Comparative study: Banana-polyester fiber with guava extract (GuaBaNIKA sock) as an alternative to cotton in prosthetic socks / The Health Sciences Journal

INTRODUCTION@#Skin problems are commonly reported by amputees due to perspiration discomfort inside the prosthesis. Cotton is commonly used in prosthetic socks but its properties are not ideal. This study compared the banana-polyester sock dyed with guava extract (GuaBaNIKA) and cotton socks in terms of air permeability, absorbency and antibacterial activity.@*METHODS@#This was a quantitative quasi-experimental study that compared GuaBaNIKA and cotton socks in terms of air permeability, absorbency and antibacterial activity using standard tests. Fibers from banana pseudostem were mixed with polyester, processed into yarn then fabric and dyed with guava leaf extract. Air permeability was analyzed using Mann-Whitney U Test and descriptive analysis was used for absorbency and antibacterial activity.@*RESULTS@#The mean air permeability for GuaBaNIKA was significantly higher than that of cotton (295.5 vs 112.7 cm3/s/cm2). The air permeability scores were higher in GuaBaNIKA in all 10 specimens tested. GuaBaNIKA absorbed water faster than cotton (< 1 vs > 60 seconds). Both GuaBaNIKA and cotton knit socks did not produce a zone of inhibition.@*CONCLUSION@#GuaBaNIKA is more absorbent and permeable than cotton but did not exhibit antibacterial activity. GuaBaNIKA has the potential to be an alternative to cotton in prosthetic socks.

Intra-arterial fibrinolysis for the management of acute ischemia on a below-knee amputation stump. Case report / Fibrinólise intra-arterial para tratamento da isquemia aguda em coto de amputação infrapatelar. Relato de caso

ABSTRACT Preservation of the knee joint has enormous advantages in terms of mobility and rehabilitation of an amputee. Any cause of breakdown requiring revision to an above-knee amputation is a major setback because it reduces the patient's rehabilitative potential. We report a case of intra-arterial thrombolysis use to save a below-knee amputation stump with acute ischemia. A 56-year-old man who sought the emergency department with 1-day history of acute pain on his right below-knee stump. The angiography confirmed popliteal artery occlusion. Pharmacomechanical thrombectomy, with Aspirex (rotational catheter to restore blood flow in occluded vessel, by removing occlusion material from the vessel) and recombinant tissue plasminogen activator, was performed. After 9 years of follow-up the patient remained asymptomatic, capable of independent ambulation with prosthetic limb. Intra-arterial fibrinolysis seems to be a safe and effective treatment for cases of acutely ischemic amputation stump.

RESUMO A preservação da articulação do joelho tem grandes vantagens para a mobilidade e a reabilitação de um amputado. Qualquer causa que exija revisão para uma amputação acima do joelho é um grande revés, porque reduz o potencial de reabilitação do paciente. O objetivo aqui foi descrever o uso de trombólise intra-arterial para salvar um coto de amputação abaixo do joelho com isquemia aguda. Homem, 56 anos, procurou pronto atendimento de nosso hospital com histórico de 1 dia de dor aguda em seu coto de amputação infrapatelar direito. A angiografia confirmou oclusão da artéria poplítea. Foi realizada trombectomia farmacomecânica com Aspirex (cateter rotativo para restabelecer o fluxo sanguíneo em vasos ocluídos, removendo material de oclusão do vaso) e ativador do plaminogênio tecidual recombinante. Após 9 anos de seguimento, o paciente permanecia assintomático, capaz de deambulação independente com membro protético. A fibrinólise intra-arterial parece ser um tratamento seguro e eficaz para casos selecionados de coto de amputação com isquêmica aguda.

A case of cutaneous Arthrinium phaeospermum infection after lower limb amputation / 中华皮肤科杂志

A 59?year?old female patient, who received bilateral lower limb amputation 39 years ago, presented with eczematoid changes in both lower limbs for over 20 years, and with chronic granuloma?like lesions complicated by verrucous hyperplasia for more than 10 years. There were large areas of infiltrative and proliferative lesions with exudation and peripheral erythema at the amputation sites in both knee joints. The lesions were hard with tenderness on palpation. Microscopic examination of lesional scales with 10%KOH showed negative results for fungi. However, three times of culture on the Sabouraud dextrose agar(SDA)medium all grew the same kind of fungus, and the front side and reverse side of its filamentous colony were white and orange yellow respectively. Microculture showed that linear hyaline conidiophores came out from lageniform mother cells with conidia ascending alongside. The conidia looked like dark brown eye lens, with an equatorial germ slit. Based on these findings, this fungus was identified as Arthrinium phaeospermum. Periodic acid?Schiff (PAS) staining showed scattered hyphae in the stratum corneum. The internal transcribe spacer(ITS)sequence of the isolated fungus showed 99%consistency with that of Arthrinium phaeospermum. The patient was diagnosed with cutaneous Arthrinium phaeospermum infection, and treated with oral itraconazole capsules 200 mg/d for 16 days. One month later, follow?up showed satisfactory outcomes.

Reintegração de amputação digital distal com enxerto composto e difusão plasmática ampliada distal no plano dérmico palmar - relato de um caso em criança de 2 anos de idade e revisão da literatura / Reintegration of distal digital amputation with composite graft and plasmatic diffusion expanded distally on the palmar dermal plane - a case report of a 2-year-old child and a literature review

Nas amputações mais distais da ponta dos dedos, o reimplante microcirúrgico pode não ser praticável. Nestes casos, o enxerto composto oferece os melhores resultados funcionais e estéticos, sendo, porém, incerta a sua reintegração. Várias técnicas foram aventadas para melhorar a sobrevida do enxerto volumoso, basicamente diminuindo o seu volume, associando ou não um retalho cutâneo. Outras técnicas criam uma superfície adicional de contato para difusão plasmática, o "bolso subcutâneo", sem diminuir o volume do enxerto composto, com altas taxas de sucesso. O presente artigo apresenta um caso de amputação da ponta distal do dedo mínimo (zona I de Ishikawa) numa criança de 2 anos de idade. Impossível de reimplante microcirúrgico, a reintegração foi feita com enxerto composto do coto amputado, sem desbridamento, e com a criação de uma nova superfície de contato para difusão plasmática, na extremidade distal do coto enxertado, no plano dérmico da região hipotênar, aumentando assim a área de contato e diminuindo a distância radial da difusão plasmática no enxerto composto. Doze dias após, esse contato adicional foi separado e ambas as superfícies apresentaram sangramento. A reintegração foi total, com mínimas cicatrizes no dedo e na região hipotênar. Uma breve revisão bibliográfica foi feita e discutidos os conceitos cirúrgicos, assim como os fatores que influenciam na sobrevida do enxerto composto. Na área receptora, o plano anatômico mais adequado e melhor vascularizado, para o contato adicional com o enxerto, necessita ser determinado.

In more-distal amputations of the fingertips, microsurgical replantation is not feasible. For these cases, composite graft provides the best functional and aesthetic results. However, its reintegration is uncertain. Several techniques have been proposed to improve bulky graft survival by basically reducing its volume, regardless of whether a skin flap is connected. Other techniques create an additional contact surface for plasmatic diffusion, the so-called subcutaneous pocket, without reducing the composite graft volume and yielding high success rates. This article presents a case of amputation of the distal tip of the fifth digit (Ishikawa zone I) of a 2-year-old child. Because of the impossibility of microsurgical replantation, a composite graft was used to reintegrate the amputated stump, without debridement, by creating a new contact surface for plasmatic diffusion at the distal end of the grafted stump, on the dermal plane in the hypothenar region, thereby increasing the contact area and decreasing the radial distance for the plasmatic diffusion of the composite graft. Twelve days later, the additional contact was separated and both surfaces presented bleeding. Full reintegration occurred with minimal scarring of the finger and hypothenar region. A brief literature review was conducted, discussing surgical concepts and factors that influence composite graft survival. The most appropriate and best vascularized anatomic plane for additional contact with the graft in the recipient area needs to be determined.

Outcomes of Ultrasound-Guided Extracorporeal Shock Wave Therapy for Painful Stump Neuroma

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma. METHODS: Thirty patients with stump neuroma at the distal end of an amputation site were assigned randomly to the ESWT group (n=15) and the transcutaneous electrical nerve stimulation (TENS)+desensitization+pharmacological treatment group (n=15). For 3 weeks, the ESWT group received a weekly session involving 1,500 pulses at 0.10 mJ/mm2, while the control group was treated 10 times each, 40 minutes per day with TENS and desensitization treatment, and daily medication for 3 weeks. ESWT stimulation was given by focusing on the area at the neuroma site clearly identified by ultrasound. RESULTS: The changes in the McGill pain questionnaire were 38.8+/-9.0 prior to treatment and 11.8+/-3.1 following the treatment. The corresponding values for the control group were 37.2+/-7.7 and 28.5+/-10.3. The changes between groups were significantly different (p=0.035). The change in visual analog scale prior to and after treatment was 7.0+/-1.5 and 2.8+/-0.8 in the ESWT group, respectively, and 7.2+/-1.4 and 5.8+/-2.0 in the control group. These changes between the groups were also significantly different (p=0.010). The outcome in the pain rating scale also showed significant differences between groups (p0.05). CONCLUSION: The study findings imply that ESWT for stump neuroma is superior to conventional therapy.

Avaliação pré e pós protética da circunmetria dos cotos de amputados transtibiais / Pre-and post prosthetic transtibial stump circumference

O edema no coto é umas das complicações mais comuns após uma amputação e pode ser reduzido com o enfaixamento elástico, sendo controlado por medidas da circunmetria, utilizando-se fita métrica. A protetização precoce e a prevenção de contraturas são prioridades na reabilitação. Objetivo: Avaliar as medidas da circunmetria do coto de amputados transtibiais, após o período pré-protetização e pós-protetização. Método: Foram incluídos sete pacientes amputados transtibiais, com média de idade de 54 anos. Foram consideradas três medidas da circunmetria: medida 1 (durante a avaliação da Fisiatria), medida 2 (no 1º dia com prótese - período pré-protetização) e medida 3 (após 12 semanas de uso de prótese - período Pós-Protetização). Resultados: Os dados mostraram a variação das medidas da circunmetria dos cotos dos pacientes, tanto no período pré-protetização, como no pós-protetização. Conclusão: O período pré-protetização, com o uso de enfaixamento elástico e realização de exercícios, assim como o pós-protetização, com o treino de marcha com prótese, são capazes de alterar a circunmetria do coto. Sugere-se a confecção de uma prótese provisória até a estabilização das medidas do coto para posteriormente confeccionar a prótese definitiva.

Stump's edema is one of the most common complications after amputation and can be reduced wearing elastic bandages, being controlled by circumference measurements using a tape measure. Early prosthetic fitting and prevention of contractures are priorities in the rehabilitation. Objective: To evaluate the circumference measurements of the stump of transtibial amputees, before and after prosthetic periods. Method: Seven patients with transtibial amputation and an average of 54 years old were included in the study. We considered three measures of circumference: measure 1 (during the evaluation of the Physiatry), measured 2 (on the first day with prosthesis - Pre-fitting period), and measured 3 (after 12 weeks using prosthesis - Post-fitting period). Results: The data showed variation on circumference measurements of the stumps on both Pre-fitting and Post-fitting periods. Conclusion: The Pre-fitting period, with the use of elastic bandages and exercises, as well as the Post-fitting, with gait training with prosthesis, are able to change the stump circumference. We suggest creating a temporary prosthesis until the measurements of the stump are stabilized for further fabricate the definitive prosthesis.

A study of rehabilitation of the non ideal stumps impairing prosthesis dressing / 中国康复理论与实践

@#Only by dressing the prosthesis can they play their compensatory functions for the amputees.The effectiveness of the compensatory is closely related to the condition of the stumps.Because of the complications,it is impossible to dress prosthesis to some stumps.This paper is a studying discussion on the rehabilitation of the non ideal stumps impairing prosthesis dressing,which of the 81 cases among the 164 amputees hospitalized in China Rehabilitation Research Center during the last 8 years.The paper advances the conception of the non ideal stumps impairing prosthesis dressing;the categories of non ideal stumps and their impairment to the prosthesis dressing and the principle and methods of the rehabilitation and the improvement of the making of the prosthesis and the method of the operations. To improve the conditions of the non ideal stumps,a good and comfortable prosthesis will be dressed.The compensatory functions will be satisfactorily played.