ASSISTIVE DEVICE FOR APPLYING ABOVE-KNEE SUCTION SOCKET.
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The vascular changes in rabbits after amputation were studied in vivo with arteriography, after intracardial injection of contrast. In the amputated extremity an initial vasoconstriction of the arteries was found. Thereafter changes were observed in arteries and veins, both in the operated and contralateral extremities, depending on the level of amputation and the manner in which the stump was closed. After amputation distally on the extremity and after stump closure without myoplasty arteriovenous shunting was observed in the amputation stump. Arteriovenous shunts were not seen after knee disarticulation and after proximal amputation on crus with myoplasty. Inactivity of the muscles in the amputation stump is supposed to be the cause of the shunt formation. After mid-femur amputation a permanent vasoconstriction of the femoral artery was observed, whereas artery dilation was seen when amputation on the femur was combined with plugging of the medullary cavity.
Pollicisation remains a good solution to restore the function of the adult thumb after injury. This technique requires a good knowledge of plastic hand surgery to perform an emergency or secondary reconstruction, sparing the functional integrity and enhancing the value of the stumps. The authors report their own experience of 15 cases treated between 1985-1990.
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Data on 40 upper limb amputees (11 bilateral) with regard to stump pain, phantom sensation and phantom pain is presented. All the patients lost their limbs as a result of violent injuries intended to terrorise the population and were assessed 10-48 months after the injury. All amputees reported stump pain in the month prior to interview and ten of the 11 bilateral amputees had bilateral pain. Phantom sensation was common (92.5%), but phantom pain was only present in 32.5% of amputees. Problems in translation and explanation may have influenced the low incidence of phantom pain and high incidence of stump pain. In the bilateral amputees phantom sensation, phantom pain and telescoping all showed bilateral concordance, whereas stump pain and neuromas did not show concordance. About half the subjects (56%) had lost their limb at the time of injury (primary) while the remainder had an injury, then a subsequent amputation in hospital (secondary). There was no association between the incidence of phantom pain and amputation irrespective of being primary or secondary.
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