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Harnoncourt L, Gstoettner C, Pflaum L, Laengle G, Aszmann OC. [Fillet flap transfer as alternative to conventional lower limb amputation]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:651-659. [PMID: 38985169 PMCID: PMC11341707 DOI: 10.1007/s00113-024-01460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND The fitting of a prosthesis after lower limb amputation is associated with several challenges. Skeletal stump-prosthesis interfaces and selective nerve transfer can partially overcome these but are also associated with new impairments that emphasize the necessity of innovative approaches. The concept of so-called spare part surgery with the use of fillet flaps could play an important role in this respect. OBJECTIVE An overview of the classical prosthesis-associated discomforts, advantages and disadvantages of treatment strategies and presentation of alternative surgical concepts. MATERIAL AND METHODS A selective literature search was carried out considering the experiences of the authors and perspectives with respect to the advantages and disadvantages of the surgical treatment options. Furthermore, a clinical case is presented. RESULTS AND CONCLUSION The transfer of the sole of the foot as a fillet flap to the weight-bearing region of the amputation stump offers a number of benefits, such as creating a fully weight-bearing stump, prevention of neuralgia, preserved sensation and conservation of the body image. As long as the calcaneal region is not impaired, this technique can be performed in amputations below as well as above the knee. The question of whether parts of the bone should be included in the transfer must be individually evaluated for each patient. This approach enables optimization of the residual limb stump for the subsequent fitting of a prosthesis for the patient.
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Affiliation(s)
- L Harnoncourt
- Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich
| | - C Gstoettner
- Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - L Pflaum
- Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich
| | - G Laengle
- Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - O C Aszmann
- Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich.
- Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Zhang R, Wang X, Liu S, Qiu S, Ruan H, Kang Q. Modified Calcanization of Tibia for Hindfoot Defect Reconstruction: Method and Preliminary Results. Orthop Surg 2024. [PMID: 39210604 DOI: 10.1111/os.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/31/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES To introduce our modified technique for calcanization of the tibia in managing massive bony loss of hindfoot and preliminary outcomes. METHODS From January 2015 to December 2021, modified calcanization of the tibia were performed in 10 patients with unilateral loss of the calcaneus. Clinical outcomes were assessed based on the American Orthopaedic Foot & Ankle Society score and Symptom Checklist-90-Revised questionnaire. Paired two-group t-test was applied to compare the parameters. RESULTS The mean lengthened length of the tibia was 77.3 ± 3.0 mm (range, 74-83 mm). The mean external fixation time was 123.7 ± 52.1 days (range, 117-134 days) and the mean external fixation index was 1.601 ± 0.046 days/mm. All patients stuck to the postoperative follow-up plan with an average follow-up time of 29.7 ± 3.4 months (range, 24-35 months). Deformities of the injured limbs were well corrected. Based on American Orthopaedic Foot & Ankle Society score, eight good and two fair results were achieved. The mental status of all patients was within the normal range, and several indices of the Symptom Checklist-90-Revised questionnaire of each patient were improved after the whole procedure. CONCLUSION We demonstrate that the modified calcanization of the tibia is qualified for total loss of calcaneus with limited complications. Early rehabilitation is attainable since external fixation time is shortened due to a simplified procedure.
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Affiliation(s)
- Rui Zhang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenghe Liu
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuo Qiu
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongjiang Ruan
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinglin Kang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lee PS, Gao RZ, Colpitts A, Murdock RW, Dittmer D, Schirm A, Tung JY, Ren CL. Air microfluidics-enabled soft robotic transtibial prosthesis socket liner toward dynamic management of residual limb contact pressure and volume fluctuation. BIOMICROFLUIDICS 2022; 16:034107. [PMID: 35783680 PMCID: PMC9242678 DOI: 10.1063/5.0087900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
Residual limb volume fluctuation and the resulting contact pressures are some of the key factors leading to skin ulcerations, suboptimal prosthetic functioning, pain, and diminishing quality of life of transtibial amputees. Self-management of socket fit is complicated by peripheral neuropathy, reducing the perception of pressure and pain in the residual limb. We introduce a novel proof-of-concept for a transtibial prosthetic socket liner with the potential to dynamically adjust the fit between the limb and socket. The core of the technology is a small air microfluidic chip (10 cm3 and 10 g) with 10 on-chip valves that enable sequential pressurizing of 10 actuators in custom sizes to match the pressures required by the residual limb's unique anatomy. The microfluidic chip largely reduced the number of electromechanical solenoid valves needed for sequential control of 10 actuators (2 instead of 10 valves), resulting in the reduction of the required power, size, mass, and cost of the control box toward an affordable and wearable prosthetic socket. Proof-of-concept testing demonstrated that the applied pressures can be varied in the desired sequence and to redistribute pressure. Future work will focus on integrating the system with biofidelic prosthetic sockets and residual limb models to investigate the ability to redistribute pressure away from pressure-sensitive regions (e.g., fibular head) to pressure tolerant areas. Overall, the dynamic prosthesis socket liner is very encouraging for creating a dynamic socket fit system that can be seamlessly integrated with existing socket fabrication methods for managing residual limb volume fluctuations and contact pressure.
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Affiliation(s)
- Peter S. Lee
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | - Run Ze Gao
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | - Alyson Colpitts
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | | | - Doug Dittmer
- Freeport Campus, Grand River Hospital, 3570 King St. E, Kitchener, Ontario N2A 2W6, Canada
| | - Andreas Schirm
- Prosthetic Ability, 1-407 Gage Ave., Kitchener, Ontario N2M 5E1, Canada
| | - James Y. Tung
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | - Carolyn L. Ren
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
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Mekki WA, Kliushin NM, Sudnitsyn AS. Calcaneogenesis: the use of tibial bone transport for treatment of massively infected hindfoot defects. Acta Orthop Belg 2022; 88:127-134. [PMID: 35512163 DOI: 10.52628/88.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Massive hindfoot defects which result after se- questrectomy of chronic osteomyelitis (COM) or Trauma or after tumors resection is a real challenge to the treating surgeons with either amputation or other reconstructive plastic procedures as the only available options, Calcaneal osteomyelitis is a major cause with classical surgical management to cure the infection has limited success in preservation of the hindfoot shape, function, and mechanical stability. The surgical procedure reported with the use of the Ilizarov apparatus for partial or total calcaneal OM is aimed to preserve the Hindfoot. Materials and Methods We retrospectively reviewed 10 patients which were treated by radical debridement of the infected area, Ilizarov frame application and arthrodesis with bone reconstruction by the Ilizarov apparatus using tibial transport for Hindfoot salvage. The mean age at presentation was 33.5 years (range; 24-57) and the mean follow-up was 5.1 years (range; 2-12).Patients clinical and radiographic data were assessed according to the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle- Hindfoot score. Results The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score was 48.3(range; 38-86) while the mean postoperative (AOFAS) was 58.5 (range; 45-73) , p value < 0.01 . Clinically all patients had anatomically stable feet with deformity correction and no signs of infection recurrence. Conclusion The use of Ilizarov distal tibial bone transport to fill massive hindfoot defects proved to be a reliable method for elimination of infection and reconstruction of large defects without the need for bony or soft tissue plastic procedures. The technique also has the ability to produce a rigid limb fixation following debridement and to fill in massive hindfoot defects due to other etiologies as well.
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Chihuri ST, Youdan GA, Wong CK. Quantifying the risk of falls and injuries for amputees beyond annual fall rates-A longitudinal cohort analysis based on person-step exposure over time. Prev Med Rep 2022; 24:101626. [PMID: 34976679 PMCID: PMC8683996 DOI: 10.1016/j.pmedr.2021.101626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 12/21/2022] Open
Abstract
People with lower-limb loss even with community walking ability have high annual fall and injury rates. True fall and injury risk may be obscured if exposure to risk measured by person-steps over time is not considered. Risk was higher for amputees with limited walking ability per person-step exposure over time. Incorporating person-step exposure over time clarifies fall and injury risk level.
People with lower-limb loss (PLL) have high annual fall and injury rates. People with transtibial amputations have better walking function than those with transfemoral amputations but paradoxically incur more fall-related injuries. Risk exposure, however, has not been previously considered. This study examined whether all-cause fall and injury incidence per person-step exposure over time varied in PLL of different walking abilities. The prospective cohort design, conducted at a major medical center, included five assessments 1-month apart. Walking ability level was categorized by Houghton Scale scores: ≥9 indicating community walking and ≤ 8 indicating limited community-household walking. Accelerometer-measured daily step counts were collected via StepWatch4 monitors. The main outcome measures, self-reported all-cause falls and injuries were assessed using the standard National Health Injury Survey. Generalized estimating equations, using Poisson distributions and log of step count as an offset, determined fall and injury incidence rate ratio [IRR] according to walking ability level. Ten people, aged 33–63 years with amputations of different causes and levels, were assessed monthly over five months. The community walking group (n = 6) had six falls and seven injuries; the limited community walking group (n = 4) had four falls and three injuries. For PLL, limited community walking ability was associated with higher incidence of falls (IRR = 6.10, 95%CI = 1.12–33.33, p = 0.037) and injuries (IRR = 8.56, 95%CI = 1.73–42.40, p = 0.009) when accounting for person-steps. Considering per person-step exposure over time added precision to fall and injury risk assessment that clarified the risks: PLL with limited community walking ability have higher fall and injury risks.
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Affiliation(s)
- Stanford T Chihuri
- Columbia University, Mailman School of Public Health, 722 West 168 Street, New York, NY 10032, USA
| | - Gregory A Youdan
- Teachers College Columbia University, Biobehavioral Sciences, 1152B Thorndike Hall Box 5, New York, NY 10027, USA
| | - Christopher K Wong
- Columbia University Irving Medical Center, Rehabilitation and Regenerative Medicine, 617 West 168 Street Georgian #311, New York, NY 10032, USA
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Wernke MM, Ficanha EM, Thomas Z, Maitland ME, Allyn KJ, Albury A, Colvin J. Mechanical testing of frontal plane adaptability of commercially available prosthetic feet. J Rehabil Assist Technol Eng 2022; 9:20556683221123330. [PMID: 36093414 PMCID: PMC9459498 DOI: 10.1177/20556683221123330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Prosthetic feet have limited adaptability in the frontal plane. Research
shows walking on uneven terrain is difficult for many prosthesis users. A
new prosthetic foot, the META Arc, was designed with a polycentric ankle
joint that allows relatively free movement in the frontal plane to address
this limitation. Previous simulations of the polycentric ankle mechanism
found potential benefits such as reduced lateral movement of a proximal mass
during forward progress and reduced forces being transferred upward from the
ground through the foot. Methods Standard mechanical testing protocols were used to evaluate the Meta Arc
prosthetic foot’s performance and six comparable feet commercially
available. Results The results found the META Arc prosthetic foot had increased frontal plane
adaptability as well as reduced lateral forces, and reduced inversion
eversion moment compared to the six comparison feet on 10-degree cross-slope
test conditions. All included prosthetic feet had similar results for the
percent of energy return and dynamic force in the sagittal plane. Conclusions These results suggest the inclusion of the polycentric ankle within the META
Arc foot will provide more stability without sacrificing forward walking
performance.
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Affiliation(s)
| | | | - Zac Thomas
- WillowWood Global LLC, Mount Sterling, OH, USA
| | | | | | - Alex Albury
- WillowWood Global LLC, Mount Sterling, OH, USA
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McGeehan MA, Adamczyk PG, Nichols KM, Hahn ME. A simulation-based analysis of the effects of variable prosthesis stiffness on interface dynamics between the prosthetic socket and residual limb. J Rehabil Assist Technol Eng 2022; 9:20556683221111986. [PMID: 35859652 PMCID: PMC9289901 DOI: 10.1177/20556683221111986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: Loading of a residual limb within a prosthetic socket
can cause tissue damage such as ulceration. Computational simulations may be
useful tools for estimating tissue loading within the socket, and thus provide
insights into how prosthesis designs affect residual limb-socket interface
dynamics. The purpose of this study was to model and simulate residual
limb-socket interface dynamics and evaluate the effects of varied prosthesis
stiffness on interface dynamics during gait. Methods: A spatial contact model of a residual limb-socket interface
was developed and integrated into a gait model with a below-knee amputation.
Gait trials were simulated for four subjects walking with low, medium, and high
prosthesis stiffness settings. The effects of prosthesis stiffness on interface
kinematics, normal pressure, and shear stresses were evaluated. Results: Model-predicted values were similar to those reported
previously in sensor-based experiments; increased stiffness resulted in greater
average normal pressure and shear stress (p < 0.05). Conclusions: These methods may be useful to aid experimental studies
by providing insights into the effects of varied prosthesis design parameters or
gait conditions on residual limb-socket interface dynamics. The current results
suggest that these effects may be subject-specific.
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Affiliation(s)
| | - Peter G Adamczyk
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kieran M Nichols
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael E Hahn
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
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Kang NV, Woollard A, Michno DA, Al-Ajam Y, Tan J, Hansen E. A consecutive series of targeted muscle reinnervation (TMR) cases for relief of neuroma and phantom limb pain: UK perspective. J Plast Reconstr Aesthet Surg 2021; 75:960-969. [PMID: 34840118 DOI: 10.1016/j.bjps.2021.09.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/12/2021] [Accepted: 09/27/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies have suggested that targeted muscle reinnervation (TMR) can improve symptoms of neuroma pain (NP) and phantom limb pain (PLP) in patients. OBJECTIVES Our primary objective was to measure changes in NP and PLP levels following TMR surgery at 4-time points (baseline, 3, 6- and 12-months postoperatively). Secondary aims included identification of the character and rate of any surgical complications and patients' satisfaction with TMR. METHODS A retrospective review of outcomes of 36 patients who underwent TMR surgery to treat intractable NP and/or PLP after major amputation of an upper (UL) or lower limb (LL) at a single centre in London, UK over 7 years. The surgical techniques, complications, and satisfaction with TMR are described. RESULTS Forty TMR procedures were performed on 36 patients. Thirty patients had complete data for NP and PLP levels at all pre-defined time points. Significant improvements (p<0.01) in both types of pain were observed for both upper and LL amputees. However, there were varying patterns of recovery. For example, UL amputees experienced worsening of PLP in the first few months post-operatively whereas surgical complications were more common in LL cases. Patients were overwhelmingly satisfied with the improvements in their symptoms (90%). CONCLUSIONS TMR surgery appeared to relieve both NP and PLP although the retrospective nature of this study limits the strength of this conclusion. However, complication rates were high, and it is crucial for surgeons and patients to fully understand the course and outcomes of this novel surgery prior to undertaking treatment.
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Affiliation(s)
- Norbert Venantius Kang
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom.
| | - Alexander Woollard
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom
| | - Dominika Antonina Michno
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom
| | - Yazan Al-Ajam
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom
| | - Jaclyn Tan
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom
| | - Esther Hansen
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom
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Mountan S, Duncan C, Hansen C. Resolution of prosthesis-related residual limb wounds after botulinum toxin for secondary hyperhidrosis. PM R 2021; 14:1026-1028. [PMID: 34564952 DOI: 10.1002/pmrj.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Shanalee Mountan
- Division of Physical Medicine & Rehabilitation, The University of Utah, Salt Lake City, Utah, USA.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA.,Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Christopher Duncan
- Division of Physical Medicine & Rehabilitation, The University of Utah, Salt Lake City, Utah, USA.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Colby Hansen
- Division of Physical Medicine & Rehabilitation, The University of Utah, Salt Lake City, Utah, USA.,Primary Children's Hospital, Salt Lake City, Utah, USA
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Rosenblatt NJ, Stachowiak A, Reddin C. Prosthetic Disuse Leads to Lower Balance Confidence in a Long-Term User of a Transtibial Prosthesis. Adv Wound Care (New Rochelle) 2021; 10:529-533. [PMID: 34232743 PMCID: PMC8260888 DOI: 10.1089/wound.2019.1086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/29/2019] [Indexed: 11/12/2022] Open
Abstract
Residual limb wounds or ulcers are one of the most frequent skin problems reported by lower extremity prosthesis users. Healing often requires prosthesis disuse, which can logically impair physical functioning. However, there are limited data available to support this idea. We report the impact of prosthesis disuse by presenting assessments of balance, gait, physical activity, and balance confidence obtained on a case subject before experiencing a wound and following reintroduction to a well-fit prosthesis after wound-related prosthesis disuse. The case subject was a 76-year-old male who suffered a unilateral, transtibial amputation due to synovial sarcoma 13 years before. After presenting with a history of pain in the area of a chronic skin plaque, he received a punch biopsy, which resulted in 4 weeks of prosthesis disuse followed by 12 weeks of limited use before a final well-fitting socket was received. The following data were collected 24 weeks before the biopsy and 4 weeks after receiving the final well-fitting socket: Berg Balance Scale, L-test of walking, quantitative gait analysis, Activity-specific Balance Confidence Scale, and 1 week of community-based activity. Balance confidence decreased nearly 19%, walking speed decreased by 12%, and steps/day decreased by 19% following ∼4 months of prosthesis disuse/limited use; functional measures were not impacted. Lower balance confidence is not trivial as it can lead to activity avoidance and increased fall risk. Interventions to target balance confidence changes following prosthesis disuses may be important to minimize the impact of disuse on physical and mental well-being.
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Affiliation(s)
- Noah J. Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Aaron Stachowiak
- Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois
| | - Christopher Reddin
- Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois
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Petkovšek-Gregorin R. Razjede in njihovo celjenje pri pacientih po amputaciji. OBZORNIK ZDRAVSTVENE NEGE 2021. [DOI: 10.14528/snr.2021.55.2.2987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Najpogostejši vzroki, ki vplivajo na celjenje razjed pri pacientih po amputaciji, so periferna arterijska bolezen, sladkorna bolezen in kronična venska insuficienca. Namen raziskave je bil prepoznati dejavnike, ki lahko vplivajo na celjenje razjede na amputacijskem krnu.Metode: Uporabljena je bila kvantitativna neeksperimentalna raziskovalna metodologija. Izvedena je bila retrospektivna raziskava s pregledom negovalne dokumentacije o spremljanju razjede. V raziskavo je bilo vključenih 134 pacientov po amputaciji spodnjega uda z razjedo, hospitaliziranih v letu 2017. Uporabljeni sta bili opisna statistika in logistična regresija.Rezultati: Razjedo, nastalo zaradi različnih vzrokov, je imelo 134 pacientov. Ženske imajo v primerjavi v moškimi več možnosti za prisotnost razjede ob odpustu (RO = 4,8, 95 % IZ: 1–22), prav tako pacienti, ki so imeli razjedo že ob sprejemu (RO = 7,7, 95 % IZ: 3–19,2), in tisti z več kot eno razjedo (RO = 4,7, 95 % IZ: 1–22,3). Pri pacientih, ki imajo razjedo na amputacijskem krnu, imajo večjo možnost, da se bo ta do konca rehabilitacije zacelila (RO = 0,2, 95 % IZ: 0,1–0,6 p = 0,004).Diskusija in zaključek: Ugotovitve nakazujejo, da je pri ženskah večja verjetnost, da razjeda ob odpustu ne bo zaceljena, kot pri pacientih, pri katerih je bila razjeda prisotna že ob sprejemu, in pri tistih, ki imajo več razjed. Treba bi bilo izvesti raziskavo, ki bi zajela večje število pacientov. Prav tako bi bilo treba natančneje določiti parametre spremljanja.
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Chronic prosthesis-related residual limb ulcer treated with autologous micro-fragmented adipose tissue. Regen Ther 2021; 18:21-23. [PMID: 33778135 PMCID: PMC7985278 DOI: 10.1016/j.reth.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/21/2021] [Indexed: 11/23/2022] Open
Abstract
A 56-year-old male with a past medical history significant for a left below-knee amputation and a left total knee replacement presented with knee pain at a non-healing stage 2 prosthesis-related residual limb ulcer. The ulcer at the weight-bearing surface at the anterior patella had not closed despite three years of conservative management; including offloading and wound clinic follow up. To assist with the healing process, the ulcer was treated with autologous micro-fragmented adipose tissue therapy. He was injected with 8 mLs of minimally manipulated adipose tissue (Lipogems) underneath the ulcer. Upon the four-week follow-up, his pain had resolved, and the wound was significantly reduced in size with new skin appearing. The goal of this case report is to examine if autologous micro-fragmented adipose tissue can represent a feasible and safe treatment option for chronic prosthesis-related residual limb ulcers. To our knowledge, this is the first reported case using micro-fragmented adipose therapy to treat a chronic prosthesis-related residual limb ulcer.
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Abstract
Patients with amputation have unique characteristics and needs that must be considered when services are being provided through a virtual platform. The types of amputation rehabilitation services that can be provided virtually are numerous and vary from a full clinical team evaluation to individual therapy services. Whether services are being provided in person or through a virtual platform, rehabilitation of the person with amputation ideally involves a collaborative interdisciplinary team. The potential benefits of providing amputation rehabilitation care through a virtual platform include enhanced access to specialized services, reduced travel burden, and improved continuity of care.
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Affiliation(s)
- Joseph Webster
- Central Virginia Veterans Affairs Healthcare System, 1201 Broad Rock boulevard, Richmond, VA 23249, USA.
| | - Patricia Young
- Amputation System of Care, Office of Connected Care, VA Central Office, Washington, DC, USA
| | - Jessica Kiecker
- Department of PM&R, Minneapolis VA Health Care System, 1 Veterans Dr., Minneapolis, MN 55417, USA
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Steer JW, Worsley PR, Browne M, Dickinson AS. Predictive prosthetic socket design: part 1-population-based evaluation of transtibial prosthetic sockets by FEA-driven surrogate modelling. Biomech Model Mechanobiol 2020; 19:1331-1346. [PMID: 31256276 PMCID: PMC7423807 DOI: 10.1007/s10237-019-01195-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/23/2019] [Indexed: 11/26/2022]
Abstract
It has been proposed that finite element analysis can complement clinical decision making for the appropriate design and manufacture of prosthetic sockets for amputees. However, clinical translation has not been achieved, in part due to lengthy solver times and the complexity involved in model development. In this study, a parametric model was created, informed by variation in (i) population-driven residuum shape morphology, (ii) soft tissue compliance and (iii) prosthetic socket design. A Kriging surrogate model was fitted to the response of the analyses across the design space enabling prediction for new residual limb morphologies and socket designs. It was predicted that morphological variability and prosthetic socket design had a substantial effect on socket-limb interfacial pressure and shear conditions as well as sub-dermal soft tissue strains. These relationships were investigated with a higher resolution of anatomical, surgical and design variability than previously reported, with a reduction in computational expense of six orders of magnitude. This enabled real-time predictions (1.6 ms) with error vs the analytical solutions of < 4 kPa in pressure at residuum tip, and < 3% in soft tissue strain. As such, this framework represents a substantial step towards implementation of finite element analysis in the prosthetics clinic.
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Affiliation(s)
- J. W. Steer
- Bioengineering Science Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - P. R. Worsley
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - M. Browne
- Bioengineering Science Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - A. S. Dickinson
- Bioengineering Science Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
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Evaluating shear and normal force with the use of an instrumented transtibial socket: A case study. Med Eng Phys 2019; 71:102-107. [PMID: 31331756 DOI: 10.1016/j.medengphy.2019.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/21/2022]
Abstract
Patients with transtibial amputation experience ulcers on their residual limb. The loading between the device and underlying material plays a role in loads transmitted to the skin. The objective was to evaluate normal and shear forces at the socket/liner interface during walking. A 53 year old male (85.45 kg and 177.8 cm) with a transtibial amputation participated in this case study. A transtibial prosthesis was instrumented with a load cell to measure normal and shear forces at the socket interface. Three conditions were evaluated during walking: gel liner, additional three ply sock and a hole in the gel liner. Shear and normal forces were highest with the addition of a three ply. Longitudinal shear stresses ranged from 0.4-7.66 kPa, transverse shear stresses ranged from 0.01-7.79 kPa and normal stresses ranged from 2.7-61.9 kPa. Increased shear and normal forces can cause a significant decrease in blood perfusion, linked to an increased risk of ulcer formation. Experimental force results are also important for future work involving finite element modeling of the skin/liner/device interface.
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Highsmith MJ, Goff LM, Lewandowski AL, Farrokhi S, Hendershot BD, Hill OT, Rábago CA, Russell-Esposito E, Orriola JJ, Mayer JM. Low back pain in persons with lower extremity amputation: a systematic review of the literature. Spine J 2019; 19:552-563. [PMID: 30149083 DOI: 10.1016/j.spinee.2018.08.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lower extremity amputation (LEA) is associated with an elevated risk for development and progression of secondary health conditions. Low back pain (LBP) is one such condition adversely affecting function, independence, and quality of life. PURPOSE The purpose of this study was to systematically review the literature to determine the strength of evidence relating the presence and severity of LBP secondary to LEA, thereby supporting the formulation of empirical evidence statements (EESs) to guide practice and future research. STUDY DESIGN/SETTING Systematic review of the literature. METHODS A systematic review of five databases was conducted followed by evaluation of evidence and synthesis of EESs. RESULTS Seventeen manuscripts were included. From these, eight EESs were synthesized within the following categories: epidemiology, amputation level, function, disability, leg length, posture, spinal kinematics, and osseointegrated prostheses. Only the EES on epidemiology was supported by evidence at the moderate confidence level given support by eight moderate quality studies. The four EESs for amputation level, leg length, posture, and spinal kinematics were supported by evidence at the low confidence level given that each of these statements had some evidence not supporting the statement but ultimately more evidence (and of higher quality) currently supporting the statement. The remaining three EESs that addressed function, disability and osseointegrated prosthetic use were all supported by single studies or had comparable evidence that disagreed with study findings rendering insufficient evidence to support the respective EES. CONCLUSIONS Based on the state of the current evidence, appropriate preventative and, particularly, treatment strategies to manage LBP in persons with LEA remain a knowledge gap and an area of future study.
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Affiliation(s)
- M Jason Highsmith
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, 13000 Bruce B. Downs Blvd., Tampa, FL, 33612, USA; School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher Ave. Tampa, FL, 33612, USA; 319th Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, 2801 Grand Ave. Pinellas Park, FL, USA, 33782.
| | - Lisa M Goff
- Center of Innovation on Disability & Rehabilitation Research, James A. Haley Veterans' Administration Hospital, 8900 Grand Oak Ci, Tampa, FL, 33637, USA
| | | | - Shawn Farrokhi
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, 34800 Bob Wilson Dr. San Diego, CA, 92134, USA; The Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, 34800 Bob Wilson Dr. San Diego, CA, 92134, USA
| | - Brad D Hendershot
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, Bethesda, 4494 North Palmer Rd, Bethesda, MD, 20889, USA; Department of Rehabilitation, Research and Development Section, Walter Reed National Military Medical Center, Bethesda, 4494 North Palmer Rd, Bethesda, MD, 20889, USA
| | - Owen T Hill
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, Ft. Sam Houston, 3851 Roger Brooke Dr, San Antonio, TX, 78234, USA
| | - Christopher A Rábago
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, Ft. Sam Houston, 3851 Roger Brooke Dr, San Antonio, TX, 78234, USA; Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA, Ft. Sam Houston, 3851 Roger Brooke Dr, San Antonio, TX, 78234, USA
| | - Elizabeth Russell-Esposito
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, Ft. Sam Houston, 3851 Roger Brooke Dr, San Antonio, TX, 78234, USA; Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA, Ft. Sam Houston, 3851 Roger Brooke Dr, San Antonio, TX, 78234, USA
| | - John J Orriola
- Shimberg Health Sciences Library, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612
| | - John M Mayer
- U.S. Spine & Sport Foundation, 3760 Convoy St #101. San Diego, CA, 92111, USA
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Webster JB. Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations. Phys Med Rehabil Clin N Am 2019; 30:89-109. [DOI: 10.1016/j.pmr.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tran L, Caldwell R, Quigley M, Fatone S. Stakeholder perspectives for possible residual limb monitoring system for persons with lower-limb amputation. Disabil Rehabil 2018; 42:63-70. [PMID: 30182755 DOI: 10.1080/09638288.2018.1492634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To gather ideas from lower-limb prosthesis users and certified prosthetists regarding possible residual limb monitoring system features and data presentation. We also gathered information on the type of residual limb problems typically encountered, how they currently manage those problems, and their ideas for methods to better manage them.Materials and methods: Two focus groups were held; one with certified prosthetists and another with lower-limb prosthesis users. Open-ended questions were used in a moderated discussion that was audio recorded, transcribed, and assessed using applied thematic analysis.Results and conclusions: Seven individuals participated in each focus group. Prosthetists came from a mix of practice settings, while prosthesis users were diverse in level of amputation, aetiology, and years of experience using lower-limb prostheses. Residual limb problems reported by participants were consistent with those in the literature. Participants suggested better managing residual limb problems through improved education, better detection of residual limb problems, and using sensor-based information to improve prosthetic technology. Participants favoured short-term use of a possible residual limb monitoring systems to troubleshoot residual limb problems, with temperature and pressure the most frequently mentioned measurements. Participants described that an ideal residual limb monitoring system would be lightweight, not interfere with prosthesis function, and result in benefits with regard to prosthetic care and socket function that outweighed inconveniences or concerns regarding system use. A potential positive of system use included having objective data for reimbursement justification, although it was pointed out that the residual limb monitoring system itself also needed to be reimbursable.Implications for RehabilitationStakeholders suggested better managing residual limb problems through improved education, better detection of residual limb problems, and using sensor-based information to improve prosthetic technology.Stakeholders favored short-term use of a possible system to troubleshoot residual limb problems, with temperature and pressure the most frequently mentioned measurements.Stakeholders described that an ideal residual limb monitoring system would be lightweight, not interfere with prosthesis function, and result in benefits with regard to prosthetic care and socket function that outweighs any inconveniences or concerns regarding system use.Stakeholders indicated that a potential positive of system use included having objective data for reimbursement justification, although it was pointed out that the residual limb monitoring system itself also needed to be reimbursable.
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Affiliation(s)
- Lilly Tran
- Northwestern University Prosthetics-Orthotics Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ryan Caldwell
- Northwestern University Prosthetics-Orthotics Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Scheck & Siress Prosthetics, Orthotics, and Pedorthics, Schaumburg, IL, USA
| | - Matthew Quigley
- Discipline of Prosthetics and Orthotics, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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