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Dar PMUD, Mir N, Katiyar AK, Sati HC, Priyadarshini P, Alam J, Kumar S, Gupta A, Sagar S. Outcome predictors of patients who underwent limb amputation/s following trauma at a level I trauma center in North India. Eur J Trauma Emerg Surg 2024; 50:233-242. [PMID: 37233748 DOI: 10.1007/s00068-023-02273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Limb amputation is one of the oldest medical operations, dating back over 2500 years to Hippocrates' time. In developing countries like India, most of the patients are young, and trauma is the primary cause of limb amputation. The objectives of this study were to investigate the factors that can predict the outcome of patients who underwent upper or lower limb amputations. MATERIALS AND METHODS This was a retrospective analysis of the prospectively collected data of patients who underwent limb amputations from January 2015 to December 2019. RESULTS From January 2015 to December 2019, 547 patients underwent limb amputations. Males predominated (86%). Road traffic injuries (RTI) were the most common (323, 59%) mechanism of injury. Hemorrhagic shock was present in 125 (22.9%) patients. Above-knee amputation was the most common (33%) amputation procedure performed. The correlation of hemodynamic status at presentation with the outcome was statistically significant (p-0.001). Outcome measures like delayed presentation, hemorrhagic shock, Injury severity scores (ISS), and the new injury severity scores (NISS) were statistically significant (p-0.001) when compared to the outcome. There were 47 (8.6%) mortalities during the study period. CONCLUSION Factors that affected the outcome were delayed presentation, hemorrhagic shock, higher ISS, NISS, MESS scores, surgical-site infection, and associated injuries. Overall mortality during the study was 8.6%.
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Affiliation(s)
- Parvez Mohi Ud Din Dar
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Jammu, Jammu and Kashmir, India
| | - Nida Mir
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Anand Kumar Katiyar
- Department of Surgery Division, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Pratyusha Priyadarshini
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Junaid Alam
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Subodh Kumar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Amit Gupta
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sushma Sagar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Qaarie MY. Life Expectancy and Mortality After Lower Extremity Amputation: Overview and Analysis of Literature. Cureus 2023; 15:e38944. [PMID: 37309338 PMCID: PMC10257952 DOI: 10.7759/cureus.38944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/14/2023] Open
Abstract
Lower limb amputation (LLA) is a major surgical procedure with a significant impact on quality of life and mortality rates as well. Previous studies have shown that mortality rates following LLA can range from 9-17% within 30 days in the UK. This study systematically evaluates and reviews the published literature on life expectancy, mortality, and survival rates following lower extremity amputation (LEA). We have conducted a comprehensive search on Medline, CINAHL, and Cochrane Central databases resulting in 87 full-text articles. After a thorough review, only 45 (52.9%) articles met the minimum inclusion criteria for the study. Our analysis indicated 30-day mortality rates following LEA ranged from 7.1% to 51.4%, with an average mortality rate of 16.45% (SD 14.35) per study. Furthermore, 30-day mortality rates following below-knee amputation (BKA) and above-knee amputation (AKA) were found to be between 6.2% to 51.4%, X= 17.16% ± 19.46 SD and 12.7 to 21.7%, X= 16.15% ± 4.17 SD, respectively. Our review provides a comprehensive insight into the life expectancy, mortality, and survival rates following LEA. These findings highlight the importance of considering various factors, including patient age, presence of comorbidities such as diabetes, heart failure, and renal failure, and lifestyle factors such as smoking, in determining prognosis following LLA. Further research is necessary to determine strategies for improving outcomes and reducing mortality in this patient population.
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Thompson SF, McCall KB, Patel DV, Schwerdtfeger WA, Stoner J, Hollabaugh K, Teague DC. In-Hospital Morbidity and Mortality of Traumatic Lower-Extremity Amputations. Orthopedics 2020; 43:e561-e566. [PMID: 32745226 DOI: 10.3928/01477447-20200721-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/29/2019] [Indexed: 02/03/2023]
Abstract
Traumatic lower-extremity amputations often result in complications and surgical revisions. The authors report the in-hospital morbidity and mortality of traumatic lower-extremity amputations at a metropolitan level I trauma center for a large rural region and compare below-knee (BK) vs higher-level amputation complications. They retrospectively reviewed 168 adult patients during a 10-year period (2005 to 2015) who had a traumatic injury to the lower extremity that required an amputation. Main outcome measurements included amputation level, complication rates, intensive care unit (ICU) admission rates, length of stay, total trips to the operating room (OR), and Injury Severity Score (ISS). A total of 95 patients had through-knee/above-knee (TK/AK) amputations, and 73 patients had BK amputations. The majority of injuries occurred in the non-urban setting. The TK/AK group had higher ICU admission rates (76% vs 35%, P<.0001), longer overall hospital length of stay (22.0 vs 15.5 days, P=.01), more total OR trips (6.5 vs 5.0, P=.04), and higher ISS (17.0 vs 11.5, P<.0001). A complication was experienced by 64% of all patients during the initial hospitalization. The TK/AK group had higher complication rates than the BK group, including wound infection, pulmonary embolus, rhabdomyolysis, compartment syndrome, and death. Patients with TK/AK traumatic amputations have a greater burden of injury with higher complication rates, increased ICU admissions, increased length of stay, and increased ISS and require more return trips to the OR compared with patients with BK amputations. [Orthopedics. 2020;43(6):e561-e566.].
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Grudziak J, Mukuzunga C, Melhado C, Young S, Banza L, Cairns B, Charles A. Etiology of major limb amputations at a tertiary care centre in Malawi. Malawi Med J 2020; 31:244-248. [PMID: 32128034 PMCID: PMC7036427 DOI: 10.4314/mmj.v31i4.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Amputations in low- and middle-income countries (LMICs) represent an important cause of disability and economic hardship. LMIC patients are young and suffer from preventable causes, such as trauma and trauma-related infections. We herein studied the etiology in amputations in a Malawian tertiary care hospital over a 9-year period. Methods Operative and anaesthesia logs at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, were reviewed for 2008–2016. Baseline demographic and clinical variables and type of amputation performed were collected. Only major limb amputations, defined as above or below the knee, above or below the elbow, and above the wrist, were included in this study. Results A total of 610 patients underwent 630 major amputations during the study period. Of these, 170 (27%) patients were female, and the median age of the cohort was 39 (interquartile range [IQR] 25–55). Of these patients, 345 (54.8%) had infection or gangrene recorded among the indications for amputation, 203 (32.2%) had trauma, 94 (14.9%) had cancer and 67 (10.6%) had documented diabetes. Women underwent diabetes-related amputations more often than men (37 out of 67, or 56.1%), and were significantly younger when their amputations were due to diabetes (median age 48 vs 53 years old, P=0.004) or trauma (median age 21 vs 30 years old, P=0.02). The commonest operative procedures were below the knee amputations, at 271 (43%), and above the knee amputations, at 213 (33.8%). Conclusion Amputations in Malawi affect primarily the young, in the most economically productive time of their lives, in contrast to amputees in high-income countries. Preventable causes, such as infection and trauma, lead to the majority of amputations. These etiologies represent an important primary prevention target for public health efforts in LMICs.
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Affiliation(s)
- Joanna Grudziak
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | | | | | - Sven Young
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,University of Malawi College of Medicine, Lilongwe, Malawi
| | - Leonard Banza
- UNC Project, Malawi.,University of Malawi College of Medicine, Lilongwe, Malawi.,Institute of Clinical studies (K1) and Centre for International Health, University of Bergen, Norway
| | - Bruce Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, USA.,Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,UNC Project, Malawi
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Devaraj H, Aw KC, McDaid AJ. Review of functional materials for potential use as wearable infection sensors in limb prostheses. Biomed Eng Lett 2019; 10:43-61. [PMID: 32175129 DOI: 10.1007/s13534-019-00132-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/30/2019] [Accepted: 09/17/2019] [Indexed: 12/31/2022] Open
Abstract
The fundamental goal of prosthesis is to achieve optimal levels of performance and enhance the quality of life of amputees. Socket type prostheses have been widely employed despite their known drawbacks. More recently, the advent of osseointegrated prostheses have demonstrated potential to be a better alternative to socket prosthesis eliminating most of the drawbacks of the latter. However, both socket and osseointegrated limb prostheses are prone to superficial infections during use. Infection prone skin lesions from frictional rubbing of the socket against the soft tissue are a known problem of socket type prosthesis. Osseointegration, on the other hand, results in an open wound at the implant-stump interface. The integration of infection sensors in prostheses to detect and prevent infections is proposed to enhance quality of life of amputees. Pathogenic volatiles having been identified to be a potent stimulus, this paper reviews the current techniques in the field of infection sensing, specifically focusing on identifying portable and flexible sensors with potential to be integrated into prosthesis designs. Various sensor architectures including but not limited to sensors fabricated from conducting polymers, carbon polymer composites, metal oxide semiconductors, metal organic frameworks, hydrogels and synthetic oligomers are reviewed. The challenges and their potential integration pathways that can enhance the possibilities of integrating these sensors into prosthesis designs are analysed.
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Affiliation(s)
- Harish Devaraj
- Department of Mechanical Engineering, Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| | - Kean C Aw
- Department of Mechanical Engineering, Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| | - Andrew J McDaid
- Department of Mechanical Engineering, Faculty of Engineering, The University of Auckland, Auckland, New Zealand
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Das N, Nagpal N, Bankura SS. A review on the advancements in the field of upper limb prosthesis. J Med Eng Technol 2019; 42:532-545. [PMID: 30875266 DOI: 10.1080/03091902.2019.1576793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Amputation is one of the serious issue across the globe which is mainly caused by trauma, medical illness or congenital condition. Because of steep increase in amputation incidences, the need for progress in technicality of prosthesis is becoming imperative. In this article, the journey of advancements in upper arm prosthesis has been discussed step by step. Moreover, it has also been enunciated that how from a simple replacement for an arm it now has reached the mark of giving a patient a fully functional limb with the help of sensors and myoelectric transducers that are able to translate the remaining muscle signals into full movement of the prosthesis. However, researches are still going on to make the design of the prosthetic more impressive having better range of movement, to establish its interface with brain more efficiently and to make the control of prosthetic more user friendly. In this review, a special emphasis has also been given to myoelectric prosthesis as this prosthetic system possesses a decisive influence on rehabilitation results. Moreover, this prosthetic system is extremely elegant and cutting-edge in both design and technology and offers a great wearer comfort.
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Affiliation(s)
- Nilanjan Das
- a Accendere, CL Educate Ltd. , New Delhi , India
| | - Nikita Nagpal
- b Department of Biotechnology , Manav Rachna International Institute of Research and Studies , Faridabad , India
| | - Shailee Singh Bankura
- b Department of Biotechnology , Manav Rachna International Institute of Research and Studies , Faridabad , India
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Markatos K, Karamanou M, Saranteas T, Mavrogenis AF. Hallmarks of amputation surgery. INTERNATIONAL ORTHOPAEDICS 2018; 43:493-499. [PMID: 29948012 DOI: 10.1007/s00264-018-4024-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/04/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To highlight the most important innovations and milestones in the historical evolution of amputation and disarticulation surgery through the ages, from the early antiquity until the modern era. METHOD A thorough search of the literature was undertaken in PubMed and Google Scholar as well as in physical books in libraries to summarize current and classic literature on the hallmarks of the history of amputation surgery in the course of medical history. RESULTS Amputation of a limb is one of the oldest surgical procedures. Initially, it was fraught with complications and dismal outcome of the patients because of hemorrhage and infection. Due to lack of analgesics and narcotics the operation had to take only a few minutes. Obtaining experience, the surgeons evolved the operative technique and refined the procedure, anesthesia and perioperative analgesia was introduced, instruments were developed, and rehabilitation has enabled functional and social reintegration of amputees. CONCLUSION From the Hippocratic era until currently, the surgical approach to amputation has changed little. However, the indications for amputations have changed a lot and had been refined, especially in diabetic patients and in those with severe chronic peripheral vascular disease. An exponential decrease in mortality for an operation once fraught with complications was due to the development of the tourniquet, proper vessel ligation and repair, antisepsis, and anesthesia.
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Affiliation(s)
| | - Marianna Karamanou
- Department of History of Medicine, University of Crete, School of Medicine, Herakleion, Greece
| | - Theodosios Saranteas
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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Sabzi Sarvestani A, Taheri Azam A. Amputation: a ten-year survey. Trauma Mon 2013; 18:126-9. [PMID: 24350170 PMCID: PMC3864397 DOI: 10.5812/traumamon.11693] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 06/11/2013] [Accepted: 07/28/2013] [Indexed: 11/16/2022] Open
Abstract
Background Limb loss occurs due to different causes and has been increased in many countries. It has without exception, great economic, psychological and social impacts. Objectives This study assesses the demographics of amputees in one city of Iran. Patients and Methods This retrospective study was undertaken on all of the amputees between April 2002 and December 2011. Patients’ demographics including age, sex, the amputated limb, etiology of limb loss and level of amputation were recorded. Results We had 216 patients in the study. The average number of amputations was 21.6 per year and varied from 14 to 32. The mean age of amputation was 39.26± 12.6 years. Of the patients, 172 were male (79.62%) and 44 female (20.37%); 119 of the amputations (55.09 %) were major and 97 minor (44.9 %). The most common cause of amputation was trauma and the most common was the toe. In trauma patients the mean age was 38.12± 10.25 years and 98 (83.7%) were male. Conclusions In contrast to similar studies in developed countries, trauma was found to be the major cause of all types of amputations. Results of this study may be used in prevention planning.
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Affiliation(s)
- Amene Sabzi Sarvestani
- Department of Surgery, Imam Ali Educational Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author: Amene Sabzi Sarvestani, Department of Surgery, Imam Ali Educational Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-5413425717 Fax: +98-7125223566, E-mail:
| | - Afshin Taheri Azam
- Department of Orthopedics, Tehran University of Medical Sciences,Tehran, IR Iran
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Wagels M, Rowe D, Senewiratne S, Theile DR. History of lower limb reconstruction after trauma. ANZ J Surg 2012; 83:348-53. [PMID: 22989362 DOI: 10.1111/j.1445-2197.2012.06271.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The principles guiding reconstruction of the lower limb after trauma have become established over 300 years through advances in technology and studies of epidemiology. This paper reviews how these principles came about and why they are important. METHODS This is a structured review of historical and recent literature pertinent to lower limb reconstruction. The outcomes assessed in the pre-modern era were wound mortality, amputation mortality and amputation rate. In the modern era, infection and non-union emerged as measures of outcome, which are morbidity- rather than mortality-based. Indications for amputation published during the eras are taken to reflect the reconstructive practices of the time. RESULTS Amputation and wound mortality fell throughout the pre-modern era, from 70% and 20% to 1.8% and 1.8%, respectively. Amputation rates peaked in the American Civil War (53%) but have remained less than 20% since then. Infection and non-union rates in the modern era have fluctuated between 5% and 45%. CONCLUSIONS Priority areas for research include refinement of soft tissue reconstruction, injury classification, standardization of outcome measures and primary prevention. The impact of débridement and antisepsis on outcomes should not be forgotten as progress is made.
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Affiliation(s)
- Michael Wagels
- Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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Chalya PL, Mabula JB, Dass RM, Ngayomela IH, Chandika AB, Mbelenge N, Gilyoma JM. Major limb amputations: a tertiary hospital experience in northwestern Tanzania. J Orthop Surg Res 2012; 7:18. [PMID: 22578187 PMCID: PMC3413574 DOI: 10.1186/1749-799x-7-18] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 05/11/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Major limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where the prosthetic services are poor. The purpose of this study was to outline the patterns, indications and short term complications of major limb amputations and to compare our experience with that of other published data. METHODS This was a descriptive cross-sectional study that was conducted at Bugando Medical Centre between March 2008 and February 2010. All patients who underwent major limb amputation were, after informed consent for the study, enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS version 11.5 computer software. RESULTS A total of 162 patients were entered into the study. Their ages ranged between 2-78 years (mean 28.30 ± 13.72 days). Males outnumbered females by a ratio of 2:1. The majority of patients (76.5%) had primary or no formal education. One hundred and twelve (69.1%) patients were unemployed. The most common indication for major limb amputation was diabetic foot complications in 41.9%, followed by trauma in 38.4% and vascular disease in 8.6% respectively. Lower limbs were involved in 86.4% of cases and upper limbs in 13.6% of cases giving a lower limb to upper limb ratio of 6.4:1 Below knee amputation was the most common procedure performed in 46.3%. There was no bilateral limb amputation. The most common additional procedures performed were wound debridement, secondary suture and skin grafting in 42.3%, 34.5% and 23.2% respectively. Two-stage operation was required in 45.4% of patients. Revision amputation rate was 29.6%. Post-operative complication rate was 33.3% and surgical site infection was the most common complication accounting for 21.0%. The mean length of hospital stay was 22.4 days and mortality rate was 16.7%. CONCLUSION Complications of diabetic foot ulcers and trauma resulting from road traffic crashes were the most common indications for major limb amputation in our environment. The majority of these amputations are preventable by provision of health education, early presentation and appropriate management of the common indications.
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Affiliation(s)
- Phillipo L Chalya
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Joseph B Mabula
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Ramesh M Dass
- Department of Orthopaedic, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Isdori H Ngayomela
- Department of Orthopaedic, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Alphonce B Chandika
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Nkinda Mbelenge
- Department of Orthopaedic, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Japhet M Gilyoma
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
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Manring MM, Hawk A, Calhoun JH, Andersen RC. Treatment of war wounds: a historical review. Clin Orthop Relat Res 2009; 467:2168-91. [PMID: 19219516 PMCID: PMC2706344 DOI: 10.1007/s11999-009-0738-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 01/27/2009] [Indexed: 01/31/2023]
Abstract
The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.
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Affiliation(s)
- M. M. Manring
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO USA
| | - Alan Hawk
- National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, DC USA
| | - Jason H. Calhoun
- Department of Orthopaedic Surgery, The Ohio State University, N1043 Doan Hall, 410 W 10th Ave, Columbus, OH 43210-1228 USA
| | - Romney C. Andersen
- Orthopaedic Traumatology, Walter Reed National Military Medical Center, Bethesda, MD USA
- Orthopaedic Traumatology, Walter Reed National Military Medical Center, Washington, DC USA
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Ebrahimzadeh MH, Rajabi MT. Long-term outcomes of patients undergoing war-related amputations of the foot and ankle. J Foot Ankle Surg 2007; 46:429-33. [PMID: 17980838 DOI: 10.1053/j.jfas.2007.08.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Indexed: 02/03/2023]
Abstract
Long-term clinical and functional outcomes for patients undergoing foot and ankle amputations are not well documented. We attempted to document long-term outcomes for patients who required lower extremity amputations as a result of wounds suffered during wartime. For this study, 27 Iranian soldiers who had wounds requiring amputation of the foot and ankle were selected for follow-up. The participants' wartime medical records were reviewed, a clinical examination was performed, and each participant completed a questionnaire. Postamputation follow-up averaged 17.5 years. The most prevalent (66.6%) cause of injury was a land mine. The prevalences of different clinical symptoms reported by the amputees at the time of the last follow-up were as follows: 11 (40.7%) with phantom sensation, 6 (22.2%) with phantom pain, 12 (44.4%) with stump pain, 12 (44.4%) with back pain, 9 (33.3%) with contralateral knee pain, and 4 (14.8%) with ipsilateral knee pain; 20 (74%) reported treatment for psychological conditions. In regard to social conditions, 13 (48.1) were currently employed, or had been employed, for a number of years after the amputation; 26 (96%) had children, and all of the patients were married. The results of this observational study indicate that individuals have significant long-term pain and discomfort after war-related lower extremity amputation. Although all 27 (100%) of the amputees were able to maintain satisfactory family functioning, only 13 (48.1%) of the study participants were able to remain productively employed after undergoing amputation, and 20 (74%) reported long-term psychological problems in addition to their physical pain.
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Affiliation(s)
- Mohammad H Ebrahimzadeh
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Ebrahimzadeh MH, Fattahi AS, Nejad AB. Long-term Follow-up of Iranian Veteran Upper Extremity Amputees From the Iran-Iraq War (1980???1988). ACTA ACUST UNITED AC 2006; 61:886-8. [PMID: 17033556 DOI: 10.1097/01.ta.0000236014.78230.77] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite their frequency, there are limited reports concerning long-term follow up of upper limb amputation among battle-injured patients, which occurred at a young age. The purpose of this study was to evaluate how well these patients function years after their injury. METHODS The study consisted of a thorough assessment and examination and review of the history and war time medical records of 25 Iranian veteran amputees from imposed Iran-Iraq war with a comprehensive survey including a detailed questionnaire. Information was analyzed and compared with limited similar reports in the literature. RESULTS Out of 200 war amputees there were 25 unilateral upper limb amputees; all others were lower limb amputees. The average age at the time of injury was 23.06 years, average age at follow-up was 41.55 years, and the average time between injury and follow-up was 17.5 years. The most common level of amputation was below elbow (40%), and the most common cause of war injury was artillery shells, mortar or rocket shells. The prevalence of clinical symptoms of phantom sensation, phantom pain, phantom movement and stump pain were; 64%, 32%, 20%, 24%, respectively. All patients were married (100%) and had children except one case (96%). Sixty percent of patients were employed. Thirty-six percent had a documented psychiatric history ranging from minor depression to posttraumatic stress disorders. CONCLUSION The study showed-despite long period of time between war, amputation, and follow-up-there is a significant rate of amputation symptoms, but on the other hand good family and social function of the patients.
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Affiliation(s)
- Mohammad H Ebrahimzadeh
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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