[Medical-surgical complications and their impact on patients' return to work whilst follow-up major lower-limb amputations in Hospital del Trabajador in Santiago (HTS)]. / Complicaciones médico-quirúrgicas y su impacto en el retorno laboral durante el seguimiento de pacientes con amputación mayor de extremidades inferiores en el Hospital del Trabajador de Santiago (HTS).

INTRODUCTION: The presence of different complications whilst follow-up amputee patients reaches 10-80%. The main objective of this research is to assess the impact of these in the return-to-work of lower-limb traumatic amputation cases. MATERIALS AND METHODS: A retrospective cohort research was carried out. Clinic-demographic variables information was recollected in order to assess its linkage to different medical-surgical complications and functional outcomes. Survival curves were created to evaluate the return-to-work of patients with and without complications. RESULTS: A total of 46 patients, on average aged 45.7 years old (91.3% men, 71.7% without comorbidities), were included on this research. The most frequent level of amputation was transtibial (65.2%). Residual limb pain, phantom pain, dermatological-infectious complications and painful neuroma were registered in 80.4%, 58.7%, 50% y 30.4% of the cases respectively. Half of the patients had returned to their workplace after 2years of post-surgical follow-up. The return-to-work rates were significantly lower in patients suffering from residual limb pain (p=0.0083) and from painful neuroma (p=0.0051). CONCLUSION: Complications are frequent during traumatic-amputee patients' follow-up and, some of them, may impact on the return-to-work rate.

Can Early Post-Operative Scoring of Non-Traumatic Amputees Decrease Rates of Revision Surgery?

Background and Objectives: Medical registries evolved from a basic epidemiological data set to further applications allowing deriving decision making. Revision rates after non-traumatic amputation are high and dramatically impact the following rehabilitation of the amputee. Risk scores for revision surgery after non-traumatic lower limb amputation are still missing. The main objective was to create an amputation registry allowing us to determine risk factors for revision surgery after non-traumatic lower-limb amputation and to develop a score for an early detection and decision-making tool for the therapeutic course of patients at risk for non-traumatic lower limb amputation and/or revision surgery. Materials and Methods: Retrospective data analysis was of patients with major amputations lower limbs in a four-year interval at a University Hospital of maximum care. Medical records of 164 patients analysed demographics, comorbidities, and amputation-related factors. Descriptive statistics analysed demographics, prevalence of amputation level and comorbidities of non-traumatic lower limb amputees with and without revision surgery. Correlation analysis identified parameters determining revision surgery. Results: In 4 years, 199 major amputations were performed; 88% were amputated for non-traumatic reasons. A total of 27% of the non-traumatic cohort needed revision surgery. Peripheral vascular disease (PVD) (72%), atherosclerosis (69%), diabetes (42%), arterial hypertension (38%), overweight (BMI > 25), initial gangrene (47%), sepsis (19%), age > 68.2 years and nicotine abuse (17%) were set as relevant within this study and given a non-traumatic amputation score. Correlation analysis revealed delayed wound healing (confidence interval: 64.1% (47.18%; 78.8%)), a hospital length of stay before amputation of longer than 32 days (confidence interval: 32.3 (23.2; 41.3)), and a BKA amputation level (confidence interval: 74.4% (58%; 87%)) as risk factors for revision surgery after non-traumatic amputation. A combined score including all parameters was drafted to identify non-traumatic amputees at risk for revision surgery. Conclusions: Our results describe novel scoring systems for risk assessment for non-traumatic amputations and for revision surgery at non-traumatic amputations. It may be used after further prospective evaluation as an early-warning system for amputated limbs at risk of revision.

[Psychological consequences of amputations in work accidents]. / Consecuencias psicológicas de las amputaciones por accidente laboral.

OBJECTIVE: Amputations in work accidents are a phenomenon with a high incidence and peculiar characteristics. The few studies about the effects of amputation are referred to large limbs, and show that, beyond the physical consequences, there are important psychological consequences. The goal of this paper was to show the updated knowledge on the main psychopathological consequences of amputations in work accidents, as well as the variables that can modulate them. METHODS: A non-systematic bibliographic review was carried out, with varied ad hoc searches for the different variables studied. RESULTS: Studies have focused mainly on anxiety and depressive symptoms, post-traumatic stress disorder, and phantom limb pain. Modulating variables whose presence improves the prognosis of these persons have been identified, such as adaptation to daily life, physical exercise, coping strategies, resilience and quality of life. CONCLUSIONS: The different psychological areas reviewed should be considered when attending people who have suffered an amputation in a work accident. Likewise, enhancing the modulating variables whose presence improves the prognosis is an interesting field for professional intervention.

OBJETIVO: Las amputaciones en accidente laboral son un fenómeno con gran incidencia y características peculiares. Los escasos estudios que abordan los efectos de la amputación se refieren a grandes extremidades y muestran que, más allá de las secuelas físicas, existen consecuencias importantes a nivel psicológico. El objetivo de este artículo fue mostrar el conocimiento actualizado sobre las principales consecuencias psicopatológicas de las amputaciones por accidente laboral y de las variables que pueden modularlas. METODOS: Se llevó a cabo una revisión bibliográfica de carácter no sistemático, con búsquedas variadas ad hoc para las distintas variables estudiadas. RESULTADOS: Los estudios se han centrado principalmente en la sintomatología ansiosa y depresiva, el trastorno de estrés postraumático y el dolor del miembro fantasma. También se han identificado variables moduladoras que mejoran el pronóstico: adaptación a la vida cotidiana, ejercicio físico, estrategias de afrontamiento, resiliencia y calidad de vida. CONCLUSIONES: Las distintas áreas psicológicas afectadas revisadas deben considerarse al acompañar a las personas con amputación por accidente laboral. Asimismo, potenciar las variables moduladoras cuya presencia mejora el pronóstico es un campo interesante para la intervención profesional.

Traumatic lower extremity amputation as a risk factor for venous thromboembolism.

BACKGROUND: This study aimed to evaluate whether lower extremity (LE) amputation among civilian casualties is a risk factor for venous thromboembolism. METHODS: All patients with severe LE injuries (AIS ≥3) derived from the ACS-TQIP (2013-2020) were divided into those who underwent trauma-associated amputation and those with limb salvage. Propensity score matching was used to mitigate selection bias and confounding and compare the rates of pulmonary embolism (PE) and deep vein thrombosis (DVT). RESULTS: A total of 145,667 patients with severe LE injuries were included, with 3443 patients requiring LE amputation. After successful matching, patients sustaining LE amputation still experienced significantly higher rates of PE (4.2% vs. 2.5%, p â€‹< â€‹0.001) and DVT (6.5% vs. 3.4%, p â€‹< â€‹0.001). A sensitivity analysis examining patients with isolated major LE trauma similarly showed a higher rate of thromboembolic complications, including higher incidences of PE (3.2% vs. 2.0%, p â€‹= â€‹0.015) and DVT (4.7% vs. 2.6%, p â€‹< â€‹0.001). CONCLUSIONS: In this nationwide analysis, traumatic lower extremity amputation is associated with a significantly higher risk of VTE events, including PE and DVT.

Consecuencias psicológicas de las amputaciones por accidente laboral / Psychological consequences of amputations in work accidents

Fundamentos: Las amputaciones en accidente laboral son un fenómeno con gran incidencia y características peculiares. Los escasos estudios que abordan los efectos de la amputación se refieren a grandes extremidades y muestran que, más allá de las secuelas físicas, existen consecuencias importantes a nivel psicológico. El objetivo de este artículo fue mostrar el conocimiento actualizado sobre las principales consecuencias psicopatológicas de las amputaciones por accidente laboral y de las variables que pueden modularlas. Métodos: Se llevó a cabo una revisión bibliográfica de carácter no sistemático, con búsquedas variadas ad hoc para las distintas variables estudiadas. Resultados: Los estudios se han centrado principalmente en la sintomatología ansiosa y depresiva, el trastorno de estrés postraumático y el dolor del miembro fantasma. También se han identificado variables moduladoras que mejoran el pronóstico: adaptación a la vida cotidiana, ejercicio físico, estrategias de afrontamiento, resiliencia y calidad de vida. Conclusiones: Las distintas áreas psicológicas afectadas revisadas deben considerarse al acompañar a las personas con amputación por accidente laboral. Asimismo, potenciar las variables moduladoras cuya presencia mejora el pronóstico es un campo interesante para la intervención profesional.(AU)

Background: Amputations in work accidents are a phenomenon with a high incidence and peculiar characteristics. The few studies about the effects of amputation are referred to large limbs, and show that, beyond the physical consequences, there are important psychological consequences. The goal of this paper was to show the updated knowledge on the main psychopathological consequences of amputations in work accidents, as well as the variables that can modulate them. Methods: A non-systematic bibliographic review was carried out, with varied ad hoc searches for the different variables studied. Results: Studies have focused mainly on anxiety and depressive symptoms, post-traumatic stress disorder, and phantom limb pain. Modulating variables whose presence improves the prognosis of these persons have been identified, such as adaptation to daily life, physical exercise, coping strategies, resilience and quality of life. Conclusions: The different psychological areas reviewed should be considered when attending people who have suffered an amputation in a work accident. Likewise, enhancing the modulating variables whose presence improves the prognosis is an interes-ting field for professional intervention.(AU)

Study on the preservation effects of the amputated forelimb by machine perfusion at physiological temperature.

PURPOSE: Ischemia and hypoxia are the main factors limiting limb replantation and transplantation. Static cold storage (SCS), a common preservation method for tissues and organs, can only prolong limb ischemia time to 4 - 6 h. The normothermic machine perfusion (NMP) is a promising method for the preservation of tissues and organs, which can extend the preservation time in vitro by providing continuous oxygen and nutrients. This study aimed to evaluate the difference in the efficacy of the 2 limb preservation methods. METHODS: The 6 forelimbs from beagle dogs were divided into 2 groups. In the SCS group (n = 3), the limbs were preserved in a sterile refrigerator at 4 °C for 24 h, and in the NMP group (n = 3), the perfusate prepared with autologous blood was used for the oxygenated machine perfusion at physiological temperature for 24 h, and the solution was changed every 6 h. The effects of limb storage were evaluated by weight gain, perfusate biochemical analysis, enzyme-linked immunosorbent assay, and histological analysis. All statistical analyses and graphs were performed using GraphPad Prism 9.0 one-way or two-way analysis of variance. The p value of less than 0.05 was considered to indicate statistical significance. RESULTS: In the NMP group, the weight gained percentage was 11.72% ± 4.06%; the hypoxia-inducible factor-1α contents showed no significant changes; the shape of muscle fibers was normal; the gap between muscle fibers slightly increased, showing the intercellular distance of (30.19 ± 2.83) µm; and the vascular α-smooth muscle actin (α-SMA) contents were lower than those in the normal blood vessels. The creatine kinase level in the perfusate of the NMP group increased from the beginning of perfusion, decreased after each perfusate change, and remained stable at the end of perfusion showing a peak level of 4097.6 U/L. The lactate dehydrogenase level of the NMP group increased near the end of perfusion and reached the peak level of 374.4 U/L. In the SCS group, the percentage of weight gain was 0.18% ± 0.10%, and the contents of hypoxia-inducible factor-1α increased gradually and reached the maximum level of (164.85 ± 20.75) pg/mL at the end of the experiment. The muscle fibers lost their normal shape and the gap between muscle fibers increased, showing an intercellular distance of (41.66 ± 5.38) µm. The contents of vascular α-SMA were much lower in the SCS group as compared to normal blood vessels. CONCLUSIONS: NMP caused lesser muscle damage and contained more vascular α-SMA as compared to SCS. This study demonstrated that NMP of the amputated limb with perfusate solution based on autologous blood could maintain the physiological activities of the limb for at least 24 h.

Exploring the barriers and facilitators to community reintegration for adults following traumatic upper limb amputation: a mixed methods systematic review.

PURPOSE: Traumatic upper limb amputation (ULA) is a profound injury impacting participation in activities of daily living, including those within the community setting. The objective of this work was to review literature exploring barriers, facilitators, and experiences of community reintegration in adults following traumatic ULA. METHODS: Databases were searched using terms synonymous with the amputee population and community participation. Study methodology and reporting were evaluated using McMaster Critical Review Forms, with a convergent segregated approach to synthesis and configuration of the evidence. RESULTS: A total of 21 studies met the inclusion criteria, including quantitative, qualitative and mixed-method study designs. Restoring function and cosmesis with prostheses facilitated work participation, driving and socialisation. Positive work participation was predicted by male gender, younger age, medium-high education level and good general health. Work role and environmental modifications were common, as were vehicle modifications. Qualitative findings provided insight into social reintegration from a psychosocial perspective, particularly negotiating social situations, adjusting to ULA and re-establishing identity. The review findings are limited by the absence of valid outcome measures and clinical heterogeneity across the studies. CONCLUSION: There is a dearth of literature on community reintegration following traumatic upper limb amputation, indicating a need for further research with strong methodological rigour.Implications for RehabilitationUpper limb amputation can restrict participation in activities in the community including work, socialisation, driving, leisure, and recreation.Clinicians can support community reintegration by addressing personal and environmental factors that both facilitate or inhibit participation in community activities.Prosthetics can be a facilitator for participation in community activities through the restoration of function and cosmesis.Clinicians can facilitate return to work through work modification recommendations or supported transitions to more suitable roles.

Distal femur segmental gap reconstruction using ipsilateral amputated tibia in trauma setting - A case report.

Background: A 32 year old patient who sustained an ipsilateral Gustilo Anderson 3C open fractures of the distal femur and tibia, following an MVA (Motor Vehicle Accident). The femoral shaft fracture had a 6 cm gap, which was spanned with a tibial diaphyseal autograft harvested from the amputated ipsilateral leg and stabilized with a retrograde intramedullary nail, thus enabling preservation of the knee joint and a functional weight bearing below knee prosthesis. Conclusion: Distal femur segmental gap reconstruction using ipsilateral amputated tibia in trauma setting was shown to be a feasible surgical technique.

Finger prosthesis: A novel way to restore the form, function, and esthetics.

Key Clinical Message: A well-customized prosthesis with a life-like esthetic and function are the primary determining factors for its acceptance and success. RTV silicones can prove to be very effective and useful in fabricating such prosthesis. Abstract: Complete or partial finger amputations impact an individual's psychological and physical well-being and are considered the most frequently observed pattern of hand loss. A customized prosthesis offers the patient rehabilitative, functional, and psychological advantages. Retention is the key to the success of such prosthetic restoration. The present case report describes a novel technique that utilizes passive vacuum fit and mechanical retention to restore controlled function movements as a metal wire framework. The procedure was economical, most importantly, produced life-like anatomy of the missing digit and restored the function to some extent.

Barriers and facilitators to community reintegration in adults following traumatic upper limb amputation: an exploratory study.

PURPOSE: To explore barriers and facilitators to community reintegration experienced by people following traumatic upper limb amputation (ULA). METHODS: An exploratory qualitative study was conducted with ten adults with major ULA due to trauma. Data from individual, semi-structured interviews was analysed using Braun and Clarke's reflexive thematic analysis. RESULTS: Underlying and influencing community reintegration for participants, was a process of adjustment to the impacts of amputation on everyday function and re-establishing their identity. Participants felt social networks and peer support facilitated the return to social and community activities, as did drawing on personal attributes such as positivity, resilience and self-belief. Prosthetic devices were facilitative for community reintegration by minimising visible differences and unwanted attention through restored cosmesis and in the performance of functional tasks to fulfil social norms and meaningful roles despite issues with comfort and function. Despite the adaptation and evolution of abilities, perspectives and identities, the functional impact of ULA on everyday community activities was an ongoing challenge for all participants. CONCLUSION: ULA has a significant and lifelong impact on an individual's ability to complete tasks and fulfil meaningful roles in the community. Recommendations based on the study's findings will inform clinicians to support community reintegration for people following traumatic ULA.

Rehabilitative environments and interventions that promote self-efficacy, positivity, problem-solving skills and resilience may support adjustment and community reintegration following upper limb amputation.Facilitating appropriate peer support and the strengthening of existing social supports may assist social and community reintegration.The facilitative effects of prosthetics on community participation and reintegration may be enhanced through client-centred, goal-directed and timely prosthetic provision and training.Ongoing barriers and challenges with community participation may indicate the need for ongoing therapeutic intervention and support.

Knee Joint Rescue in a Traumatic Amputation With Coverage by a Fillet-Free Flap From the Amputated Leg.

Traumatic amputation is a severe injury that requires urgent surgical care. A fillet-free flap from the amputated limb is the most conservative way to ensure proper coverage of the stump when replantation is not possible. We report the case of a male patient who suffered from a traumatic limb amputation in a motorcycle accident. A free fillet flap from the posterior compartment of the leg carrying the posterior tibial pedicle, the soleus muscle, and skin tissue harvested from the amputated limb was performed to cover the amputation stump and thus allow preservation of the knee joint. In our case report, the patient conserved almost maximal knee joint range of motion (130°). He regained the ability to walk only two months after the initial trauma. Prosthetic fitting occurred quickly and without any particular issues throughout the process. Regarding quality of life, after one year, our patient had a five-level EQ-5D version (EQ-5D-5L) score of 21,221, and his 36-Item Short Form Survey (SF-36) score was divided between the five components in 85 points in physical functioning, 100 points in role limitations due to physical health, 100 points in role limitations due to emotional problems, 50 points in energy/fatigue, 68 points in emotional well-being, 75 points in social functioning, 45 points in pain, and 95 points in general health. This technique helped provide good coverage of the stump while preserving a functional knee joint, allowing for effective prosthetic fitting in the future and therefore optimizing our patient's quality of life.

Prognostic Factors for Attempted Finger Replantation and Revascularisation after Traumatic Amputation: A 16-Year Retrospective Cohort Study.

Background: The aim of this study was to evaluate the impact of variant factors on finger replantation and revascularisation after traumatic amputation, which also included duty shift and the level of main operator. Methods: To determine the prognostic factors for the survival rate of finger replantation and revascularisation after traumatic finger amputation, we retrospectively reviewed the cases of finger replantation conducted from January 2001 to December 2017. Data collected consisted of the basic information of the patients, trauma-related factors, details of the operation and treatment outcomes. Descriptive statistics and data analysis was performed to assess outcomes. Results: In total, 150 patients with 198 replanted digits were enrolled in this study. The median age of the participants was 42.5 years, and 132 (88%) patients were men. The overall successful replantation rate was 86.4%. Seventy-three (36.9%) digits had Yamano type 1 injury; 110 (55.6%), Yamano type 2 injury and 15 (7.6%), Yamano type 3 injury. In total, 73 (36.9%) digits were completely amputated and 125 (63.1%) were not. Half of the replantation procedures (101, 51.0%) were performed during night shift (16:00-00:00), 69 (34.8%) during day shift (08:00-16:00) and 28 (14.1%) during graveyard shift (00:00-08:00). Multivariate logistic regression demonstrated that the trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Conclusions: The trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Other factors including duty shift and the level of operator did not reach statistically significance. Further studies must be conducted to validate the results of the current study. Level of Evidence: Level III (Prognostic).

Development of overuse musculoskeletal conditions after combat-related upper limb amputation: a retrospective cohort study.

STUDY DESIGN: Retrospective cohort study INTRODUCTION: Service members who have sustained traumatic amputations are typically young and otherwise healthy. Beyond standard care, these individuals desire long, highly active, and relatively pain-free lifestyle, whether that is returning to active duty or transitioning to civilian life. Development of overuse musculoskeletal conditions could have a significant influence on quality of life for Service members with traumatic upper limb amputation. PURPOSE OF THE STUDY: Compare one-year incidence of overuse musculoskeletal injuries in Service members with different levels of combat-related upper limb amputation to Service members with minor combat-related upper limb injuries. METHODS: Service members with deployment-related upper limb injury (N = 519), 148 major upper limb amputation (55 with amputation at or above elbow, 93 with amputation below elbow) and 371 minor upper limb injury were included in the study. Outcomes of interest clinical diagnosis codes associated with overuse conditions of the upper limb, neck and upper back, lower limb, low back pain, and all regions combined, one year before and one year after injury. RESULTS: Overall, the one-year incidence of developing at least one musculoskeletal overuse condition after upper limb amputation was between 60% and 65%. Service members with upper limb amputations were 2.7 to 4.7 times more likely to develop an overuse upper limb condition, 3.6 to 3.8 times more likely to develop a neck and upper back condition, 2.8 to 4.4 times more likely to develop a lower limb condition, and 3.3 to 3.9 times more likely to develop low back pain as compared those who sustained minor combat-related injuries. No significant differences in the odds of developing a musculoskeletal condition was found between the above elbow and below elbow amputation groups. CONCLUSIONS: Incidence of secondary overuse conditions is elevated in Service members with upper limb amputation and warrants focused research efforts toward preventative and rehabilitative interventions.

Impact of Yoga Intervention in Lower Limb Amputees following Trauma in Relation to Behavior and Quality of Life: A Randomized Controlled Trial.

Background: Yoga is an emerging intervention causing improvement in physical, mental, and spiritual well-being. Its role in improving outcomes in patients with amputation was investigated. Methodology: Patients with traumatic lower limb amputation (n = 50) were enrolled and randomized to the Yoga group (n = 26) against control (n = 24). Sociodemographic details, quality of life (QOL) (World Health Organization QOL-BREF), Depression anxiety stress scale (DASS), Rosenberg self-esteem scale, and amputee body image score were applied at baseline, 6,-18 weeks of amputation. Results: Sociodemographic and clinical variables were comparable between groups. At 18 weeks, the Yoga group had better QOL (P = 0.005) than the control group. Symptoms of depression (0.02) and anxiety (<0.001) reduced, and self-image (P = 0.015) improved significantly at 6 weeks, while stress (P = 0.003) reduced at 18 weeks in the yoga group. Despite comparable body image scores, the prosthesis usage (hours/day) was more (P = 0.005) in the Yoga (6.9 ± 3.2) group against the control (12 ± 2.7). Conclusion: Yoga improves QOL and self-esteem and reduces depression, anxiety, and stress symptoms in patients with traumatic amputation.

Extra-anatomic temporary intravascular shunting to assist with replantation of an amputated hand with prolonged ischemic time.

Although temporary intravascular shunting has been reported to assist with hand revascularization and replantation after traumatic amputation, most reports have described using ipsilateral upper limb inflow. We present a case of a traumatic hand amputation in a patient who had presented with 4 to 5 hours of warm ischemic time. Because the replantation team believed that extra-anatomic revascularization would be necessary, we performed a novel type of temporary intravascular shunting by connecting two arterial sheaths placed in the ulnar and superficial femoral arteries. This permitted the hand to be successfully replanted away from the inflow source and resulted in a good long-term functional outcome.

Traumatic Finger Amputations: Epidemiology and Mechanism of Injury, 2010-2019.

BACKGROUND: Traumatic finger amputations are a common and well-known hand injury, yet there are few studies addressing long-term epidemiologic data and associated mechanisms of injury. This paper aims to use a large national database to identify the relationship of patient demographics and mechanism of injury in finger amputations. METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for finger amputations in the United States from 2010 to 2019. Patient demographic information was collected and analyzed by gender, race, age, and further statistical analysis was performed to determine correlations with consumer products. RESULTS: Finger amputations accounted for an estimated 234,304 emergency department visits from 2010 to 2019. Most of the patients were male (79%) and identified as white (46.2%). The most commonly implicated products overall were power saws and related power tools, followed by doors and then lawn mowers. A bimodal age incidence was observed with the highest incidence rates occurring in children ages 0 to 4, followed by a second peak incidence rate in the adults ages 65 to 74. The most common mechanisms of injury were found to differ in patients less than 19 and those 20 and over. CONCLUSION: Traumatic finger amputations have a bimodal incidence with changing epidemiology and mechanism of injury with age. The first peak occurs from ages 0 to 4, involves predominantly doors, and has a male to female ratio of 1.30. The second peak occurs from ages 65 to 74, involves mostly power saws, and has a male to female ratio of 6.68. LEVEL OF EVIDENCE: Prognostic, Level IV.

Early application of cryoanalgesia to the brachial plexus prevents development of phantom limb pain after traumatic forequarter amputation: A case report.

Background: Amputation of an extremity frequently results in significant phantom limb pain. The etiology of which is not well understood. Central and peripheral factors appear to play a role. Pain relief interventions often are attempted several weeks to months later. Peripheral nerve injury can rapidly result in cortical somatosensory changes potentially making early intervention important in preventing any permanent changes in nerve pathways. Case report: We present a case of traumatic forequarter (interscapulothoracic) amputation treated with cryoanalgesia of the brachial plexus for pain control <72 h after injury. The patient denied painful phantom limb pain and postoperative pain at the surgical site immediately following surgery and over a six month follow up period. Conclusion: Cryoanalgesia facilitates extended duration of pain control of the affected peripheral nerve which may be of particular benefit in patients sustaining either surgical or traumatic amputations, particularly when applied early to prevent the transmission of noxious signals to the central nervous system.

Ten-year outcome of unilateral leg replantation after bilateral lower leg amputation following traumatic injury: A case report.

The absolute indications for lower limb replantation are not unequivocally established; rather, this procedure is still challenging and controversial. We report a case of a young male who underwent bilateral leg amputation, followed by unilateral replantation. The patient demonstrated good 10-year outcomes. A 23-year-old man had both of his lower legs crushed by heavy machinery that fell from the back of a truck, leading to amputation of bilateral lower limbs. Although bilateral amputation was recommended due to severe contusion on both sides, the patient and his family strongly requested replantation of the right leg, and surgery was started approximately 3 h after the injury. In addition to the emergency replantation, six surgeries were performed thereafter. Five months after the first surgery, the patient was fitted with a left lower leg prosthesis and started gait training. He was discharged 8 months later. Ten years after the replantation, the patient is satisfied with his leg. He has a normal gait with a prosthesis and has integrated into society with no functional deficit. There are still no clear standards for replantation after leg amputation, and individual decisions must be made based on the severity of the injury and the patient's general condition. In this case, we respected the patient's strong will to preserve the right leg and decided on the treatment plan. As a result, the patient was highly satisfied, and the spared right leg facilitated the patient's physical and mental recovery.

Traumatic penile partial amputation of unusual occurrence: A case report.

We report the clinical case of a 9-year-old boy admitted for open trauma to the penis which occurred 3 hours before his admission by domestic accident. The child pounding vegetables, was awkwardly struck on the penis with a pestle. After conditioning, exploration in the operating room found partial amputation of the glans with complete rupture of the urethra. Washing with trimming and urethral anastomosis on a urinary catheter were performed. Healing was obtained without urethral stenosis. Injuries to the penis in children are not common and their management can be tricky.

A Prospective Trial Comparing Outcomes at 11 Months of a Standard Cross-Finger Flap versus a Laterally Based Thenar Flap for Fingertip Reconstruction.

Background: The standard cross-finger flap (CFF) and laterally based thenar flap (LTF) are the time-tested modalities of fingertip reconstruction. We were unable to find any studies that have compared these two flaps for fingertip reconstruction. The aim of this study is compare the outcomes of these two flaps at 11 months after fingertip reconstruction. Methods: This is a prospective study of 40 patients with fingertip amputation who underwent reconstruction with either a standard CFF or an LTF. Data with regards to the patient, the injury, treatment and complications were recorded. Patients were followed up weekly for the first 6 weeks and at 3, 6, 9 and 12 months thereafter. Outcome measures assessed at final follow-up included passive range of motion, two-point discrimination, cold intolerance, patient aesthetic satisfaction with the flap, assessment of donor scar and psychosocial benefit. Results: Fingertip reconstruction was done with 23 CFFs and 17 thenar flaps. Partial necrosis was noted in three thenar flaps. The mean follow-up period was 11 months. The sensory recovery and aesthetic satisfaction with the flap were greater in thenar flap group. There were no differences between the two flaps in the other outcome measures. Conclusions: Sensory recovery and aesthetic outcomes were better in thenar flaps compared to a CFF. However, thenar flap were associated with a greater incidence of partial flap loss. Level of Evidence: Level III (Therapeutic).