Answers
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
Diabetic foot ulcers require complex multidisciplinary care and frequently require surgery for debridement of infected tissue. Problems arise in neuropathy and lack of sensation to trivial trauma, which is then slow to heal. Treatment starts with prevention, with regular podiatry input and education to prevent minor foot trauma. Appropriate footwear with good nail care and debridement can help with prevention of foot ulcers. Risks for developing ulcers include poor diabetic control, other diabetic complications such as nephropathy and retinopathy and concurrent arterial vascular disease. In established ulceration, infection may be from atypical organisms, so broad-spectrum antimicrobials are needed. Surgery focuses on debridement, drainage of abscesses and treatment of osteomyelitis. Vascular bypasses can help if vascular disease is also present. Amputation is a considered in failed medical and surgical therapy. Inpatients require diligent care to prevent pressure ulcers and attention to hydration and glycaemic control.
Rehabilitation after Trauma
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
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.
Malignant tumors
Archana Singal, Shekhar Neema, Piyush Kumar in Nail Disorders, 2019
Ewing sarcoma is a rare tumor almost exclusively seen in persons under 20 years of age. Only about 1% occur in the small bones of the hands and feet. Pain and swelling with low-grade fever are the leading symptoms. Two forms are distinguished: skeletal and extraskeletal Ewing sarcoma. The extraskeletal Ewings sarcoma is cytogenetically and molecular genetically identical to peripheral primitive neuroectodermal tumor (PNET), but is less well differentiated histologically. Its clinical presentation is a neoplasm with a diameter of 5–10 cm. One case of probable skeletal Ewing sarcoma was observed in the tip of a toe radiographically causing lytic lesions.120 The pulp was swollen and ulcerated. A subungual Ewing sarcoma was observed by F. Facchetti (unpublished 2012). Treatment was successful by amputation.121 Another recent case showed complete destruction of the nail unit.122 The clinical differential diagnosis includes osteomyelitis, tuberculosis, enchondroma, and a variety of benign tumors. Treatment is by generous local excision and chemotherapy.
Identifying priorities and developing strategies for building capacity in amputation research in Canada
Published in Disability and Rehabilitation, 2021
Sander L. Hitzig, Amanda L. Mayo, Ahmed Kayssi, Ricardo Viana, Crystal MacKay, Michael Devlin, Steven Dilkas, Aristotle Domingo, Jacqueline S. Hebert, William C. Miller, Jan Andrysek, Fae Azhari, Heather L. Baltzer, Charles de Mestral, Douglas K. Dittmer, Nancy L. Dudek, Sharon Grad, Sara J. T. Guilcher, Natalie Habra, Susan W. Hunter, W. Shane Journeay, Joel Katz, Sheena King, Michael W. Payne, Heather A. Underwood, José Zariffa, Andrea Aternali, Samantha L. Atkinson, Stephanie G. Brooks, Stephanie R. Cimino, Jorge Rios
Individuals who experience lower or upper limb loss face multiple challenges to their mobility, function, physical and mental health [1–4], and ability to participate in their community [5–7]; which can negatively influence quality of life (QoL) [8–10]. For instance, people with limb loss struggle with activities of daily living [11], and are at high risk for developing secondary complications, such as osteoarthritis (in the contralateral limb), osteopenia/osteoporosis in the residual limb (increasing the risk for fracture), low back pain, phantom limb pain, and psychosocial issues stemming from poor body image [12–15]. Causes for amputation include trauma (e.g. workplace accident, motor vehicle accident), dysvascular disease (due to complications from diabetes and/or peripheral vascular disease), infection, cancer, frostbite and congenital limb deficiencies.
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.
Relationship between degree of disability, usefulness of assistive devices, and daily use duration: an investigation in children with congenital upper limb deficiencies who use upper limb prostheses
Published in Assistive Technology, 2023
Hiroshi Mano, Satoko Noguchi, Sayaka Fujiwara, Nobuhiko Haga
Previous studies reported that congenital upper limb deficiencies (ULDs) occur at a prevalence of 3.39 per 10,000 live births (Mano, Fujiwara, Takamura, et al., 2018) or 3.9–6.2 per 10,000 total births (Bedard et al., 2015; Castilla et al., 1995; Vasluian et al., 2013). Given how intractable the condition is, patients with congenital ULDs require comprehensive care and several of therapeutic supports. Treatment approaches may vary according to the type of deficiency and can include prosthetic intervention, reconstruction surgery, and amputation with subsequent prosthetic/orthotic therapy. Transverse deficiencies resemble an amputation residual limb, in which the limb has developed normally to a particular level beyond which no skeletal elements are present. All others are classed as longitudinal, in which there is a reduction or absence of an element or elements within the long axis of the limb (Day, 1991). While surgery is the preferred treatment for longitudinal deficiencies (e.g. reconstruction of the thumb and wrist centralization on the ulna are the treatment choices for radial deficiency) (Colen et al., 2017), prosthetic intervention is often considered first in transverse deficiencies. In the upper limb deficiencies, prosthetic or orthotic intervention was likely chosen in cases of deficiency at the metacarpal or proximal to metacarpal level (Mano, Fujiwara, Takamura, et al., 2021). This is also the preferred treatment for acquired amputation.
Related Knowledge Centers
- Birth Defect
- Fetus
- Surgery
- Cancer
- Limb
- Injury
- Gangrene
- Preventive Healthcare
- Congenital Amputation
- Toe