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BACKGROUND: This controlled experimental study aimed to compare ectopic replantation with other replantation techniques in a rat model of crush amputations. It also assessed the impact of different replantation methods on the viability of amputates. METHODS: Forty male Wistar albino rats were divided into four groups. Groin flaps served as the amputation model. Group 1 underwent guillotine-style amputation followed by orthotopic replantation, Group 2 experienced crush-type amputation and orthotopic replantation, Group 3 had crush-type amputation and orthotopic replantation with a vein graft, and Group 4 underwent crush-type amputation followed by ectopic replantation. Flap viability and perfusion rates were assessed on day 3 using an infrared perfusion assessment system. The ratio of viable area to total flap area and thrombus formation in the pedicle vessels were evaluated on day 7. RESULTS: Infrared evaluations on day 3 post-replantation revealed flap perfusion percentages of 73.5% in Group 1, 11.1% in Group 2, 65% in Group 3, and 64.1% in Group 4. Statistical analysis indicated that Group 1 exhibited the highest perfusion rates, while Group 2 showed the lowest. No differences were observed between Groups 3 and 4. On the seventh day, the average surviving flap areas were found to be 74.6% in Group 1, 2.5% in Group 2, 64.5% in Group 3, and 64% in Group 4. Statistically, Group 1 exhibited the best outcomes, while Group 2 had the poorest, with no differences between Groups 3 and 4. Additionally, thrombus formation was observed in the vessels of two animals in Group 1, nine in Group 2, and three each in Groups 3 and 4. Significant statistical differences were noted among the groups. CONCLUSION: The results indicate that ectopic replantation and replantation with a vein graft are equally effective. The preferred method for crush-type replantations may depend on the patient's and the amputated limb's conditions. In crush-type amputations, we recommend vein graft repair if the patient's overall condition supports replantation and if crushed segments can be debrided without excessive shortening of the amputated part. If these conditions are not met, temporary ectopic replantation is advised to preserve the amputated limb. Keywords: Crush-type injury; ectopic replantation; microsurgery; replantation; vascular anastomosis. AMAC: Bu galismanin amaci, deneysel bir kontrollu galisma ile, ezilme tipi amputasyon modelinde ektopik replantasyonu diger replantasyon teknikleriyle karsilastirmak ve replantasyon teknigine bagli olarak ampute canliliginda meydana gelen degisiklikleri degerlendirmektir. GEREC VE YONTEM: 40 adet erkek Wistar Albino sigani 4 gruba ayrildi. Amputasyon modeli olarak kasik flepleri kullanildi. Grup 1'e giyotin tarzi amputasyon ve ortotopik replantasyon, Grup 2'ye ezilme tipi amputasyon ve ortotopik replantasyon, Grup 3'e ezilme tipi amputasyon ve ven grefti ile ortotopik replantasyon, Grup 4'e ezilme tipi amputasyon ve ektopik replantasyon uygulandi. Flep canliligi ve perfuzyon oranlari 3. gunde kizilotesi perfuzyon degerlendirme sistemi ile degerlendirildi. Canli alanin toplam flep alanina orani ve pedikul damarlarda trombus olusumu 7. gunde degerlendirildi. BULGULAR: Replantasyon sonrasi uguncu gun yapilan kizilotesi degerlendirmeye gore flep perfuzyon yuzdeleri Grup 1 'de %73.5, Grup 2'de%11.1, Grup 3'te %65, Grup 4'te %64.l olarak belirlendi. istatistiksel analizde Grup l en iyi sonucu veren grup oldu. Grup 2 en kotu sonuglari alirken, Grup 3 ve 4 arasinda fark yoktu. Yedinci gunde canliligini surduren flep alanlari Grup l'de ortalama %74.6, Grup 2'de ortalama %2.5, Grup 3'te ortalama %64.5, Grup 4'te ortalama %64 olarak tespit edildi. istatistiksel degerlendirmede en iyi sonucu Grup l, en kotu sonucu ise Grup 2 alirken, Grup 3 ile 4 arasinda fark yoktu. 7. gunde Grup l'de 2, Grup 2'de 9, Grup 3 ve 4'te 3'er hayvanin damarlarinda trombus olusumu tespit edildi. Gruplar arasinda istatistiksel olarak anlamli fark vardi. SONUC: Ektopik replantasyon ve ven grefti ile replantasyonun sonuglarinin birbirine ustunlugu yoktur. Ezilme tipi replantasyonlarda tercih edilecek yontem hastanin ve amputatin durumuna gore degisiklik gosterebilir. Ezilme tipi amputasyonlarda, hastanin genel durumu replantasyon igin uygunsa ve ampute kismi gok fazla kisaltmadan ezilmis segmentleri debride etmek mumkunse ven grefti ile onarimi oneriyoruz. Bu kosullar saglanamiyorsa amputatin kurtarilmasi igin gegici ektopik replantasyon oneriyoruz. Anahtar sozcukler: Ezilme tipi yaralanma; ektopik replantasyon; mikrocerrahi; replantasyon; vaskuler anastomoz.

Tibial aplasia. Treatment by tibialization of the fibula and compensation for shortening by holding the foot in equinus position in Bangui, Central African RepublicObjective. Congenital absence of the tibia (congenital tibial aplasia) causes significant disability when walking. The usual treatment, which involves lengthening the lower leg or early amputation followed by prosthetic fitting, requires technical resources that are often lacking in developing countries. The proposed alternative consists of tibialization of the fibula with limb lengthening and by preservation of the foot equinismus.Patients and method. The records of 25 children with congenital tibial aplasia were reviewed. Ten of these children underwent tibialization of the fibula (operated between one and three years of age) and amputation (at six and eight years of age) in two cases.Results. With a mean follow-up period of two years and seven months, correct alignment of the lower leg and foot below the knee was achieved in all cases of tibialization of the fibula. Two children achieved independent walking. Three children were lost for follow-up.Discussion. The management of congenital tibial aplasia must consider the local socioeconomic context. Although the follow-up period in this study is short, the protocol is simple and well-accepted by families.Conclusion. Conservative treatment of tibial aplasia through tibialization of the fibula with equinus preservation to compensate the shortening is simple and takes local socioeconomic constraints into account, while avoiding the limitations and costs of modern protocols. Furthermore, it is always well accepted by families.L’aplasie tibiale. Traitement par tibialisation de la fibula et compensation du raccourcissement par maintien du pied en équinisme à Bangui, République centrafricaineObjectif. L’absence congénitale du tibia (aplasie tibiale congénitale) entraine un handicap important pour la marche. Son traitement habituel (allongement du segment jambier ou amputation précoce puis appareillage) fait appel à des moyens techniques qui font souvent défaut dans les pays en développement. L’alternative proposée ici consiste en une tibialisation de la fibula avec égalisation des membres par conservation de l’équinisme du pied.Patients et méthode. Les dossiers de 25 enfants présentant une aplasie tibiale congénitale ont été revus. Parmi ceux-ci, 10 enfants ont été opérés par tibialisation de la fibula dans 8 cas (opérés entre 1 et 3 ans) et par amputation dans 2 cas (à 6 et 8 ans).Résultats. Avec un recul moyen de deux ans et sept mois, la tibialisation de la fibula a été obtenue dans tous les cas avec un alignement correct du segment jambier et du pied sous le genou. Deux enfants ont acquis une marche indépendante. Trois enfants ont été perdus de vue.Discussion. La prise en charge de l’aplasie tibiale congénitale doit tenir compte du contexte socio-économique local. Bien que le recul de la série présentée soit peu important, le protocole utilisé a l’avantage de la simplicité et d’être bien accepté par les familles.Conclusion. Le traitement conservateur de l’aplasie tibiale par tibialisation de la fibula avec conservation de l’équinisme pour compenser le raccourcissement est un traitement simple, qui tient compte des impératifs socio-économiques locaux et qui évite les contraintes et les coûts des protocoles modernes. Il est de plus toujours accepté par les familles.

Background Postamputation neuroma pain can prevent comfortable prosthesis wear in patients with limb amputations, and currently available treatments are not consistently effective. Targeted muscle reinnervation (TMR) is a decade-old technique that employs a series of novel nerve transfers to permit intuitive control of upper-limb prostheses. Clinical experience suggests that it may also serve as an effective therapy for postamputation neuroma pain; however, this has not been explicitly studied. Questions/purposes We evaluated the effect of TMR on residual limb neuroma pain in upper-extremity amputees. Methods We conducted a retrospective medical record review of all 28 patients treated with TMR from 2002 to 2012 at Northwestern Memorial Hospital/Rehabilitation Institute of Chicago (Chicago, IL, USA) and San Antonio Military Medical Center (San Antonio, TX, USA). Twenty-six of 28 patients had sufficient (> 6 months) followup for study inclusion. The amputation levels were shoulder disarticulation (10 patients) and transhumeral (16 patients). All patients underwent TMR for the primary purpose of improved myoelectric control. Of the 26 patients included in the study, 15 patients had evidence of postamputation neuroma pain before undergoing TMR. Results Of the 15 patients presenting with neuroma pain before TMR, 14 experienced complete resolution of pain in the transferred nerves, and the remaining patient’s pain improved (though did not resolve). None of the patients who presented without evidence of postamputation neuroma pain developed neuroma pain after the TMR procedure. All 26 patients were fitted with a prosthesis, and 23 of the 26 patients were able to operate a TMR-controlled prosthesis. Conclusions None of the 26 patients who underwent TMR demonstrated evidence of new neuroma pain after the procedure, and all but one of the 15 patients who presented with preoperative neuroma pain experienced complete relief of pain in the distribution of the transferred nerves. TMR offers a novel and potentially more effective therapy for the management of neuroma pain after limb amputation. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Jährlich werden in Deutschland ca. 62.000 Amputationen durchgeführt. Das sind die aktuellen Zahlen aus dem Jahr 2019 – mit weiterhin steigender Tendenz und mit einem Trend hin zur Minoramputation [1]. Gehparameter wie Ausdauer, Geschwindigkeit, Koordination und Balance werden durch diese zusätzliche sensorische Information adressiert, und auch medikamentös therapierefraktäre Phantomschmerzen. Besonders in unterversorgten Regionen könnte der Einsatz dieser neuen Technologien die Versorgungsquote mit notwendigen Spezialtherapien, wie Spiegeltherapie und gezieltem Prothesensteuer-Training, ausbauen. Kröger, K; Berg, C; Santosa, F; Malyar, N; Reinecke, H. Lower limb amputation in Germany: An analysis of data from the German Federal Statistical Office between 2005 and 2014.

In this report of two randomized trials, patients with type 2 diabetes at risk for cardiovascular disease received the sodium–glucose cotransporter 2 inhibitor canagliflozin or placebo and were followed for 188 weeks. Canagliflozin reduced the risk of cardiovascular events.

Abstract Objective. To define clinical phenotypes of postamputation pain and identify markers of risk for the development of chronic pain. Design. Cross-sectional study of military service members enrolled 3-18 months after traumatic amputation injury. Setting. Military Medical Center Subjects. 124 recent active duty military service members Methods. Study subjects completed multiple pain and psychometric questionnaires to assess the qualities of phantom and residual limb pain. Medical records were reviewed to determine the presence/absence of a regional catheter near the time of injury. Subtypes of residual limb pain (somatic, neuroma, and complex regional pain syndrome) were additionally analyzed and associated with clinical risk factors. Results. A majority of enrolled patients (64.5%) reported clinically significant pain (pain score ≥3 averaged over previous week). 61% experienced residual limb pain and 58% experienced phantom pain. When analysis of pain subtypes was performed in those with residual limb pain, we found evidence of a sensitized neuroma in 48.7%, somatic pain in 40.8%, and complex regional pain syndrome in 19.7% of individuals. The presence of clinically significant neuropathic residual limb pain was associated with symptoms of PTSD and depression. Neuropathic pain of any severity was associated with symptoms of all four assessed clinical risk factors: depression, PTSD, catastrophizing, and the absence of regional analgesia catheter. Conclusions. Most military service members in this cohort suffered both phantom and residual limb pain following amputation. Neuroma was a common cause of neuropathic pain in this group. Associated risk factors for significant neuropathic pain included PTSD and depression. PTSD, depression, catastrophizing, and the absence of a regional analgesia catheter were associated with neuropathic pain of any severity.

Background Symptomatic neuroma occurs in 13% to 32% of amputees, causing pain and limiting or preventing the use of prosthetic devices. Targeted nerve implantation (TNI) is a procedure that seeks to prevent or treat neuroma-related pain in amputees by implanting the proximal amputated nerve stump onto a surgically denervated portion of a nearby muscle at a secondary motor point so that regenerating axons might arborize into the intramuscular motor nerve branches rather than form a neuroma. However, the efficacy of this approach has not been demonstrated. Questions/purposes We asked: Does TNI (1) prevent primary neuroma-related pain in the setting of acute traumatic amputation and (2) reduce established neuroma pain in upper- and lower-extremity amputees? Methods We retrospectively reviewed two groups of patients treated by one surgeon: (1) 12 patients who underwent primary TNI for neuroma prevention at the time of acute amputation and (2) 23 patients with established neuromas who underwent neuroma excision with secondary TNI. The primary outcome was the presence or absence of palpation-induced neuroma pain at last followup, based on a review of medical records. The patients presented here represent 71% of those who underwent primary TNI (12 of 17) and 79% of those who underwent neuroma excision with secondary TNI (23 of 29 patients) during the period in question; the others were lost to followup. Minimum followup was 8 months (mean, 22 months; range, 8–60 months) for the primary TNI group and 4 months (mean, 22 months; range, 4–72 months) for the secondary TNI group. Results At last followup, 11 of 12 patients (92%) after primary TNI and 20 of 23 patients (87%) after secondary TNI were free of palpation-induced neuroma pain. Conclusions TNI performed either primarily at the time of acute amputation or secondarily for the treatment of established symptomatic neuroma is associated with a low frequency of neuroma-related pain. By providing a distal target for regenerating axons, TNI may offer an effective strategy for the prevention and treatment of neuroma pain in amputees. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

After transhumeral amputation, four patients had implantation of a self-contained, osseointegrated prosthesis with a neuromusculoskeletal interface that allowed intuitive control of the prosthetic hand and arm over 3 to 7 years. A video shows use of the prostheses in daily life.

Background We aimed to use open source data to understand the incidence, trends, and regional differences of finger and partial hand amputations on a national level in individuals aged 15 or older in Sweden. Methods We analyzed 6,918 patients aged 15 and older who had experienced finger and partial hand amputations. Incidence rates, trends, and regional disparities were assessed using negative binomial regression models and Student’s t-tests. Future trend prediction was performed using Poisson regression. Results Finger amputations declined most, followed by partial hand and thumb amputations. Regional variations existed, with Stockholm having the lowest and Gotland highest incidence respectively. Overall, the incidence of finger, thumb and partial hand amputations in Sweden decreased slightly. Future trend analysis indicated decreasing incidence. Conclusion Although, lacking in definition, publicly available data can be used for monitoring of finger, thumb, and partial hand amputation incidence on a national level. Sex, age, and regional differences were observed, suggesting the need for targeted interventions to address disparities and mitigate the burden of finger and partial hand amputations on affected individuals.