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Results for “ARTIFICIAL LIMB”

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PubMed1990

[Congenital limb abnormalities: amputate or not amputate?].

Congenital limb deficiencies pose quite a number of questions, problems and tasks that go far beyond the surgical and prosthetic-orthotic aspects present. The question of amputation in view of improved function and appearance as well as easier prosthetic provision can be answered only in the context of the orthopaedic-surgical and prosthetic possibilities available. Social, cultural and religious factors are in addition enumerated that have to be taken into account.

Amputation, Surgical↗

PubMed1996

Rotationplasty.

Today rotationplasty is well established as an acceptable procedure for limb salvage in patients who have a malignant tumor in the femur or tibia. The main indication is that it is the alternative to amputation. Rotationplasty should further be used in the very young child because of growth-dependent complications that can be expected after tumor resection and any kind of reconstruction. This article covers the classification of the different types of rotationplasties, the operative procedure, prosthetic care, and the functional results.

Artificial Limbs↗

PubMed2006

Method of quadriceps attachment following upper tibial resection.

Limb salvage procedures for osteosarcomas of the upper tibia present combined problems of knee-joint and tibial reconstruction. Many methods of overcoming this have been described. We describe a new technique of prosthetic knee-joint and upper-tibial reconstruction, combined with a vascularized fibular bone flap for reattachment of the quadriceps muscle and tendon unit, resulting in superior long-term function.

Adolescent↗

PubMed1989

Prosthetics, orthotics, and assistive devices. 3. Prosthetics.

This self-directed learning module highlights new advances in prosthetics. It is part of the chapter on prosthetics, orthotics, and assistive devices for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section contains information regarding conventional and myoelectric upper limb prosthetics, above-knee (AK) socket designs and materials, and foot and ankle systems. New advances that are covered in this section include the narrow medial-lateral AK socket, the flexible AK socket, and new prosthetic foot and ankle systems. Proper understanding and clinical application of this technology is essential for the optimal prosthetic rehabilitation of the amputee.

Artificial Limbs↗

PubMedDate not supplied

3-S prosthesis: a preliminary report.

We report a new prosthetic suspension system ideally suited for active young amputees. The silicone suction socket (3-S) utilizes a silicone sleeve that intimately fits the residual limb, providing a suction-type suspension for both upper and lower extremities. Seven juvenile amputees were evaluated. Six were successful and one was deemed a failure. Details of the design concepts, fabrication, and method of donning the prosthesis are described. We believe that the 3-S design is a significant improvement over conventional prosthetic suspension, offering important advantages to the active pediatric amputee.

Activities of Daily Living↗

PubMed1985

Ground reaction forces and center of pressure patterns in the gait of children with amputation: preliminary report.

Ground reaction forces and center of pressure (CP) were studied during gait in children with unilateral lower extremity amputations. Five children, three with knee disarticulations and two with above-knee amputations, walked at slow, normal, and fast speeds, while wearing a conventional SACH prosthetic foot and again, while wearing an experimental CAPP prosthetic foot. Fore-aft (F-A) and vertical force (VF) components and CP patterns were examined for a total of 90 trials. Walking speed had a significant effect on both F-A and VF amplitudes. No differences, however, were found between the force amplitudes of the SACH foot and CAPP foot. Significant asymmetries were found in the force and amplitudes of a child's natural limb versus the prosthetic limb; the retarding and propelling F-A forces in the prosthetic limb were significantly less than the corresponding forces in a child's natural limb. The CP patterns during stance phase were markedly different for a child's natural limb, prosthetic limb with the SACH foot, and prosthetic limb with the CAPP foot. With the CAPP foot, the CP remained in the forefoot region during stance. In contrast with the CAPP foot, the SACH foot had a potential for producing a flexor moment at the knee joint at the initiation of the foot-ground contact. Stability in the prosthetic knee was enhanced when the children wore a CAPP prosthetic foot.

Adolescent↗

PubMed1982

Upper limb prosthetics for high level arm amputation.

The paper covers the analysis of residual stump and upper body motions and their involvement in the patients' manipulatory functions. Attention is given to prosthetic techniques that do not restrict the residual motions. A single cable controlled hybrid arm prosthesis is presented with different individual cases. The kinetic structure and the control of prosthesis vary in each case to meet the individual manipulatory characteristic of the patient. The universal unconventional technique is presented which has modular possibilities seen from the kinematic point of view.

Amputation Stumps↗

PubMed2002

A biomechanical study of two postoperative prostheses for transtibial amputees: a custom-molded and a prefabricated adjustable pneumatic prosthesis.

We evaluated an adjustable pneumatic prefabricated prosthesis and a rigid custom-molded prosthesis for immediate postoperative use. Twelve transtibial amputations were performed on cadaver limbs. Differential variable reluctance transducers were placed subcutaneously across the wound edge medially and laterally. The limbs were then placed in either the pneumatic prosthesis (five limbs) or the rigid prosthesis (seven limbs). The specimens underwent static and cyclic loading to simulate weight bearing. The strain readings for static and cyclic loading were greater in the rigid prosthetic group. Only the mean medial strain measurement after cyclic loading was statistically significant. The results demonstrate that the pneumatic prosthesis places less strain across the wound than a rigid prosthesis.

Air↗

PubMed1996

Painful neuromata following upper limb amputation.

Painful neuromata occurring after upper limb amputation are a significant cause of stump pain and limit the success of prosthetic training and use. There is little information in the literature regarding incidence, consequences or outcomes of painful neuromata subsequent to upper limb amputation. This article reports an analysis of thirty-two consecutive upper limb amputees. Of these 25% had moderate-to-severe stump pain and clinical signs suggestive of neuromata. All patients with neuromata were limited in their ability to use a prosthesis prior to surgery and following failure of conservative measures, were referred for surgical opinion. Six patients have undergone surgical management. The results of surgery, with respect to pain and prosthetic usage, are discussed.

Adolescent↗

PubMedDate not supplied

[Skin pathology caused by the use of limb prostheses].

Skin problems affecting the limb stump of amputee are common but often they are observed a little. The Authors describe our experience in order of these skin pathologies caused by use of prostheses during stage at INAIL Prosthese Center in Vigorso di Budrio (Bologna). The aims of this report are to renew interest in these problems and to facilitate earlier recognition and treatment of troublesome skin disorders in the amputee.

Adult↗

PubMed1996

Frictional action at lower limb/prosthetic socket interface.

The frictional action at stump/socket interface is discussed by a simplified model and finite element model analyses and clinical pressure measurements. The friction applied to the stump skin produces stresses within tissue and these stresses may damage the tissues and affect their normal functions. The combination of normal and shear stresses is considered to be a critical factor leading to amputee's discomfort and tissue damage. However, friction at the stump/socket interface has a beneficial action. A simplified residual limb model and a finite element model using real geometry have been developed to analyse the support action of friction. Both results show that the friction plays a critical role both in supporting the load of the amputee's body during the support phase of the gait cycle and in preventing the prosthesis from slipping off the limb during swing phase. Pressure at the below-knee socket during walking were measured with conditions of different friction. The results reveal that a larger pressures was produced at the lubricated interface than at the normal interface. A proper choice of coefficient of friction will balance the requirements of relief of load stress and reduction of slip with the general ability to support loads.

Amputation Stumps↗

PubMed2004

Comparative study between patellar-tendon-bearing and pressure cast prosthetic sockets.

This study compared the pressure distribution at the residual limb and socket interface in amputees wearing a pressure cast (PCast) socket system with amputees wearing the patellar-tendon-bearing (PTB) socket. The PCast system requires the subject to place his or her residual limb in a pressure chamber. Pressure is applied to the residual limb while the subject adopts a normal standing position. Four unilateral male amputees were fitted with both PTB and PCast sockets. Using a specially built strain-gauge-type pressure transducer, we recorded residual limb and socket pressure profiles for each subject wearing the two types of sockets during standing and walking. While some subjects exhibited similar anterior-posterior or medial-lateral pressure profiles for both prostheses, especially during push-off, other subjects exhibited high pressure distally in the PCast socket or higher-pressure concentration at the proximal region in the PTB socket.

Adult↗

PubMed1991

[Data on possibilities of rehabilitation of lower limb amputees].

The authors investigated ways to improve the results of rehabilitation during the course of their clinical practice. During the last 2 years, amputation was performed on 136 patients and 50 patients were supplied with temporary protheses. 38 patients out of 50 answered the question form supplied. After analysis of the question form, the authors summarized the possibilities to improve the results of prolonged mobilisation and rehabilitation. This programme stresses the need for 1. early mobilisation-teaching to walk and 2. care of body and soul.

Amputees↗

PubMed1997

Transtibial prosthesis for a patient with Kaposi's sarcoma lesions on the residual limb.

A man with acquired immunodeficiency syndrome (AIDS) and widespread Kaposi's sarcoma (KS) presented with a transtibial amputation secondary to foot infection and intractable pain. Several open and draining KS lesions were present on the residual limb. There were two concerns: (1) prescribing a prosthesis to a person who likely had a limited future as a prosthetic user; and (2) how the lesions would tolerate pressure and shear forces in a prosthesis. There have been no previous reports of KS lesions of residual limbs. We prescribed a patellartendon-bearing prosthesis with supracondylar suspension. The lesions did not worsen with weight-bearing, and healed with concomitant treatment. The patient remains a functional ambulator 1 year after amputation. This case suggests that KS lesions can tolerate pressure and shear forces, which is important in considering prosthetic prescriptions as well as prescriptions of orthoses and other devices.

AIDS-Related Opportunistic Infections↗

PubMed1991

Skewflap versus long posterior flap in below-knee amputations: multicenter trial.

A multicenter trial of alternative techniques for below-knee amputation is described in which surgeons in 11 centers randomized 191 patients with end-stage occlusive vascular disease to two different methods of stump construction. The skewflap technique was performed in 98 and the long posterior flap was performed in 93. The two groups were well matched in respect to age, sex, smoking, diabetes, and indications for amputation. Early outcome was compared in terms of 30-day mortality rate: skew 11 (11%) deaths versus long posterior flap 16 (17%); the state of the wound at 1 week (primary healing 60% in both groups); the need for surgical revision at the same level 7 (7%) versus 7 (8%), and revision to a higher level 10 (10%) versus 7 (8%). Follow-up information at 6 months was available from records or by mailed questionnaire in 188 (98%) at 6 months, 20 died during that interval. It showed that a prosthetic limb was fitted to 64 (84%) of skew flaps and 50 (77%) of long posterior flaps. Walking, alone or with support, was achieved in 59 (78%) and 46 (71%), respectively. None of these differences reached statistical significance. It is concluded that the skew flap is just as effective as the long posterior flap and is an excellent option for below-knee amputation.

Aged↗

PubMedDate not supplied

Function of children with myelodysplasia and lower extremity amputations.

This is a retrospective study of the functional status of children who underwent a lower extremity amputation for complications of myelodysplasia. With a computerized surgical database, 12 children with myelodysplasia who underwent an amputation at the Boyd level or above at a single children's referral hospital between 1983 and 2001 were identified. Four patients could not be contacted, but the remaining 8 patients were evaluated through chart review and interview to assess the impact of the amputation on their function. With a mean follow-up time of 9 years (range, 5-15 years), all 6 of the patients with a below-knee or Boyd amputation continued to ambulate using a prosthesis. Most patients occasionally reported having ulcers on their residual limb, but these cases were easily managed and did not result in amputation revisions.The only patient in this series with an above-knee amputation and the only patient with a knee disarticulation were exclusively wheelchair ambulators and no longer owned a prosthesis. This study supports the notion that children with myelodysplasia can have amputations and successfully wear a prosthesis to maintain their ambulation.

Adolescent↗

PubMed1994

The free-fillet flap for reconstruction of the upper extremity.

The pedicled fillet flap concept has been successfully applied in both the upper and lower extremities for the treatment of difficult wounds. However, in cases of complete extremity amputation, the transfer of pedicled flaps from the amputated part is not possible. In such instances, we have designed free-fillet flaps from the amputated limb to provide wound coverage when replantation of the amputated part was contraindicated. This technique allows immediate wound coverage and preservation of functional amputation stump length, without the morbidity of an additional donor site. We present three cases that demonstrate the utility of this technique as an additional reconstructive option in patients with unreplantable upper-extremity amputations.

Adult↗

PubMed2001

A reappraisal of a modified through-knee amputation in patients with peripheral vascular disease.

BACKGROUND: Through-knee amputation provides a longer lever arm and improved muscle control of the limb compared with above-knee amputation. Through-knee amputation also allows use of a total end-bearing prosthesis, which avoids the ischial pressure and suspension belts required of the above-knee amputation prosthesis. Several reports in the European literature tout the superiority of the through-knee amputation over the above-knee amputation in the patient with vascular disease. Through-knee amputation has received little attention in the United States, however, owing to the belief that the long flaps necessary to close a standard through-knee amputation are associated with an unacceptable rate of wound problems and offer no functional ambulatory advantage to above-knee amputation. We reviewed our experience with a modified technique of through-knee amputation in a group of patients with severe lower extremity ischemia who were not candidates for below-knee amputation to determine the incidence of wound complications and their functional outcome. METHODS: Since 1996, 12 patients with severe lower extremity arterial insufficiency have undergone through-knee amputation utilizing a technique designed to limit flap length and facilitate the fit of a suction prosthesis. Two patients died of myocardial infarction in the immediate postoperative period and were excluded from the study. In the remaining 10 patients (1 man, 9 women; mean age 63 years (range 40 to 86), the below-knee amputation level was precluded because of gangrene or nonhealing wounds of the mid leg in 5 patients, failure of a previous below-knee amputation attempt in 4 patients, and severe ischemia that would compromise below-knee amputation healing in 1 patient. Nine patients had at least one failed vascular reconstruction procedure. RESULTS: Mean follow-up is 25 months (range 6 to 41). Six (60%) patients had primary healing of their amputations. Two (20%) patients had delayed healing (6 weeks and 8 weeks). Two (20%) patients developed wound infections, which required amputation revision to the above-knee level. Seven (70%) patients were fitted with a suction socket prosthesis and are fully ambulatory. One patient healed but has not ambulated because of ischemia and subsequent ulceration of the contralateral limb. CONCLUSIONS: These data show that through-knee amputation is associated with an acceptable primary healing rate (80%) and satisfactory functional outcomes (70% ambulation) in a high-risk vascular population. The functional advantages of through-knee amputation over above-knee amputation make it the preferred alternative for patients with vascular disease.

Adult↗