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Traumatic Amputation on Arrival
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Akash Kumar Ghosh, Vishal Kumar
Traumatic amputation is the accidental loss of an extremity or a part of it. Upper limb amputations account for around 65% of traumatic amputations and usually involve the working and active age bracket of 15–40 years.
Rehabilitation after Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
In the UK, vascular disease and diabetes are the main reasons for elective amputation (>90%). Traumatic amputation is commonly caused by road traffic collisions and industrial accidents. The level of traumatic amputation increases during conflicts due to explosive ordnance, and this has a lasting legacy with lower limb amputation worldwide as a result of residual ordinance (land mines) resulting in over 10,000 lost limbs every year.1 Approximately 10,000 amputations are performed in the UK annually, 50% of which will be referred to a limb fitting centre (see Table 34.2). Traumatic amputations typically affect the lower limb, causing vascular and/or neural damage with associated bone and soft-tissue injury. Primary amputation may be required; however, the decision may be delayed until an accurate demarcation of viable tissue is made as similar outcomes are seen between immediate and delayed amputation.4 Amputation does not necessarily have to be at the level of bone injury, as internal fixation of the fracture at a level of otherwise healthy soft tissue can allow amputation with a longer residual limb. Special care is required in looking after the skin and fashioning a muscle flap in the residual limb as these are weight-bearing structures.
Catastrophic haemorrhage
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
The elastic content of arteries makes them highly resistant to blunt injury, but susceptible to incision or ballistic fragment penetration. Catastrophic extremity or junctional haemorrhage is therefore relatively rare following blunt trauma, with early deaths usually resulting from central vascular deceleration injuries or traumatic brain injury (3). In contrast, the superficial location of blood vessels within the extremities and across junctional zones makes them particularly vulnerable to penetrating injury at these sites (4). Traumatic amputation is a common cause of catastrophic haemorrhage following blast injury on the battlefield (5) but uncommon in civilian practice where it occasionally follows farming and industrial accidents or accidental explosions. However, the rise in terrorist activity over the last decade means such injuries are likely to become increasingly common in civilian practice, too.
Degree of Soft Tissue Injury is a Major Determinant of Successful Arterial Repair in the Extremity: A New Classification of Extremity Arterial Injury?
Published in Journal of Investigative Surgery, 2022
Peijun Deng, Jiantao Yang, Jacques Henri Hacquebord, Bengang Qin, Honggang Wang, Ping Li, Liqiang Gu, Jian Qi, Qingtang Zhu
Following institutional review board approval (NO. 2021247), a retrospective study was conducted on data from all adult patients treated in our institution for traumatic extremity arterial injury of a major vessel between January 2013 and December 2020. The inclusion criteria were as follows: 1) single or multiple arterial injury in an extremity and resulting in 2) ipsilateral limb ischemia at the time of presentation. Limb ischemia was defined as 1) poor capillary refill or 2) weak pulse or pulselessness. The exclusion criteria were:1) age < 16 years, 2) injury below the wrist and ankle, 3) unstable vital signs, 4) polytrauma, 5) preexisting peripheral vascular disease, and 6) traumatic amputation. Finally, 106 patients were included in this study (Figure 1). The median age of patients was 36 years [interquartile range (IQR): 25.25-45], with 16 women and 90 men.
The relationship between self-reported physical functioning, mental health, and quality of life in Service members after combat-related lower extremity amputation
Published in Disability and Rehabilitation, 2022
Susan L. Eskridge, Jessica R. Watrous, Cameron T. McCabe, Mary C. Clouser, Michael R. Galarneau
Future research incorporating objective measures can assist in determining whether the reported worsening function is a true deficit or a perception of a deficit. This difference could guide rehabilitation toward physical health treatments for a true deficit or mental health for perceived deficits. Investigations into prosthesis satisfaction would provide insight to how prosthesis functioning relates to QOL. Additionally, clinical research should examine the impact of using evidence-based treatments for PTSD and depression on physical functioning outcomes within an integrated rehabilitation program. Finally, these findings are generalized to Service members with a combat-related amputation. Further study is necessary to determine whether these findings generalize to any traumatic amputation.
More than half of persons with lower limb amputation suffer from chronic back pain or residual limb pain: a systematic review with meta-analysis
Published in Disability and Rehabilitation, 2022
Matthijs Oosterhoff, Jan H. B. Geertzen, Pieter U. Dijkstra
Regarding RLP and back pain, number of persons ranged from 19 to 1569 per study, in total 10 201 persons. The weighted mean ± SD (standard deviation) age of study persons was 51 ± 10 years, ranging from 23 to 73 years. The weighted mean ± SD time since amputation was 15 ± 7 years, ranging from 0.4 to 32 years. The median proportion prosthesis use was 0.98 (IQR 0.80–1.00), the median proportion male gender 0.82 (IQR 0.70–0.99). Most persons had undergone a traumatic amputation with a weighted mean proportion of 0.68, followed by the proportion vascular cause of 0.20, and a proportion diabetic cause of 0.08. A mean weighted proportion of 0.51 had undergone an above knee amputation, a mean proportion of 0.40 a below knee amputation, and a mean proportion of 0.08 a bilateral amputation.