Clinical outcomes of a low-cost single-channel myoelectric-interface three-dimensional hand prosthesis

BACKGROUND: Prosthetic hands with a myoelectric interface have recently received interest within the broader category of hand prostheses, but their high cost is a major barrier to use. Modern three-dimensional (3D) printing technology has enabled more widespread development and cost-effectiveness in the field of prostheses. The objective of the present study was to evaluate the clinical impact of a low-cost 3D-printed myoelectric-interface prosthetic hand on patients' daily life. METHODS: A prospective review of all upper-arm transradial amputation amputees who used 3D-printed myoelectric interface prostheses (Mark V) between January 2016 and August 2017 was conducted. The functional outcomes of prosthesis usage over a 3-month follow-up period were measured using a validated method (Orthotics Prosthetics User Survey–Upper Extremity Functional Status [OPUS-UEFS]). In addition, the correlation between the length of the amputated radius and changes in OPUS-UEFS scores was analyzed. RESULTS: Ten patients were included in the study. After use of the 3D-printed myoelectric single electromyography channel prosthesis for 3 months, the average OPUS-UEFS score significantly increased from 45.50 to 60.10. The Spearman correlation coefficient (r) of the correlation between radius length and OPUS-UEFS at the 3rd month of prosthetic use was 0.815. CONCLUSIONS: This low-cost 3D-printed myoelectric-interface prosthetic hand with a single reliable myoelectrical signal shows the potential to positively impact amputees' quality of life through daily usage. The emergence of a low-cost 3D-printed myoelectric prosthesis could lead to new market trends, with such a device gaining popularity via reduced production costs and increased market demand.

Squamous Cell Carcinoma Arising in an Amputation Stump / 대한피부과학회지

Amputation of the lower extremities followed by the use of an artificial leg is very common. However, malignancy arising in an amputation stump is an extremely rare event. In this report, we describe a case of squamous cell carcinoma arising in the amputation stump of a 56-year-old Korean man. To the best of our knowledge, similar cases have not been previously reported in Korea.

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

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

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

Extracorporeal Shock Wave Therapy For Treatment of Intractable Stump Pain

Amputation stump pains can be developed in amputation sites after high voltage electrical burn injuries. We experienced one case of these severe stump pains in an upper extremity amputation patient. A 35-year-old man had a 38% total body surface area high voltage electrical burn. The patient underwent skin grafting and left shoulder disarticulation. During the rehabilitation period, he complained about severe stump area pains and phantom pains. We injected 0.5% Bupivacaine and Triamcinolone on the stump neuroma site but the pain sustained. After extracorporeal shock wave therapy (ESWT,) the pain subsided and did not recur. The patient was satisfied with functional and pain outcomes, so we report this case.

Plastia del muñón en paciente con neurofibromatosis tipo 1 / Plasma of the wrist in patient with neurofibromatosis type 1

La neurofibromatosis tipo 1 o enfermedad de Von Recklinghausen (NF1) es uno de los desórdenes genéticos heredables más comunes en el hombre. Se presenta el caso de una paciente femenina de 59 años, afecta de neurofibromatosis tipo 1 con antecedentes de amputación supracondílea del miembro inferior izquierdo a la edad de 19 años por elefantiasis, que provocó deformidad total de la extremidad y que acude por presentar deformidad del muñón que le impide ponerse la prótesis para caminar. Se realizaron complementarios y se procedió a realizar la plastia del muñón con evolución favorable. Se presenta este caso por el interés que dimana de su singularidad en la especialidad de Angiología del Hospital Militar Central Dr. Carlos J. Finlay, donde fue necesaria la intervención quirúrgica con resultados favorables en la rehabilitación de la paciente(AU)

Neurofibromatosis type 1 or Von Recklinghausen disease (NF1) is one of the most common hereditary genetic disorders in human. We present the case of a 59 year female patient, affected by neurofibromatosis type 1. She has a history of supracondylar amputation of the lower left limb at age 19 due to elephantiasis, which caused her total limb deformity. She comes for presenting deformity of her stump that prevents her from putting on the prosthesis to walk. Complementary procedures were performed and the stent plasty was performed with favorable evolution. This case is presented by the interest that arises from its singularity in the specialty of Angiology at Dr. Carlos J. Finlay Central Military Hospital, where the surgical intervention was necessary resulting favorably in the patient's rehabilitation(AU)

Bloqueo neurolítico de neuromas recidivantes guiado por ultrasonografía / Neurolytic blockof recurrent neuromas guided by ultrasound

Los neuromas de muñón son causa de dolor intenso de difícil control. El bloqueo neurolítico es una alternativa en el tratamiento, y el uso de la ultrasonografía se impone para garantizar la efectividad del proceder. En este reporte de caso se describe la realización de la neurolisis con alcohol absoluto de varios neuromas recidivantes en un muñón de miembro superior, guiados por ultrasonido, en un paciente con dolor crónico que no resuelve con tratamiento médico.

Stump-neuromas cause difficult deep pain control. Neurolytic block is an alternative treatment, and ultrasound guarantee the certainty of the procedure. This case report describes the realization of neurolysis with total alcohol of various stump-neuromas, guided by ultrasound, in a patient with chronic pain that don´t solve with medic treatment.

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

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

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

Enfermagem frente à reabilitação de pacientes submetidos à amputação / Nursing facing rehabilitation of patients submitted to amputation

Investigar como a enfermagem enfrenta o cuidado ao paciente submetido à amputação de extremidades e quais as ações que contribuem para reabilitação após a alta hospitalar. Método: estudo qualitativo, análise temática. Questões norteadoras: Como a enfermagem enfrenta o cuidado ao paciente com amputação? Os cuidados durante a hospitalização podem contribuir para reabilitação após a alta hospitalar? Coleta com entrevistas gravadas, com 10 profissionais da equipe de enfermagem de uma rede hospitalar pública, Porto Alegre/RS. Porto Alegre/RS. Resultados: na análise emergiram as duas categorias: características dos pacientes amputados; A equipe de enfermagem frente ao cuidado do paciente amputado. Conclusão: a criação de protocolo sistematizado de atendimento e a revisão do sistema de suporte no pós-alta, pode contribuir para a reabilitação da pessoa amputada.

Investigate how nursing care faces the care to the patient with amputation of the extremities and which actions contribute for the re-habilitation after the hospital discharge. Method: qualitative study and thematic analysis. Guiding questions: How does nursing face the care to the patient with amputation? Can the care given during the hospitalization contribute for the re-habilitation after the hospital discharge? Collection with recorded interviews, signature of free and cleared up consent statements, in October 2011, with 10 professionals of the nursing staff from a public hospital network, Porto Alegre-RS. Results: two categories derived from the analysis: Characteristics of the amputated patients; The nursing staff facing the care to the amputated patient. Conclusion: the creation of a systematized attendance protocol and the revision of the support system in the post-discharge can contribute for the amputated subject re-habilitation.

Investigar como la enfermería enfrenta el cuidado al paciente sometido a amputación de extremidades y las acciones que contribuyen para la rehabilitación tras el alta hospitalaria. Método: estudio cualitativo, análisis temático. Cuestiones orientadoras: ¿Cómo la enfermería enfrenta el cuidado al paciente con amputación? ¿Pueden los cuidados durante la hospitalización contribuir para la rehabilitación tras el alta hospitalaria? Recolección con entrevistas grabadas, firma de declaraciones de consentimientos libres y esclarecidos, en octubre 2011, con 10 profesionales del equipo de enfermería de una red hospitalaria pública, Porto Alegre-RS. Resultados: del análisis surgieron dos categorías: Características de los pacientes amputados; El equipo de enfermería frente al cuidado del paciente amputado. Conclusión: creación de protocolo sistematizado de atendimiento y la revisión del sistema de.

Vacuum sealing drainage combined with free skin graft in repairing cutaneous deficiency of traumatic shank amputation stump / 中国骨伤

<p><b>OBJECTIVE</b>To observe clinical efficacy in treating cutaneous deficiency of traumatic shank amputation stump with full-thickness skin graft combined with vacuum sealing drainage.</p><p><b>METHODS</b>From September 2009 to December 2012, 15 patients with cutaneous deficiency of traumatic shank amputation stump were treated with full-thickness skin graft combined with vacuum sealing drainage. Among patients, there were 11 males and 4 females with an average age of 41.5 (ranged from 25 to 62) years old. Ten cases were caused by traffic accident and 5 cases were caused by heavy object, 9 cases on left and 6 cases on right. Six patients with smashed wound were treated with debridement and amputation, combined with vacuum aspiration in-emergency; 9 patients caused by infection and necrosis were treated with debridement and amputation, combined with vacuum aspiration, and full-thickness skin graft were performed at stage II. The skin defect area of residual limbs ranged from 40 cm x 20 cm to 25 cm x 15 cm.</p><p><b>RESULTS</b>All patients were followed up from 3 months to 1 year. Full-thickness skin graft of residual limbs were survived,and obtained satisfactory walking function with prosthetic. Residual skin increased thicken, wearproof without rupture and pain.</p><p><b>CONCLUSION</b>Full-thickness skin graft combined with vacuum sealing drainage in treating cutaneous deficiency of traumatic shank amputation stump could reserve the length of residual limbs, increase survival rate of skin graft with less scar of survival skin, get good wearability and it is conducive to prosthetic wear. It is a simple and easy treatment method.</p>

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

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

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

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

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

Role of the Surgical Glove in Modified Vacuum-Assisted Wound Healing

Vacuum-assisted wound healing has been proven to be more efficacious than conventional dressings. Vacuum dressing has been frequently modified given the restrictions in resources available. Here we present a modified method of vacuum dressing by using surgical or gynaecological gloves for lower and upper limb wounds. Vacuum dressing was applied with parts of a surgical or gynaecological glove and Opsite with T-tailing of the suction outlet. Vacuum-assisted wound healing using the surgical gloves showed relatively good wound healing in the amputation stump, finger, arm, and leg in the cases studied.

Non-microsurgical technique of fingertip replantation: A report of three cases

The goal of surgery in fingertip amputation is to restore finger length, preserve function and at the same time provide cosmetic acceptability. Treatment options are varied and can range from simple suturing of the stump to microvascular replantation surgery. We report three cases of fingertip amputations in one adult and two pediatric patients treated with non-microsurgical replantation of the fingertip using the palmar "pocket" technique.

Coverage of Electrically Burned Upper Extremity Amputation Stumps by a Pedicled Latissimus Dorsi Flap

PURPOSE: In cases of high voltage electrical burns, a wound occurs as current enters or leaves the body and is accompanied by deep tissue injury. If upper extremity amputation is inevitable, consideration should be given to the residual limb functions, secondary reconstruction, and wearing of an upper prosthesis. Our hospital has achieved satisfactory outcomes through the use of a pedicled latissimus dorsi (LD) flap in patients undergoing transhumeral amputation and shoulder disarticulation due to upper extremity damage from high voltage electrical burns. METHODS: The study was targeted to five patients who suffered high voltage electrical burns, underwent above-elbow amputation, and were reconstructed in the acute and secondary phases using a pedicled LD flap from January 2005 to December 2011. All patients underwent equilateral pedicled LD flap surgery, with primary closure at the donating site. RESULTS: The average age of patients was 49.6 years (38~64); they were all male. One patient underwent sublayer skin grafting after a pedicled muscular LD flap, and four patients had a pedicled myocutaneous LD flap: one patient among the four had a forearm flap after the pedicled myocutaneous LD flap. All flaps were well adhered, and post-surgical flap reduction and local flaps were performed for adequate sizing and aesthetic improvement. CONCLUSION: In cases of upper arm amputation due to wide upper extremity damage caused by electrical burns, the use of the pedicled LD flap and adequate amputation length made subsequent wearing of a prosthesis possible. The pedicled LD flap procedure allowed reconstruction of a relatively large area of soft tissue and the surgery to the donating site was unproblematic.

Squamous Cell Carcinoma Showing Rapid Metastasis after Leg Amputation due to Chronic Osteomyelitis / 대한피부과학회지

Marjolin's ulcer is a malignant lesion, which arises in a chronic wound. When squamous cell carcinoma occurs in Marjolin's ulcer, the prognosis is known to be worse than that of cutaneous squamous cell carcinoma, due to other etiologies. A 56-year-old male who was diagnosed as chronic osteomyelitis was recommended for a surgical amputation of the left lower leg. After amputation, the histology of chronic ulcer revealed squamous cell carcinoma. In a few months period, multiple suppurative ulcers and nodules appeared near the amputation stump, as well as the proximal sites of the left leg, which appeared to spread rapidly. Biopsy of a representative lesion and positron emission tomography-computed tomography revealed a metastatic squamous cell carcinoma and malignant lymphadenopathy. Aggressive amputation without appropriate preoperative evaluation to detect the locoregional metastasis may be an inadequate option of the treatment for the patient due to a rapid spread of cancer metastasis, which may happen immediately after an amputation. Therefore, it is important to obtain a thorough preoperative evaluation of recalcitrant ulcer from osteomyelitis before the decision to undergo an amputation.

Reverse Anterolateral Thigh Flap to Reconstruct a Below-Knee Amputation Stump: Two Case Reports

During below knee amputation, the amputation stump must be covered with well-vascularized and sensate soft tissue. Many flaps can be used for this purpose, but available reconstructive options are limited. We performed reverse flow ALT flap elevation on two patients with below knee amputations to reconstruct defects in the stumps. The sizes of the defects in the stumps were 4x16 cm and 5x5 cm, respectively. The most distal portion of the defects were located 20 cm and 16 cm lateral to the knee joint in a curve, respectively. The size of the elevated flap was 5x18 cm for case 1 and 18x10 cm for case 2. The respective pivot points of the pedicles were 7 cm and 6 cm above the patella and the respective lengths of the pedicles were 17 cm and 16 cm. In both cases, venous congestion occurred on the second postoperative day and the flap distal to 10 cm or more from below the knee joint was necrotized at the second postoperative week. Surgeons should be cautious when using a reverse ALT flap to reconstruct a soft tissue defect located 10 cm or more distal from below the knee joint. Since a pedicle longer than 15 cm may develop partial necrosis of the flap, simultaneous application of antegrade venous drainage is recommended.

Bloqueio isquiático-femoral guiado por ultra-som para revisão de coto de amputação: relato de caso / Bloqueo isquiático-femoral guiado por ultrasonido para revisión de muñón de amputación: relato de caso / Ultrasound-guided sciatic-femoral block for revision of the amputation stump: case report

JUSTIFICATIVA E OBJETIVOS: O emprego da ultra-sonografia na anestesia regional vem se tornando cada vez mais difundido pelo seu papel facilitador e pela sua eficácia. A visualização direta por meio da ultra-sonografia permite que se identifiquem os nervos periféricos, independentemente da capacidade de se obter estimulação sensitiva ou motora. RELATO DO CASO: Paciente submetido à revisão de coto de amputação no nível do joelho sob bloqueio isquiático-femoral guiado por ultra-som com 40 mL de ropivacaína a 0,5 por cento, promovendo bloqueio sensitivo completo e anestesia cirúrgica de excelente qualidade. CONCLUSÕES: A assistência ultra-sonográfica é capaz de ampliar o espectro de utilização dos bloqueios periféricos nas intervenções cirúrgicas sobre membros amputados em situações em que a neuroestimulação não pode ser utilizada.

BACKGROUND AND OBJECTIVES: The use of ultrasound in regional blocks has become increasingly used because its role as a facilitator and its efficacy. Direct ultrasound visualization allows the identification of peripheral nerves, independently of the ability of obtaining sensitive or motor stimulation. CASE REPORT: This is the case of a patient who underwent revision of the amputation stump at the knee under ultrasound-guided sciatic-femoral block with 40 mL of 0.5 percent ropivacaine, promoting complete sensitive blockade and excellent surgical anesthesia. CONCLUSIONS: Ultrasound assistance is capable of amplifying the spectrum of uses of peripheral nerve blocks in surgical interventions on amputated limbs in situations neurostimulation cannot be used.

JUSTIFICATIVA Y OBJETIVOS: El uso del ultrasonido en la anestesia regional se ha venido convirtiendo cada vez más en algo muy difundido por su rol de facilitador y por su eficacia. La visualización directa a través del ultrasonido permite que se identifiquen los nervios periféricos, independientemente de la capacidad de poder obtenerse una estimulación sensitiva o motora. RELATO DEL CASO: Paciente sometido a revisión de muñón de amputación al nivel de la rodilla bajo bloqueo isquiático-femoral guiado por ultrasonido con 40 mL de ropivacaína a 0,5 por ciento, promoviendo bloqueo sensitivo completo y anestesia quirúrgica de excelente calidad. CONCLUSIONES: La asistencia ultra sonográfica es capaz de ampliar el espectro de utilización de los bloqueos periféricos en las intervenciones quirúrgicas sobre miembros amputados en situaciones en que la neuro estimulación no puede ser utilizada.

Comparison of removable rigid dressing and elastic bandage in reducing the residual limb volume of below knee amputees.

OBJECTIVE: Compare the reducing volumes of the residual limbs between the removable rigid dressing method and the elastic bandaging technique. STUDY DESIGN: Randomized controlled trial. Setting: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: Twenty-six below-the-knee amputees (11 men (42.3%) and 15 women (57.69%)) who were informed and gave written consents were included in this study. The mean age was 68.19 +/- 10.83 years. The patients who met the eligible criteria were randomized into two groups. Fourteen subjects (53.8%) were in the EB group and 12 (46.2%) in the RRD group. The first group was taught to use a removable rigid dressing (RRD) while the second group was taught to use an elastic bandage (EB) for stump shaping and volume reduction. Both groups were trained with the same pre-prosthetic program. The circumference of the stump was measured and calculated for volume at the beginning, 2 weeks, and 4 weeks. The volume reduction was compared between the two groups. RESULTS: Twenty subjects were amputated on the right side (76.92%). The majority underlying was diabetes mellitus (80.77%). Fifteen cases of amputation were peripheral vascular disease (57.69%). The stump volume reduction of the RRD group at 2 and 4 weeks were 42.73 +/- 62.70 and 79.9 +/- 103.33 cm3, respectively. The stump volume reduction of the EB group were 21.89 +/- 118.49 and 83.03 +/- 113.05 cm3, respectively. There were no statistically significant differences of volume reduction between the two groups at 4 weeks. CONCLUSION: Removable rigid dressing had a tendency to reduce residual limb volume of below knee amputees faster than elastic bandage at 2 weeks but the decreasing volumes were not different at 4 weeks.