patients submitted to hip disarticulation. METHODS: During the period of 16 years, 16 patients who underwent hip disarticulation were identified. All of them were studied based on clinical records regarding the gender, age at surgery, disarticulation cause, postoperative complications, mortality rates and functional status after hip disarticulation. RESULTS: Hip disarticulation was performed electively in most cases and urgently in only three cases. The indications had the following origins: infection (n = 6), tumor (n = 6), trauma (n = 3), and ischemia (n = 2). The mean post-surgery survival was 200.5 days. The survival rates were 6875% after six months, 5625% after one year, and 50% after three years. The mortality rates were higher in disarticulations with traumatic (66.7%) and tumoral (60%) causes. Regarding the eight patients who survived, half of them ambulate with crutches and without prosthesis, 25% walk with limb prosthesis, and 25% are bedridden. Complications and mortality were higher in the cases of urgent surgery, and in those with traumatic and tumoral causes. CONCLUSION: Hip disarticulation is a major ablative surgery with obvious implications for limb functionality, as well as high rates of complications and mortality. However, when performed at the correct time and with proper indication, this procedure can be life-saving and can ensure the return to the home environment with a certain degree of quality of life.

RESUMO OBJETIVO: Apresentar um estudo retrospectivo em 16 pacientes submetidos a desarticulação da anca. MÉTODOS: Foram identificados 16 pacientes submetidos a desarticulação da anca ao longo de 16 anos. Todos foram estudados por meio dos registos clínicos quanto a sexo, idade na cirurgia, causa da desarticulação, complicações no pós-operatório, índices de mortalidade e grau de funcionalidade após a desarticulação da anca. RESULTADOS: A desarticulação da anca foi feita eletivamente na maioria das situações e apenas de forma urgente em três casos. As indicações tiveram as seguintes origens: infecção (n = 6), tumor (n = 5), traumatismo (n = 3) e isquemia (n = 2). O tempo médio global de sobrevivência pós-cirurgia foi de 200,5 dias. Os índices de sobrevivência foram de 68,75% após seis meses, 56,25% após um ano e de 50% após três anos. Os índices de mortalidade foram mais elevados nas desarticulações de causa traumática (66,7%) e de causa tumoral (60%). Em relação aos oito pacientes que permanecem vivos, metade faz marcha com apoio de muletas canadenses e sem prótese, 25% fazem marcha com membro protético e 25% encontram-se acamados. As taxas de complicações e mortalidade foram mais elevadas nas desarticulações urgentes e nas efetuadas em consequência de traumatismos e tumores. CONCLUSÃO: A desarticulação da anca é uma cirurgia altamente mutilante, com implicações óbvias na funcionalidade do membro e taxas elevadas de complicações e mortalidade. No entanto, quando efetuado em um momento adequado e com indicação correta, esse procedimento pode salvar a vida do paciente e garantir o seu regresso ao domicílio com alguma qualidade de vida.

Desarticulación de cadera por sarcoma sinovial monofásico: Caso clínico / Hip disarticulation by monophasic synovial sarcoma: Case report

El sarcoma sinovial es una entidad morfológica, clínica y genéticamente distinta y puede tener cualquier otra ubicación. No existe una terapia estandarizada. Generalmente el tratamiento es quirúrgico, con resección radical de la lesión, aplicándose en algunos casos radioterapia adyuvante. Los sarcomas sinoviales han mostrado quimiosensibilidad a la ifosfamida con una respuesta aproximada del 24%. Se encuentran presentes más frecuentemente en las extremidades, siendo su diseminación metastásica a ganglios linfáticos regionales y/o pulmón, hígado, hueso y cerebro. Se trata de un caso clínico: paciente femenino de 40 años de edad, portadora de tumor en miembro inferior derecho, en el tercio medio del muslo, de 15x10 cm de diámetro, que compromete el vasto anterior, lateral y posterior del cuádriceps derecho, con irrupción de la aponeurosis y extensión al tejido celular subcutáneo. Por medio de la inmunohistoquímica se observó inmunomarcaje de las células neoplásicas con EMA, QAE1/AE3, vimentina, CD99, CD34 y Bcl2, como diagnóstico de sarcoma sinovial monofásico. Para el tratamiento se procedió a desarticulación de cadera, postoperatorio sin complicaciones y evolución satisfactoria. Se refiere al servicio de oncología médica para tratamiento coadyuvante. Se concluye que los procedimientos quirúrgicos en el tratamiento de tumores en extremidades se divide en resección amplia del tumor con preservación del miembro mediante endoprotesis, y la desarticulación, no existiendo evidencias clínicas que soporten la ventaja sobre cualquier otra opción terapéutica, sin embargo, el objetivo principal del procedimiento oncológico es controlar el tumor para disminuir la recurrencia y mejorar la supervivencia del paciente.

Synovial sarcoma is a clinically and genetically distinct morphological entity, and can be found in any location. There is no standard therapy. Treatment is usually surgical; with radical resection of the lesion, applying, in some cases, adjuvant radiotherapy. Synovial sarcomas have shown chemosensitivity to ifosfamide with an approximate 24% response. They are most often present in the extremities causing metastatic spread to regional lymph nodes and/or lung, liver, bone and brain. It is a clinical case: a female 40 year old patient with a tumor in right leg, on the middle third of the thigh, 15x10 cm in diameter, that involves the anterior, lateral and posterior vastus of the right quadriceps, with emergence of aponeurosis and extension to the subcutaneous tissue. Through immunohistochemical test, immuno-labeling in neoplastic cells with EMA, QAE1/AE3, vimentin, CD99, CD34 and Bcl2, as diagnosis of monophasic synovial sarcoma, was observed. For treatment, hip disarticulation was carried out, no postoperative complications and satisfactory outcome. The patient is referred to medical oncology service for adjuvant treatment. We conclude that surgical procedure in the treatment of tumors in extremities is divided into wide resection of the tumor with preservation of the member by endoprosthesis, and disarticulation amputees, with no clinical evidence to support the benefit of any other treatment option, however, the main purpose of the oncologic procedure is to control the tumor recurrence and improve patient survival.

Reinserção psicossocial de paciente jovem através de desarticulação interescápulo torácica e hemitoracectomia / Psychosocial rehabilitation of a young patient through interscapular thoracic disarticulation and hemithoracectomy

Na era das cirurgias minimamente invasivas, parece controverso advogar grandes operações. Entretanto, ainda há espaço para grandes intervenções oncológicas. É relatado caso de paciente de 23 anos de idade portador de tumor desmoide em hemitórax direito, com deformidade e erosão de arcos costais, atelectasia parcial do pulmão ipsilateral, compressão e desvio contralateral do mediastino, invasão de nervos do plexo braquial, vasos subclávios e pleura apical direita. Realizada toracectomia, ressecção de tumor em mediastino, amputação do membro superior direito, escapulectomia e reconstrução da parede torácica com tela de márlex e metilmetacrilato e confecção de retalho fasciocutâneo. O paciente encontra-se em seguimento ambulatorial com suas funções diárias quase recuperadas, limitado apenas nas atividades que envolviam o membro desarticulado. Em casos selecionados devem ser consideras grandes intervenções com o objetivo de ressecção R0 (ressecção com margens cirúrgicas livres) e melhora na qualidade de vida, atentando-se sempre para a ressocialização.

In the era of minimally invasive surgery, advocating large operations seems controversial. However, there is still room for major oncologic interventions. This is report of a 23 yearold patient with desmoid tumor in the right hemithorax, deformed and eroded ribs, ipsilateral lung partial atelectasis, contralateral mediastinal compression and shift, invasion ofnerves in the brachial plexus, subclavian vessels and right apical pleura. Thoracectomy was performed with resection of the tumor in the mediastinum, right upper limb amputation, scapulectomy, and chest wall reconstruction with methylmethacrylate and marlex screen, and use of a fasciocutaneous flap. The subject is in follow up as an outpatient andhas almost recovered his daily functions, which are now limited only for activities involving the inarticulate member. Selected cases should be considered for major interventions with aiming at R0 resection (resection with free surgical margins) and improved quality of life, always bearing in mind the need for rehabilitation and socialization.

Pathological changes of vascular tissue after rabbit limb replantation with different methods of cryopreservation / 中国组织工程研究

BACKGROUND:The cryopreservation of single tissue has achieved great advancement and is gradual y applied in clinics. However, the cryopreservation of complex tissue is rarely reported. OBJECTIVE:To investigate the morphological change in rabbit limb tissue after replantation through different rewarming methods, find the best rewarming methods of compound textured blood vessels, and provide theoretical basis for the feasibility of limb replantation after long-term cryopreservation. METHODS:Thirty New Zealand white rabbits were randomly divided into control group, slow freezing-slow thawing group, and slow freezing-rapid thawing group. The right posterior limbs of al the rabbits were cut off 1 cm above the knee joint. Except control group, the latter two groups were given limb replantation after thawing, and then the right posterior limb was again cut off after the replanted limbs were survived for 6 hours. For al groups, the histological changes and gross observation in aorta tissue were observed by light microscopy and transmission electron microscope, and the results were analyzed with statistical methods. RESULTS AND CONCLUSION:In the slow freezing-slow thawing, slow freezing-rapid thawing groups, the pathological changes (gross specimen, light microscope, electron microscope) of rabbit limbs 6 hours after replantation were worse than those in control group. Compared with slow freezing-rapid thawing group, better integrity of endothelial cells and less damage of the organel es were found in slow freezing-slow thawing group. Through deep cryogenic freezing-thawing process, rabbit limb blood vessels can maintain the structural integrity after replantation and survived at 6 hours. Slow freezing-slow thawing is better than slow freezing-rapid thawing for the preservation of severed limbs, providing evidences for the long-term survival fol owing a deep cry ogenic treatment after the severed limb replantation.

Advance in Bilateral Hip Disarticulation Prosthesis (review) / 中国康复理论与实践

@#With the development of the industry, all the parts of bilateral hip disarticulation prosthesis have been improved. The patients with bilateral hip disarticulation prosthesis can achieve the swing-to gait or swing-through gait, even the reciprocal gait.

Eighteen Year Follow-Up Results of Accessory Lower Limb Disarticulation and Pelvic Bone Reconstruction for Monocephalus Tripus Tribrachius / 대한정형외과학회잡지

Monocephalus tripus tribrachius, a type of conjoined twins with one head and three upper and lower extremities, is a rare congenital disorder. To date, no long-term follow-up results of surgical procedures for this condition have been reported in Korean literature. We experienced a case of monocephalus tripus tribrachius, which had been surgically managed with an accessory lower limb disarticulation and pelvic bone reconstruction to manage this accessory limb and accompanying comorbidities in hip joint and pelvis. Subsequently, ipsilateral Syme amputation was done for intractable deformity of foot, and later, ipsilateral femoral varus derotational osteotomy was done for inadequate coverage of femoral head observed in follow-up. We report 18-year follow-up results of the procedures with a review of literatures.

Through Knee Amputation: Technique Modifications and Surgical Outcomes

BACKGROUND: Knee disarticulations (KD) are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center. METHODS: A retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A.) between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified. RESULTS: Between 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%), arterial thrombosis (35%), and trauma (9%). Postoperative complications included superficial cellulitis (13%), soft tissue infection (4%), and flap ischemia (4%) necessitating one case of surgical debridement (4%) and four trans-femoral amputations (9%). 9 (22%) patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P<0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P<0.01. CONCLUSIONS: Knee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown.

Amputação primária no trauma: perfil de um hospital da região centro-oeste do Brasil / Primary amputation in trauma: a profile of hospital Center-west region of Brazil

CONTEXTO: Vivemos num período de epidemia do trauma. A amputação de indicação traumática incide em uma população jovem e economicamente ativa com repercussão onerosa no âmbito socioeconômico, tornando-se um problema de saúde pública. OBJETIVOS: Conhecer a casuística de amputações traumáticas realizadas na Santa Casa de Campo Grande-MS, entre 2005 e 2008. MÉTODOS: Estudo de prevalência, descritivo, longitudinal e retrospectivo. Amostragem de conveniência, realizada com revisão sistemática de prontuários de pacientes submetidos a amputações de membros inferiores e/ou superiores cuja indicação foi trauma incompatível com reconstrução. Foram excluídos os pacientes que já chegaram amputados no pronto-socorro. Avaliaram-se nível de amputação, faixa etária, sexo e escala do sistema MESS para indicação de amputação traumática. Utilizaram-se o teste quiquadrado e o teste exato de Fisher, considerando um intervalo de confiança de 95%. RESULTADOS: Foram realizadas 108 amputações no período, na faixa etária de dois anos a 78 anos, com média de 36,7 ± 12 anos e mediana de 35 anos. Houve predomínio do sexo masculino em 72% da casuística. O nível de amputação mais executado foi de amputações menores (pododáctilos e quirodáctilos). A causa mais frequente foi lesão decorrente de acidente de trânsito. CONCLUSÕES: As amputações traumáticas atingiram uma população jovem e produtiva, conforme corroborado pela literatura, com predomínio de acidentes de trânsito com lesões ortopédicas e neurológicas associadas.

BACKGROUND: We live in a period of epidemic of trauma. Amputation due to trauma affects a young and economically active population, with costly socioeconomic consequences, becoming a public health problem. OBJECTIVE: To investigate the series of amputations performed at Santa Casa de Campo Grande Hospital between 2005 and 2008. METHODS: Prevalence, descriptive, longitudinal and retrospective study. Convenience sampling was used to conduct a systematic review of medical records of patients undergoing lower and/or upper limb amputations whose diagnosis was trauma incompatible with reconstruction. Patients who arrived at the emergency department with amputated limbs were excluded from the study. We assessed the level of amputation, age, sex, and MESS score for amputation after trauma. The chi-square test and Fisher's exact test were used considering a 95% confidence interval. RESULTS: One hundred and eight amputations were performed in the period. Patients' two to 78 years; mean age was 36.7 ± 12 years, and median age was 35 years. Most patients were males (72%). The most frequent level of amputation was minor amputations (toes and fingers). The most common cause of amputation was injury resulting from traffic accidents. CONCLUSIONS: In agreement with the literature, trauma amputations affect a young and productive population, with prevalence of traffic accidents with associated orthopedic and neurological injuries.

Reconstrução após ressecção extensa de tumor das cinturas pélvica e escapular: relato de dois casos / Reconstruction following extensive tumor resection of the pelvic and scapular girdle: a report of two cases

As cirurgias radicais para tratamento dos tumores da cintura pélvica e escapular (hemipelvectomias e desarticulações interescapulotorácicas) constituem-se, em geral, em procedimentos extensos com grandes áreas de perda de substância local após ressecção do tumor. A utilização do retalho que inclui toda a musculatura anterior e posterior da coxa após dissecção do fêmur, pediculado pelos vasos femorais superficiais, foi descrita apenas uma vez na literatura. O retalho similar utilizando toda a musculatura anterior e posterior do braço após dissecção do úmero, pediculado pelos vasos subclávios para reconstrução após desarticulação interescapulotorácica, não apresenta relatos. Descrevemos dois casos - um de hemipelvectomia e outro de desarticulação interescapulotorácica - utilizando estes dois retalhos para fechamento do defeito.

Radical surgeries for treatment of scapular and pelvic girdle tumors (hemipelvectomy and interscapulothoracic amputation) are generally extended procedures, with large areas of local tissue loss after tumor resection. The use of a flap that includes all the anterior and posterior thigh musculature after femur dissection, pedicled in the superficial femoral vessels, has been described was only once in the medical literature, and there have been no reports on a similar flap using the whole anterior and posterior musculature of the arm after humerus dissection, pedicled in the subclavian vessels, for reconstruction after interscapulothoracic amputation. Here, we describe two cases - one hemipelvectomy and one interscapulothoracicl amputation - using these two the flaps to close the defect.

Design of Reciprocal Gait Prosthesis for Bilateral Hip Disarticulation / 中国康复理论与实践

@#ObjectiveTo design a reciprocal gait prosthesis connecting with the other prosthetic accessories for the bilateral hip disarticulation amputees.MethodsThe principle of reciprocal gait orthosis for paraplegia was used in the design, fitting reciprocal gait prosthesis for an amputee, which was compared with an ordinary bilateral Canadian type hip disarticulation prosthesis in the walking velocity and energy expenditure.ResultsThe amputee walked at lower energy expenditure and more like normal gait with reciprocal gait prosthesis while the walking velocity decreased, compared with the conventional prosthesis.ConclusionThis reciprocal gait prosthesis for bilateral hip disarticulation amputee needs less energy expenditure during walking like normal gait.

Bilateral hip disarticulation in paraplegics

Background: Decubitus ulcers are severe challenges to paraplegic patients, as well as to the medical providers caring for such disabled persons. Severe, chronic infection often can lead to death, especially in developing countries. Sometimes, hip disarticulation is the most appropriate surgical response to chronic ulceration. Objective: Report the results of bilateral disarticulations in 3 patients, one in Cambodia, and two in Australia. Methods: Chart reviews, examinations, and interviews with the patients were conducted to identify appropriate details of the indications and results. Results: Severe decubitus ulcers were successfully treated using the technique, without undue surgical complications. The general health of the patients was much improved. Conclusion: Bilateral hip disarticulations were performed as last stage salvage operations in three patients, who expressed satisfaction with the results, even though some problems with balance and recurrent ulceration persisted.

Rehabilitation of Hemicorporectomy Amputee:A Case Report / 中国康复理论与实践

@#Objective To investigate the rehabilitation of pelvis disarticulation amputees.Methods A case report.Results and Conclusion Rehabilitation engineering,assisted with physical therapy,can rebuild hemicorporectomy amputees' standing and walking ability,make them look as normal as possible,help them return to the society.