A New Bandage for Amputation Stumps.

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Amputation stump perfusion is predictive of post-operative necrotic eschar formation

BACKGROUND: A large proportion of patients develop poor amputation stump healing. We hypothesize that Laser-Assisted Fluorescent Angiography (LAFA) can predict inadequate tissue perfusion and healing. METHODS: Over an 8-month period we reviewed all patients who underwent lower extremity amputation and LAFA. We evaluated intra-operative LAFA global and segmental stump perfusion, and post-operative modified Bates-Jensen (mBJS) wound healing scores. RESULTS: In 15 patients, amputation stumps with lower global perfusion demonstrated higher mBJS (P = 0.01). Lower suture-line perfusion also correlated with more eschar formation (P \u3c 0.001). Diabetic patients had higher mBJS (P = 0.009), lower stump perfusion (P = 0.02), and increased eschar volume (P \u3c 0.001). CONCLUSION: LAFA is a useful adjunct for intra-operative stump perfusion assessment and can predict areas of poor stump healing and eschar formation. Diabetic patients seem to be at higher risk of stump eschar formation

The influence of standards and clinical guidelines on prosthetic and orthotic service quality : a scoping review

OBJECTIVES: Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?" MATERIALS AND METHODS: A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. RESULTS: Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. DISCUSSION AND CONCLUSION: Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery

Versatility and modifications of the cross-finger flap in reconstruction of digital soft tissue defect

Background: Hand injuries can cause major functional and cosmetic concerns. The cross-finger flap (CFF) is an effective treatment for complex finger defects. While CFF has typically been employed to treat volar aspect abnormalities, new versions now address a larger variety of digital soft tissue defects. The aim of the study was to evaluate the clinical outcome of various modified techniques of cross-finger flap which are used to reconstruct different soft tissue defect of fingers. Methods: This was a prospective observational study carried out in the department of Burn and Plastic Surgery at Dhaka Medical College Hospital, Dhaka from September 2018 to February 2020. Forty (40) patients who presented with different soft tissue defect of fingers included in this study according to inclusion and exclusion criteria. Results: The study involved predominantly male participants (80%), with a mean age of 31.70±14.28 years. The most common soft tissue defect site was the volar area (47.5%), and various modified cross-finger flap techniques were employed. The majority of patients achieved excellent functional outcomes, with 82.5% classified as good, 12.5% as satisfactory, and 5.0% as poor. Conclusions: The modifications of the cross-finger flap are versatile and useful for different sites of digital injuries with good functional outcome

Preservation of lower extremity amputation length using muscle perforator free flaps.

Coverage of any lower extremity amputation stump must be durable to resist external forces, well contoured, and thin enough for proper shoewear or prothesis fitting. Preservation of bone length to maximise the ability to ambulate is also of paramount importance. If local soft tissues are inadequate to fulfil these prerequisites, consideration of a microsurgical tissue transfer is a reasonable option, especially to cover bone or save a major joint. Muscle perforator free flaps, as shown in this series of eight patients using four different donor sites, are a versatile alternative for the necessary soft tissue augmentation. Multiple choices are available and often even from the involved lower extremity to minimise further morbidity. The vascular pedicles of this genré of flaps are relatively exceedingly long and of respectable calibre to facilitate reaching an appropriate recipient site. They can be sensate if desired. Of course, muscle function is by definition preserved. Complications are minimal and usually related to the reason for the amputation in the first place

Common Peroneal Nerve Injury Related to Small Saphenous Vein Surgery: Report of 2 Cases and Review of the Literature

Although iatrogenic damage is less often involved, deep nerve injuries are reported especially as a result of small saphenous vein (SSV) dissection. Complete or partial division of the common peroneal nerve (CPN) during varicose vein operations causes substantial and serious disability. Most CPN injuries recover spontaneously; nonetheless, some require nerve surgery. Treatment depends on the nature of CPN injury. This report chronicles 2 instances of CPN injury after SSV surgery, addressing treatment strategies and therapeutic gains. The pertinent literature is also reviewed

The Role of Foundational Relations in the Alignment of Biomedical Ontologies

The Foundational Model of Anatomy (FMA) symbolically represents the structural organization of the human body from the macromolecular to the macroscopic levels, with the goal of providing a robust and consistent scheme for classifying anatomical entities on the basis of explicit definitions. This scheme also provides a template for modeling pathology, physiological function and genotype-phenotype correlations, and it can thus serve as a reference ontology in biomedical informatics. Here we articulate the need for formally clarifying the is-a and partof relations in the FMA and similar ontology and terminology systems. We diagnose certain characteristic errors in the treatment of these relations and show how these errors can be avoided through adoption of the formalism we describe. We then illustrate how a consistently applied formal treatment of taxonomy and partonomy can support the alignment of ontologies

“An interval of comfort”: postamputation pain & long-term consequences of amputation in British First World War veterans, 1914-1985

The First World War resulted in the largest amputee cohort in history, with 41,208 amputees in the UK alone; the majority injured as young men and surviving into the late 20th century. Recent studies have estimated that significant residual limb pain affects up to 85% of military amputees: applying this figure to the First World War amputee cohort raises the possibility that up to 35,000 British veterans may have experienced chronic postamputation pain. Despite this and the fact that 13% of injuries in this conflict resulted in amputation, there has been little research into the long-term impact on veterans’ health and quality of life. Recently catalogued historical medical and pension files held at The National Archives offer the opportunity to follow up this type of injury in a large group of veterans for the first time. This thesis will use these files to document and explore long-term outcomes of amputation and chronic postamputation pain, developments made in the treatment of this condition, the impact of aging on amputee veterans and their likelihood of developing a concomitant condition from 1914 to 1985. It will examine these issues from three perspectives: that of the injured servicemen, the civil servants attempting to value and compensate those injuries, and from the clinicians’ responsible for the veterans’ medical care and rehabilitation. This research has been based on a unique model of interdisciplinary collaboration, incorporating research methods from history and clinical medicine, and will present its findings from historical material with recommendations for current practice. Given the similarities in injury patterns and prevalence of chronic residual limb, phantom and neuropathic pain between the First World War cohort and contemporary casualties, it is anticipated that the findings of the project will assist in the strategic assessment and planning for long-term pain conditions by medical staff and care providers for today’s and future blast injury amputee cohorts.Open Acces