Clinical Versus Doppler Based Assessment in Determining Amputation Level in Diabetic Foot Gangrene;A Prospective Cross-Sectional Study at Atbuth, Bauchi

Background: Amputation is defined as the surgical removal of a limb or part of a limb through the bone. If the amputation is done above or below the knee, they are termed major while minor amputations involve the partial removal of foot including forefoot resections, ray amputation of the digits or parts of the digits. Significant number of patients with diabetic foot ulcers end with amputations. In the past the amputation level was decided by clinical assessment alone, such as physical examination using color, temperature, peripheral pulses and wound bleeding during surgical procedure. The use of Doppler ultrasound to measure arterial blood pressure at the proposed amputation site has been advocated as a predictor of amputation success. An optimal choice of the level of amputation can reduce amputation complications. Methodology: A Prospective comparative randomized cross-sectional study carried out between 1st January 2022 and 1st January 2024 in ATBUTH, Bauchi amongst patients with diabetic foot Wagener stage IV and V scheduled for amputation. Outcome measures of wound break down, flap necrosis and re-amputation were assessed amongst the clinical based level assessment group and the doppler based level assessment group. Results: A total of 171 patients were recruited into the study. Males 103 and 68 are females, giving a male to female ratio of 1.5:1. mean age 47 years. There were 84 patients in the clinical based level assessment group and 87 patients in the doppler based level assessment. Conclusion: Diabetes mellitus foot disease is a significant risk factor for non-traumatic lower limb amputation and doppler level assessment is superior to clinical level in determining amputation level among diabetic patients scheduled for amputation. P-value 0.003.

Risk Factors for Lower Extremity Amputation among Diabetic Patients with Diabetic Foot Gangrene in ATBUTH, Bauchi

Background: Diabetic mellitus was described as an evolving global epidemic of the twenty-first century, due to the exponential rise in the number of people with the condition. Lower extremity amputation is one of the common complications of diabetes. With increase in the number of people with diabetes there will also be increase in the number of diabetics going for lower extremity amputation, increasing both the financial as well as psychologic burden of treatment. Methodology: A prospective cross-sectional study of all diabetic patients going for lower extremity amputation will be done. All the patients with advanced diabetic foot syndrome needing lower extremity amputation are enrolled (Wagener stage IV and V), both through the clinic and emergency center. Informed consent is obtained from the patient after which data are collected using a structured questionnaire. All the investigation results of the patients were also documented. Data collected are analyzed using the SPSS version 29. Chi-square and student t-test were used to measure significant relationship between the variables at 95% confident interval. Results: Within the period of study, which extends from 1st January 2022 to 1st of January 2024, a total of 171 patients were recruited. All diabetic patients with diabetic foot Wagener grade IV and V who presented to the clinic or emergency department were enrolled in the study. We found a significant relationship between gender, previous procedure on the affected limb or amputation of the contralateral limb, knowledge of foot care among diabetics and risk of amputation. There was, however, no statistically significant relationship between. There is no statistically significance relationship between the level of education, occupation, presence of co-morbidity with the risk of amputation among diabetic patients with foot syndrome. Conclusion: Previous lower limb procedure/amputation, male gender, paucity of knowledge on foot care, prolonged duration of the disease and method of treatment are important risk factors for the risk of amputation among diabetic patients with diabetic foot syndrome.

Prevalence and risk factors of wound complications after transtibial amputation in patients with diabetic foot

BACKGROUND Diabetic foot(DMF)complications are common and are increasing in incidence.Risk factors related to wound complications are yet to be established after transtibial amputation under the diagnosis of DMF infection.AIM To analyze the prognosis and risk factors related to wound complications after transtibial amputation in patients with diabetes.METHODS This retrospective cohort study included seventy-two patients with DMF complications who underwent transtibial amputation between April 2014 and March 2023.The groups were categorized based on the occurrence of wound complications,and we compared demographic data between the complication group and the non-complication group to analyze risk factors.Moreover,a multivariate logistic regression analysis was performed to identify risk factors.RESULTS The average follow-up period was 36.2 months.Among the 72 cases,31(43.1%)had wound complications.Of these,12 cases(16.7%)received further treatment,such as debridement,soft tissue stump revision,and re-amputation at the proximal level.In a group that required further management due to wound complications after transtibial amputation,the hemoglobin A1c(HbA1c)level was 9.32,while the other group that did not require any treatment had a 7.54 HbA1c level.The prevalence of a history of kidney transplantation with wound complications after transtibial amputation surgery in DMF patients was significantly greater than in cases without wound complications(P=0.02).Other factors did not show significant differences.CONCLUSION Approximately 43.1%of the patients with transtibial amputation surgery experienced wound complications,and 16.7%required additional surgical treatment.High HbA1c levels and kidney transplant history are risk factors for postoperative wound complications.

Jaffe-Campanacci syndrome resulted in amputation: A case report

BACKGROUND Jaffe-Campanacci syndrome(JCS)is a very rare syndrome.The treatment of JCS is more conservative,and most authors recommend that no surgery should be done in asymptomatic patients.The conventional concept holds that the natural course of non-ossifying fibromas(NOFs)grows with the development of bones,and the osteolytic region gradually stops expanding and self-healing through bone ossifying around the lesion and ossification within the lesion.But in this case,the bone lesions were potentially biologically aggressive,which led to severe limb deformities and pain.CASE SUMMARY We present the case of a 5-year-old girl with JCS presenting with not only NOF sand café-au-lait macules,but also showed features not mentioned before,severe limb pain,and at last resulted in amputation.She was admitted to our hospital after presenting with claudication and mild pain over her right thigh,which worsened when stretching or being touched.Skin examination revealed multiple café-au-lait macules on the neck,arm,axilla,and torso,including the nipples and perineum.Radiographs revealed multiple lytic lesions in the proximal part of the right humerus,distal part of the right clavicle,proximal and distal parts of the right femur,and proximal parts of the right tibia and fibula.Curettage and biopsy were performed on the distal part of the right femur.At the age of 7,the girl was re-admitted to our hospital for a pathological fracture in the middle in the right femur and underwent Intralesional excision,internal fixation,bone grafting,and spica casting.At the age of 10,the girl came to our hospital again for severe pain of the right leg.Amputation from the middle level of the right femur was performed.We present the case of a 5-year-old girl with JCS presenting with not only NOFs and café-au-lait macules,but also showed features not mentioned before,severe limb pain,and at last resulted in amputation.She was admitted to our hospital after presenting with claudication and mild pain over her right thigh,which worsened when stretching or being touched.Skin examination revealed multiple café-au-lait macules on the neck,arm,armpit,and torso,including the nipples and perineum.Radiographs revealed multiple lytic lesions in the proximal part of the right humerus,distal part of the right clavicle,proximal and distal parts of the right femur,and proximal parts of the right tibia and fibula.Curettage and biopsy were performed on the distal part of the right femur.At the age of 7,the girl was re-admitted to our hospital for a pathological fracture in the middle in the right femur and underwent Intralesional excision,internal fixation,bone grafting,and spica casting.At the age of 10,the girl came to our hospital again for severe pain of the right leg.Amputation from the middle level of the right femur was performed.CONCLUSION In our opinion,education on preventing pathological fractures and explaining the consequent serious consequences to the parents is a matter of prime significance.At the same time,prophylactic treatment(restricted exercise,support,or surgery)is also considerable for JSC.

A Multi-Finger Si_(1-x)Ge_x/Si Heterojunction Bipolar Transistor for Wireless Power Amplifier Applications

A large area multi-finger configuration power SiGe HBT device （with an emitter area of about 880μm^2） was fabricated with 2μm double-mesa technology. The maximum DC current gain β is 214. The BVCEO is up to 10V,and the BVCBO is up to 16V with a collector doping concentration of 1 × 10^17cm^-3 and collector thickness of 400nm. The device exhibits a maximum oscillation frequency fmax of 19. 3GHz and a cut-off frequency fT of 18.0GHz at a DC bias point of Ic = 30mA and VCE = 3V.MSG （maximum stable gain） is 24.5dB,and U （Mason unilateral gain） is 26.6dB at 1GHz. Due to the novel distribution layout, no notable current gain fall-off or thermal effects are observed in the I-V characteristics at high collector current.

Tourniquets do not increase the total blood loss or reamputation risk in transtibial amputations

AIM To investigate the total blood loss(TBL) and the safety with respect to the re-amputation rate after transtibial amputation(TTA) conducted with and without a tourniquet. METHODS The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between January 2013 and April 2015. All patients with a primary TTA were assessed for inclusion if the amputation was performed because of arteriosclerosis or diabetic complications. All patients underwent a standardized TTA procedure that was performed approximately 10 cm below the knee joint and performed with sagittalflaps. The pneumatic tourniquet, when used, was inflated around the femur to a pressure of 100 mmH g above the systolic blood pressure. The number of blood transfusions within the first four postoperative days was recorded. The intraoperative blood loss(OBL), which is defined as the volume of blood lost during surgery, was determined from the suction volume and by the weight difference of the surgical dressings. The trigger for a blood transfusion was set at a decrease in the Hgb level < 9.67 g/dL(6 mmol/L). Transfusions were performed with pooled red blood cells containing 245 m L per portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d. RESULTS Seventy-four out of 86 consecutive patients who underwent TTA within the two-year study period were included in the analysis. Of these, 38 were operated on using a tourniquet and 36 were operated on without using a tourniquet. There were no significant preoperative differences between the groups. The patients in both groups had a postoperative decrease in their Hgb level compared with preoperative baseline values. The patients operated on using a tourniquet received approximately three millilitres less blood transfusion per kilogram body weight compared with patients operated on without a tourniquet. The duration of surgery was shorter and the OBL was less for the tourniquet group than the non-tourniquet group, whereas no significant difference was observed for the TBL. The TBL median was 859 mL(IQR: 383-1315) in the non-tourniquet group vs 737 mL(IQR: 331-1218) in the tourniquet group(P = 0.754). Within the 30-d follow-up period, 9 patients in the tourniquet group and 11 in the non-tourniquet group underwent a reamputation at the trans-femoral level. The use of a tourniquet showed no statistically significant association with the 30-d re-amputation at the femur level in the multiple logistic regression model(P = 0.78). The only variable with a significant association with re-amputation was age(OR = 1.07; P = 0.02).CONCLUSION The results indicate that tourniquets do not cause severe vascular damage with an increased postoperative bleeding or failure rate as the result.

Curcumin upregulates S100 expression and improves regeneration of the sciatic nerve following its complete amputation in mice

The repair of peripheral nerve injury after complete amputation is difficult,and even with anastomosis,the rapid recovery of nerve function remains challenging.Curcumin,extracted from plants of the genus Curcuma,has been shown to have anti-oxidant and anti-inflammatory properties and to improve sciatic nerve crush injury in rats.Here,we determined whether curcumin had neuroprotective effects following complete peripheral nerve amputation injury.BALB/c mice underwent complete sciatic nerve amputation,followed by an immediate epineurium anastomosis.Mice were intragastrically administered curcumin at doses of 40（high）,20（moderate）,and 10 mg/kg/d（low） for 1 week.We found that myelin in the mice of the high- and moderate-dose curcumin groups appeared with regular shape,uniform thickness,clear boundary,and little hyperplasia surrounding the myelin.High and moderate doses of curcumin markedly improved both action potential amplitude of the sciatic nerves and the conduction velocity of the corresponding motor neurons,and upregulated m RNA and protein expression of S100,a marker for Schwann cell proliferation,in L4–6 spinal cord segments.These results suggest that curcumin is effective in promoting the repair of complete sciatic nerve amputation injury and that the underlying mechanism may be associated with upregulation of S100 expression.

Surgical apgar score predicts early complication in transfemoral amputees:Retrospective study of 170 major amputations

AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P < 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.

Dynamic mechanical allodynia following finger amputation:Unexpected skin hyperinnervation

The development of chronic pain after amputations is not an uncommon event. In some cases the most disabling problem is represented by the symptom called dynamic mechanical allodynia, characterized by the painful sensation evoked by gently stroking the skin. Despite the growing interest in understanding pain mechanisms, little is known about the mechanism sustaining this peculiar type of pain. We present here the case of a 53-year-old female patient who complained of severe tactile allodynia in the hand after amputation of her left second finger, resistant to several medical and surgical treatments. In order to gain information about the pain mechanism, two neurodiagnostic skin biopsies were obtained from the area of tactile allodynia and from the contralateral, normal skin area. Skin biopsies showed an unexpected increased innervation of the allodynic skin compared to the contralateral, normal skin area(+ 80.1%). Hyperinnervation has been proposed as a mechanism of pain following nerve lesions, but the increased innervation described here could be also attributed to neuronal plasticity occurring in chronic inflammatory conditions. Independently from the uncertain cause of the epidermal hyperinnervation, in this patient we tried to reduce the elevated number of epidermal nerve fibres by treating the skin with topical capsaicin(0.075%) three times a day, and obtained a persistent pain relief. In conclusion, neurodiagnostic skin biopsy might represent an useful tool for detecting derangements of epidermal innervation in patients with dynamic mechanical allodynia and can help to select an individually tailored therapeutic strategy in such difficult clinical conditions. Further studies are needed to clarify this issue and try to gain better understanding of chronic pain mechanisms in patients who underwent finger amputation.

Assistive technologies for pain management in people with amputation: a literature review

The prevalence of limb amputation is increasing globally as a devastating experience that can physically and psychologically affect the lifestyle of a person. The residual limb pain and phantom limb pain are common disabling sequelae after amputation surgery. Assistive devices/technologies can be used to relieve pain in people with amputation. The existing assistive devices/technologies for pain management in people with amputation include electrical nerve block devices/technologies, TENS units, elastomeric pumps and catheters, residual limb covers, laser systems, myoelectric prostheses and virtual reality systems, etc. There is a great potential to design, fabricate, and manufacture some portable, wireless, smart, and thin devices/technologies to stimulate the spinal cord or peripheral nerves by electrical, thermal, mechanical, and pharmaceutical stimulus. Although some preliminary efforts have been done, more attention must be paid by researchers, clinicians, designers, engineers, and manufacturers to the post amputation pain and its treatment methods.

Amputation in diabetic foot ulcer:A treatment dilemma

Diabetic foot is a clinical manifestation of diabetes with a wide range of symptoms,including ulceration,osteomyelitis,osteoarticular destruction,and gangrene,as a consequence of advanced disease.Some diabetic foot cases present general indications for amputation,including dead limb,threat to the patient’s life,pain,loss of function,or nuisance.Various tools have been introduced to help decision-making in amputation for diabetic foot.However,it remains a conundrum because diabetic foot involves multiple pathomechanisms and factors that hinder its outcomes.Sociocultural issues often impede treatment from the patient’s side.We reviewed different perspectives in diabetic foot management,particularly related to amputation.In addition to deciding whether to amputate,physicians should address amputation level,timing,and ways to avoid patient deconditioning.Surgeons should not be autocratic in these circumstances and should be aware of beneficence and maleficence when considering whether to amputate.The main goal should be improving the patients’quality of life rather than preserving the limb as much as possible.

Lower extremity amputations and long-term outcomes in diabetic foot ulcers:A systematic review

BACKGROUNDDiabetes mellitus causes a large majority of non-traumatic major and minoramputations globally. Patients with diabetes are clinically complex with amultifactorial association between diabetic foot ulcers (DFU) and subsequentlower extremity amputations (LEA). Few studies show the long-term outcomeswithin the cohort of DFU-associated LEA.AIMTo highlight the long-term outcomes of LEA as a result of DFU.METHODSPubMed/MEDLINE and Google Scholar were searched for key terms, “diabetes”,“foot ulcers”, “amputations” and “outcomes”. Outcomes such as mortality, reamputation,re-ulceration and functional impact were recorded. Peer-reviewedstudies with adult patients who had DFU, subsequent amputation and follow upof at least 1 year were included. Non-English language articles or studiesinvolving children were excluded.RESULTSA total of 22 publications with a total of 2334 patients were selected against theinclusion criteria for review. The weighted mean of re-amputation was 20.14%,29.63% and 45.72% at 1, 3 and 5 years respectively. The weighted mean of mortality at 1, 3 and 5 years were 13.62%, 30.25% and 50.55% respectively withsignificantly higher rates associated with major amputation, re-amputation andischemic cardiomyopathy.CONCLUSIONPrevious LEA, level of the LEA and patient comorbidities were significant riskfactors contributing to re-ulceration, re-amputation, mortality and depreciatedfunctional status.

Ex vivo limb perfusion for traumatic amputation in military medicine

Background:Limb loss has a drastic impact on a patient’s life.Severe trauma to the extremities is common in current military conflicts.Among other aspects,"life before limb"damage control surgery hinders immediate replantation within the short post-traumatic timeframe,which is limited in part by the ischemic time for successful replantation.Ex vivo limb perfusion is currently being researched in animal models and shows promising results for its application in human limb replantation and allotransplantation.Presentation of the hypothesis:The current lack of replantation possibilities in military operations with high rates of amputation can be addressed with the development of a portable ex vivo limb perfusion device,as there are several opportunities present with the introduction of this technique on the horizon.We hypothesize that ex vivo limb perfusion will enable overcoming the critical ischemic time,provide surgical opportunities such as preparation of the stump and limb,allow for spare-part surgery,enable rigorous antibiotic treatment of the limb,reduce ischemiareperfusion injuries,enable a tissue function assessment before replantation,and enable the development of large limb transplant programs.Testing the hypothesis:Data from in vivo studies in porcine models are limited by the relatively short perfusion time of 24 h.In the military setting,notably longer perfusion times need to be realized.Therefore,future animal studies must focus especially on long-term perfusion,since this represents the military setting,considering the time for stabilization of the patient until evacuation to a tertiary treatment center.Implications of the hypothesis:The development and clinical introduction of ex vivo limb perfusion in the military setting could lead to a drastic reduction in the number of limb amputations among service members.Ex vivo limb perfusion enables replantation surgery in Role 4 facilities and changes the clinical setting from a highly urgent,lifethreatening situation to a highly methodical,well-prepared starting point for optimal treatment of the wounded service member.With its introduction,the principle of"life before limb"will change to"life before limb before elective replantation/allotransplantation after ex vivo limb perfusion".

Association between tourniquet use and intraoperative blood loss during below-knee amputation

BACKGROUND Despite over 150000 amputations of lower limbs annually,there remains a wide variation in tourniquet practice patterns and no consensus on their necessity,especially among orthopedic patient populations.The purpose of this study was to determine whether tourniquet use in orthopedic patients undergoing below knee amputation(BKA) was associated with a difference in calculated blood loss relative to no tourniquet use.AIM To determine if tourniquet use in orthopedic patients undergoing BKA was associated with a difference in calculated blood loss relative to no tourniquet use.METHODS We performed a retrospective review of consecutive patients undergoing BKA by orthopedic surgeons at a tertiary care hospital from 2008 through 2018.Blood loss was calculated using a combination of the Nadler equation for preoperative blood volume and a novel formula utilizing preoperative and postoperative hemoglobin levels and transfusions.Univariate and forwards step-wise multivariate linear regressions were performed to determine the association between tourniquet use and blood loss.A Wilcoxon was used to determine the univariate relationship between tourniquet use and blood loss for in the restricted subgroups of patients who underwent BKA for trauma,tumor,and infection.RESULTS Of 97 eligible patients identified,67 underwent surgery with a tourniquet and 30 did not.In multivariate regression,tourniquet use was associated with a 488 mL decrease in calculated blood loss(CI 119-857,P = 0.01).In subgroup analysis,no individual group showed a statistically significant decrease in blood loss with tourniquet use.There was no significant association between tourniquet use and either postoperative transfusions or reoperation at one year.CONCLUSION We found that tourniquet use during BKA is associated with decreased calculated intraoperative blood loss.We recommend that surgeons performing this procedure use a tourniquet to minimize blood loss.

A large-area multi-fingerβ-Ga_(2)O_(3) MOSFET and its self-heating effect

The self-heating effect severely limits device performance and reliability.Although some studies have revealed the heat distribution ofβ-Ga_(2)O_(3) MOSFETs under biases,those devices all have small areas and have difficulty reflecting practical con-ditions.This work demonstrated a multi-fingerβ-Ga_(2)O_(3) MOSFET with a maximum drain current of 0.5 A.Electrical characteris-tics were measured,and the heat dissipation of the device was investigated through infrared images.The relationship between device temperature and time/bias is analyzed.

Supermicroscopy and arterio-venolization for digit replantation in young children after traumatic amputation: Two case reports

BACKGROUND To report the application of supermicroscopy combined with arterio-venolization without venous anastomosis for replantation of digits following traumatic amputation in young children.CASE SUMMARY In March 2016,we treated two children aged 2 years and 7 years with traumatic digit amputation,no venous anastomosis,and bilateral digital inherent arteries on the palmar side.Supermicroscopy combined with an arteriovenous technique was adopted to improve the replantation surgery.Postoperative management involved auxiliary treatments such as anticoagulation,composure,antiinflammatory drugs,and insulation.After treatment,the amputated fingers survived completely without major complications,with good recovery.CONCLUSION Supermicroscopy combined with arterio-venolization is a safe and effective approach to treat traumatic digit amputation in young children without venous anastomosis.

Malignant fibrous histiocytoma of the bone in a traumatic amputation stump: A case report and review of the literature

BACKGROUND Malignant fibrous histiocytoma(MFH)is one of the most common soft tissue sarcomas among adults.It is characterized by large size,high grade,and biological aggressiveness.There are many reports of MFH after local stimulation,such as bone fracture,implants,and chronic osteomyelitis.In this paper,we report a patient who developed MFH 6 years after amputation,suggesting that wound healing and mechanical force play a role in the local stimulation of this disease.CASE SUMMARY A 66-year-old man complained of persistent pain in his residual mid-thigh.He had undergone amputation surgery due to a traffic accident 6 years prior.Physical examination showed tenderness but no abnormalities in appearance.Xray radiographs and magnetic resonance imaging supported the diagnosis of a tumor,and a biopsy confirmed that the lesion was MFH.The patient received neoadjuvant chemotherapy and left hip disarticulation.During the 6-mo followup,there were no symptoms of recurrence.CONCLUSION Postsurgery MFH has been reported before,and many studies have attributed it to the biological effects of implants.Our case report shows that this disease can develop without an implant and thus highlights the importance of local stimulation.The wound-healing process and mechanical force can both promote this tumor,but whether they directly cause MFH needs further investigation.

Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with noncompressible torso injury and traumatic amputations: a retrospective study

Background: In combat operations, patients with traumatic injuries require expeditious evacuation to improve survival. Studies have shown that long transport times are associated with increased morbidity and mortality. Limited data exist on the influence of transport time on patient outcomes with specific injury types. The objective of this study was to determine the impact of the duration of time from the initial request for medical evacuation to arrival at a medical treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and noncompressible torso injury(NCTI).Methods: We completed a retrospective review of MEDEVAC patient care records for United States military personnel who sustained traumatic amputations and NCTI during Operation Enduring Freedom between January 2011 and March 2014. We grouped patients as traumatic amputation and NCTI(AMP+NCTI), traumatic amputation only(AMP),and neither AMP nor NCTI(Non-AMP/NCTI). Analysis was performed using chi-squared tests, Fisher's exact tests,Cochran-Armitage Trend tests, Shapiro-Wilks tests, Wilcoxon and Kruskal-Wallis techniques and Cox proportional hazards regression modeling.Results: We reviewed 1267 records, of which 669 had an injury severity score(ISS) of 10 or greater and were included in the analysis. In the study population, 15.5% sustained only amputation injuries(n=104, AMP only), 10.8% sustained amputation and NCTI(n=72, AMP+NCTI), and 73.7% did not sustain either an amputation or an NCTI(n=493,Non-AMP/NCTI). AMP+NCTI had the highest mortality(16.7%) with transport time greater than 60 min. While the AMP+NCTI group had decreasing survival with longer transport times, AMP and Non-AMP/NCTI did not exhibit the same trend.Conclusions: A decreased transport time from the point of injury to a medical treatment facility was associated with decreased mortality in patients who suffered a combination of amputation injury and NCTI. No significant association between transport time and outcomes was found in patients who did not sustain NCTI. Priority for rapid evacuation of combat casualties should be given to those with NCTI.

Health concerns of veterans with high-level lower extremity amputations

Background: To identify health concerns of veterans with high-level lower extremity amputations.Methods: Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists,physiotherapist and prosthetists examined 100 veterans using a short-form health-related quality of life questionnaire(SF-36) that assessed their ability to perform activities of daily living(ADL), instrumental activities of daily living(IADL) and life satisfaction(SWLS) after hip disarticulation or hemi-pelvectomy amputations. The assessment tool was designed to gather statistically useful information about their health needs.Results: The means of the Physical Component Summary(PCS), Mental Component Summary(MCS), SWLS, ADL and IADL were 48.58±29.6, 33.33±22.0, 19.30±7.7, 48.10±10.5 and 5.08±1.8, respectively. Somatization, depression, and anxiety were the most prevalent disorders;among the veterans who were visited by psychiatrists, 11.6% had a history of hospitalization in a psychiatry section, and 53.2% had a psychiatric visit. Regardless of their injury in battle, 34% of veterans were hospitalized. Hearing problems were common, and about four-fifths of the participants suffered from at least one orthopedic condition. Neuroma(49%) was the most common stump-related complication during orthopedic evaluations, though the prevalence of phantom pain was 81% during the pain assessment. A total of 87% of the participants had a history of wearing a prosthesis, but only 29% wore a prosthesis at the time of the present study.The Canadian-type of prosthesis was uncomfortable and not useful(27%) and excessively heavy(10%) according to the amputees.Conclusions: Understanding veterans’ characteristics and special needs are important to make sure that enough facilities and services are afforded to them. These findings emphasize the importance of paying close attention to different dimensions of health in veterans and can help health providers identify health needs and make regular assessments.

Profile of Amputations in National Orthopaedic Hospital, Dala, Kano

Introduction: Amputation is the removal of a body part through a bone, while disarticulation is a removal of a part through a joint. This common procedure has different causes depending on the geographical locations and cultural practices. These ranges from dead body part to malignancy. Our study focused on the profile of the amputees including the biodata, causes and the financial consequences of the procedure. Material and Methods: The case notes of all patients who had amputation from 1998-2012 (15 years) were collected and the biodata, intra-operative diagnosis, parts amputated and duration of hospital stay were retrospectively analysed. Results: One hundred and ninety six patients had various types of amputations for the duration of our study. 159 (81.12%) were males while 37 (18.88%) were females. 68 (34.69%) patients had below knee amputation. 54 (27.55%) had above knee amputation. 27 (13.78%) had above elbow amputation. 18 (9.18%) patients had below elbow amputation, while 30 (15.30%) patients had other forms of amputations. The highest number of amputees (72 patients) was within the age range of 21 - 30 yr and the least number (5 patients) was within the age range of 51 - 60 yr. The highest number of amputation (71 patients) was due to complications from by traditional bone setters intervention. Conclusion: In our study, we found that most cases were males with a mean age of 35 years and majority (34.69%) had below knee amputation, and that most cases suffered vascular occlusion leading to gangrene.