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At least 1,693 records · Page 94Linked to original sources
PubMed1999

Decrease in phantom limb pain associated with prosthesis-induced increased use of an amputation stump in humans.

The experience of phantom limb pain, non-painful phantom limb sensation and telescoping was ascertained by questionnaire in a group of upper extremity amputees wearing a functionally effective Sauerbruch prosthesis which permits extensive use of the affected limb and in a group of patients wearing a cosmetic prosthesis that did little to increase the utilization of the amputation stump. The Sauerbruch prosthesis group exhibited a significant and large decrease in amount of phantom limb pain while the cosmetic prosthesis group showed no change. Neither group experienced a decrease in non-painful phantom limb sensation or telescoping. The amount of phantom limb pain has been found to be highly correlated with the amount of injury-related, afferent-decrease cortical reorganization. It is possible that the increased use of the amputation stump induced by wearing a Sauerbruch prosthesis produced a countervailing use-dependent, afferent-increase type of cortical reorganization that reversed the phantom limb pain. These preliminary results require replication. Their therapeutic implications are discussed.

Adult↗
PubMed2002

Sympathetic nerve activity to amputated lower leg in humans. Evidence of altered skin vasoconstrictor discharge.

Transection of a peripheral nerve in the cat is known to cause a regional change in sympathetic impulse pattern. Our aim was to determine whether microneurography can be used to study sympathetic activity in the transected nerve of human amputees, and whether any such activity shows an abnormal pattern similar to that observed in the cat. Seven successful sympathetic recording sessions were performed in the peroneal nerve of four subjects with posttraumatic transtibial leg amputation; one of them was studied on four occasions. Muscle nerve sympathetic activity (MSA) was detected in all four subjects. Skin nerve sympathetic activity (SSA) was found in one patient only, but on three occasions. It was more difficult to obtain high quality sympathetic recordings than for intact nerves, particularly in patients amputated many years before our studies. MSA showed a qualitatively normal pattern at rest and during various manoeuvres. In three recordings from skin nerve fascicles without innervation zone, SSA displayed normal characteristics at room temperature and qualitatively normal responses to arousal stimuli and various manoeuvres. During body cooling there was an abnormal shift in SSA pattern with a reduction in burst duration instead of the increase occurring normally. Cardiac rhythmicity of SSA was more pronounced during body cooling than during body heating. This is also a reversal of the normal pattern. The abnormal SSA pattern during body cooling suggests increased baroreflex regulation of cutaneous vasoconstrictor neurones, similar to the change after nerve transection in the cat. This is the first time that human nerve recordings support the hypothesis of a regional alteration in sympathetic impulse pattern following a nerve lesion. The implications of this phenomenon for pain conditions remains to be explored; our patients did not suffer from phantom or stump pain.

Adult↗
PubMed1998

Correlation between magnetic resonance imaging and histopathology of an amputated forearm after an electrical injury.

A 53-year-old man sustained a 50 Hz, 60 kV electrical injury. The current flowed between his right hand and both feet. There was necrosis of the distal portion of the right forearm, and the fourth and fifth toes on the right foot. The skin on the amputated right upper extremity appeared normal except for an ulcer in the antecubital fossa and some blister scars. However, most of the muscles of the arm at the elbow were necrosed and partially replaced by fatty tissue or fibrosis. These necrotic areas corresponded to minimally increased signal intensities on T1-weighted MRI, and high signal intensities on T2-weighted images. MRI may be employed to predict amputation level after electrical injury.

Adult↗
PubMed1977

Conservative management of fingertip amputations.

A method of conservative treatment of fingertip amputations, allowing for spontaneous healing of the defect, was evaluated in a one-year study involving 17 consecutive patients and 21 amputations. Six presented with exposed bone in the lesion. These injuries healed with excellent results in terms of maintenace of maximum finger length and minimization of cosmetic deformity and functional disability. Rapid retrun to work was possible in most cases and morbidity associated with surgery was avoided.

Adolescent↗
PubMed1978

An experimental study on "replantation toxemia". The effect of hypothermia on an amputated limb.

Hind legs of dogs were amputated at the middle of the thigh and preserved in three different conditions: in ice water, in a refrigerator, and at room temperature. After 6 or 12 hours of ischemia, recirculation was established. The survival rate of the animals was observed and measurement of limb edema, potassium, pH, and lactate in the blood was performed to study the effects of hypothermia on prevention of "replantation toxemia." Cooling of the amputated limb was effective for prevention of toxemia, and the cooling effect was greater in ice water than in a refrigerator. However, when cooled in ice water, some animals died due to toxemia when the time of ischemia was prolonged to 12 hours. In the dead animals, a close relationship was observed between the developement of toxemia and metabolic acidosis due to the increase in lactate.

Amputation, Surgical↗
PubMed1982

Digital replantation and amputation--comparison of function.

Clearer indications regarding when to replant an amputated digit can be obtained by comparing the functional capabilities of two similar groups of patients, one of which has had amputations and one of which has had replantations. This paper reports such a comparative study. Function was assessed by asking the patient to perform 10 tests designed to cover a broad spectrum of everyday activities, and grip strength was compared to that in a normal hand. Grip strength was appreciably greater in patients with replanted thumbs and multiple digits, and less so in those with replanted single digits. Based on our findings on the small, but intensively studied, number of patients assessed in this review, it would appear that thumbs should always be replanted if possible. In contrast, the functional analysis shows little necessity for replantation of a single finger. Multiple digital replantation assumes lesser functional value if one or more fingers remain that can oppose the thumb to provide prehension.

Adolescent↗
PubMed1983

Dorsal transposition flap for reconstruction of lateral or medial oblique amputations of the thumb with exposure of bone.

A dorsal transposition flap for the treatment of medial or lateral oblique amputations of the thumb is indicated when the amputation extends proximal or up to the eponychial fold with loss of the paronychial fold and exposure of bone. The procedure, exemplified in three typical cases, obviates the need for cross-digit flaps and avoids the risk of digital stiffness.

Adult↗
PubMed1985

Replantation of the amputated distal part of the fingers.

Microsurgical replantation has been attempted in the distal phalanx of the finger regardless of whether zones I and II were involved. There were 70 patients with 87 amputated fingers. The patients' ages ranged from 14 months to 71 years. Fifty-one fingers were completely amputated. Five of the 87 replants failed. Seven fingers showed partial necrosis, but all others had no necrosis. Of the 74 fingers that had partial or no necrosis more than 6 months after surgery, 60 fingers (81.1%) are in excellent condition and have good daily use, and 14.8% have at least partial use. The patients were satisfied with the cosmetic appearance in all of the replanted fingers that survived.

Adolescent↗
PubMed1998

Major replantation versus revision amputation and prosthetic fitting in the upper extremity: a late functional outcomes study.

The functional outcomes of amputated arms that were either replanted or had a prosthesis were compared. In addition, factors that influenced the functional outcome of replants were evaluated. The Carroll test was used to evaluate functional capacity of 22 successful upper extremity replantations at or proximal to the wrist as well as 22 amputees (at similar levels) fitted with a variety of prosthetic devices. The outcome was excellent or good in 8 (36%) replanted limbs. This proportion was statistically higher than those grades in the prosthetic group. When the groups were more closely matched (adults with below elbow injuries), the replantation group had 6 (50%) good or excellent outcomes and the prosthetic group had none. An analysis of covariance of the replantations demonstrated a statistical association between a better outcome in younger patients with more distal injuries. This study indicates that replantation produces superior functional results compared with amputation and a prosthesis.

Adolescent↗
PubMed1984

[Painful stumps after digital amputations].

Two etiologic groups of painful digital amputation stumps may be seen, each calling for a different type of treatment. One-fourth of painful amputation stumps are due to excessive nociperception and their management usually consists of local treatment. The other three-fourths are due to thalamic sensitive deafferentation and call for neurosurgical treatment if discriminative sensitivity has not been reestablished in the painful zone. Intermittent thalamic stimulation is our choice and has led to recovery in 25 out of 26 patients who have been submitted to this type of treatment.

Amputation Stumps↗
PubMed1984

Cosmetic amputation of the long finger with carpal osteotomy.

Amputations of the third digital ray leave a central gap which can usually be closed by shifting either the second or the fourth digital rays medially. This however calls for an osteotomy with it usual hazards. To avoid metacarpal osteotomy, we have completed the amputation of the long finger in six cases with a central carpal osteotomy through the capitate. This enables the second and fourth rays to be moved intact medially and to close the gap, thus providing a cosmetic three fingered hand.

Amputation, Surgical↗
PubMedDate not supplied

Above-elbow amputation: a case study in restoring function.

Functional goals and treatment are the basis for occupational therapy. Following upper extremity amputation patients can benefit significantly from a program that concentrates on setting and achieving functional goals. Few hand therapists have the opportunity to treat a large number of amputees. This case study of treatment of above-elbow amputation discusses the use of an activities of daily living form as an aid to developing and meeting short-term goals in treatment planning.

Accidents, Traffic↗
PubMed1989

The value of skin temperature measurements in forecasting the healing of a below-knee amputation for end-stage ischaemia of the leg in peripheral vascular disease.

In order to forecast the healing of a Burgess type below-knee amputation the skin temperature of the leg has been studied before operation in 39 instances using infra-red thermography in a 26 degrees C environment. Healing bore no relation to the mean skin temperature of the calf or that of the skin at the site of the anterior incision. However, when the skin temperature at the site of the incision for the long posterior flap was greater than 30.4 degrees C or when the ratio of the temperatures at the posterior and anterior incision sites (P/A) was greater than 0.98 healing was significantly more likely to occur. It is proposed that the temperatures at these sites should be used to assess the prospect of such an amputation healing.

Aged↗
PubMed2001

Transtibial amputation. Prosthetic use and functional outcome.

Annually, roughly 80,000 to 100,000 amputations are performed with a total cost of greater than $50,000 per patient. Amputations in general and TTAs in particular are worthy of investigation to provide a cost-effective functional outcome that provides high patient satisfaction. The process of prosthetic selection, functional outcome, and avoidance of common complications begins with preoperative education of the patient and communication with the rehabilitation team. Determining an individual patient's perceptions of the process and his or her desired functional needs can help establish a baseline for prosthetic prescription and patient education. With the apparent difficulty in predicting who will be functional with a prosthesis, it seems prudent to initiate prosthetic training and fitting with all patients who have a moderate potential for use. Because many patients undergoing this operation have significant illness, as judged by the high mortality rate at follow-up, it is important to begin this process early to promote the highest recovery of functional independence. With the continual improvement in prosthetic components and postoperative management, it seems possible for the ill, elderly patient to regain near preoperative functional independence with the use of a prosthesis.

Adult↗
PubMed2000

[Nail recession emergency treatment: a new technique for the repair of fingertip amputations].

INTRODUCTION: In spite of the recent advances made in microsurgery, the reconstruction of oblique fingertip amputations remains problematical. In cases where reimplantation is technically impossible, the surgeon can utilize a number of different flaps to preserve digital length. METHODS: In certain cases, instead of local flap repair using an advancement flap, the nail complex can be recessed so that after bone shortening of the distal phalanx the free edge of the nail can be stitched to the skin without resulting tension. Two longitudinal incisions are made, and a flap including the nail complex is obtained from the distal phalanx. The dissection is made as far as the base of the middle phalanx, and is superficial so that it does not affect the distal branches of the middle phalangeal arteries. This technique was used consecutively in three cases of oblique fingertip amputations. RESULTS: The average shortening required was 10 mm. In all three cases, the nail was preserved, and pulp sensitivity was excellent (mean static two-point discrimination of 5 mm, Semmes-Weinstein monofilaments of 2.83-3.61). The mean period before return to work was 5 weeks. No proximal interphalangeal joint stiffness was noted. However, all the patients complained of pain upon exposure to cold. DISCUSSION: This technique is simple to use, and combines the advantages of bone shortening with the esthetic aspect of preserving the nail complex. No palmar dissection is necessary, and the standard risks associated with advancement flap techniques are thus avoided. Although this reconstruction method results in a shorter finger, good functioning and good immediate sensitivity are maintained.

Adult↗
PubMed2001

Successful microsurgical replantation of an amputated penis.

Traumatic amputation of the penis is a rare condition. The paper presents a 22-year old man who suffered a complete penile amputation in a result of an unfortunate accident. Microsurgical replantation of the penis was performed in the case with a complete return of sensation, sexual function and physiologic miction. Microsurgical replantation is the treatment of choice for this injury.

Adult↗
PubMed2003

NMDA-mediated mechanisms in cortical excitability changes after limb amputation.

OBJECTIVES: The aim of our study was to determine the role of N-methyl-d-aspartate (NMDA)-mediated mechanisms in cortical excitability changes after limb amputation, and their possible relationship to phantom pain. MATERIALS AND METHODS: Sixteen upper limb amputees who were suffering from chronic phantom pain received the NMDA-antagonist memantine or placebo for 3 weeks. Intracortical inhibition (ICI) and intracortical facilitation (ICF) were determined at baseline and on day 21 using transcranial magnetic stimulation. Simultaneously, phantom pain intensity was assessed. RESULTS: Memantine reduced ICF and enhanced ICI to roughly the same extent as seen in healthy subjects in a previous study. These changes were not correlated to the reduction of phantom pain. CONCLUSION: We therefore conclude that NMDA-mediated mechanisms influence changes of ICI and ICF occurring after limb amputation. However, our results suggest that these cortical excitability changes and phantom pain are independent of each other.

Adult↗