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1.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367130

ABSTRACT

Introducción: Las lesiones en las manos causadas por amoladora son comunes y generalmente ocurren en adultos jóvenes. En países en desarrollo, el ámbito doméstico y el trabajo informal son los escenarios más frecuentes. El objetivo de este estudio fue describir factores asociados a las lesiones por amoladora, y cuantificar y clasificar las heridas, según la gravedad y la región anatómica de la mano involucrada. Materiales y Métodos: Se realizó un estudio epidemiológico, retrospectivo. Entre 2016 y 2020, estudiamos a los pacientes con heridas de mano causadas por amoladora. Se analizaron el nivel educativo, la experiencia con la herramienta, el material cortado, el uso de equipo de protección personal, la edad y el sexo. Para determinar el patrón de las lesiones se realizó un análisis clínico-anatómico y radiológico detallado e individualizado. La gravedad fue evaluada con el Hand Injury Severity Score. Resultados: Se evaluó a928 pacientes (920 hombres y 8 mujeres, edad promedio 42 años). Solo el 22,4% usaba equipo de protección personal en el momento del accidente. El 84,5% (776 casos) realizaba tareas inusuales para la que esta herramienta no fue diseñada. La mano más afectada fue la izquierda (62,06%). En 784 pacientes, las heridas involucraban los dedos, el patrón de asociación predominante fue entre el 2do y 3er dedo (54,44%). Las lesiones fueron leves (24,1%), moderadas (41,3%), graves (26%) y mayores (8,6%). Conclusiones: Las lesiones por amoladora pueden resultar devastadoras. Una actualización epidemiológica reforzaría la necesidad de desarrollar métodos preventivos con el fin de disminuir su alta incidencia. Nivel de Evidencia: IV


Introduction: Hand injuries caused by angle grinders are frequent and generally take place among young adults. In developing countries, the domestic and informal work environments are the most frequent places where this could happen. The present study is aimed at describing associated factors to these types of injuries. Lesions were quantified and classified according to the sever-ity and anatomic region of the hand involved. Methods: An epidemiologic, retrospective study was performed between 2016 and 2020. The patients' level of education, previous experience using the machine, use of personal protective equipment (PPE), sex, and age were analyzed. To determine the pattern of the injuries, a clinical-anatomical and a detailed and individualized radiological analysis were performed on each patient. The severity was measured using the "Hand Injury Severity Score" (HISS). Results: 928 patients were studied (920 men, 8 women, average age of 42 years [range 18-67]). Only 22.4% were wearing PPE at the time of the accident. 776 participants were performing tasks for which the tool was not intended (84.5%). The left hand was the most af-fected (60%). In 784 patients, the injuries involved their fingers (84.48%); the predominant pattern was the index and middle finger (55%). According to the HISS, 24.1% were minor injuries, 41.3% were moderate, 26% were serious, and 8.6% were severe. Con-clusions: Injuries caused by an angle grinder can be devastating. We believe that an epidemiological update is likely to increase the need to develop preventive methods to decrease its high incidence. Level of Evidence: IV


Subject(s)
Adult , Tendon Injuries , Accidents, Occupational/statistics & numerical data , Finger Injuries , Hand Injuries , Amputation, Traumatic
2.
Rev. Assoc. Méd. Rio Gd. do Sul ; 65(2): 01022105, Abr. - Jun. 2021.
Article in Portuguese | LILACS | ID: biblio-1367437

ABSTRACT

RESUMO Introdução: Os acidentes de trânsito tornaram-se um problema de saúde pública. As amputações de membros são uma complicação grave, principalmente entre os motociclistas. Objetivo: Estudar a tendência histórica e o impacto dos acidentes de transporte com motocicletas que evoluíram com amputação de membro, no período 2008 a 2014, na região Sul do Brasil, com análise da tendência temporal das ocorrências desses acidentes, sua gravidade e sua correlação com a evolução da frota de motocicletas e automóveis. Métodos: Pesquisa observacional de tipo ecológica tendo como fonte de dados o Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH- -SUS), com análise de tendência temporal das taxas de amputações em acidentes motociclísticos no período. Resultados: Evidenciou-se que 28,36% dos amputados por acidentes de trânsito na região Sul no período ocorreram por acidentes de motocicleta, sendo que o estado de Santa Catarina contribuiu com 45,66% deste total. Na região Sul, 83,11% dos amputados eram do sexo masculino, a faixa etária dos 20-29 anos foi a mais acometida, com o dobro de risco de amputação quando comparado às demais faixas. Membros inferiores representaram 64,59% da taxa total de amputações, além de apresentar um risco 444% maior de evoluir para óbito. Houve variação média anual positiva de 0,15 amputações/1.000.000 habitantes nos três estados no período estudado. Conclusão: Os números demonstram a relevância do tema abordado e a necessidade de medidas de prevenção, visto que os acidentes graves de trânsito acometem a população jovem, do sexo masculino, economicamente ativa, provocando prejuízos sociais e econômicos significativos. PALAVRAS-CHAVE: Amputação traumática, motocicletas, acidentes de trânsito


ABSTRACT Introduction: Traffic accidents have become a public health problem. Limb amputations are a serious complication, especially among motorcyclists. Objective: To study the historical trend and impact of transport accidents involving motorcycles that evolved with limb amputation, in the period 2008-2014, in southern Brazil, analyzing the temporal trend of the occurrence of these accidents, their severity and their correlation with the evolution of the motorcycle and car fleet. Methods: An ecological observational study using the Hospital Information System of the Brazilian National Health System (SIH-SUS) as a data source, with analysis of the temporal trend of amputation rates in motorcycle accidents in the period. Results: We found that 28.36% of amputees due to traffic accidents in the South region in the period occurred due to motorcycle accidents, and the state of Santa Catarina contributed with 45.66% of this total. In the South region, 83.11% of amputees were male, the 20-29 age group was the most affected, with twice the risk of amputation as compared to the other groups. Lower limbs accounted for 64.59% of the total rate of amputations, in addition to presenting a 444% higher risk of progressing to death. There was a positive mean annual variation of 0.15 amputations/1,000,000 inhabitants in the three states in the period studied. Conclusion: The numbers demonstrate the relevance of the topic addressed and the need for preventive measures, as serious traffic accidents affect the young, economically active male population, causing significant social and economic damage. KEYWORDS: Traumatic amputation, motorcycles, traffic accidents


Subject(s)
Humans , Motorcycles , Accidents, Traffic , Amputation, Traumatic
3.
Rev. cuba. angiol. cir. vasc ; 22(1): e296, ene.-abr. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1251679

ABSTRACT

Introducción: La enfermedad arterial periférica de miembros inferiores se considera un problema de salud por presentar elevadas tasas de morbi-mortalidad y de amputaciones no traumáticas. En ocasiones se desconoce su presencia en los adultos de la población general. Objetivo: Evaluar mediante pesquiza la presencia de la enfermedad arterial periférica de miembros inferiores en personas mayores de 50 años de la población. Métodos: Estudio descriptivo y analítico en 235 personas mayores de 50 años de diferentes municipios de la capital. El diagnóstico de la enfermedad arterial se realizó por examen físico y estudio hemodinámico. Se analizaron variables sociodemográficas y algunos factores de riego cardiovasculares. Se trabajó con un nivel de confiabilidad del 95 por ciento. Resultados: Predominaron el sexo femenino (68,1 por ciento), la piel blanca (53,2 por ciento) y el grupo etáreo entre 50 y 69 años (68,1 por ciento). Hubo mayor frecuencia de la enfermedad en el sexo masculino (70,5 por ciento). El 55,7 por ciento presentó macroangiopatía diabética. Las prevalencias encontradas para la enfermedad arterial periférica y para los factores de riesgo fueron de 51,9 por ciento y de 91,5 por ciento, respectivamente. El 64,7 por ciento de las personas presentaban tres o más factores. La hipertensión (χ 2 = 23,66; p = 0,0000; OR: 3,88) y la obesidad (χ 2 = 8,74; p < 0,001; OR: 1,38) estuvieron asociadas con la enfermedad arterial periférica. Conclusiones: Las personas mayores de 50 años de edad, del sexo masculino y con más de tres factores de riesgo tienen un riesgo elevado de presentar una enfermedad arterial periférica de miembros inferiores(AU)


Introduction: Lower limb peripheral artery disease is considered a health problem because it has high rates of morbidity-mortality and non-traumatic amputations. Its presence in adults in the general population is sometimes unknown. Objective: Assess by investigation the presence of peripheral artery disease of lower limbs in people of the population over 50 years. Methods: Descriptive and analytical study in 235 people over 50 years from different municipalities of the capital. The diagnosis of arterial disease was made by physical examination and hemodynamic study. Sociodemographic variables and some cardiovascular risk factors were analyzed. The reliability level was of 95 percent. Results: Female sex (68.1 percent), white skin (53.2 percent) and the age group between 50 and 69 years (68.1 percent) predominated. There was a higher frequency of the disease in the male sex (70.5 percent). 55.7 percent had diabetic macroangiopathy. The prevalences found for peripheral artery disease and risk factors were 51.9 percent and 91.5 percent, respectively. 64.7 percent of people had three or more factors. Hypertension (χ 2 = 23.66; p = 0.0000; OR: 3.88) and obesity (χ 2 = 8,74; p < 0,001; OR: 1,38) were associated with peripheral artery disease. Conclusions: People over 50 years of age, males and with more than three risk factors have a high risk of developing peripheral lower limb artery disease(AU)


Subject(s)
Humans , Male , Female , Lower Extremity , Peripheral Arterial Disease , Amputation, Traumatic
4.
Infectio ; 25(1): 55-58, ene.-mar. 2021.
Article in Spanish | LILACS, COLNAL | ID: biblio-1154403

ABSTRACT

Resumen La infección del muñón después de amputaciones traumáticas tiene una prevalencia hasta del 34%. Las bacterias más frecuentemente aisladas son Staphylococcus aureus, Enterobacterales como Escherichia coli; Pseudomonas aeruginosa, entre otras. Estas infecciones ocurren por la inoculación directa en el momento del trauma o por gérmenes nosocomiales; la realización de curaciones de las heridas con emplastos vegetales es una práctica aún frecuente en zonas rurales de nuestro país pero su relación con infección del sitio operatorio ha sido poco explorada en la literatura. Leuconostoc spp. es un coco Gram positivo encontrado en territorio agrícola y utilizado en la industria de alimentos. Se presenta un caso de infección de un muñón transfemoral por Leuconostoc, después de una amputación traumática del miembro inferior en una paciente previamente sana con una posible asociación a curaciones con emplastos vegetales.


Abstract Infection of a traumatic amputation stump has a prevalence of 34%. The most common bacteria isolated are Staphylococcus aureus, Pseudomonas aeruginosa and Enterobacterales such as Escherichia coli. These infections occur by direct inoculation in the moment of the trauma or by nosocomial germs. Infections secondary to manipulation of the wounds with vegetable plasters have few case reports in the literature. Leuconostoc spp. is a Gram-positive coccobacillus commonly found in agricultural territory and used in the food industry. There are few case reports in the literature about bone infections by Leuconostocs pp. We present a case of an infection of the operative site of a transfemoral stump by Leuconostoc spp. after a traumatic amputation of the lower limb in a previously healthy patient who had a possible association to cures with vegetable plasters.


Subject(s)
Humans , Female , Adult , Amputation, Traumatic , Infections , Osteomyelitis , Surgical Wound Infection , Review Literature as Topic , Cocos , Leuconostoc
5.
Rev. cuba. angiol. cir. vasc ; 21(3): e175, sept.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156381

ABSTRACT

Introducción: La diabetes mellitus es la causa más importante de amputaciones no traumáticas en el mundo. El pronóstico de riesgo de amputación resulta vital para el tratamiento óptimo de los pacientes hospitalizados con pie diabético. Objetivo: Caracterizar las variables con valor pronóstico de amputación en pacientes hospitalizados con diagnóstico de pie diabético. Método: Se realizó un estudio analítico longitudinal prospectivo en el período desde diciembre de 2015 hasta diciembre de 2017, con una muestra constituida por 77 pacientes. Las variables recogidas fueron edad, sexo, resultados hemoquímicos al ingreso, co-morbilidad, control glucémico y amputaciones realizadas, estos dos últimos durante la estadía hospitalaria. Se hizo inclusión de las variables con asociación significativa en un análisis univariado (p < 0,05) en un modelo de regresión logística múltiple para evaluar su asociación independiente. Se determinaron los valores predictivos positivos, negativos, y el grado de sensibilidad y especificidad. Resultados: Los indicadores pronósticos resultantes del análisis de las variables fueron el índice leuco-hematocrito (p = 0,045), el nivel de albúmina en sangre (p = 0,004), la glicemia a mitad del ingreso (p = 0,045) y la glicemia al ingreso (p = 0,039). El índice leuco-hematocrito, menor de 6 al ingreso, se relacionó con una especificidad de 92 por ciento; la albúmina, menor de 29,9 g/L, presentó un valor predictivo positivo de 71 por ciento; la glicemia al ingreso, mayor de 21,5 mmol/L, mostró una sensibilidad de 75 por ciento; y la glicemia a mitad del ingreso, mayor de 12,9 mmol/L, manifestó una sensibilidad de 71 por ciento. Conclusiones: La evolución a la amputación de los pacientes ingresados por pie diabético se relaciona con el estado inflamatorio crónico, el estado nutricional y el control glucémico(AU)


Introduction: Diabetes mellitus is the most important cause of non-traumatic amputations in the world. The prognosis of amputation risk is vital for the optimal treatment of patients hospitalized with diabetic foot disease. Objective: Characterize variables with amputation´s prognostic value in hospitalized patients diagnosed with diabetic foot disease. Method: A prospective longitudinal analytical study was conducted in the period from December 2015 to December 2017, with a sample consisting of 77 patients. The variables collected were age, sex, hemochemical results upon admission, co-morbidity, glycaemic control and amputations performed, the latter two during the hospital stay. Variables with significant association were included in a one-variety analysis (p < 0.05) in a multiple logistic regression model to evaluate their independent association. Positive, negative predictive values, and the degree of sensitivity and specificity were determined. Results: The prognosis indicators resulting from the analysis of the variables were the leuko-hematocrit index (p = 0.045), the level of albumin in blood (p = 0.004), the glycaemia at the mid-time of the stay (p = 0.045) and the glycaemia at the admission time (p = 0.039). The leuko-hematocrit index, in less than 6 patients at admission time, was related to a specificity of 92 percent; albumin, in less than 29.9 g/L, had a positive predictive value of 71 percent; glycaemia at admission time, higher than 21.5 mmol/L, showed a sensitivity of 75 percent;and glycaemia at mid-time of the stay, higher than 12.9 mmol/L, showed a sensitivity of 71 percent. Conclusions: The evolution to amputation of patients admitted due to diabetic foot is related to chronic inflammatory state, nutritional state and glycaemic control(AU)


Subject(s)
Humans , Male , Female , Diabetic Foot , Diabetes Mellitus , Amputation/methods , Amputation, Traumatic/surgery
6.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(3): 246-253, ago. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1352327

ABSTRACT

Presentamos a un paciente que sufrió una amputación traumática de la falange distal del 5to dedo de su mano izquierda, y fue tratado mediante un reimplante sin anastomosis venosa. En el mismo acto quirúrgico, se le realizó una artrodesis definitiva con clavijas. La cirugía se efectuó con anestesia troncular del dedo, por lo cual no se requirió de un anestesista ni fue necesario un tiempo adecuado de ayuno. Debido a la localización distal de la amputación y a la ausencia de una vena dorsal viable para ser anastomosada, se optó por un drenaje venoso controlado mediante la extracción de la placa ungueal, el frotado del lecho ungueal y la colocación periódica (cada 3 h, por 7 días) de una gasa impregnada con heparina. Además, el paciente fue anticoagulado con enoxaparina 40 mg y ácido acetilsalicílico cada 24 h, por 21 días. El reimplante fue exitoso. Nivel de Evidencia: IV


We present a patient who experienced a traumatic amputation of his left fifth finger distal phalanx, and was treated using replantation without venous anastomosis. The same surgical procedure also included a final arthrodesis with Kirschner wires. Surgery was performed with digital block anesthesia, which did not require the presence of an anesthesiologist nor fasting. The distal level of the amputation and the lack of viable options for dorsal vein anastomosis motivated our decision for venous drainage controlled by nail-plate removal, nail-bed scrubbing and periodic (every 3 hours during 7 days) dressing with heparin-impregnated gauze. In addition, the patient received anticoagulant therapy with aspirin and enoxaparin 40 mg every 24 hours for 21 days. The replantation procedure was a success. Level of Evidence: IV


Subject(s)
Adult , Replantation , Finger Injuries/surgery , Amputation, Traumatic , Anesthesia, Local
7.
Rev. cuba. cir ; 58(2): e645, mar.-jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1093165

ABSTRACT

RESUMEN La amputación traumática completa se define como la separación total de un segmento del miembro del resto del cuerpo. El segmento cercenado algunas veces se puede reconectar, siempre que ambas partes de la extremidad hayan sido correctamente tratadas y se cumplan determinadas condiciones. Se presentan dos casos de amputación traumática de ambos miembros inferiores: el primero, una paciente femenina de 49 años de edad, debido a un accidente de trabajo y, el segundo, un paciente masculino de 39 años, víctima de un accidente en las vías férreas. Se expone la sintomatología presentada por ambos pacientes, su tratamiento quirúrgico y evolución(AU)


ABSTRACT Complete traumatic amputation is defined as the total separation of a limb segment from the rest of the body. The severed segment can sometimes be reconnected, provided that both parts of the limb have been correctly treated and certain conditions are met. Two cases of traumatic amputation of both lower limbs are presented: the first, a female patient of 49 years of age, due to an accident at work; and the second, a male patient of 39 years, victim of a railroad accident. The symptoms presented by both patients, their surgical treatment and evolution are exposed(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Accidents, Occupational , Lower Extremity/injuries , Amputation, Traumatic/surgery
8.
Rev. bras. ciênc. saúde ; 23(1): 65-72, 2019. tab., ilus.
Article in Portuguese | LILACS | ID: biblio-1009157

ABSTRACT

A amputação é uma perda física e psíquica. A pessoa amputada precisa se adaptar a nova forma de vida. Objetivo: O presente estudo teve como objetivo avaliar o impacto da estratégia de enfrentamento no processo de adaptação de pacientes amputados devido a algum trauma (acidente) ou doença. Método: Foram aplicados entrevista semiestruturada, Escala Modo de Enfrentamento de Problemas - EMEP e questionário sociodemográfico no período de agosto a outubro de 2015, no Hospital de Base do Distrito Federal. Realizou-se um estudo quantitativo de corte transversal, com amostra não probabilística por conveniência. Os critérios de inclusão da pesquisa foram todos os pacientes que sofreram amputação por trauma ou doença, com condições cognitivas de participar da pesquisa e que aceitaram participar. Resultados: Dos 31 entrevistados, 9,7% sofreram amputação por trauma e 90,3% por doença. Foram considerados mal adaptados ao tratamento 12,9% dos entrevistados. A amostra encontrada foi dividida em dois grupos em relação ao seu modo de enfrentamento, a saber: a) enfrentamento focalizado no problema e b) práticas religiosas/pensamento fantasioso. Conclusão: A análise dos achados sugere uma não associação entre estratégias de enfrentamento e adaptação, dada a não variação nas estratégias de enfrentamento encontradas. Não foi possível concluir se não existe diferença quanto à estratégia de enfrentamento de pacientes amputados por trauma ou por doença. (AU)


Introduction: Amputation is a physical and psychological loss. The amputated person needs to adapt to a new way of life. Objective: The present study aimed to evaluate the coping strategy impact into the adaptation process of the amputated patient due to trauma (accident) or disease. Methods: Semi-structured interview, Ways of Coping Scale and sociodemographic questionnaire were applied during August, September and October of 2015 in the "Hospital de Base of Distrito Federal" and performing a quantitative cross-sectional study, with a non-probabilistic sample by convenience. The inclusion criteria of the research were all of the patients who suffered amputation due to trauma or disease, with cognitive conditions to participate in the research and who accepted to participate. Results: Among the 31 participants, 9,7% suffered amputation due to trauma and 90.3% due to a disease. Only 12.9% of the participants were considered ill-adapted to the treatment. The sample found was divided into two groups in relation to their mode of coping, namely: a) problem-focused and b) religious practices/fantasy thinking. Conclusion: The analysis of the findings suggests no association between coping strategies and adaptation, given the non-variation in coping strategies encountered. It was not possible to conclude that there is no difference in the coping strategy of patients amputated due to trauma or illness. (AU)


Subject(s)
Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Amputation, Traumatic/prevention & control , Rehabilitation/psychology
9.
Article in English | WPRIM | ID: wpr-762006

ABSTRACT

PURPOSE: The clinical characteristics and results of femoropopliteal artery injury (FPAI) remain unclear. In this study, we evaluated the outcomes and risk factors of limb loss in patients treated for FPAI. MATERIALS AND METHODS: We retrospectively reviewed data from a database of patients who underwent revascularization for an FPAI at a single institution between January 2013 and December 2017. We reviewed and analyzed the characteristics, postoperative results, and factors that influence amputation rates. RESULTS: Twenty-four femoropopliteal arterial reconstructions in 24 patients were included in this study. Among the patients were 20 (83.3%) male with a first-quartile age of 28 years and a third-quartile age of 45 years (range, 15–68 years). The mean injury severity score (ISS) was 16 (range, 4–55), and 5 patients (20.8%) had ISSs of >20 points. The mean mangled extremity severity score (MESS) was 3.8 (range, 1–11), and 8 patients (33.3%) had MESSs of >5 points. In terms of arterial reconstruction methods, autogenous saphenous vein grafting, vein patching, and primary closure were performed in 9 patients (37.5%), 4 patients (16.7%), and 11 patients (45.8%), respectively. Despite arterial reconstruction, 5 patients (20.8%) underwent above-knee amputation. ISSs of >20, MESSs of >7, and orthopedic fixation were statistically significant factors associated with amputation. CONCLUSION: In cases of FPAI with ISSs of >20, MESSs of >7, and orthopedic fixation, amputations should be considered. We were also careful to attempt limb salvage in such cases.


Subject(s)
Amputation , Amputation, Traumatic , Arteries , Extremities , Femoral Artery , Humans , Injury Severity Score , Limb Salvage , Lower Extremity , Male , Orthopedics , Popliteal Artery , Retrospective Studies , Risk Factors , Saphenous Vein , Transplants , Vascular System Injuries , Veins
10.
Rev. colomb. ortop. traumatol ; 33(3-4): 108-114, 2019. ilus.
Article in Spanish | LILACS, COLNAL | ID: biblio-1377876

ABSTRACT

Introducción Las amputaciones traumáticas del pulgar representan un pequeño pero devastador porcentaje de consulta de urgencias. Se presenta aquí la experiencia de un caso de pulgarización de índice como manejo reconstructivo en una amputación compleja de pulgar de la mano dominante en un niño de 10 años. El objetivo es reportar el proceso quirúrgico de pulgarización del índice como alternativa reconstructiva en la amputación traumática de pulgar y analizar los resultados obtenidos. Materiales y métodos Reporte de un caso de amputación traumática de pulgar el cual se reconstruyó tomando como base la técnica de pulgarización descrita por Buck-Gramko, modificada por el equipo quirúrgico para obtener los resultados requeridos en anatomía, funcionalidad y estética. Paciente evaluado a los 6 meses postquirúrgicos con excelentes resultados medidos a través de la escala Percival Hand Score para funcionalidad del pulgar obteniendo el puntaje máximo de calidad superior a 20 puntos. Se recuperaron las funciones de pinza fina y prensión cilíndrica de la mano con independencia para movilidad de flexo-extensión, aducción y oposición del pulgar en más del 90% de su capacidad. Discusión La pulgarización del índice es una alternativa quirúrgica importante para el manejo de las amputaciones traumáticas de pulgar, por los excelentes resultados que se obtienen en cuanto a funcionalidad, anatomía y estética.


Background Traumatic amputation of the thumb is an uncommon injury but nevertheless a devastating one, and represents a small percentage of emergency visits. The aim of this study is to present the experience of index finger pollicisation as a complex reconstructive management for a thumb amputation of the dominant hand in a 10-year-old patient, as well performing an analysis of the functional results. Case Report A 10-year-old patient with traumatic amputation of thumb had a surgical reconstruction of the injury by using an index finger pollicisation technique as described by Buck-Gramcko and modified by the senior author in order to achieve the results required in anatomy, functionality, and aesthetics. Excellent results, measured by Percival Hand functionality thumb Score, were obtained 6 months after the surgery, with a maximum score of 20 points (higher quality). Pincer grip and cylindrical hand grip skills were recovered as well as flexion, extension, adduction, and opposition of the thumb for an overall rate 90% when compared with an uninjured thumb. Discussion Index finger pollicisation is important for the management of traumatic thumb amputation due to the excellent results obtained in terms of functionality, aesthetics, and anatomy, and should always be considered as a surgical alternative.


Subject(s)
Humans , Thumb , Amputation, Traumatic , Reconstructive Surgical Procedures , Index
11.
Article in English | WPRIM | ID: wpr-762641

ABSTRACT

OBJECTIVE: To study factors associated to the quality of life in a North African sample of lower limbs amputees. METHODS: We conducted a prospective study in the Department Physical Medicine and Rehabilitation, University Hospital of Monastit, Tunisia. A consecutive sample of patients with amputations of the lower limbs was included. The evaluated parameters were quality of life using the Short-Form quality-of-life questionnaire (SF-36), pain using a visual analog scale, function using, the perimeter of walking (PW), the Special Interest Group of the Amputee Medicine (SIGAM) and the Locomotion Capacities Index of the Prosthetic Profile of the Amputee (LCI), and psychological status thanks to the Hospital Anxiety and Depression scale. In the study, the patients were evaluated at the first consultation (T0) and again at 12 months (T1). RESULTS: We included 85 patients (age, 59.3±16.7 years) with a sex ratio of 3. The patient quality of life was positively correlated to distal type of amputation, traumatic origin, better LCI (p≤0.001, r=0.349), SIGAM (p=0.046) and PW. A negative correlation was noted with age (p=0.012, r=−0.483) and higher psychological scores (p=0.002, r=−0.321). CONCLUSION: In our sample of North African lower limbs amputees the age and the functional status were the most important predictors of the quality of life.


Subject(s)
Amputation , Amputation, Traumatic , Amputees , Anxiety , Depression , Humans , Locomotion , Lower Extremity , Physical and Rehabilitation Medicine , Prospective Studies , Prostheses and Implants , Public Opinion , Quality of Life , Sex Ratio , Tunisia , Visual Analog Scale , Walking
12.
Cambios rev. méd ; 17(2): 78-82, 28/12/2018. ilus
Article in Spanish | LILACS | ID: biblio-1005250

ABSTRACT

INTRODUCCIÓN. Las lesiones catastróficas del miembro superior han sido lesiones devastadoras que afectaron a muchas estructuras esenciales como la mano, antebrazo, brazo y órganos adyacentes, que casi siempre conducen a una incapacidad significativa, de forma directa o mediante el impacto psicosocial que se relacione con la ausencia o atrofia de miembros. OBJETIVO. Demostrar la versatilidad y efectividad del uso del colgajo paraescapular para cubrir defectos severos postraumáticos en un miembro superior catastrófico. Así como, dar a conocer resultados de una amputación digital que preserve la mayor funcionalidad de la mano. CASO CLINICO. Paciente masculino de 37 años, que sufrió quemadura eléctrica de alto voltaje de tercer grado del 30,0% de superficie corporal total. Se realizó tratamiento con colgajo paraescapular para defecto axilar y amputación digital funcional en manos. RESULTADOS. Al quinto mes postquirúrgico se evidenció todos los movimientos conservados en la extremidad superior sin retracción a nivel axilar. Tras la rehabilitación se consiguió conservar en las manos gran porcentaje de fuerza prensil y motricidad fina. DISCUSIÓN. El colgajo paraescapular permitió una reconstrucción temprana y definitiva del defecto extenso, mejorando la funcionalidad de la extremidad superior derecha. La amputación digital preservó una máxima longitud funcional, permitiendo una curación rápida de las heridas, disminuyendo costos y estancia hospitalaria. CONCLUSIÓN. El colgajo paraescapular brindó cobertura a defectos de hombro y axila que permitió recuperar todos los ángulos de movilidad de la extremidad afectada, sin retracción de la piel. La amputación funcional de rayos en la mano admitió conservar fuerza prensil y motora, mejorando la calidad de vida.


INTRODUCTION. Catastrophic injuries of the upper limb have been devastating injuries that affected many essential structures such as the hand, forearm, arm and adjacent organs, which almost always lead to a significant disability, directly or through the psychosocial impact that is related to the absence or atrophy of members. OBJECTIVE. Prove the versatility and effectiveness of the use of the paraescapular flap to cover severe post-traumatic defects in a catastrophic upper limb. As well as, present results of a digital amputation that preserves the greatest functionality of the hand. CLINICAL CASE. A 37 year old male patient, who suffered a third degree high voltage electrical burn of 30,0% of total body surface area. Treatment was performed with paracapular flap for axillary defect and functional digital amputation in hands. RESULTS. By the fifth postoperative month, all movements preserved in the upper extremity without retraction at the axillary level were evident. After the rehabilitation it was possible to keep in the hands a great percentage of prehensile strength and fine motor skills. DISCUSSION. The paraescapular flap allowed an early and definitive reconstruction of the extensive defect, improving the functionality of the right upper extremity. The digital amputation preserved a maximum functional length, allowing a quick healing of the wounds, reducing costs and hospital stay. CONCLUSION. The paraescapular flap provided coverage for shoulder and axilla defects, which allowed recovery of all the angles of mobility of the affected limb, without retraction of the skin. The functional amputation of rays in the hand allowed conserving prehensile and motor strength, improving the quality of life.


Subject(s)
Humans , Male , Adult , Surgical Procedures, Operative , Surgical Flaps , Wounds and Injuries , Burns, Electric , Upper Extremity , Amputation, Traumatic , Mortality , Disabled Persons , Sick Leave
13.
Rev. bras. ortop ; 53(2): 200-207, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-899252

ABSTRACT

ABSTRACT Objective: To assess the homodigital flap surgical procedure, as well as the function of the finger, pain, sensation, esthetics, and patient satisfaction. Method: Retrospective analysis of records and questionnaires of patients who underwent this surgical technique between the months of May 2013 and October 2016. Eight were included in the study, with an average follow-up period of 23 months. Patients with digital pulp lesions of the thumbs and those who did not perform rehabilitation were excluded. All underwent the two-point discrimination test, the Semmes-Weinstein test, and range of motion evaluation. The age varied from 22 to 59 years (average of 32.9), six (75%) being male patients. Results: Three patients (37.5%) had involvement of the right hand and five of the left (62.5%). Regarding the etiology, seven suffered injury and one a chemical burn. The average distance obtained from the two-point discrimination test was 7.3 mm. All patients who underwent the Semmes-Weinstein test obtained response to the purple filament. The average sum of the range of motion of the affected digit was 98.9%. The flap area was on average 294.4 mm2. The return to work averaged seven weeks. A positive Tinel sign was found in the donating area and two reported intolerance to cold. Partial or total necrosis of the flap was not observed. Conclusion: The homodigital flap technique presented satisfactory esthetics and functional results regarding feasibility, sensation, and digital mobility in pulp lesions.


RESUMO Objetivo: Avaliar o procedimento cirúrgico de retalho homodigital, bem como a função do quirodáctilo, a dor, a sensibilidade, a estética e a satisfação do paciente. Método: Análise retrospectiva de prontuários e questionários de pacientes submetidos a essa técnica entre maio de 2013 e outubro de 2016. Oito pacientes foram incluídos no estudo, com uma média de seguimento de 23 meses. Foram excluídos os pacientes com lesões de polpa digital em polegares e os que não fizeram reabilitação. Todos os pacientes fizeram os testes de discriminação entre dois pontos, Semmes-Weinstein, e avaliação do arco de movimento. A idade variou entre 22 e 59 anos (média de 32,9), seis (75%) eram do sexo masculino. Resultados: Três pacientes (37,5%) tiveram acometimento da mão direita e cinco (62,5%), da esquerda. Com relação à etiologia, sete sofreram lesão traumática e um sofreu queimadura química. A distância média obtida no teste de discriminação entre dois pontos foi de 7,3 mm. Todos os pacientes submetidos ao teste Semmes-Weinstein obtiveram resposta ao filamento de cor roxa. A média da somatória do arco de movimento do dígito acometido foi de 98,9%. A área do retalho foi em média de 294,4 mm2. O retorno ao trabalho foi em torno de sete semanas. Um apresentou sinal de Tinel positivo na área doadora e dois referiram intolerância ao frio. Não se observou necrose parcial ou total do retalho. Conclusão: A técnica do retalho homodigital apresentou resultados estéticos e funcionais satisfatórios quanto à viabilidade, sensibilidade e mobilidade digital em lesões da polpa.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Amputation , Amputation, Traumatic , Fingers/surgery , Surgical Flaps
14.
Fisioter. Bras ; 19(S4): f:3-l:4, 2018.
Article in Portuguese | LILACS | ID: biblio-948751

ABSTRACT

Introdução: As amputações de origem traumática, que é responsável por 10,6% das amputações em membros inferiores, tem incidência maior nos sujeitos antes dos 50 anos de idade, em conseqüência de fraturas expostas, contaminação severa da ferida, lesões tipo esmagamento que levam a necrose progressiva do músculo ou lesões de reconstrução incapacitante [1]. O trauma, característico nas amputações de membro inferior, corresponde a uma lesão ocorrida no terreno vásculo-ortopédico e de forma combinada, na maioria das vezes [2]. Um dos principais focos da reabilitação de indivíduos amputados de membros inferiores é o restabelecimento da marcha, funcional e independente, sob a utilização de uma prótese para compensar, se possível, a funcionalidade perdida. A utilização da prótese em conjunto à reabilitação tem o intuito de devolver ao paciente, o ortostatismo e a capacidade de deambular [3]. A presença de fatores de risco cardiovasculares pode justificar e até mesmo explicar grande parte das doenças do sistema cardíaco [4]. A literatura nos relata maior demanda metabólica ao andar após a amputação transtibial, porém as pesquisas concentram-se em indivíduos amputados por causa vascular [5]. Objetivo: Avaliar a aptidão cardiorrespiratória do amputado de causa traumática e sua predisposição a doenças coronarianas. Material e métodos: Estudo de natureza quantitativa, de delineamento experimental do tipo transversal, sendo o grupo formado por três pacientes amputados transtibiais unilateral de causa traumática, emparelhados em sexo, idade e Índice de Massa Corporal. O estudo foi realizado com pacientes do Serviço de Reabilitação Física da UNISC- Universidade de Santa Cruz do Sul, no Laboratório de Atividade Física e Saúde da universidade. Os sujeitos responderam ao questionário de risco coronariano, proposto pela Michigan Heart Association (2003), que é formado por uma tabela contendo oito fatores de risco, sendo eles idade, hereditariedade, peso corporal, tabagismo, sedentarismo, hipercolesterolemia, hipertensão arterial e gênero. Cada fator de risco possui seis opções de resposta. Toda resposta equivale a um escore que representa o risco coronariano relativo àquele fator. A soma dos escores obtidos nas respostas dos oito fatores corresponde a uma pontuação, que representa o risco ao desenvolvimento de doença caronariana. A classificação desse risco é realizada pela comparação da pontuação obtida no questionário com a tabela de classificação formulada pela própria Michigan Heart Association (2003). A classificação do risco coronariano é definida como: bem abaixo da média (06-11 pontos); abaixo da média (12-17 pontos); médio (18-24 pontos); moderado (25-31 pontos); alto (32-40 pontos); e muito alto (41-62 pontos). Posterior realizaram teste ergométrico em esteira sob protocolo de Bruce modificado, sendo obtidos seus volumes máximos de oxigênio. Resultados: A média de idade dos pacientes foi 22,6 anos. O paciente A apresentou aptidão cardiorrespiratória regular, e os pacientes B e C apresentaram aptidão fraca e muito fraca. Em relação à recuperação da FC no primeiro minuto após o teste, o paciente B não apresentou resultados esperados. Ao analisar o índice de oxigênio consumido pelo miocárdio, este necessitou de maior trabalho cardiovascular (6270 mmHg.bpm), quando comparado aos pacientes A e C, respectivamente, 3190 mmHg.bpm e 3570 mmHg.bpm. Conclusão: Houve um aumento da predisposição ao desenvolvimento de doenças coronarianas para os amputados participantes, mesmo estes sendo de causa traumática. (AU)


Subject(s)
Humans , Male , Female , Adult , Amputation, Traumatic , Oxygen Consumption , Wounds and Injuries , Cardiovascular Diseases
15.
Cad. Saúde Pública (Online) ; 34(5): e00007517, 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-889986

ABSTRACT

Resumo: O setor elétrico brasileiro registra elevados índices de mortalidade por acidentes de trabalho que vêm sendo associados à terceirização, introduzida como forma de rebaixamento de custos. Para diminuir o tempo de interrupção do fornecimento de energia aos consumidores, o setor adotou, como solução tecnológica, o religador automático. Essa medida apresenta características perversas para os trabalhadores de manutenção. O objetivo deste estudo é analisar origens e consequências de acidentes de trabalho em sistemas elétricos dotados de religador automático utilizando o Modelo de Análise e Prevenção de Acidentes (MAPA). O MAPA foi usado na investigação de dois acidentes de trabalho visando a explorar as origens organizacionais dos eventos. Caso 1 - ao trocar linha secundária desenergizada, um trabalhador foi atingido por cabo primário energizado (13,8kV). O sistema foi religado três vezes, agravando as lesões (amputação de membro inferior). Caso 2 - acidente de trabalho fatal ocorrido durante instalação de cruzeta nova, em linha energizada, parcialmente isolada. A extremidade de uma mão francesa metálica encostou na linha secundária energizada e eletrocutou o operador de manutenção. O componente desligador do religador automático não funcionou. As análises contribuem para desvelar como a lógica de gestão de negócios pode participar nas origens de acidentes de trabalho via falhas da gestão de manutenção, da gestão de força de trabalho de terceiras e, em especial, da gestão de segurança em sistemas dotados de religadores. As decisões pela automação para garantir a distribuição de energia não podem negligenciar os riscos aos trabalhadores da rede elétrica e, tampouco, deixar de reconhecer a importância do controle sobre as condições de segurança.


Abstract: The Brazilian electricity sector has recorded high work-related mortality rates that have been associated with outsourcing, used to cut costs. In order to decrease the power outage time for consumers, the industry adopted the automatic circuit recloser as the technical solution. The device has hazardous implications for maintenance workers. The aim of this study was to analyze the origins and consequences of work accidents in power systems with automatic circuit recloser, using the Accident Analysis and Prevention (AAP) model. The AAP model was used to investigate two work accidents, aimed to explore the events' organizational origins. Case 1 - when changing a deenergized secondary line, a worker received a shock from the energized primary cable (13.8kV). The system reclosed three times, causing severe injury to the worker (amputation of a lower limb). Case 2 - a fatal work accident occurred during installation of a new crosshead on a partially insulated energized line. The tip of a metal cross arm section strap touched the energized secondary line and electrocuted the maintenance operator. The circuit breaker component of the automatic circuit recloser failed. The analyses revealed how business management logic can participate in the root causes of work accidents through failures in maintenance management, outsourced workforce management, and especially safety management in systems with reclosers. Decisions to adopt automation to guarantee power distribution should not overlook the risks to workers in overhead power lines or fail to acknowledge the importance of ensuring safe conditions.


Resumen: El sector eléctrico brasileño registra elevados índices de mortalidad por accidentes de trabajo, que están siendo asociados a la tercerización, introducida como forma de reducción de costes. Para disminuir el tiempo de interrupción de la energía a los consumidores, el sector adoptó como solución tecnológica, el reconectador automático. Esta medida presenta características perversas para los trabajadores del sector de mantenimiento. El objetivo de este estudio es analizar los orígenes y consecuencias de los accidentes de trabajo en sistemas eléctricos dotados de reconectador automático, utilizando el Modelo de Análisis y Prevención de Accidentes (MAPA). El MAPA se usó en la investigación de dos accidentes de trabajo, con el objetivo de explorar las causas organizativas de los eventos. Caso 1 - al cambiar la línea secundaria sin energía, un trabajador fue alcanzado por un cable primario con energía (13,8kV). El sistema se reconectó tres veces, agravando las lesiones (amputación de miembro inferior). Caso 2 - accidente de trabajo fatal ocurrido durante la instalación de una cruceta nueva, en una línea con energía, parcialmente aislada. La extremidad de una cruceta metálica cayó en la línea secundaria con energía y electrocutó al obrero de mantenimiento. El componente que desconectaba el reconectador automático no funcionó. Los análisis contribuyen a desvelar cómo la lógica de gestión de negocios puede ser partícipe en las causas de accidentes de trabajo, vía fallos en la gestión del mantenimiento, de la gestión de fuerza de trabajo de terceras personas y, en especial, de la gestión de seguridad en sistemas dotados de reconectadores. Las decisiones de la automatización para garantizar la distribución de energía no pueden obviar los riesgos para los trabajadores de la red eléctrica y tampoco dejar de reconocer la importancia del control sobre las condiciones de seguridad.


Subject(s)
Humans , Male , Accidents, Occupational/prevention & control , Contract Services/statistics & numerical data , Electric Injuries/mortality , Electric Injuries/prevention & control , Electric Wiring , Electricity , Brazil , Accidents, Occupational/mortality , Accidents, Occupational/trends , Safety Management/standards , Fatal Outcome , Accident Prevention/standards , Amputation, Traumatic
16.
S. Afr. j. surg. (Online) ; 56(4): 4-8, 2018. tab
Article in English | AIM, AIM | ID: biblio-1271031

ABSTRACT

Background: Significant mortality and morbidity occur after major lower limb amputation for diabetes-related footcomplications and peripheral arterial disease. Risk factors for atherosclerosis and medical comorbidities are common in amputation for diabetes-related foot complications and are major determinants of outcome. Conversely, the effect of post-hospitalisation circumstances on outcome has not been systematically studied. We hypothesised that poor socioeconomic circumstances after discharge would have an adverse effect on the outcome of major amputation in a developing country.Objectives: To determine the association of the status of post discharge socioeconomic circumstances on the outcome of dysvascular amputation. Methods: This was a prospective cohort study. Patients scheduled for major dysvascular lower limb amputation were recruited. Data were collected regarding the socioeconomic circumstances to which patients would be discharged, such as housing, income and personal care. Patients were followed up at our hospital, at clinics and later telephonically for three years. Mortality and wound morbidity were documented. Association of differences in status of socioeconomic factors and outcomes was analysed statistically.Results: Ninety nine patients were enrolled. Eight patients died in hospital and 91 were discharged. The socioeconomic circumstances of discharged patients were relatively favourable, the majority living in brick houses (92%) with running water (87%). Most patients had a regular income (86%), more than half had state/government grants. The availability of co-habitants, care givers and accessible medical facilities was also favourable. None of the different socioeconomic status levels demonstrated an effect on morbidity or mortality, all associations having a p-value greater than 0.05 (Chi-squared Fisher's exact and Spearman's rank correlation tests).Conclusion: No association between socioeconomic status factors and post-discharge outcome of amputees was demonstrated. This is probably because the dysvascular amputees in this study cohort were living in relatively favourable circumstances


Subject(s)
Amputation, Traumatic/mortality , Diabetes Mellitus/mortality , Patients , South Africa
17.
Ethiop. med. j. (Online) ; 56(2): 1-6, 2018.
Article in English | AIM, AIM | ID: biblio-1262003

ABSTRACT

Introduction: Limb amputation in pediatric age group is relatively infrequent compared to adults and is often associated with profound social, psychological and economic impacts on the growing child and family. There is few published literature specifying the cause of limb amputation in pediatrics in Ethiopia. The aim of this study is to determine the cause and patterns of paediatric limb amputation at 'Tikur Anbessa' specialized hospital and make recommendations towards reducing the incidence.Methods: This was a retrospective study conducted at 'Tikur Anbessa' Specialized teaching Hospital between May 2005 and April 2015. Data were retrieved from medical records and operation logbook of all pediatric patients aged 15 years and below who underwent limb amputations during the study period. Information regarding age, sex, indications and levels of amputation were studied.Results: A total number of 99 patients with 102 amputations were involved in the study. Their age ranged between 4 and 15 years with mean age of 10.5 ( SD ±3.2) years. There were 75 boys and 24 girls (male: female ratio=3.1:1). The most common indication for limb amputation was gangrene arising from treatment of limb injuries by traditional bone setters, locally called "Wogeshas" (55.5%), followed by malignancy (29.2%) and trauma (11.1%). An intractable bone and soft tissue infection accounted only for 2% of the amputations (2). Three limb amputations in one patient and two in another one were due to a condition with unclear vascular etiology resulting in multiple gangrenous limbs. Majority of the amputations were in the upper limbs.Conclusion: Traditional bone setters' practice related gangrene, late presenting musculoskeletal malignancy and trauma were the three most common causes for pediatric limb amputation in Ethiopia. Given that, all are non-communicable conditions, we can conclude that the majority of the amputations could have been prevented by provision of health education, early presentation and appropriate treatment in a modern health facility


Subject(s)
Amputation, Traumatic/etiology , Amputation, Traumatic/prevention & control , Ethiopia , Medicine, Traditional , Pediatrics
18.
Article in French | AIM, AIM | ID: biblio-1264181

ABSTRACT

L'amputation d'un membre pelvien compromet l'une des grandes fonctions motrices de l'homme qu'est la marche. Et plus le niveau d'amputation est proximal, plus importantes sont les difficultés fonctionnelles. Objectif : Etudier la qualité de vie des amputés trans-fémoraux, appareillés à Cotonou. Méthode : Etude transversale à visée descriptive et analytique, ayant consisté à revoir en Janvier et Février 2013, les amputés trans-fémoraux suivis et appareillés au CNHU-HKM de Cotonou, de 2003 à 2012, soit 10 ans plus tôt. Après examen clinique du moignon et de la prothèse, la qualité de vie de ces patients a été évaluée grâce au Medical Outcome Study Short Form 36 (MOS SF36). Résultats : Les patients ont été surtout des hommes (76%), âgés de 12 à 77 ans avec une moyenne de 40,56 ans. Leur revenu mensuel moyen a été de 61000F CFA. L'amputation a été surtout à gauche (70%), complication de traumatisme (78%), de diabète (10%) ou d'infection (10%). La prothèse leur a été confectionnée depuis 35,54 mois en moyenne et 88% en ont été satisfaits. La qualité de vie des sujets a été excellente (30%), très bonne (66%). Elle a été influencée par l'âge des patients. Conclusion : La qualité de vie des amputés trans-fémoraux de notre étude apparaît encourageante pour la plupart des patients. Cela semble discordant au vu du bas niveau de développement économique de notre pays qui devrait influencer la qualité de l'appareillage. La solidarité africaine n'a-t-elle pas aussi eu une part importante dans le déterminisme de la qualité de vie de ces patients ?


Subject(s)
Amputation, Traumatic , Amputees , Benin , Joint Prosthesis , Patients , Quality of Life
19.
Arch. pediatr. Urug ; 88(5): 269-273, oct. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-887792

ABSTRACT

Resumen Introducción: el uso de fuegos artificiales y dispositivos de pirotecnia forma parte de celebraciones y espectáculos públicos en todo el mundo. En Uruguay, su uso se encuentra concentrado en los meses estivales en eventos públicos y privados. Hay normativas para su uso, la importación y venta está regulada. En el verano de 2014-2015 hubo cuatro niños con lesiones graves de mano producidas por explosivos. Todas en circunstancias similares, compartieron el mismo mecanismo lesional y vinculados a un único dispositivo. En el año 2016 hubo más niños con iguales injurias. Objetivo: comunicar una serie de niños con injurias provocadas por un tipo de explosivo de pirotecnia con un patrón diferente al conocido previamente. Resultados: n=6. Todos varones, cinco adolescentes. Los seis presentaron lesiones severas en manos con amputación de uno o varios dedos, determinando secuelas estéticas y funcionales. Discusión: se identifica los dispositivos con alto contenido en pólvora y el mal uso de los mismos como factores asociados a las lesiones graves de mano. Se realizó una campaña desde la Sociedad Uruguaya de Pediatría, el Departamento de Emergencia Pediátrica, el Ministerio de Salud y otras autoridades para abordar este problema. Se prohíbe la venta de ese dispositivo. Conclusiones: la utilización de dispositivos de pirotecnia con alto contenido de pólvora como el megapetardo o superbomba puede determinar lesiones graves de mano, mutilantes y secuelas permanentes. No se recomienda la manipulación de fuegos artificiales por parte de los niños. El cumplimiento de las normativas vigentes y el correcto uso de los mismos podrían contribuir a disminuir estas injurias.


Summary Introduction: the use of fireworks and pyrotechnic devices are ways of public entertainment and celebration around the world. In Uruguay, they are more frequently used during summer-time in public and private events. Usage, import and sales are regulated by law. In summer 2014-2015 four children presented severe hand injuries caused by blasts, all of which occurred under similar conditions, shared the same injury mechanism and were linked to a specific device. In 2016 there were more children with similar lesions. Objective: to report a series of children with hand lesions caused by a certain type of pyrotechnic device with a pattern that was different from the one previously known. Results: n=6. All of them males 5 adolescents. The 6 children studied presented severe lesions in hands with amputation of 1 or several fingers, which resulted in aesthetic and functional sequelae. Discussion: devices with a high dose of gunpowder and their incorrect use are identified as factors associated to severe lesions. The Uruguayan Society of Pediatrics, the Pediatrics Emergency Department and the Ministry of Health, among other authorities, conducted a campaign to address this issue. The sale of this device is prohibited. Conclusions: the use of pyrotechnic devices with a high dose of gunpowder such as mega firecrackers or superbombs can result in severe hand lesions, mutilation and permanent sequelae. The handling of fireworks by children is not recommended. Fulfillment of updated regulations and the correct use of fireworks might contribute to diminishing these injuries.


Subject(s)
Humans , Male , Blast Injuries/prevention & control , Accidents caused by Explosives/prevention & control , Hand Injuries/prevention & control , Amputation, Traumatic/prevention & control
20.
HU rev ; 43(3): 205-210, jul-set 2017.
Article in Portuguese | LILACS | ID: biblio-946589

ABSTRACT

O diabetes mellitus (DM) está associado ao desenvolvimento de complicações macroangiopáticas e microangiopáticas. Sugere-se que o pé diabético seja responsável por até 70% das amputações não traumáticas em membros inferiores. O objetivo foi identificar a frequência de alterações vasculares e neurológicas dos pés em pacientes diabéticos internados. Foi realizado um estudo descritivo transversal em hospital universitário de agosto/2015 a agosto/2016. Os pacientes foram submetidos a exame físico detalhado dos pés com avaliação das sensibilidades protetora plantar, vibratória e dolorosa e pesquisa do reflexo aquileu. Também foram colhidos dados socio-demográficos e de presença de comorbidades. Considerou-se portador de neuropatia quem apresentou perda de dois tipos de sensibilidade, e de vasculopatia quem teve claudicação intermitente ou pulsos com diminuição de amplitude. Dos 76 pacientes examinados, 61,8% do sexo feminino, a média de idade foi 60,7 ± 13,5 anos. Destes, 64,4% apresentavam sobrepeso/obesidade (IMC 28,6 ± 6,3). O tempo de diagnóstico do DM foi de 9,5 anos ± 7,6. Associação com tabagismo estava presente em 47,3% dos pacientes, e com etilismo em 38,1% . A comorbidade mais prevalente foi hipertensão arterial sistêmica, em 80,2%. Alteração na avaliação dos pés mais comum foi diminuição de sensibilidade, presente em 69,7% dos pacientes. Redução de pulsos foi encontrada em 34,2%, e 6,5% dos pacientes eram amputados. 13,2% dos indivíduos estudados apresentavam sinais de vasculopatia e neuropatia associadamente ao exame físico. Não houve diferença entre grupos com vasculopatia e neuropatia em relação ao tempo e controle de DM, e frequencia de complicações crônicas. Alta frequência de alterações neurovasculares foi evidenciada, o que reforçou a importância da avaliação periódica dos pés, visando evitar complicações, piora da qualidade de vida e aumento do custo para saúde pública.


Diabetes mellitus (DM) is associated with the development of macroangiopathic and microangiopathic complications. It is suggested the diabetic foot is responsible for up to 70% of the non-traumatic amputations in the lower limbs. We aimed to identify the frequency of vascular and neurological alterations of the feet in hospitalized diabetic patients. A descriptive cross-sectional study was carried out in a university hospital from August/2015 to August/2016. Patients underwent a detailed physical examination of the feet with evaluation of plantar, vibratory and painful protective sensitivities and aquileu reflex. Socio-demographic data and the presence of comorbidities were also collected. It was considered neuropathy loss of two types of sensitivities, and vasculopathy intermittent claudication and nonpalpable pulses. From 76 patients examined (61.8% female), mean age was 60.7 ± 13.5 years. 49 patients (64.4%) were overweight / obese (BMI 28.6 ± 6.3). The time of DM diagnosis was 9.5 years ± 7.6. 47,3% subjects presented the association with smoking and 38,1% with alcoholism. The most prevalent comorbidity was systemic arterial hypertension(80.2%). The most common change in the assessment of foot was sensitivity reduction, present in 69.7% of patients. Reduction of pulses was found in 34.2%, and 6.5% of the patients had undergone before amputation. 13,2% os the subjects had simultaneous signs of vasculopathy and neuropathy. There was no difference between groups with and without physical examination changes in relation to the time and control of DM, and the frequency of chronic complications. We showed a high frequency of neurovascular changes, which reinforced the importance periodic assessment of feet, aim at avoiding complications which worsen quality of life and increasing public health costs.


Subject(s)
Diabetic Foot , Diabetes Mellitus , Lower Extremity , Amputation , Amputation, Traumatic , Amputees
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