Infected Epidermoid Cyst Including Multiple Nails at the Amputated Thumb Stump: A Case Report

Fingertip amputation is a common injury among trauma occurring in the upper extremity. After amputation of the fingertip, there are several treatment options according to the degree of damage. Also, the skin flap is sometimes performed when skin defects are accompanied. Among the complications associated with fingertip injury, cyst formation at the amputation stump is rare but some cases have been reported based on the pathologic findings. There was a case of an infected epidermal inclusion cyst containing multiple nail plates at the amputation stump of the thumb, so we would like to report it with a review of the literature.

Icing the Pain–Ultrasound-Guided Cryoablation of Symptomatic Post-Amputation Stump Neuroma

Purpose To assess the feasibility and outcome of ultrasound-guided cryoablation in patients with a sensitized stump neuroma after limb amputation. Material and Methods Seven patients (3 females, 4 males; mean age 42 years) were included in this retrospective study. Ultrasound-guided cryoablation of a previously identified painful stump neuroma was performed. Pain was assessed on the visual analogue scale (VAS) and compared before and after cryoablation (Wilcoxon Test). The degree of pain alleviation was correlated with patient age, duration of pain before ablation and time interval between amputation and ablation (Spearman correlation). A p-value less than 0.05 was deemed statistically significant. Results Nine cryoablations were performed for 8 neuromas. Technical success was 100%, there were no major complications. Mean follow-up was 27 months. There was a statistically significant decrease of pain from mean 8.3 / 10 (baseline) to 4 /10 (on day one), 2.1 / 10 (at one week) and 3 / 10 (at last follow-up) (p < 0.05). Patient satisfaction with cryoablation treatment was very high (median score 70 / 100). Conclusion In our small population observational study, ultrasound-guided cryoablation of a sensitized stump neuroma was effective and safe for pain alleviation with very good long-term results. Level of Evidence Level 2, Observational study with dramatic effect

Rehabilitation of patients after diabetic foot amputation

Background: Diabetic foot is a diabetes-related complication that often requires amputation due to ulcer, necrosis, infection, and wound healing problems. Amputation decreases ambulation ability and worsens the patient’s general condition. Thus, active gait training is important after amputation.Current Concepts: The level of amputation depends on the anatomical position, for example, toe amputation and transfemoral amputation. The impairment of ambulatory function is also determined by the position of amputation. Continuous rehabilitation exercise is encouraged for ambulation before surgery. Wound management and pain control are needed for early rehabilitation exercise after surgery. The maturation of the amputation stump is especially important and needed for prosthesis wearing. If the general condition of the patient permits, muscle strengthening exercises, joint range of motion exercises, and ambulation exercises should be started as soon as possible.Discussion and Conclusion: Sufficient understanding of functional decline after amputation is required. The clear goal of ambulation should be set in consideration of the patient’s general condition and ability to walk before surgery. The ultimate goal of amputation is not only to remove necrosis, ulcers, and infected tissues but also to restore ambulatory function. Thus, expertise and significant effort before and after surgery are required.

Critical Wound Complication Following Major Amputation for Acute Limb Ischemia

Limb amputation has a severe somatic and psychological impact, that can furthermore have complications, which lead to increased morbidity, mortality, hospitalization days, health care costs, delay prosthetic application, and social reintegration. Proper therapeutic management must be initiated in cases with amputation stump complications to ensure the best result. This paper aims to present the therapeutic management of a patient with sepsis after above–the–knee amputation, performed after acute limb ischemia. The patient presented in our clinic 10 days postoperatively with local infection, wound dehiscence, and sepsis.

A predictive score for 30-day survival for patients undergoing major lower limb amputation for peripheral arterial obstructive disease

To analyze outcomes following major lower extremity amputations (mLEAs) for peripheral arterial obstructive disease, gangrene, infected non-healing wound and to create a risk prediction scoring system for 30-day mortality. In this single-center, retrospective, observational cohort study. All patients treated with above-the-knee amputation (AKA) or below-the-knee amputation (BKA) between January 1st, 2010 and June 30th, 2018 were identified. The primary outcome of interest was early (≤ 30 days) mortality. Secondary outcomes were postoperative complications and freedom from amputation stump revision/failure. We identified 310 (77.7%) mLEAs performed on 286 patients. There were 188 (65.7%) men and 98 (34.3%) women with a median age of 79 years (IQR, 69–83 years). We performed 257 (82.9%) AKA and 53 (17.1%) BKA. There were 49 (15.8%) early deaths, which did not differ among the age quartiles of this cohort (15.4% vs. 14.3% vs. 15.4% vs. 19.5%, P = 0.826). Binary logistic regression analysis identified age > 80 years (OR 2.24, 95% CI 1.17–4.31; P = 0.015), chronic obstructive pulmonary disease (OR 2.12, 95% CI 1.11–4.06; P = 0.023), and hemodialysis (OR 2.52, 95% CI 1.15–5.52; P = 0.021) to be associated with early mortality. The final score (range 0–10) identified two subgroups with different mortality at 30 days: lower-risk (score < 4, 10.8%), and higher-risk (score ≥ 4: 28.7%; OR 3.2, 95% CI 1.63–6.32; P < 0.001). In our experience, mLEAs still have a 14% mortality rate over the years. Our lower-risk group (score < 4) is characterized by a lower rate of perioperative death and longer survival. Graphic abstract

Improvement of prosthetics technology and inpatient rehabilitation of patients with amputation hip stumps

Timely and comprehensive assessment of indications and contraindications for prosthetics of patients with a faulty amputation stump has proven to increase the prosthetics efficiency based on adequate approaches to treatment by selecting the correct timing of prosthetics and taking into account the general condition of the patient. Timely elimination of existing defects in the amputation stump with the help of surgical and complex physiotherapeutic procedures, as well as early prosthetics, enables patients with amputation stumps to quickly adapt to the prosthesis. The proposed Prosthetics Efficiency Evaluation Program (PEEP), developed by the authors, allows assessing the degree of prosthetics efficiency and complex rehabilitation of a patient objectively and reliably.

Single-cell resolution of MET and EMT programs during zebrafish fin regeneration

SUMMARYWhile humans have limited potential for limb regeneration, some vertebrates can regenerate bony appendages following amputation. During zebrafish fin regeneration, mature osteoblasts at the amputation stump dedifferentiate and migrate to the blastema, where they re-enter the cell cycle and then re-differentiate to form new bone. Osteoblastic cells exhibit dual mesenchymal and epithelial characteristics during fin regeneration, however little is known about why or how this occurs. Using single-cell RNA-sequencing, we found osteoprogenitors are enriched with components associated with the epithelial-to-mesenchymal transition (EMT) and its reverse, mesenchymal-to-epithelial transition (MET). In trajectory analyses, osteoblastic cells solely expressed EMT components, or transiently expressed MET components prior to expressing those for EMT. We found that cdh11, a cancer EMT marker, is expressed during osteoblast dedifferentiation. We also found that esrp1, a regulator of alternative splicing in epithelial cells whose expression is important for MET, is expressed in a subset of osteoprogenitors during outgrowth. This study provides a valuable single cell resource for the study of osteoblast differentiation during zebrafish fin regeneration, and identifies MET- and EMT-associated components which may be important for successful appendage regeneration.

Microvascular free flaps from the lower abdomen for preservation of amputation length in the lower extremity

BACKGROUND: The length of the amputation stump is crucial for optimal prosthetic fitting and rehabilitation. Especially in traumatic amputation, direct closure of the stump may be challenging, and bone shortening is frequently needed. To avoid excessive bone shortening, coverage of exposed bone with free flaps is a versatile option. OBJECTIVE: Here we present our experience with the utilization of free flaps from the lower abdomen for the coverage of amputations stumps of the lower extremity. METHODS: Between March 2008 and October 2010, five patients (three female, two male) with complex wounds on amputation stumps of the lower extremity were treated with a mean age of 50 years (range: 15–72 years). Six abdominal free flaps were performed in five patients (one bilateral case), including four deep inferior epigastric artery (DIEP-) and two muscle-sparing transverse rectus abdominis muscle (ms-TRAM-) flaps. Patient’s and operative data were collected retrospectively. RESULTS: One complete flap failure occurred (overall success rate: 83.3%). Three of five patients gained full ambulatory status. CONCLUSIONS: Due to the low donor site morbidity a long vascular pedicle and the large amount of available tissue, abdominal based free flaps represent our first choice for microsurgical reconstruction of lower extremity stumps.