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Principles of lower limb prosthetics and rehabilitation
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Rajiv S Hanspal, John Sullivan
Limb amputation surgery and prosthetic replacement is one of the earliest recorded surgical operations dating back to 5th century BC. Historian Herodotus relates the story of a Persian soldier and prisoner who cut off his foot in order to secure his freedom and replaced it with a wooden foot. The common cause of amputation has generally been traumatic and as a life-saving procedure. Most of the developments in amputation and prosthetics have generally been associated with war, as is evident even today. However, in the western world, the cause of amputation is increasingly due to vascular disease. Amputation becomes a necessary surgical procedure to remove a limb that has otherwise become useless and life threatening.
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
A 25-year-old man arrives in the emergency department following a fall from 15 feet onto concrete. He is moving all four limbs. His blood pressure is 110/70 and his heart rate is 80 beats per minute. He is not opening his eyes to voice. What will you do?Assess him according to ATLS protocolCheck his airway, breathing and circulation whilst maintaining C spine immobilisationObtain intravenous access by two large-bore cannulaePerform primary and secondary survey to include thorough neurological examinationSend bloods for FBC, U+E, amylase, clotting, glucose, group and saveRequest a portable chest and pelvic x-ray and obtain urgent CT imaging of his head to rule out intracerebral injury (primary brain injury and intracerebral bleed as a cause of his lowered GCS)
Pain management
Published in Barbara Smith, Linda Field, Nursing Care, 2019
This proposed gating mechanism is thought to occur in specific dorsal horn cells within the spinal cord called substantia gelatinosa. The theory helped to clarify the variation in perception of pain in relation to identical pain stimulation – in other words, the same pain stimulation can lead to different perceptions of that pain in individuals and the experience of pain is not related directly to the level of pain input. This can be highlighted in cases where pain is disproportionate to the severity of injury, such as the soldier in the battlefield, or when pain occurs long after an injury has healed, such as chronic lower back pain or phantom limb pain. In phantom limb pain, the person feels pain even though the limb has been amputated.
Advances in additive manufacturing processes and their use for the fabrication of lower limb prosthetic devices
Published in Expert Review of Medical Devices, 2023
Shaurya Bhatt, Deepak Joshi, Pawan Kumar Rakesh, Anoop Kant Godiyal
Prosthetic devices are used to physically support a person with a disability, caused due to loss of a limb or a certain portion of limb or a body part due to disease or trauma. Prosthetic devices can replace the missing part in the body of a person and help to regain the working capabilities of the lost part. Prostheses can be of many types, such a foot prosthesis, hand prostheses, and many more. The part of the limb that is left after loss is known as residual limb. A prosthesis socket acts as inter-connection between the prosthesis and residual limb, and helps to transfer load and motion from the residual limb to the prosthesis. The naming of prostheses is carried out based on joint and limb involved. Four common nomenclatures of prostheses are Above Elbow (AE), Below Elbow (BE), Above Knee (AK), and Below Knee (BK). Prostheses can also be named based on the bone involved, like transradial prosthesis, transhumeral prosthesis, transfemoral prosthesis, and transtibial prosthesis, as were used in various studies [1–4]. It is estimated that 25.5 million people in the world need prosthetic/orthotic devices [5]. In India, 2.21% of total population is disabled, in which 20% has disability related to movement [6].
A Large Segmental Mid-Diaphyseal Femoral Defect Sheep Model: Surgical Technique
Published in Journal of Investigative Surgery, 2022
David S. Margolis, Gerardo Figueroa, Efren Barron Villalobos, Jordan L. Smith, Cynthia J. Doane, David A. Gonzales, John A. Szivek
Large weight bearing long bone segmental defects can occur in patients secondary to severe traumatic injury or bone resections due to cancer or infection. Although bone has a high potential for endogenous healing, critical size bone defects will not heal without intervention. Numerous treatment options exist for this problem such as the use of allograft, vascular autograft, the induced membrane technique and distraction osteogenesis [1–3]. However, each of these treatment modalities has numerous complications. Many patients do not successfully heal these defects and necessitate amputation. Even when successful, the outcome of limb salvage is similar to limb amputation [4, 5]. Due to the poor prognosis of these injuries there is a substantial need to discover effective treatments for extensive bone loss.
The Incraft stent graft for the treatment of abdominal aortic aneurysms: an iliac-friendly device with an effective conventional proximal sealing mechanism
Published in Expert Review of Medical Devices, 2022
Nikolaos Schoretsanitis, Efstratios Georgakarakos, Christos Argyriou, Miltos Lazarides, Kiriakos Ktenidis, Nikolaos Papanas, Savas Deftereos, George S. Georgiadis
The iliac limbs are deployed into the limb gates of the aortic main body. The overlap between the aortic main body and the iliac limb can vary between 2 and 5 cm on the ipsilateral side and between 2 and 4 cm on the contralateral side. This allows the intraoperative length adjustment and limits the need for limb extensions. Suture knots on the outer surface of the limb comprise an interlocking mechanism to eliminate the risk of limb separation. The iliac limb presents a series of z-stents cranially, one or more taper stents (if other than a straight configuration), and a diamond sealing ring caudally. The cranial diameter is constant at 13 mm, while the length and the caudal diameter of the limbs can vary. The iliac limbs are available in sizes 10, 13, 16, 20, and 24 mm with a treatment range of iliac artery diameters between 9.0 and 22 mm and in four different lengths (8, 10, 12, 14 cm). The iliac limb delivery system has a 12 Fr outer diameter for prosthesis diameters between 10 and 20 mm, and a 13 Fr for prosthesis diameters of 24 mm.