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PubMed1992

[The epaulette flap: replantation of osteomyocutaneous forearm segments in interscapulo-thoracic amputation].

Despite sophisticated artificial limb devices available today, forequarter amputation following trauma or tumor resection will lead to severe impairment of function. To close the posttraumatic or oncologically required extended defects and to improve prosthetic supplementation coverage of the thoracic wall should be performed by sparing the whole forearm as an osteomyocutaneous flap. In cases of concomitant serial rib resection radius and ulna will serve as stabilizators of the thoracic wall, thus avoiding a flail chest. Indications, technical details and clinical outcome of three salvage replantations after interscapulo-thoracic ablation will be discussed.

Amputation, Surgical↗

PubMed2000

Evaluation of polypropylene prostheses designed by the International Committee of the Red Cross for trans-tibial amputees.

Thirty-two (32) trained prosthesis users with 34 trans-tibial amputations, mostly due to war, were fitted with prostheses fabricated from polypropylene (PP) prosthetic components designed and manufactured by the International Committee of the Red Cross (ICRC). The patients were followed prospectively for 10 and 19 months. All but one patient had at least one other type of prosthesis to compare with. Twenty-eight (28) patients were satisfied with the PP prosthesis. Among these 23 found the PP prosthesis the preferred artificial limb, and one patient found the PP limb equal to the aluminium prosthesis previously in use. In 6/28 patients having an aluminium (ALU) prostheses this was found the best, and the 1 already mentioned found it equivalent to the new technology. In only 1/20 cases having an Automated Fabrication of Mobility Aids (AFMA) prosthesis available this was found the best. One (1) double-amputee found all three designs equal. Minor failures of the PP prostheses were encountered; in 4 cases small cracks in the hard socket; in 3 cases cracks of the cosmetic socket seam. From an overall prospect the PP technology can be recommended for trans-tibial prostheses.

Adult↗

PubMedDate not supplied

Major lower extremity amputation in patients with peripheral arterial insufficiency with special reference to the transgenicular amputation.

The selection of the proper level for lower extremity amputation in patients with advanced arterial ischemia poses a multiplicity of problems with regard to operative mortality, stump healing, re-amputation rate and rehabilitation status. In a retrospective study all these parameters have been evaluated in 413 patients submitted to below-knee (bk, n = 196), transgenicular (tg, n = 93) and above-knee (ak, n = 124) amputation between 1971 and 1980. As compared to the ak resection, the bk amputation has the following advantages: lower operative mortality (9% vs. 30.5%), higher prosthetic fitting rate (85% vs. 66%) and significantly improved rehabilitation (walking with artificial limb: bk 84%, ak 22%). Regarding surgical mortality (8.5%) and prosthetic gait (66%), the tg amputation was nearly equivalent to the bk resection and turned out to be clearly superior to the ak amputation. As compared to the latter procedure, knee disarticulation and bk amputation had a greater risk of delayed wound healing and re-amputation at a higher level (ak: 13.5 resp. 1%, tg: 22.5 resp. 25%, bk: 35% resp. 16%). The patient with a bk amputation has the best prospect concerning a successful rehabilitation. Whenever the very important knee joint cannot be saved an ak amputation should be avoided in favour of a knee disarticulation.

Adult↗

PubMed1997

Nontraumatic lower extremity amputations in diabetic and non-diabetic subjects in Madrid, Spain.

The purpose of this study was to determine the incidence of non-traumatic lower extremity amputations (LEAs) in diabetic and non-diabetic subjects in Madrid, Spain, and their direct cost. All patients who underwent LEAs between the 1st of January 1994 and the 31st of December 1996, and who had lived in area 7 of the city (569,307 inhabitants) for at least the last 6 months, were identified through operating theatre records cross-checked with Vascular Surgery Department discharge records. In addition, the direct cost of LEAs per year was estimated, taking into account the length of the hospital stay, the period of rehabilitation in the outpatient clinic after discharge, and the use of artificial limbs and their maintenance. The incidence of LEAs was 1.6 (95% CI: 1.1-2.2) per 10(5) non-diabetic subjects and 46.1 (95% CI: 34.5-57.6) per 10(5) diabetic patients. Relative risk was 28. Total direct costs associated with LEAs per year were US$ 56,131 in the diabetic population and US$ 30,765 in the non-diabetic population. Thus, potential cost savings associated with excess amputations in the diabetic population was estimated at US$ 541,353 per year of US$ 94,736 per 10(5) inhabitants. It is concluded that the incidence of LEAs in both diabetic and non-diabetic populations in area 7 is the lowest reported in European countries. The potential cost savings per 10(5) inhabitants and per year is estimated at US$ 94,736.

Adult↗

PubMed1991

[Amputation and arthrodesis of the shoulder joint after brachial plexus lesions].

Nine patients with severe irreversible brachial plexus lesions were submitted to arthrodesis of the shoulder joint and/or amputation of the forearm, the latter with the object of fitting an artificial limb. In one patient, the arm was re-implanted and biceps function of strength M2 was obtained. Three patients were submitted to microsurgical interventions on the plexus. All of the patients were visited in their homes after an average period of observation of three years (1-8 years). Seven patients were equipped with prostheses, three of these with myoelectric prostheses. One patient employed an orthosis and one had been submitted to arthrodesis of the shoulder joint only. Three of the patients were fitted with prostheses 12 years after the accident but nevertheless obtained good prosthetic function. One of these patients had even been fitted with a prosthesis on the non-dominant side. Forearm amputation was chosen in order to control rotation and to avoid projection of the proximal part of the prosthesis up over the shoulder joint. The absent/reduced sensibility at the level of the amputation did not result in pressure problems from the prosthesis. All of the patients used their prostheses. Pain is not an indication for amputation surgery but does not hinder a good functional result.

Accidents, Traffic↗

PubMed2003

Prosthetic socket fit comfort score.

PURPOSE: To validate a simple numerical scale to record the socket comfort of an artificial limb. METHOD: This study has adapted the numerical rating scale for pain (Downie et al.(1)) to form a 11 point scale to record the socket comfort score (SCS). Patients were asked to rate the comfort of their socket on a 0 - 10 scale where 0 and 10 represented the most uncomfortable and the most comfortable socket imaginable. Ratings of clinical evidence of poor fit were recorded independently by the physician and the prosthetist. Patients gave new numerical ratings of comfort after any necessary intervention to the socket. Repeatability, criterion related validity, sensitivity to change and use in clinical practice was studied on 44 consecutive patients in the prosthetic rehabilitation clinic. RESULTS: The study showed the reported SCS was consistent and reliable, high correlations being found between three scores obtained from patients by independent recorders. A strong relationship existed between the reported SCS and clinical evidence of poor fit judged by the physician and by the prosthetists' ratings. Significant positive changes in SCS were found after intervention to improve the fit. CONCLUSION: SCS has shown repeatability, criterion related validity and sensitivity to change. It has clinical utility and wider use is recommended.

Adult↗

PubMed1988

Development and testing of thermoplastic structural components for modular prostheses.

The wider use of thermoplastic structural components in modular artificial limbs would enable their general properties of low density, corrosion resistance and mouldability and more specific properties of certain thermoplastics such as shock absorption, fatigue and wear resistance to be used to the advantage of patients and manufacturers. They provide an alternative to metal and carbon fibre reinforced resin systems. Emphasis has been placed on the development of rotationally moulded Nylon 11 shank sections, using Philadelphia recommended load levels as the design criteria for structural integrity. Laboratory testing underlined the importance of fatigue testing of thermoplastic components since structural deterioration due to creep--a time dependent mechanical property of thermoplastics--can be ascertained in fatigue testing but would not be evident on the shorter timescale of the static test. Experimental below-knee prostheses incorporating suitably designed plastic shanks and alignment devices can withstand high static loads and exhibit long fatigue lifetimes in excess of 2 million cycles. The shank design offered an opportunity for testing under service conditions the validity of the Philadelphia Static Load level (2.5 kN) since shank failure loads are around this figure. Patient trials of experimental prostheses based on various combinations of plastic shanks and alignment devices and conducted over 33 months indicate that the Static Load Level along with fatigue testing is a satisfactory test criterion for general service use of thermoplastic prosthetic components.

Artificial Limbs↗

PubMed2001

[The first osseointegrated percutaneous prosthesis anchor for above-knee amputees].

A percutaneous osseointegrated anchoring device for above-knee implantation designed to enable permanent attachment of an artificial limb is described. In addition to a technical description, the two-stage operative procedure, together with the rehabilitation process in an 18-year-old man, is also detailed. Following amputation and complete healing of the soft tissues, a surface-structured metal pin capable of supporting large loads, is driven into the medullary canal of the thigh bone. A metal sleeve having an identical surface structure serves to close off the medullary canal and provide an interface with the soft tissues. Screwed to the end of the pin is a conical metal adapter to which is attached a silicone cylinder whose right-angled distal end is located subcutaneously and ends in a titanium mesh. The first part of the implantation procedure is concluded by closing the silicone cylinder with a plastic plug for 6 weeks to permit osseous integration and the ingrowth of tissue into the mesh. In a second step, the plastic plug is removed via a skin incision, and the permanent load-bearing metal adapter fitted. In the above-mentioned patient wound healing at the metal/tissue interface was complication-free, since the implanted silicone cylinder prevented the "wedge effect" caused by the build-up of "luxuriant" tissue. After a further healing phase of 6 weeks, rehabilitation with an exoprosthesis took only 2 weeks, after which time, the patient was able to walk without a walking aid, and returned to work.

Adolescent↗

PubMed1985

Stochastic analysis of myoelectric temporal signatures for multifunctional single-site activation of prostheses and orthoses.

This paper is concerned with a stochastic time-series analysis of the temporal signatures of myoelectric (ME) signals including the determination of model order and sampling rate. The paper considers the use of time-series parameters for the activation of artificial limbs for high-level amputees, of stimulation electrodes or of powered braces for paralysed persons, in several degrees of freedom, from a single or two surface-electrode pairs at locations where considerable ME cross-talk exists. The multifunctional capability from a single site is based on the differences between the time-series (TS) parameters for different muscle activation patterns at the same ME site, these differences being thus used for limb function discrimination via easily trainable muscle activation patterns at the vicinity of the electrode site. Specifically, the analysis is in terms of identifying the AR parameters of a time-domain autoregressive (AR) signature model both for the complete ME spectrum and for parts thereof, and in terms of the autocorrelation of the signal and of the models residual. Determination of sampling rate and of model orders is discussed in detail. It is shown that, using online real-time analysis, differences in the AR time-series parameters can be observed for different trainable patterns of muscle activation, at the same electrode location, even at the same ME power levels, as long as considerable cross-talk exists at the electrode site. These parameter differences can be accentuated if one considers the AR parameters for lower-frequency spectral windows. A case is made in this paper for employing TS analysis to squeeze out information in a distinct but low-level ripple of the low frequency spectrum of the signal. This information tends to be ignored in frequency domain, but is all that the AR parameters care for in TS analysis, since they are not concerned, with a flat-average low-frequency spectrum, i.e., its white-noise-like part, which is the residual term of the AR Model and not an AR parameter. Discrimination between different functions from a single electrode-site, at even the same power level, is thus shown to require considerable cross-talk at the given site, and to require the consideration of only the low-frequency part of the spectrum.

Artificial Limbs↗

PubMed1952