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

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

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

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

Ruta integral de atención en salud para personas con amputaciones de miembro inferior, para mejorar el funcionamiento y la calidad de vida / Integral pathway of health care for people with lower limb amputations, to improve the functioning and quality of life / Rota abrangente de cuidados de saúde de pessoas com amputações de membros inferiores, para melhorar o funcionamento e qualidade de vida

Resumen Objetivo: Presentar el estudio mediante el cual se construyó una ruta integral de atención en salud (RIAS) para la atención del paciente amputado de miembro inferior por causas traumática, vascular o diabetes mellitus, cuyo fin es implementar las recomendaciones de la Guía de práctica clínica del paciente amputado y garantizar la atención integral en salud de esta población en Colombia. Con la ruta se pretende orientar a los actores involucrados en la ejecución de intervenciones individuales para el diagnóstico, el tratamiento y la rehabilitación, e impactar en los desenlaces en salud y equidad de esta población. Metodología: Este estudio responde a una estrategia de mejoramiento de la atención en salud. Para esto, se revisó el Manual metodológico para la elaboración e implementación de las RIAS; se creó el grupo desarrollador de la ruta; se priorizaron y describieron las intervenciones en función del proceso continuo de atención en salud; se evaluó la práctica asistencial actual con grupos focales de pacientes y profesionales; se formularon los resultados esperados en el proceso de gestión y atención en salud (hitos), y se elaboró el diagrama de la ruta. Resultados: A partir de la Guía de práctica clínica se elaboraron 25 intervenciones individuales priorizadas y caracterizadas según el actor responsable, la población objetivo y el entorno. Para cada una de las intervenciones se presentan resultados esperados en salud, calidad de prestación de servicios, aspectos relacionados con la equidad, y la perspectiva de pacientes y actores involucrados con la atención. Se construyeron los indicadores para el seguimiento e implementación de la ruta. Conclusión: Se construyó la primera ruta integral de atención en salud del paciente con amputación de miembro inferior, de acuerdo con los lineamientos del manual del Ministerio de Salud y de la Protección Social.

Abstract Objective: Build an Integral Health Care Pathway for the care of patients with lower limb amputation due to traumatic, vascular or diabetes mellitus causes, in order to implement the recommendations of the cpg for amputee patients and guarantee comprehensive health care for this population in Colombia. Methodology: This study is a strategy to improve health care. Carried out by a review of the Methodological Manual for the Development and Implementation of Comprehensive Health Care Pathway, then the development group was created. A process of prioritization and description of required individual interventions was developed based on health care. Evaluation of current care practice with focus groups, formulation of milestones and development of the intervention diagram. Results: 25 individual interventions were prioritized and characterized according to the responsible actor, target population and environment. Expected results in health, quality of service delivery, issues related to equity, as well as the perspective of patients and actors involved with care are shown. Indicators were built for monitoring and implementation of the pathway. Conclusion: With the previous results, the first Integral Health Care Pathway for the Lower Limb Amputee Patient was developed. It intends to guide the actors involved, when executing individual interventions for the diagnosis, treatment and rehabilitation, to impact outcomes in health and equity of this group .

Resumo Objetivo: Construir uma Rota de Atenção Integral à Saúde do Paciente Amputado do Membro Inferior por causas traumáticas, vasculares ou diabetes mellitus, com a finalização de implementar as recomendações do gpc do paciente amputado e garantir a atenção integral na saúde desta población em Colômbia. Metodologia: Este estudo responde a uma estratégia para melhorar os cuidados de saúde. Foi realizada uma revisão do Manual Metodológico para o Desenvolvimento e Implementação de Rotas Integrais de Atenção à Saúde, criação do grupo de desenvolvimento da rota. Um processo de priorização e descrição das intervenções individuais necessárias foi desenvolvido com base na continuidade dos cuidados de saúde. Avaliação da prática assistencial atual com grupos focais, formulação de marcos e desenvolvimento do diagrama de intervenção. Resultados: 25 intervenções individuais foram priorizadas e caracterizadas de acordo com o ator responsável, população-alvo e ambiente. Determinação dos resultados esperados em saúde, qualidade da prestação de serviços, questões relacionadas a equidade, bem como a perspectiva de pacientes e atores envolvidos no atendimento. Foram construídos indicadores para o monitoramento e implementação da rota. Conclusão: Com os resultados anteriores, foi construída a primeira Rota de Atenção Integral à Saúde do paciente com amputação de membros inferiores por causas traumáticas e neurovasculares, com sua implementação, visando orientar os atores envolvidos na execução de intervenções individuais para a diagnóstico, tratamento e reabilitação, impactar os resultados em saúde e eqüidade dessa população.

Brain functional connectivity in lower limb amputees / 中国康复理论与实践

@#Objective To investigate the changes of functional brain connectivity over multiple frequency bands in resting-state electroencephalography (EEG) for lower limb amputation patients. Methods Resting-state EEG was collected from 18 lower limb amputees and 22 healthy controls from November, 2020 to June, 2021. Functional connectivity matrix was constructed with phase-locked values (PLV), and compared between groups. Results The functional connectivity was weaker in the amputees than in the controls on α band (t = 3.433, P = 0.001) and β band (t = 3.806, P = 0.001), and there was no significant difference on δ band (t = 1.429, P = 0.161) and θ band (t = 1.211, P = 0.233). Conclusion EEG functional connectivity weakens in lower limb amputees in on the α and β band, which results in neuroplasticity of multiple brain regions, not only for limb-respond cortex, but also for frontal, temporal and occipital cortices.

Effect of lower limb amputation level on aortic hemodynamics: a numerical study / 生物医学工程学杂志

It has been found that the incidence of cardiovascular disease in patients with lower limb amputation is significantly higher than that in normal individuals, but the relationship between lower limb amputation and the episodes of cardiovascular disease has not been studied from the perspective of hemodynamics. In this paper, numerical simulation was used to study the effects of amputation on aortic hemodynamics by changing peripheral impedance and capacitance. The final results showed that after amputation, the aortic blood pressure increased, the time averaged wall shear stress of the infrarenal abdominal aorta decreased and the oscillatory shear index of the left and right sides was asymmetrically distributed, while the time averaged wall shear stress of the iliac artery decreased and the oscillatory shear index increased. The changes above were more significant with the increase of amputation level, which will result in a higher incidence of atherosclerosis and abdominal aortic aneurysm. These findings preliminarily revealed the influence of lower limb amputation on the occurrence of cardiovascular diseases, and provided theoretical guidance for the design of rehabilitation training and the optimization of cardiovascular diseases treatment.

A five years retrospective study of factors influencing outcome of major lower limb amputations

Background: The word amputation is derived from Latin -Amputare - to cut away. The amputation is indicated when the limb is considered as dead limb/ deadly limb/ dead loss limb. Often cases are referred to tertiary centre late, resulting in complications which requires surgical management. Aim of the study was to compare the outcomes of major lower limb amputations and to identify risk factors associated with mortality and morbidity following major lower limb amputations.Methods: A retrospective observational study was done for 5 years between January 2014 to November 2019, comprising 276 patients undergoing major lower extremity amputations. Adult patients undergoing lower extremity amputations for ischemic, infected or gangrenous lower limb were included and patients who underwent amputations for trauma or tumours were excluded. The data regarding comorbidities, postoperative complications, outcome of major lower limb amputations were evaluated.Results: 276 patients underwent lower limb amputations (above knee amputations (AKA)-127, below knee amputations (BKA)-134, forefoot amputations-15). Male patients outnumbered females (6.7:1) and most of them were of elderly age group (mean age 60.56 years). The most common indications for amputations in our study were peripheral vascular disease (120), diabetes (87), necrotizing fasciitis (37). The 1 year mortality rates following lower limb amputations in our study were 14% (BKA) and 34% (AKA).Conclusions: Lower limb amputations are associated with high mortality rates. Mortality can be expected in both the early and the late postoperative periods and is most probably related to serious comorbidities, such as renal and heart disease, rather than the level of amputation.

Lower Limb Amputations- A Necessary Evil- An Observational Study from a North Indian Tertiary Care Hospital

Limb loss to amputation is a major problem especially in developing countries where majority of the cases are preventable. It is a burden, not just for the patient, but also for their care givers which imposes tremendous financial and psychological burden upon them. The aim was to outline the patterns, indications and complications of lower limb amputations among patients admitted to MMIMSR, Mullana, Ambala, India, which is a tertiary care centre.METHODSThis was a prospective, observational study that was conducted at MMIMSR, Ambala, for a period of 18 months. 50 patients underwent lower limb amputations in our hospital during the study period.RESULTSThe age ranged between 23 to 85 years. Males outnumbered females by a ratio of 4.5:1. Toe disarticulations were the most common. Diabetes mellitus (DM) was the most common cause (62%) followed by Non-DM peripheral vascular disease (PVD) (22%). Two patients expired in the post-operative period. Infection of the stump was the most common local complication in the post-operative period. Hospital stay ranged from 6 days to 40 days.CONCLUSIONSAlthough trauma is still the most common cause of lower limb amputations (LLA) in the developing nations, amputations for complications of diabetes is on the rise and may be the leading aetiology in future. Diabetic gangrene followed by PVD were the common causes of amputation in our settings. The study shows that most of the causes are potentially avoidable. Community health education programmes that are primarily focussing on road safety measures, early presentation to the physician and good diabetic control are pivotal to decrease the incidence of amputations for preventable indications.

Tumor de células gigantes en el antebrazo / Forearm giant cell tumor

RESUMEN El tumor de células gigantes se define como un tumor óseo benigno que invade las partes blandas localmente de forma agresiva. Se presenta una paciente con un tumor de células gigantes recidivante en el tercio distal del radio derecho, con signos de necrosis superficial e infección sobreañadidos, la cual, dada la magnitud y severidad de la lesión, requirió una amputación supracondílea de la extremidad. Presentó una evolución postoperatoria favorable, con recuperación física y psicológica(AU)

ABSTRACT Giant cell tumor is defined as a benign bone tumor that aggressively invades soft tissue locally. We present a patient with a recurrent giant cell tumor in the distal third of the right radius, showing signs of superimposed necrosis and infection, which, given the injury magnitude and severity, required supracondylar amputation of the limb. Her postoperative evolution was favorable, and this patient underwent physical and psychological recovery(AU)

RÉSUMÉ La tumeur à cellules géantes est définie comme une tumeur osseuse bénigne qui envahit agressivement les parties molles locales. Une patiente atteinte de tumeur récidivante à cellules géantes au niveau du tiers distal du radius droit, avec signes de nécrose superficielle et d'infection surajoutés, laquelle a requis une amputation supracondylienne du membre, due à la magnitude et à la sévérité de la lésion, est présentée. Elle a montré une évolution postopératoire favorable, avec une bonne récupération physique et psychologique.

Patrón de decisión quirúrgica en la prescripción de amputaciones con escala MESS en fracturas de tibia expuesta grado III-B Gustilo-Anderson / Surgical decision pattern in the prescription of MESS-scale amputations in tibia fractures exposed grade III-B Gustilo-Anderson

Resumen: Introducción: El manejo de la extremidad severamente traumatizada continúa siendo materia de debate. Las fracturas de tibia III-B de Gustilo-Anderson tienen un amplio espectro de variantes, no hay guías mediante esta clasificación para un manejo. MESS ha demostrado asociación funcional y pronóstica. Objetivo: Identificar el patrón de decisión por parte de los cirujanos para la prescripción de amputaciones en fracturas de tibia expuesta grado IIIB Gustilo-Anderson con escala MESS. Material y métodos: Es un estudio descriptivo, observacional, prospectivo, transversal y analítico. Se evaluaron 131 ortopedistas de un centro de referencia de patología traumática, quienes con uso de la escala MESS evaluaron 10 casos clínicos representativos de fracturas de tibia expuesta grado III-B de Gustilo-Anderson presentados en dispositivo electrónico. Se evaluó la concordancia de las decisiones entre cirujanos que laboran y expertos. Se realizó análisis inferencial mediante χ2 (p < 0.05) de las variables del estudio: experiencia del cirujano, postgrados académicos, práctica clínica frecuente de amputaciones, concordancia de las decisiones con escala MESS con respecto al patrón de prescripción obtenido por expertos. Resultados: No se encontró asociación entre las variables con la aplicación de MESS (χ2 = 1.28, p = 0.2575). Los cirujanos de más de 10 años incrementaron una vez la posibilidad de coincidir con el resultado de expertos (OR = 2.088, IC 95%) (p = 0.0066). Conclusión: Las variables como postgrados académicos, experiencia quirúrgica y práctica clínica frecuente no influyen en la correcta aplicación de la escala MESS. Los cirujanos de más de 10 años de experiencia incrementaron al doble la posibilidad de una decisión precisa.

Abstract: Introduction: The management of severely traumatized extremity continues to be a matter of debate. Gustilo-Anderson tibial fractures III-B have a wide spectrum of variants, there are no guidelines using this classification for management. MESS has demonstrated functional and prognostic association. Objective: To identify the pattern of decision made by surgeons for the prescription of amputations in tibial fractures exposed grade III-B Gustilo-Anderson with MESS scale. Material and methods: This is a descriptive, observational, prospective, transversal, analytical study. One hundred thirty-one orthopedists from a traumatic pathology referral center were evaluated, using the MESS scale to evaluate 10 representative clinical cases of Gustilo-Anderson grade III-B tibial fractures presented in an electronic device. The concordance of the decisions between working surgeons and experts was evaluated. Inferential analysis was performed using the χ2 (p < 0.05) of the study variables: surgeon experience, academic postgraduate studies, frequent clinical practice of amputations, concordance of decisions with MESS scale with respect to the prescription pattern obtained by experts. Results: There was no association between the variables, with the application of MESS. (χ2 = 1.28, p = 0.2575). Surgeons of more than 10 years, increased once the possibility of matching the result of experts (OR = 2.088, 95% CI) (p = 0.0066). Conclusion: Academic degrees, surgical experience, and frequent clinical practice do not influence the correct application of the MESS scale. Surgeons with more than 10 years of experience have doubled the possibility of a precise decision.

Advance in Neural Plasticity of Cerebral Motor Cortex for Upper-limb Amputee (review) / 中国康复理论与实践

Nerve conduction block, proprioceptive loss and phantom limb pain after amputation may result in brain plasticity. In addition, the mirror neuron system of amputees plays an important role in their learning ability. However, there are few studies on adaptability of the motor cortex in upper limb amputees, and the central mechanism of motor control and learning of the residual limb or prosthesis needs more studies.

Stepwise Rehabilitation of the Triple Amputee Combined With Dysfunction of the Sound Limb

To find a multiple amputee more severe than a triple amputee is not easy. This is a report of a 36-year-old patient with right knee disarticulation, left trans-femoral amputation and right elbow disarticulation due to peripheral ischemic necrosis, when he was applied vasopressor in septic shock condition. His left hand was also 2nd, 3rd, 4th, and 5th distal interphalangeal joint disarticulation status, and it was more difficult for him to do rehabilitation program, such as donning and doffing the prostheses. For more efficient rehabilitation training program, we first focused on upper extremities function, since we believed that he might need a walking aid for gait training later. After 13 weeks of rehabilitation program, he has become sit to stand and walk short distance independently with an anterior walker. Although he still needs some assistance with activities of daily living, his Functional Independence Measure score improved from 48 to 90 during the course of 13 weeks.

Effect of nursing intervention on preoperative anxiety of patients with amputation due to trauma / 中国实用护理杂志

Objective To discuss the nursing intervention effect on reducing anxiety of patients with amputation due to trauma. Methods 30 trauma patients needing amputation were given pertinent nursing intervention according to the psychological problems existing in them by special nurses from admission to operation.Self-rating anxiety scale (SAS)was used to evaluated the anxiety of patients ten minutes after informing them of the operation and ten minutes before the operation.The anxiety level was compared before and after the intervention. Results After the nursing intervention,the level of anxiety was alleviated compared with that on admission. Conclusions Strengthening the nursing intervention can effectively reduce the anxiety level of patients with amputation due to trauma before operation,and improve the initiative and compliance of treatment in patients.

Pseudosindactilia y amputación como principales signos del síndrome de bandas amnióticas / Pseudosyndactyly and amputation as the main features of the amniotic band syndrome

Introducción. Las bandas amnióticas causan un espectro muy amplio de malformaciones fetales, desde labio-paladar hendido e hidrocefalia hasta estrangulación y amputación de extremidades; presenta una prevalencia que va de 1:1,200 a 1:15,000 nacimientos. El siguiente caso clínico se reporta con el objetivo de describir los principales signos del síndrome de bandas amnióticas. Caso clínico. Madre de 21 años, primigesta, con antecedente de vulvovaginitis en el primer trimestre, sin tratamiento; control prenatal irregular sin ultrasonidos obstétricos. El embarazo culminó en cesárea a las 30 semanas por presentar oligohidramnios severo. Se obtuvo producto femenino de 1,200 g y Apgar 7-8. A la exploración física se encontró pseudosindactilia con zona de anillo uniendo a las falanges por el vértice, pie equino varo izquierdo y pierna derecha amputada desde la región tibial media terminando en punta, con escara en porción distal. Además, en estudio radiológico se observaron las falanges del segundo, tercer y cuarto dedos unidas al centro en vértice y peroné hipoplásico. Conclusiones. Los anillos de constricción, la amputación de una o más extremidades y la pseudosindactilia son signos importantes y consistentes que apoyan el diagnóstico del síndrome de bandas amnióticas, con un mal pronóstico para la función aunque bueno para la vida.

Background. Amniotic band syndrome causes a wide spectrum of congenital defects such as cleft lip, hydrocephalus, and growth restriction of limbs, with or without amputation. The condition occurs in every 1:1,200 to 1:15,000 deliveries. The objective of this report is to define the most important features of amniotic band syndrome. Case report. We report the case of a 21 -year-old female with a first pregnancy. No prenatal care or ultrasound studies were carried out, but the patient reported experiencing vaginal discharge during the first trimester. The pregnancy resulted in cesarean section at 30 gestational weeks because of severe oligohydramnios. A 1200-g female was delivered with Apgar 7-8. The newborn presented congenital amputation of the right leg and pseudosyndactyly of the left hand with a ring constriction of the third phalange of the second, third and fourth finger, a left equinovarus foot and amputation of the right leg from the middle third of the tibial region. These findings were confirmed by x-ray. Conclusions. Constriction rings, limb amputation and pseudosyndactyly are important and consistent features with the amniotic band syndrome. Functional prognosis is nonfavorable, but prognosis for life productivity is good.

Advances of residual limb muscle atrophy in biomechanics research / 医用生物力学

Muscle atrophy of the stumps after lower limb amputation has always been a crucial factor resulted in inefficient clinical rehabilitation and athletic recovery for the amputated patients. Therefore, understanding the initiating and developing mechanism of muscle atrophy is very important for the improvement of amputation，restoration training and prosthetic design，which is also widely concerned in the prosthetic rehabilitation field. This paper will review the advances of residual limb muscle atrophy researches on the approaches and models，the mechanical properties of the residual limb，the micro pathologic characteristics as well as the prevention strategies of muscle atrophy in recent years. It can be concluded that further researches are needed to study the special physiologic and mechanical environment in residual limb, which affected the growth of muscle cells as well as the dynamic balance of the muscle protein synthesis and decomposition before completely understanding the mechanism of residual limb muscle atrophy and definitely clarifying its real cause.

Surgical Treatment of Diabetic Foot Disease / 임상당뇨병

Diabetic foot diseases which require surgical treatment consists of diabetic foot ulcer, infection and neuropathic arthropathy. Surgical procedures for diabetic foot ulcers and infections such as drainage, debridement, partial foot amputation and major limb amputation are most common procedures and arthodesis with or without deformity correction can be performed for specific diabetic neuropathic arthropathies. Underlying pathomechanism of diabetic foot disease includes diabetic peripheral neuropathy and vasculopathy. Treating physicians should be aware that concomitant complications of long-standing diabetic status such as cardiovascular and renal dysfunction should be addressed to treat intractable diabetic foot diseases successfully. However, with advent of adjuvant treatment which increases vascular supply on ischemic limb disease, proper surgical treatment on diabetic foot disease can prevent or delay major limb amputations, sustaining functional capability of diabetic patients.

Utilização da safena magna in situ para arterialização do arco venoso do pé / The great saphenous vein in situ for the arterialization of the venous arch of the foot

CONTEXTO: O tratamento da isquemia crítica de membros inferiores sem leito arterial distal pode ser realizado por meio da inversão do fluxo no arco venoso do pé. OBJETIVO: O objetivo deste trabalho foi apresentar a técnica e os resultados obtidos com a arterialização do arco venoso do pé, mantendo a safena magna in situ. MÉTODOS: Dezoito pacientes, dos quais 11 com aterosclerose (AO), 6 com tromboangeíte obliterante (TO) e 1 com trombose de aneurisma de artéria poplítea (TA) foram submetidos ao método. A safena magna in situ foi anastomosada à melhor artéria doadora. O fluxo arterial derivado para o sistema venoso progride por meio da veia cujas válvulas são destruídas. As colaterais da veia safena magna são ligadas desde a anastomose até o maléolo medial, a partir do qual são preservadas. RESULTADOS: Dos pacientes, 10 (55,6 por cento) mantiveram suas extremidades, 5 com AO e 5 com TO; 7 (38,9 por cento) foram amputados, 5 com AO, 1 com TO e 1 com Ta; houve 1 óbito (5,5 por cento). CONCLUSÃO: A inversão do fluxo arterial no sistema venoso do pé deve ser considerada para salvamento de extremidade com isquemia crítica sem leito arterial distal.

BACKGROUND: Critical lower limb ischemia in the absence of a distal arterial bed can be treated by arterialization of the venous arch of the foot. OBJETIVE: The objective of this paper was to present the technique and the results of the arterialization of the venous arch of the foot with the in situ great saphenous vein. METHODS: Eighteen patients, 11 with atherosclerosis (AO), 6 with thromboangiitis obliterans (TO) and 1 with popliteal artery aneurysm thrombosis were submitted to venous arch arterialization. The in situ great saphenous vein was anastomosed to the best donor artery. Arterial flow derived from the venous system progresses through the vein whose valves were destroyed. The collateral vessels of the great saphenous vein are linked from the anastomosis to the medial malleolus and preserved from this point onward. RESULTS: Limb salvage was achieved in 10 (55.6 percent) patients, 5 with AO and 5 with TO. Seven (38.9 percent) patients were amputated, 5 with AO, 1 with TO and 1 with Ta. One (5.5 percent) patient died. CONCLUSION: Arterialization of the venous system of the foot should be considered for the salvage of limbs with critical ischemia in the absence of a distal arterial bed.

Arterialización venosa temporal del pie diabético / Temporal venous arterialization of the diabetic foot

La primera idea que tuvieron los cirujanos (1902) para evitar amputaciones por isquemia fue la de desviar el flujo arterial al sistema venoso por intermedio de una fístula arteriovenosa entre vasos adyacentes, pero con resultados inciertos. Desde entonces se han inventado las simpatecomias, las endarteriectomias y los injertos puentes o bypass y, últimamente, otros avances médicos, quirúrgicos y endovasculares. Sin embargo, en el mundo se siguen haciendo amputaciones, sobre todo en diabéticos. La arterialización de las venas del pie, basada en la vieja idea de la circulación invertida, constituye una esperanza más para estos pacientes ya condenados a la pérdida del miembro. Objetivo: Demostrar que la arterialización de las venas del pie en diabéticos con lesiones neuroisquémicas, generalmente infectadas (pie diabético), es un método eficaz y durable, aunque el puente solo funcione temporalmente. Pacientes y método: De enero de 2000 a febrero de 2009, 59 pacientes con pie diabético fueron tratados por arterialización de las venas del pie...

The first idea of surgeons (1902) to avoid amputations due to ischemia was to deviate the arterial flow to the venous system using an arteriovenous fistula between adjacent vessels; however, the results were unreliable. Since then, sympathectomies, endarterectomies and bypasses have been created, and more recently, other medical, surgical, and endovascular advances have been used. However, amputations continue to be performed worldwide mainly in diabetic patients. The arterialization of the foot veins, based on the old idea of inverted blood flow, is a new possibility for these patients who, otherwise, could lose their limbs. Objective: To demonstrate that arterialization of the foot veins in diabetic patients with neuroischemic lesions, usually infected (diabetic foot), is an effective and long-lasting method, even though the bypass only works temporally. Patients and method: From January 2000 to February 2009, 59 patients with diabetic foot were threated by means of arterialization of the foot veins. An early death was not included in the analysis. Of the 58 remaining patients, 44 were male and 14 were female. Their mean age was 71 years old: (53-91 years). Fifty-four of them were classified as being Fontaine IV and four were IIIB...

Aspectos psicológicos da cirurgia de amputação / The psychological aspects of amputation surgery

O trabalho do psicólogo com pessoas amputadas é crescente, em virtude das questões de saúde da população, tais como o aumento da expectativa de vida e de comorbidades. O objetivo do artigo é apresentar uma revisão da literatura sobre os aspectos emocionais presentes na vida de pacientes submetidos à amputação de membros. Primeiramente foram descritos os tipos de amputações de membros, apontando as causas, incidência e níveis da operação no corpo; em seguida a implicação da relação médico paciente na decisão pela cirurgia; e posteriormente, buscou-se relacionar e discutir os aspectos emocionais relacionados com a amputação através pesquisas e estudos da área. Considera-se que os aspectos emocionais têm destaque no processo de amputação, porém existem lacunas a serem pesquisadas no campo da Psicologia, para o embasamento das intervenções e atuações adequadas às reais demandas nesta área.

The Psychologist’s work with amputees is increasing due to Public Health issues such as an increase in life expectancy and co-morbidities. The objective of this article is to present a review of the available literature related to emotional aspects associated with amputee patients. Firstly the types of limb amputations were described indicating their causes, incidence and the extent of surgery. Secondly the implications of the doctor/patient relationship on the decision to undergo surgery are considered. Finally an attempt is made to relate and discuss the emotional aspects of amputation with reference to research and studies in this area. In consideration of the fact that emotional aspects are given special attention in amputation cases, it is clear that additional psychological research is needs to provide a better basis for interventions and actions, adapting them to actual demands in this field.

Clinical analysis and treatment of poor stumps after lower limb amputation / 中华物理医学与康复杂志

Objective To analyze the cause of poor stumps and to introduce the methods of treatment, so that the rate of poor stump would be decreased. Methods We evaluate 109 cases of lower limb amputees with a total of 110 residual limbs. Evaluation content included: Skin (scars, dermatitis, folliculitis, open wounds, tactile and pain sensation); characteristics of residual limb shape (conical, bulbous, edematous cylindrical); strength of the stump; range of motion of the residual limb; muscle tone; strength of the stump and phantom pain. Results Forty-six cases out of 110 are unqualified. All poor stumps can be fit with the prosthetic through rehabilitation care. Conclusion Poor stumps are those unsuitable for fitting of the prosthetic. Special treatments are required to fit them with prosthetic. Because of the improvement of the prosthetic technology, length of the residual limb is no longer the main obstruction for fitting prosthetic. Instead the skin soft tissue condition of the stump is becoming the main reason of failure in fitting the prosthetic.