【Abstract】 Objective To investigate and evaluate the effectiveness of covering amputated raw surface with freetissue transplantation from damaged limbs. Methods Between August 2010 and June 2011, 5 cases of severe injury of lower extremities were treated, including 4 males and 1 female with an age range of 3 years and 8 months to 43 years. Of them, 3 cases suffered from traffic accident injury and 2 had machine injury. The disease duration was 2-9 hours. Among the 5 cases, 1 suffered from half pelvis destruction and traumatic amputation of hip joint, 1 from comminuted open fracture of proximal femur, and another 3 from thigh destruction with survival soft tissue of legs. All cases were treated with emergency operation of amputation. The raw surface of the residual stumps was 20 cm × 10 cm to 20 cm × 20 cm in size. Two lateral anterior thigh flaps and 3 posterior tibial artery flaps were harvested from the damaged limbs. The flap size ranged from 15 cm × 10 cm to 25 cm × 20 cm. The wounds were repaired with free tissue transplantation. Results Five transplanted tissue flaps were survival. Skin necrosis occurred in the wound edge at 7-10 days postoperatively and was cured after excision of necrotic tissue, dressing change or vacuumed drainage for 1-2 months. All wounds healed and the patients were followed up 1-3 months. No sinus tract or ulceration was observed. The appearance of stumps was satisfactory. Conclusion The effectiveness of repairing amputated raw surface with free tissue transplantation from amputated limbs is satisfactory. It is an effective procedure to repair the raw surface of amputated stumps.
Objective To observe the effectiveness of vacuum seal ing drainage (VSD) combined with anti-takenskin graft on open amputation wound by comparing with direct anti-taken skin graft. Methods Between March 2005 andJune 2010, 60 cases of amputation wounds for limbs open fractures were selected by using the random single-blind method.The amputation wounds were treated with VSD combined with anti-taken skin graft (test group, n=30) and direct anti-takenskin graft (control group, n=30). No significant difference was found in age, gender, injury cause, amputation level, defect size,preoperative albumin index, or injury time between 2 groups (P gt; 0.05). In test group, the redundant stump skin was usedto prepare reattached staggered-meshed middle-thickness skin flap by using a drum dermatome deal ing after amputation,which was transplanted amputation wounds, and then the skin surface was covered with VSD for continuous negative pressuredrainage for 7-10 days. In control group, wounds were covered by anti-taken thickness skin flap directly after amputation, andconventional dress changing was given. Results To observe the survival condition of the skin graft in test group, the VSDdevice was removed at 8 days after operation. The skin graft survival rate, wound infection rate, reamputation rate, times ofdressing change, and the hospital ization days in test group were significantly better than those in control group [ 90.0% vs.63.3%, 3.3% vs. 20.0%, 0 vs. 13.3%, (2.0 ± 0.5) times vs. (8.0 ± 1.5) times, and (12.0 ± 2.6) days vs. (18.0 ± 3.2) days, respectively](P lt; 0.05). The patients were followed up 1-3 years with an average of 2 years. At last follow-up, the scar area and grading, and twopointdiscrimination of wound in test group were better than those in control group, showing significant differences (P lt; 0.05).No obvious swelling occurred at the residual limbs in 2 groups. The limb pain incidence and the residual limb length were betterin test group than those in control group (P lt; 0.05). Whereas, no significant difference was found in the shape of the residual limbs between 2 groups (P gt; 0.05). In comparison with the contralateral limbs, the muscle had disuse atrophy and decreasedstrength in residual limbs of 2 groups. There was significant difference in the muscle strength between normal and affected limbs(P lt; 0.05), but no significant difference was found in affected limbs between 2 groups (P gt; 0.05). Conclusion Comparedwith direct anti-taken skin graft on amputation wound, the wound could be closed primarily by using the VSD combined withanti-taken skin graft. At the same time it could achieve better wound drainage, reduce infection rate, promote good adhesion ofwound, improve skin survival rate, and are beneficial to lower the amputation level, so it is an ideal way to deal with amputationwound in the phase I.
Objective To review the progress in amputation technique of diabetic foot. Methods Recent l iterature concerning the amputation technique of diabetic foot was reviewed and analyzed. Results According to the different levels of the amputation, the diabetic foot’s amputation can be classified as major amputation and minor amputation, and differentkinds of methods can derive from these styles. Different factors should be considered when the style and method of amputation are chosen. Conclusion To the diabetic foot amputation, the general rule is to l imit the amputation level on the premise of the good cl inical effect. The health state, the region of the diabetic foot, the tissue perfusion, the susceptibil ity to infection in local tissue, and the abil ity of wound healing are important factors in selecting the styles and methods of diabetes-related amputations. Importance should be attached to the synthesis treatments of diabetes to prevent the higher level amputation.
Objective To investigate the characteristics of patients with crush injury in Wenchuan earthquake and the corresponding operational methods. Methods From May 12th 2008 to June 18th 2008, 202 patients with crush injury of soft tissue were treated, including 110 males and 92 females. Twenty-five patients aged 19 months to 16 years, 129 patients aged 17-60 years and 48 patients aged above 61 years. The crushed time was 30 minutes to 154 hours. Sixty cases of openinjuries were treated by debridement and dressing or suture; 16 cases of damaged extremities (18 l imbs) and 6 cases of acute renal failure due to crush syndrome (8 l imbs) received amputation; 32 cases of interfascial space syndrome crisis (42 l imbs) were treated by fascia cavity decompression; 15 cases received the resection of necrotic muscle for 31 times; and 9 cases received continuous renal replacement therapy (CRRT). Results All the wounds healed except 2 cases which died from intestinal bleeding and intracranial hemorrhage during the treatment of CRRT. Two cases were discharged 8 months after treatment, while the other 198 cases recovered and were discharged 15-120 days after treatment. The average hospital ization time was 53 days. Twenty-two cases (26 l imbs) were fixed with artificial l imbs 3-6 months after amputation and achieved good functional outcome. Conclusion The treatment principle of crush injury is “be active to decompress and be prudent to amputate”, the hardening muscle and the increasing level of creatine kinase and blood potassium are the golden indicators of fascia cavity decompression. Decompression at an earl ier period is preferred when there is a dilemma to choose, and open amputation should be performed when the necrotic muscle is hard to clear or the necrosis boundary is not distinct.
Objective To summarize the experience in treatment and diagnosis of popliteal artery trauma and to determine the factors for amputation. Methods From February 1995 to January 2006, 28 patients with popliteal artery trauma were treated. The disease course was more than 8 hours. Of them, there were 25 males and 3 females, aging from 3 to 53 years. Trauma was caused by traffic accident in 12 cases, by falling from height in 3 cases, by firearm in 2 cases, by sharp instruments in 3 cases, by strangulation in 2 cases and by others in 6 cases. No arteriopalmus or weak arteriopalmus wereobserved in 18 cases and in 8 cases respectively. Popliteal artery exposure or active bleeding was seen in 2 cases; the popliteal arteries were examined by operation in 8 cases; color ultrasound Doppler flow imaging showed color flood flowsignals were through popliteal artery and its branches in 20 cases. Defect sizeof popliteal artery was less than 5 cm in 7 cases and more than 5 cm in 9 cases. End to end anastomosis reconstruction by saphenous vein graft and direct suture was performed in 16 cases and ampulation in 12 cases. The time of the revascularization of the leg was 8-150 hours (mean 31.8 hours). Results All patients were followed up 6 months to 11 years with an average of 4.2 years. In 16 cases given end to end anastomosis reconstruction, 15 cases achieved revascularization and limb survival; lower limb function restored to normal within 1 year in 12 cases; foot drop and ankle joint contracture occurred in 3 casesand the survival rate of limbs was 94%. Amputation was given in 12 of 28 casesbecause of severe trauma. The rate of amputation was 43% and the rate of disability was 54%. Conclusion Popliteal artery trauma should be treated as soon as the diagnosis is made. If the revascularization is more than 8 hours or circulatory compensation is not complete, it will affect the leg survival. Delayed diagnosis and severe traumas are the cause of high rate ofamputation in popliteal artery trauma.
Objective To explore the effect of a teamwork intervention during their rehabilitation process for patients who had undergone an amputatation after an earthquake. Methods A total of 85 patients undergoing amputation were included in the study. A rehabilitation team consisting of orthopaedic doctors, orthopaedic nurses, physical therapists, professional therapists, psychology consultants, volunteers, social workers, patients and their relatives participated in the comprehensive rehabilitation program. The outcome of this teamwork intervention was evaluated. Results Statistically significant improvement was observed in terms of patients’ physiological, psychological and social roles after the teamwork intervention ( Plt;0.05). Conclusion The teamwork intervention can improve the overall outcome of rehabilitation, including quality of life, in amputated patients following an earthquake.
ObjectiveTo explore the clinical effect of systematic rehabilitation nursing for patients with lower limb amputation before prosthesis fitting. MethodsFifty patients with lower limb amputation before prosthetic fitting from January 2009 to December 2012 were assessed by rehabilitation team members, and then received the nursing progress according to the assessment results. The conditions of the patients before and after nursing intervention were evaluated and compared. ResultsAfter the patients received systematic rehabilitation nursing intervention, the standard rate of rehabilitation nursing knowledge and satisfaction rate of the nursing quality at the departure of the patients was 87.24% and 93.25% respectively. The muscle strength reached level 4 or higher in 4 patients, who could have the prosthesis fitting. ConclusionSystematic rehabilitation nursing for patients with lower limb amputation before prosthesis fitting can help patients to reserve the function as possible, improve the ability of living and quality of life, and reduce the burden of the patients and family to return to society earlier.
ObjectiveTo assess the long-term effectiveness and safety of autologous bone marrow mononuclear cells (BM-MNC) transplantation in the treatment of critical diabetic lower arteriosclerosis obliterans (ASO). MethodsBetween January 2007 and January 2010, 61 patients with critical diabetic lower ASO were treated with standard medical therapies in 29 cases (control group) or with standard medical therapies and autologous BM-MNC transplantation in 32 cases (treatment group). There was no significant difference in gender, age, disease duration, Fontatine stage, glucose (GLU), triglyceride (TG), total cholesterol (CHOL), low-density lipoprotein-cholesterol (LDL-C), hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) between 2 groups (P>0.05). The endpoints were overall survival (OS) and amputation-free survival (AFS). The risk indexes for ASO were observed and compared between 2 groups before and after treatments. ResultsThe patients were followed up 2-36 months, and no malignant tumor occurred. The OS rate, OS time, AFS rate, and AFS time were 82.76% (24/29), (32.31±9.08) months, 37.50% (9/24), and (21.28±13.35) months in the control group and were 78.13% (25/32), (32.47±6.96) months, 68.00% (17/25), and (28.38±9.48) months in the treatment group;all indexes showed no significant differences (P>0.05). OS rate, OS time, AFS rate, and AFS time showed no significant differences between 2 groups at the other time (P>0.05) except AFS time at 1 year, which was significantly short in the control group than the treatment group (t=2.806, P=0.007). At the endpoint of follow-up, the indexes of GLU, TG, CHOL, LDL-C, HbA1c, SBP, and DBP showed no significant differences between before and after treatments and between 2 groups (P>0.05) in 49 survival patients (24 in control group and 25 in treatment group). ConclusionAutologous BM-MNC transplantation is safe and effective in the treatment of critical diabetic lower ASO, which can significantly improve AFS rate and prolong AFS time with no risks.
ObjectiveTo summarize the clinical experience of the retrograde replantation for amputated toe. MethodsBetween January 2010 and August 2015, 11 cases of amputated toes (15 toes) were treated by the retrograde replantation. All patients were male, with a mean age of 31 years (range, 18-45 years). The causes included cutting injury in 6 cases (9 toes) and crush injury in 5 cases (6 toes). One case had amputated great toe and distal segment of the second toe combined with the third toe nail bed contusion; 1 case had amputated proximal great toe and middle segment of the second and third toes; 1 case had amputated proximal segment of great toe and middle segment of the second toe; 7 cases had amputated distal segment of the great toe; and 1 case had amputated middle segment of the fifth toe. The time from injury to hospital was 1-3 hours (mean, 2 hours). ResultsThirteen toes survived completely after operation. Toe necrosis occurred in 1 toe; partial dorsal skins necrosis and nail bed necrosis occurred in 1 toe, and was cure after repaired with dorsalis pedis island flap. The rate of success for replantation of amputated toes was 93.33% (14/15). X-ray examination showed fracture healing of all survival toes at 8-12 weeks after operation (mean, 10 weeks); internal fixation was removed. Eleven cases were followed up 3-12 months (mean, 7.5 months). The survival toes had good appearance and toenail. The two point discrimination was 9-12 mm (mean, 10 mm) at last follow-up. The patients could walk and run normally. ConclusionIt is an ideal surgical method to use retrograde replantation to treat amputated toe, with the advantages of simple operation and high survival rate.
ObjectiveTo systematically evaluate the efficacy of mirror therapy for phantom limb sensation and phantom limb pain in amputee. MethodsDatabases include PubMed, EMbase, The Cochrane Library (Issue 9, 2015), CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about mirror therapy for phantom limb sensation and phantom limb pain in amputee from inception to 1st Sept. 2015. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then metaanalysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs involving 129 patients were included. The results of meta-analysis showed that, there was no significant difference between the mirror therapy group and the control group in relieving the phantom limb sensation and phantom limb pain in amputee (MD=-7.29, 95%CI -27.73 to 13.16, P=0.48). ConclusionMirror therapy could improve the control of phantom limb, however, there is no sufficient evidence to support the effect of mirror therapy on pain management in amputee. The long-term effect of mirror therapy is still under exploration. Due to the limited quantity and quality of the included studies, larger-sample, high quality designed RCTs are needed to verify the above conclusion.