MyMedR

Awareness, potential factors, and post-amputation care of stump flexion contractures among transtibial amputees

Ghazali MF, Abd Razak NA, Abu Osman NA, Gholizadeh H

Turk J Phys Med Rehabil, 2018 Sep;64(3):268-276.

PMID: 31453521 DOI: 10.5606/tftrd.2018.1668

Objectives: This study aims to assess the level of awareness of transtibial amputee patients on stump contractures and their compliance with efforts implemented to prevent the condition.

Patients and methods: This study included 50 unilateral transtibial amputees (26 males, 24 females; mean age 55.4±14.7 years; range, 18 to 78 years) who met the respondent criteria of the study. The respondents were randomly selected and were issued with a questionnaire.

Results: The majority of the transtibial amputees were aware of stump contracture complications. It was found that they also preferred methods of prevention which required less effort, was cost-effective, and were also practical.

Conclusion: More focus should be placed on contracture prevention methods which were most complied with by the patients. This is because the effectiveness of a prevention method is highly influenced by patients' compliance with the method. Patients with a higher risk of developing stump contractures should be also given more attention in post-amputation care.

Matched MeSH terms: Amputation; Amputation Stumps

Fulltext Gangrene of the penis

Lwin M, Abdullah MA

Med J Malaysia, 1995 Mar;50(1):108-9.

PMID: 7752962

A case of gangrene of the penis, rarely seen at our University Hospital is reported. Urolithiasis, urinary tract infection, infected piles and anaemia were found to be associated with the condition. Because of rapid spread of the gangrene, partial amputation was required in this reported case.

Matched MeSH terms: Amputation

Fulltext Successful ankle replantation in two cases with different presentations

Wen APY, Jusoh MH, Saad AZM, Halim AS, Faisham NWIW, Azman WSW

Arch Plast Surg, 2020 Mar;47(2):182-186.

PMID: 31462030 DOI: 10.5999/aps.2018.00514

We report our experience of treating two patients with ankle amputation with different presentations. The first case was a clean-cut sharp amputation. The second case was an avulsion injury following a motor vehicle accident in a patient who arrived 8 hours after the injury. Replantation was successful in both cases. In avulsion injuries, a secondary operation for wound coverage is required at a later stage. With good strategy and a support team, encouraging limb survival outcomes are possible post-replantation.

Matched MeSH terms: Amputation

Fulltext Open traumatic scapulothoracic dissociation: Case report of a rare injury

Anbarasan A, Mohamad NH, Mariapan S

Trauma Case Rep, 2018 Dec;18:42-45.

PMID: 30533482 DOI: 10.1016/j.tcr.2018.11.013

Open traumatic scapulothoracic dissociation is a rare and devastating injury. We are reporting a 21-year-old male factory worker who sustained a traumatic open scapulothoracic dissociation. His left arm was caught in conveyer belts resulting the arm, scapula, clavicle, and pectoral muscle torn from the body by tremendous traction force. He presented with pulseless, flail and cold limb and was promptly resuscitated and surgically managed with forequarter amputation.

Matched MeSH terms: Amputation

Fulltext Complete Brachial Plexus Injury - An Amputation Dilemma. A Case Report

Choong C, Shalimar A, Jamari S

Malays Orthop J, 2015 Nov;9(3):52-54.

PMID: 28611911 MyJurnal DOI: 10.5704/MOJ.1511.017

Brachial plexus injuries with intact yet flail limb presents with problems of persistent neuropathic pain and recurrent shoulder dislocations, that render the flail limb a damn nuisance. As treating surgeons, we are faced with the dilemma of offering treatment options, bearing in mind the patient's functional status and expectations. We present a case of a 55-year old housewife with complete brachial plexus injury begging for surgical amputation of her flail limb, 6 years post-injury. Here we discuss the outcome of transhumeral amputation and the possibility of offering early rather than delayed amputations in this group of patients.

Matched MeSH terms: Amputation

Fulltext Metacarpal Lengthening Of The Thumb Via Distraction Osteogenesis: A Case Report

Chung WH, Eo CK, Muspirah Z, Sood A

Malays Orthop J, 2015 Mar;9(1):41-43.

PMID: 28435597 MyJurnal DOI: 10.5704/MOJ.1503.009

Amputation of the thumb invariably causes marked functional impairment of the hand especially, pinch and grasp functions. In rural areas where highly skilled microvascular surgeries are not available, distraction osteogenesis provides an easy and safe alternative of thumb reconstruction. We report a case of crush injury of the right hand in a 37 year old gentleman in which the right thumb was amputated at the level of the proximal phalanx. Metacarpal lengthening of the thumb was performed by using distraction osteogenesis.

Matched MeSH terms: Amputation

Fulltext Surgical Fixation of a Comminuted Inter-Trochanteric Fracture in a Patient with Bilateral Below Knee Amputation

Lee BH, Ho SW, Kau CY

Malays Orthop J, 2018 Mar;12(1):54-56.

PMID: 29725516 DOI: 10.5704/MOJ.1803.013

Surgical fixation of hip fractures in patients with below knee amputation is challenging due to the difficulty in obtaining optimal traction for reduction of the fracture. Surgeons may face difficulty in positioning such patients on the traction table due to the absence of the foot and distal lower limb. There are several techniques described to overcome this technical difficulty. In this case report, we present a case of a 64-year old gentleman with bilateral below knee amputation presenting with a comminuted right intertrochanteric fracture. We highlight a simple and effective method of applying skin traction to obtain adequate reduction for hip fracture fixation.

Matched MeSH terms: Amputation

Fulltext Recent Progress in Development of Dressings Used for Diabetic Wounds with Special Emphasis on Scaffolds

Awasthi A, Gulati M, Kumar B, Kaur J, Vishwas S, Khursheed R, et al.

Biomed Res Int, 2022;2022:1659338.

PMID: 35832856 DOI: 10.1155/2022/1659338

Diabetic wound (DW) is a secondary application of uncontrolled diabetes and affects about 42.2% of diabetics. If the disease is left untreated/uncontrolled, then it may further lead to amputation of organs. In recent years, huge research has been done in the area of wound dressing to have a better maintenance of DW. These include gauze, films, foams or, hydrocolloid-based dressings as well as polysaccharide- and polymer-based dressings. In recent years, scaffolds have played major role as biomaterial for wound dressing due to its tissue regeneration properties as well as fluid absorption capacity. These are three-dimensional polymeric structures formed from polymers that help in tissue rejuvenation. These offer a large surface area to volume ratio to allow cell adhesion and exudate absorbing capacity and antibacterial properties. They also offer a better retention as well as sustained release of drugs that are directly impregnated to the scaffolds or the ones that are loaded in nanocarriers that are impregnated onto scaffolds. The present review comprehensively describes the pathogenesis of DW, various dressings that are used so far for DW, the limitation of currently used wound dressings, role of scaffolds in topical delivery of drugs, materials used for scaffold fabrication, and application of various polymer-based scaffolds for treating DW.

Matched MeSH terms: Amputation

Fulltext Estimation of body segmental orientation for prosthetic gait using a nonlinear autoregressive neural network with exogenous inputs

Tham LK, Al Kouzbary M, Al Kouzbary H, Liu J, Abu Osman NA

Phys Eng Sci Med, 2023 Dec;46(4):1723-1739.

PMID: 37870729 DOI: 10.1007/s13246-023-01332-6

Assessment of the prosthetic gait is an important clinical approach to evaluate the quality and functionality of the prescribed lower limb prosthesis as well as to monitor rehabilitation progresses following limb amputation. Limited access to quantitative assessment tools generally affects the repeatability and consistency of prosthetic gait assessments in clinical practice. The rapidly developing wearable technology industry provides an alternative to objectively quantify prosthetic gait in the unconstrained environment. This study employs a neural network-based model in estimating three-dimensional body segmental orientation of the lower limb amputees during gait. Using a wearable system with inertial sensors attached to the lower limb segments, thirteen individuals with lower limb amputation performed two-minute walk tests on a robotic foot and a passive foot. The proposed model replicates features of a complementary filter to estimate drift free three-dimensional orientation of the intact and prosthetic limbs. The results indicate minimal estimation biases and high correlation, validating the ability of the proposed model to reproduce the properties of a complementary filter while avoiding the drawbacks, most notably in the transverse plane due to gravitational acceleration and magnetic disturbance. Results of this study also demonstrates the capability of the well-trained model to accurately estimate segmental orientation, regardless of amputation level, in different types of locomotion task.

Matched MeSH terms: Amputation

Fulltext Limb Salvage Surgery for Musculoskeletal Oncology

Wan Ismail WF

Malays J Med Sci, 2015 Jul-Aug;22(4):1-5.

PMID: 26715902

The management of musculoskeletal tumours has progressed tremendously over the past few decades. Limb salvage surgery has become a standard practise without compromising the oncological outcome. Patients generally will benefit with superior function and a better quality of life compared with definitive amputation. The multidisciplinary approach and advancement of surgeries are important to achieve patient survival and optimum function.

Matched MeSH terms: Amputation

Fulltext Ability to return to driving after major lower limb amputation

Engkasan JP, Ehsan FM, Chung TY

J Rehabil Med, 2012 Jan;44(1):19-23.

PMID: 22124514 DOI: 10.2340/16501977-0904

The aims of this study were to examine the ability of patients to return to driving cars and riding motorcycles after lower limb amputation, and to explore the factors that significantly affect such ability.

Matched MeSH terms: Amputation/adverse effects; Amputation/rehabilitation*

Interface pressure profile analysis for patellar tendon-bearing socket and hydrostatic socket

Moo EK, Osman NA, Pingguan-Murphy B, Abas WA, Spence WD, Solomonidis SE

Acta Bioeng Biomech, 2009;11(4):37-43.

PMID: 20405814

Conventionally, patellar tendon-bearing (PTB) sockets, which need high dexterity of prosthetist, are widely used. Lack of chartered and experienced prosthetist has often led to painful experience of wearing prosthesis and this will in turn deter the patients to wear the prosthesis, which will further aggravate stump shrinkage. Thus, the hydrostatic socket which demands relatively lower level of fabricating skill is proposed to replace the PTB socket in order to produce the equivalent, if not better, quality of support to the amputee patients. Both sockets' pressure profiles are studied and compared using finite element analysis (FEA) software. Three-dimensional models of both sockets were developed using MIMICS software. The analysis results showed that hydrostatic socket did exhibit more uniform pressure profiles than that of PTB socket. PTB socket showed pressure concentration near the proximal brim of the socket and also at the distal fibula. It was also found that the pressure magnitude in hydrostatic socket is relatively lower than that of PTB socket.

Matched MeSH terms: Amputation Stumps/physiopathology; Amputation Stumps/surgery

Fulltext Bilateral femoral neuropathy associated with disseminated intravascular coagulopathy: a case report

Cheok CY, Merican A, Ng WM

Med J Malaysia, 2006 Feb;61 Suppl A:97-9.

PMID: 17042241

We report a case of 20-year-old man who presented with bilateral femoral nerve palsy following resuscitation for traumatic massive blood loss and its consequence. A high suspicious index for this complication may lead to its early recognition. Its related pathoanatomy is discussed based on the described evidences in the literature. Nonoperative treatment remains as a recommended option for coagulopathy-related neuropathy.

Matched MeSH terms: Amputation, Traumatic/complications; Amputation, Traumatic/surgery*

The patellar tendon bar! Is it a necessary feature?

Abu Osman NA, Spence WD, Solomonidis SE, Paul JP, Weir AM

Med Eng Phys, 2010 Sep;32(7):760-5.

PMID: 20678997 DOI: 10.1016/j.medengphy.2010.04.020

The purpose of this investigation was to vary the load on the patellar tendon bar and to study the subsequent effect this has on the pattern of the pressure distribution at the stump-socket interface. Ten male subjects from the Southern General Hospital in Glasgow, UK participated in this study. Measuring systems utilising strain gauge and electrohydraulic technologies were designed, developed and constructed to enable pressure measurements to be conducted. One transducer, the patellar tendon (PT) transducer, was attached to the patellar tendon bar of the socket such that the patellar tendon bar was capable of being translated by +/-10 mm towards or away from the tendon. The results of this study showed that the position of the patellar tendon bar had no significant effect on the pressure distribution around the socket indicating that it is an unnecessary feature, which, we propose, may be eliminated during manufacture of a trans-tibial socket.

Matched MeSH terms: Amputation Stumps/physiopathology*; Amputation Stumps/surgery*

Fulltext Chronic osteomyelitis secondary to human bite: a case report

Tan W, Wazir N, Chiu C, Ko M

Malays Orthop J, 2012 Nov;6(3):40-1.

PMID: 25279055 MyJurnal DOI: 10.5704/MOJ.1207.003

We report a case of a human bite that was initially inadequately treated and progressed to chronic osteomyelitis, finally resulting in digital amputation. Human bites are seemingly innocuous, but if neglected, may lead to subsequent infection and morbidity. Persistence of symptoms should alert the practitioner to the possibility of infection extending to the soft tissue or bone. Bacteriological studies commonly yield mixed aerobic and anaerobic flora. Early debridement and antibiotic treatment may prevent development of severe soft tissue or bone infection.

Matched MeSH terms: Amputation

Clinical evaluation of two prosthetic suspension systems in a bilateral transtibial amputee

Gholizadeh H, Abu Osman NA, Kamyab M, Eshraghi A, Lúvíksdóttir AG, Wan Abas WA

Am J Phys Med Rehabil, 2012 Oct;91(10):894-8.

PMID: 22173083

The effects of Seal-In X5 and Dermo liner (Össur) on suspension and patient's comfort in lower limb amputees are unclear. In this report, we consider the case of a 51-yr-old woman with bilateral transtibial amputation whose lower limbs were amputated because of peripheral vascular disease. The subject had bony and painful residual limbs, especially at the distal ends. Two prostheses that used Seal-In X5 liners and a pair of prostheses with Dermo liners were fabricated, and the subject wore each for a period of 2 wks. Once the 2 wks had passed, the pistoning within the socket was assessed and the patient was questioned as to her satisfaction with both liners. This study revealed that Seal-In X5 liner decreased the residual limb pain experienced by the patient and that 1-2 mm less pistoning occurred within the socket compared with the Dermo liner. However, the patient needed to put in extra effort for donning and doffing the prosthesis. Despite this, it is clear that the Seal-In X5 liner offers a viable alternative for individuals with transtibial amputations who do not have enough soft tissue around the bone, especially at the end of the residual limb.

Matched MeSH terms: Amputation/methods*; Amputation/rehabilitation*; Amputation Stumps

Fulltext Knowledge, attitude, and practice of self-wound management among patients with diabetic foot ulcer (DFU) in Pahang. [Abstract]

Saidi S

International Medical Journal Malaysia, 2017;16(11):1-1.

MyJurnal

Introduction: A survey in 2011 reported that the prevalence of diabetes in Malaysia is 20.8% (2.8 million people) and 88% have uncontrolled diabetes. Diabetic foot ulcer (DFU) is one of the common diabetes complications in Malaysia that leads to other devastated situation including infection, amputation and death. In Pahang, 95% of the patients have uncontrolled diabetes and 50% of them suffered from DFU. Self-wound management is an important element in reducing the risk of further complications of DFU. However, little is known on the patients' understanding of diabetes and their practice of self wound management. This study aimed to understand the knowledge, attitude and practice of self-wound management among patients with diabetic ulcer in Pahang.
Materials and method: A quantitative, cross-sectional study was conducted in a tertiary hospital in Pahang involving 100 participants. Participants were recruited using purposive sampling from April 2017 until May 2017. Participants' knowledge, attitude and practice of self-wound management were measured using self-administered questionnaires. Additionally, the data on socio-demographic was gathered. The data was computed into SPSS and analyzed using descriptive and inferential statistics.
Results: Out of 100 participants, 95% of them had good knowledge on diabetes and DFU, 84% had a positive attitude towards self-wound management and 56% perceived good practices of self-wound management. However, a chi-square test between knowledge on diabetes and DFU and practice of self-wound management found no significant interaction (p > 0.05). Meanwhile, there was a significant interaction between attitude and practice of self-wound management (p < 0.05).
Conclusion: Good knowledge on diabetes and DFU do not determine the patients’ practice of self-wound management. However, positive attitude towards self-wound management would contribute to the practice and willingness of the patients to selfmanage their foot ulcer wound at home.

Matched MeSH terms: Amputation

Fulltext Limb salvage surgery in chronic osteomyelitis: a case report

Muhammad Hafiz, A.S., Mohd Yazid, B., Norliyana, M., Rasyidah, R.

Medicine & Health, 2018;13(1):286-290.

MyJurnal

Osteomyelitis refers to an infection of the bone characterized by progressive inflammatory destruction caused by infecting microorganism. Open fracture carries the risk of developing osteomyelitis from 3 to 50% with a high amputation rate. Salvage of the limb is always a challenge and needs perseverance. We report the case of a 44-year-old male with chronic osteomyelitis with successful multiple limb salvage surgeries. The curative approach to chronic osteomyelitis has the following goals including arrest of infection, pain reduction and salvage of limb and function. With regard to survival and function, the result obtained in this case is more promising compared to above knee amputation.

Matched MeSH terms: Amputation

Management of Symmetrical Peripheral Gangrene

Foead AI, Mathialagan A, Varadarajan R, Larvin M

Indian J Crit Care Med, 2018 Dec;22(12):870-874.

PMID: 30662227 DOI: 10.4103/ijccm.IJCCM_379_18

Symmetrical peripheral gangrene (SPG) is a rare, debilitating disease that deserves more widespread concern among the medical fraternities. The objective of this review is to outline the etiology, pathology findings, and management practices of SPG. About 18%-40% mortality rate was reported, and survivors have high frequency of multiple limb amputations. SPG is the hallmark of disseminated intravascular coagulation (DIC). The main pathogenesis theory, to date, is microthrombosis associated with disturbed procoagulant-anticoagulant balance. The treatment of SPG is largely anecdotal and theoretically involves heparin-based anticoagulation and substitution of natural anticoagulants. Early recognition, prompt management of DIC, and underlying conditions may halt the progression of the disease. The multicenter randomized controlled trial should be set up to formulate the proper treatment guidelines.

Matched MeSH terms: Amputation

Fulltext Malaysian clinical practice guidelines for management of diabetic foot: A synopsis for the primary care physician

Tharumaraja T, Che-Ahmad A, Wong PF, Ahmad Hamid AH, Hasan MI, Bajuri MY, et al.

Malays Fam Physician, 2021 Mar 25;16(1):103-113.

PMID: 33948148 DOI: 10.51866/cpg0001

Diabetic foot requires careful attention and coordinated management by a dedicated team. Screening, prevention, adequate assessment, and appropriate referral are crucial to prevent complications. Multimodal treatment and rehabilitation are recommended to ensure a better quality of life and reduction of amputation rate in people with diabetic foot.

Matched MeSH terms: Amputation

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