Rescate articular con colgajo anterolateral del muslo / Joint rescue with anterolateral thigh flap

La preservación del nivel de amputación tanto de la extremidad superior como de la inferior, puede mejorar la función residual y el proceso de rehabilitación protésica de la misma. Ambas van a estar condicionadas por la longitud restante de la extremidad, la presencia o no de articulaciones operativas y la calidad de la cobertura del muñón. Presentamos 2 casos de amputaciones. El primero es un caso agudo de amputación traumática de extremidad superior a la altura del tercio proximal de antebrazo, que asocia avulsión cutánea circular desde el tercio medio del brazo y con articulación de codo conservada. El segundo, es la secuela de una amputación infracondílea de extremidad inferior por osteosarcoma que presenta fístulas cutáneas con drenaje supurativo por osteomielitis en el muñón tibial. En ambos pacientes realizamos cobertura con colgajo anterolateral de muslo anastomosado a la arteria radial en el caso de la extremidad superior, y a la arteria genicular descendente en la extremidad inferior. En los dos casos el postoperatorio transcurrió sin complicaciones, logrando preservar las articulaciones del codo y de la rodilla respectivamente, así como la posterior rehabilitación protésica. Consideramos que el colgajo anterolateral del muslo permite aportar tejido de buena calidad como cobertura del muñón de amputación. Dadas las características del tejido aportado y su volumen, es idóneo tanto para cobertura de defectos agudos como de déficits de almohadillado en casos crónicos (AU)

Sometimes, the severity of the trauma or the existence of a cancer force to amputate a limb. The prosthetic rehabilitation process and residual function will be influenced by the remaining length of the limb, the presence or absence of functional joints and the quality of the coverage of the stump. Two cases of amputations are shown. The former is an acute traumatic upper limb amputation at the level of the proximal third of forearm with skin avulsion from the middle third of the arm and the elbow joint preserved. The second case is the sequelae of an amputation below the knee due to lower extremity osteosarcoma, which was referred with suppurative draining cutaneous fistulas as a consequence of an osteomyelitis of the femur in the stump. In both patients the stumps were covered with anterolateral thigh flap anastomosed over the radial artery in the case of the upper extremity, and over the descending genicular artery in the lower extremity. In both cases the postoperative course was uneventful, preserving the elbow and knee respectively and allowing the subsequent prosthetic rehabilitation. We consider that anterolateral thigh flap is a suitable option for the treatment of the amputation stump. Given the characteristics of the tissue and volume provided by this flap, it is appropriate for coverage of acute defects and for padding deficits in chronic cases (AU)

Complications following an amputation.

In 2005 there were an estimated 1.6 million individuals in the United States living with limb loss. This number has been projected to more than double by 2050 to 3.6 million, making an understanding of management of the individual with amputation essential for the physiatrist. This article highlights common complications following amputation and discusses the approach to evaluation, treatment, and developing management strategies to ensure optimal functional outcomes for this population of patients.

Lateral femoral condyle fracture and patella dislocation in below-the-knee amputation.

Treatment of a 42-year-old patient with below-the-knee amputation from 15 years ago who presented with lateral femoral condyle fracture and patella dislocation is described. In addition, the advantages of transtibial over transfemoral amputation are discussed.

Timing the commitment to a wound-healing response of denervated limb stumps in the adult newt, Notophthalmus viridescens.

Adult newt limbs that are denervated 1 day after amputation undergo a wound-healing response and, although they become reinnervated, will not regenerate unless reinjured. Experiments were designed to determine when denervated limb stumps of adult newts become committed to a wound-healing response. In Experiment I, limbs were amputated and denervated 1 day after amputation. On days 7, 14, 21, 28, and 35 days after the initial amputation and denervation, stumps were reamputated to remove the distal tip. This design varied the time the distal stump was devoid of nerves before reamputation. None of the limbs reamputated at 7 days regenerated. About half of the limbs reamputated at 14 days regenerated and almost all of those reamputated at days 21, 28, and 35 regenerated. In Experiment II, limbs were denervated and then amputated on day 7 or 14, at two different levels. Limbs with a short stump became innervated earlier and regeneration occurred more frequently at both levels of amputation. The results of these experiments show that denervated limb stumps become committed to a wound-healing response between days 7 and 14 after amputation/denervation. If sufficient nerves arrive before day 7, a regeneration response is initiated. If the stump is denervated for 14 days or longer, commitment to wound healing occurs and ingrowing nerves cannot initiate a regeneration response.

Preventing falls and stump injuries in lower limb amputees during inpatient rehabilitation: completion of the audit cycle.

OBJECTIVES: To study the factors contributing to falls among recent lower limb amputees, and to reduce the number of falls during inpatient rehabilitation and resulting injuries. DESIGN: Retrospective, followed by prospective, cohort study, then a follow-up study conducted after interventions. SETTING: Twenty-bedded inpatient rehabilitation unit for amputees. SUBJECTS: Lower limb amputees. INTERVENTIONS: Patient education, environmental modifications and application of a bivalve plaster of Paris stump protector to patients who were aged 70 or over, or cognitively impaired. MAIN OUTCOME MEASURES: Numbers of falls and other accidents, and resulting injuries. RESULTS: In phase 1 of the study, a retrospective audit of incident forms that had been completed on lower limb amputees who had an accident during their inpatient rehabilitation, between 1 April 1996 and 31 Ocotber 1998, was carried out. This showed that approximately a third of admissions (32%) were complicated by an accident. Most accidents were falls. In phase 2, a prospective study of 113 patients admitted to the unit was undertaken. Patients who fell were significantly older than those who did not. In phase 3, 62 consecutive patients were studied. There were 37 accidents in total, of which 35 were falls. Compared with the phase 2 study, there was no reduction in the proportion of patients who had a fall or other accident in phase 3, but significantly fewer falls resulted in any injury (p = 0.05). CONCLUSIONS: Although the interventions employed did not reduce the proportion of patients who had falls or other accidents, significantly fewer falls resulted in injuries.

Total surface bearing below-knee prosthesis: advantages, disadvantages, and clinical implications.

OBJECTIVE: To investigate the total surface bearing (TSB) prosthesis for below-knee amputee patients and to determine its clinical indications. DESIGN: Case series. SETTING: University hospital and the Welfare Center for the Disabled. PATIENTS: Thirty-two subjects who could walk with the TSB prosthesis and had already used the patellar-tendon bearing (or Kondylen-Bettung Münster) socket. MAIN OUTCOME MEASURE: Subjective assessment of the TSB socket, consisting of an overall rating and ratings of 13 individual items, was performed, and results were analyzed with Fisher's exact test. RESULTS: Seventy-five percent of the subjects were satisfied overall with the TSB socket. Of the 13 items, comfort, ease to swing, pain, piston movement, tightness, skin irritation, appearance, and durability were regarded as good by more than 75% of the patients. Donning, perspiration, odor, and staining were regarded as poor by more than 20%. Items that were significantly related with overall satisfaction with the TSB socket were comfort, ease to swing, and piston movement, while donning was significantly related to dissatisfaction. CONCLUSION: The TSB socket is suitable for and preferred by many amputee subjects, but some problems remain to be solved.