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At least 19 recordsLinked to original sources
PubMed1992

Traumatic amputation by explosive blast: pattern of injury in survivors.

Explosive blast causes a pattern of injury including primary blast lung, secondary fragment injury and traumatic amputation of limbs. Major traumatic amputation is rare in survivors of bomb blast but common in those who die. The mechanism of such injury has not been previously determined, but must be established if protective measures are to be developed for members of the armed forces. The nature of 41 traumatic amputations in 29 servicemen who survived to reach medical care after blast injury was investigated to determine the anatomical level of amputation and the pattern of soft tissue damage. Joints were an infrequent site of amputation and the tibial tuberosity was a particularly frequent site of lower-limb severance. Comparison of the pattern of injury was made with that seen in ejecting fast-jet pilots, who frequently suffer major flailing injury; there appears to be a substantially different injury distribution. The accepted mechanism of traumatic amputation, avulsion by the dynamic overpressure, is challenged; it is suggested that the shockwave resulting from an explosion is capable of causing at least bone disruption in a limb.

Amputation, Traumatic↗
PubMed1978

Phantom limbs and related phenomena in recent traumatic amputations.

Seventy-three soldiers who had traumatic amputations were examined from 1 to 6 months after limb loss. All experienced phantom limb sensations and 67 percent experienced phantom limb pains, usually transient. Stump pain occurred in 43 percent and was associated with phantom pain in 54 percent of these. Of the 23 percent of the entire group who had evident stump pathology, 33 percent had phantom pains only, 20 percent had stump pains only, 40 percent had both, and 7 percent were pain-free. All stump ends exhibited an area of hyperpathia with hypoesthesia. Phantom pain probably results from peripheral or spinal cord mechanisms, or both, rather then from more rostral mechanisms.

Adult↗
PubMed1992

[Not a tourniquet, but compressive dressing. Experience from 68 traumatic amputations after injuries from mines].

In autumn 1991, 68 patients with traumatic amputations after injuries caused by mines were evacuated to the United Nation's field hospital in the demilitarized zone between Iraq and Kuwait. Most were seen during a three week period when civilians harvested mines. During the first days of this period, continuous bleeding distally to applied tourniquets was frequently observed. Orders were issued to remove any tourniquets and cover the wounds with a very tight elastic bandage. Prehospital intravenous infusions were decreased. Three out of 18 patients died prior to the change of routine compared with one out of 50 afterwards. The new directives led to visibly less haemorrhage. Haemoglobin on admission was mean 8.6 g/100 ml during the first part of the observation period compared with mean 10.5 g/100 ml with the new routine. 23 patients received blood transfusions. Fewer patients needed transfusions after the use of tourniquets was discontinued. A tourniquet should not be used in the treatment of bleeding extremity injuries. In extensive crush injuries and traumatic amputations a compressive dressing should be used, applied from the end of the extremity in a proximal direction.

Adult↗
PubMed1977

Traumatic amputation of digits: the fate of remaining blood. An experimental and clinical study.

Experimental studies on rabbit ears amputated by either a clean sharp division or severed by a crushing blow showed that twice as much blood remained in the crush group. Microthrombi and tissue thrombi were seen in this group only. A review of 142 digital replantations performed over a 10 year period showed 126 survivals. Ninety-three were complete amputations and 80 of these survived; 49 were incomplete amputations and 46 survived after revascularization attemps. Of 74 clear amputations, 68 survived; of 68 crush-type amputations, 58 survived. Circulatory disturbances occurred in 36 replanted digits; 16 could not be salvaged. The primary cause of complications was venous obstruction. In 80 digital replantations done from January, 1974, to December, 1975, success was obtained in 75 (93.75 percent). Irrigation of vessels of the severed part is done only in cases of double level amputation, severely crushed or those due to avulsion. Heparin, low molecular weight dextran, urokinase, and antibiotics are given for several days after operation.

Amputation, Traumatic↗
PubMedDate not supplied

Traumatic amputations. A vietnam experience.

Ninety-two acute combat amputations were performed in 70 casualities of the Vietnam conflict. In the 67 surviving patients with 83 stumps, primary closure was done in 24 limbs (30%) and delayed closure in 11 more. Closed cases were observed 2 weeks and no failures noted. In selected patients early suture of war amputations can be practiced with a satisfactory result.

Adolescent↗
PubMedDate not supplied

[Reconstructive surgery of the thumb after traumatic amputation (author's transl)].

The authors analysed the results of two series of patients treated either by lengthening (16 cases) or digital pollicization (45 cases). The conclusions about the indications for the two techniques are as follows: When the amputation is proximal and the sole lesion, pollicization of the ring finger is preferred. In distal amputations in children, pollicization is still indicated, but in adults, lengthening, with a pedicle island-flap to give sensation is preferable. In amputations of the thumb associated with lesions of other digits, pollicization is not feasible; in these cases, the authors recommend a toe transplant using micro-surgical technique.

Adolescent↗
PubMed1991

Per Primam thumb replantation for all patients with traumatic amputations.

Forty-two complete thumb replantations performed between 1980 and 1984 were reviewed. The mean follow-up time was 14 months. Replantation was attempted for all thumb amputations regardless of mechanism or severity of injury. Sixteen (38%) failed intraoperatively or postoperatively. Thumbs with narrow zones of injury showed a significantly higher survival rate than those with wide zones of injury. Eighty percent of those with poor arterial flow intraoperatively ultimately failed, despite pharmacologic treatment and multiple vein-graft anastomoses. Two thumbs with no vein repairs ultimately survived. Reexploration for loss of perfusion succeeded in 60% of cases. Total metacarpophalangeal and proximal interphalangeal active motion postoperatively averaged 68 degrees. Median static two-point discrimination returned to 11 mm. Avulsed thumbs survived in 46% of cases. Replantation should be attempted in all cases of thumb amputation, as success cannot be predicted by mechanism or severity of injury. Thumbs with poor intraoperative flow (20%) or no venous return (50%) can survive and should not be primarily amputated. Vein grafting is not mandatory if shortening allows anastomoses to be tension free. Prompt reexploration of acute vascular occlusions is worthwhile.

Adult↗
PubMed1978

[Reconstructive microsurgery in traumatic amputations of wrist and fingers (authors transl)].

A specialised department for vascular microsurgery was established in the Research Institute for Clinical and Experimental Surgery in 1973. 58 replantations of fingers in 42 patients were made. Total percentage of healing was 52 (30 fingers). Doppler's flowmetry is very useful for the control of microanastomoses of the arteries in fingers. Reconstruction of vessels in fingers was made with an operative microscope (magnification 16--24 times), special microtechnique and 10/0 sutures. Successful replantation is possible even 10--12 hours after severance, it the finger is kept in hypothermia at + 4 degrees C. Rapid admission of the patients to the hospital, i.e. improved information and emergency transport may shorten ischaemic time. The first stage of replantation is the marking of arteries and veins in the finger and in the stump. It is essential to suture not less than 2--3 veins for one artery and nerve. Thorough rehabilitation is of utmost importance to get the best functional results.

Amputation, Traumatic↗