Life Care Planning for the Amputee
Roger O. Weed, Debra E. Berens in Life Care Planning and Case Management Handbook, 2018
In general, the longer the length of the residual limb, the better the prosthetic function that can be expected. In the leg, amputation below the knee (transtibial) provides for lower energy expenditure than the use of an above-knee (transfemoral) prosthesis. Salvaging the leg at a below-knee level is now the goal of leg amputation surgery in the United States (Moore & Malone, 1989). Disarticulation levels for the arm and leg have certain relative contraindications and should be carefully considered on an individual basis. Full thickness skin and soft tissue coverage are also helpful in achieving ideal prosthetic functional outcomes. However, with the new gel liner interfaces, scarred skin and poor soft tissue coverage can be dealt with in a more satisfactory manner than in the past.
Mangled Extremity
Raymond Anakwe, Scott Middleton in Trauma Vivas for the FRCS (Tr & Orth), 2017
Current guidance from the BOA and BAPRAS is that open tibial fractures should be operated on within 24 hours with a combined ‘orthoplastic’ approach. Surgery should be undertaken more urgently if there is gross contamination or an arterial injury requiring repair. The level of amputation should be guided by the soft tissue injury and the level at which adequate soft tissue coverage can be obtained. Preservation of length improves energy expenditure during rehabilitation for the patient but should not compromise the adequacy of the debridement. In a clean wound, it would be usual to perform a definitive procedure at the time, fashioning flaps at the index surgery. For this injury, it may be possible to undertake a below knee amputation. For crush, blast or grossly contaminated injuries, the evidence suggests that flaps should not be fashioned at the index procedure and at least one further debridement should be undertaken to reduce the risks of subsequent infection, retained contamination or flap failure.
Orthopedic Treatment of the Traumatized Lower Extremity
Armstrong Milton B. in Lower extremity Trauma, 2006
Georgiadis et al. (29) compared the long-term outcomes and the quality of life in patients who had an open fracture of the tibial shaft with severe soft-tissue loss managed with either limb salvage with a free flap or with early below-the-knee amputation. The patients who had limb salvage had more complications, more operative procedures, and a longer stay in the hospital than the patients who had an early amputation. The long-term functional results for 16 patients who had a successful limb-salvage procedure were compared with those for 18 patients who had a below-the-knee amputation. The patients who had had a successful limb-salvage procedure took significantly more time to achieve full weight bearing, were less willing or able to work, and had higher hospital charges than the patients managed with early amputation, and significantly more patients who had limb salvage considered themselves severely disabled.
Late-onset Vibrio vulnificus septicemia without cirrhosis
Published in Baylor University Medical Center Proceedings, 2019
Michelle T. Lee, An Q. Dinh, Stephanie Nguyen, Gus Krucke, Truc T. Tran
Initial management included intravenous fluids with broad-spectrum antibiotics (vancomycin, cefepime, clindamycin). On hospital day 4, cultures showed lactose-negative, oxidase-positive gram-negative bacilli; given potential infection with Aeromonas or Vibrio, doxycycline was added. Leukocytosis and fevers persisted despite resolving symptoms, and sudden clinical decompensation occurred on hospital day 5. The patient developed hypotension refractory to fluids and ecchymoses with enlarging bullae (Figure 1b). Prompt reevaluation was concerning for rapidly progressing necrotizing fasciitis. A below-knee amputation was performed and the patient gradually improved without postoperative complications. Vibrio vulnificus was identified from blood cultures, and antibiotics were changed to ceftriaxone and doxycycline.
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
When a person loses the part of the leg below-knee (BK), i.e. the knee joint is intact, then the amputation is known as below-knee amputation, and the prosthesis used in this case is below-knee prostheses or transtibial prostheses. SLS process has been used to fabricate energy storage and return (ESAR) feet for transtibial amputees [44]. Compared with a carbon fiber foot, its mechanical loading response and locomotor patterns were within permissible range and showed promising results [44]. Even a home 3D-printing technology can prove to be a viable method for producing prostheses [80]. A prosthesis was developed using the FDM technique using PLA material and produced an ESAR foot, which provides better comfort than solid ankle cushioned heel (SACH) foot. On testing for plantarflexion and dorsiflexion, 3D-printed feet showed promising results compared to SACH foot [80]. Acrylonitrile butadiene (ABS) has been used with FDM to fabricate an ESAR foot for transtibial amputees [81]. The FEM analysis and physical testing of the developed foot showed that it fulfills the structural strength requirements and can be used as a passive ESAR foot [81]. PLA material has also been used to develop transtibial prosthetic foot by 3D printing [57].
Distant metastatic foci of infection in adult patients with diabetic foot – not as rare as we think?: case series and review of the literature
Published in Infectious Diseases, 2021
Mazen S. Bader, John Hawboldt, Yasmeen Vincent, Neal Irfan, Dominik Mertz, Alison Farrell, Annie Brooks
In Table 3, the patients’ baseline data in our case series and reported in the literature were similar. Prior amputation was more prevalent in our case series. Surgical treatment with excision of bone or amputation was performed in 13 patients (six had below knee amputation) from the literature while only one patient had below knee amputation in our case series. Staphylococcus aureus was the only organism isolated in our case series and was the most common organism reported in cases from the literature. Other organisms such as Streptococcus spp and gram-negative organisms were isolated in the cases from the literature. While the heart (seven patients) was the most common distant metastatic foci of infection in our case series, spine (17 patients) was the most common site in cases from literature. In the cases from the literature, 13 patients demonstrated spinal infections, had epidural, psoas, or paraspinal abscesses; however, only one case in our case series demonstrated these distant metastatic foci. Two-thirds of our cases were treated with antibiotic and source control while this occurred in half of cases from literature. Finally, the combined outcome (death or relapse of infection) was reported in half of our cases while it was reported in approximately one-third of cases from literature. Twenty-one patients in both series had functional impairment due to their affected organ such as decreased mobility and impaired vision.
Related Knowledge Centers
- Birth Defect
- Fetus
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- Cancer
- Limb
- Injury
- Gangrene
- Preventive Healthcare
- Congenital Amputation
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