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Microsurgery 2021 Apr 17. Epub 2021 Apr 17.

Akdeniz University Faculty of Medicine, Antalya, Turkey.

Although there have been numerous reports of major replantation of upper extremity amputations, limited numbers of above-elbow amputation replantation have been reported. We present the technical details of two successful replantations of forequarter amputations in a nine-year-old girl and a three-year-old boy. In both cases, the forequarter was amputated due to avulsion traction injuries resulting in amputation including the entire upper limb, while the integrity of the scapula and parascapular muscles was maintained, with no injury to the glenohumeral joint. Read More

Int J Surg Case Rep 2021 Feb 28;79:479-483. Epub 2021 Jan 28.

Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore. Electronic address:

Introduction: Acute type A aortic dissection (AAAD) is a surgical emergency with high operative mortality. Distal propogration of the dissecting flap can lead to malperfusion of territory supplied by the aorta including axillary and brachial arteries causing ischaemia of the upper limb.

Case Presentation: We present a case of a 67 year old gentleman who had AAAD and developed upper limb malperfusion after repair. Read More

Hand (N Y) 2021 Feb 17:1558944721992467. Epub 2021 Feb 17.

Medical College of Wisconsin, Milwaukee, USA.

Targeted muscle reinnervation (TMR) has been shown to improve phantom and neuropathic pain in both the acute and chronic amputee population. Through rerouting of major peripheral nerves into a newly denervated muscle, TMR harnesses the plasticity of the brain, helping to revert the sensory cortex back toward the preinsult state, effectively reducing pain. We highlight a unique case of an above-elbow amputee for sarcoma who was initially treated with successful transhumeral TMR. Read More

BMJ Case Rep 2021 Jan 26;14(1). Epub 2021 Jan 26.

General Surgery, Amrita School of Medicine, Amrita Viswavidyapeetham, Kochi, India.

Novel COVID-19 continues to intrigue medical professionals with its varied presentations. Though it affects the respiratory tract primarily, thrombogenesis has been the Achilles' heel. A 44-year-old man diagnosed with COVID-19 presented with upper limb pain at a local hospital and was found to have thrombosis of the right axillary artery. Read More

Niger Med J 2020 Sep-Oct;61(5):288-290. Epub 2020 Oct 13.

Department of Orthopaedics and Trauma, University College Hospital, Ibadan, Nigeria.

The term "sideswipe injury" has become synonymous and used interchangeably with the term "traffic elbow." However, with the continuous rise in the use of the tricycle as a means of public transportation in some developing countries, a rise in sideswipe injuries of various severities is being experienced. We report a case of sideswipe injury to the left knee region of a 45-year-old female who was a passenger in the backseat of a tricycle. Read More

Int J Surg Case Rep 2020 19;77:618-623. Epub 2020 Nov 19.

DDRC SRL, Trivandrum, India.

Introduction: We present a rare case of Malignant Peripheral Nerve Sheath Tumour (MPNST) of the upper limb, which was excised thirteen times in thirteen years and ultimately ended in above elbow amputation.

Presenting Complaint And Investigations: A 48 year old female presented initially with a localised swelling of 2 cms diameter in the front of the left elbow in 2007, which was excised. It recurred repeatedly and was excised. Read More

Cureus 2020 Jul 7;12(7):e9051. Epub 2020 Jul 7.

Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, IND.

A 22-year-old female presented with painful, progressive swelling of the right forearm for six months. Physical examination revealed a 7 cm x 5 cm firm, tender soft-tissue swelling over the anterior aspect of the right proximal forearm with normal overlying temperature. X-rays showed increased soft tissue shadow but without any bony involvement. Read More

J Burn Care Res 2020 11;41(6):1304-1305

General Surgery, St. John's Medical College, Bengaluru, India.

Electrical injuries are among the most devastating of burn injuries. High-voltage electrical injuries result in extensive deep tissue damage and are associated with multiple complications, long-term morbidity, and a high mortality rate. We describe the case of a 16-year-old male cable operator who suffered high-voltage electric injury of left upper limb and anterior abdominal wall. Read More

Ortop Traumatol Rehabil 2020 Apr;22(2):85-93

University Rehabilitation Institute, Linhartova Ljubljana, Slovenia.

Background: There is a lack of studies on adjustment to upper limb prosthesis with large representative samples that would compare different prosthesis types and use standardised outcome measures. Hence, we wanted to assess satisfaction with, and level of adjustment to, an upper-limb prosthesis among people after an upper limb amputation in our country.

Material And Methods: We conducted a cross-sectional descriptive study. Read More

Cureus 2020 Feb 1;12(2):e6842. Epub 2020 Feb 1.

Internal Medicine, Fatima Jinnah Medical University, Lahore, PAK.

Subclavian artery thrombosis is a rare cause of upper limb ischemia resulting from occlusion of the upper extremity blood supply. Symptomatic presentation is quite rare and therefore remains underdiagnosed by physicians. Possible catastrophic clinical consequences necessitate prompt rectification of the underlying disease and risk factors. Read More

Malawi Med J 2019 12;31(4):244-248

Department of Surgery, University of North Carolina at Chapel Hill, USA.

Introduction: Amputations in low- and middle-income countries (LMICs) represent an important cause of disability and economic hardship. LMIC patients are young and suffer from preventable causes, such as trauma and trauma-related infections. We herein studied the etiology in amputations in a Malawian tertiary care hospital over a 9-year period. Read More

J Clin Med 2019 Dec 20;9(1). Epub 2019 Dec 20.

Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.

Global brachial plexopathies including multiple nerve root avulsions may result in complete upper limb paralysis despite surgical treatment. Bionic reconstruction, which includes the elective amputation of the functionless hand and its replacement with a mechatronic device, has been described for the transradial level. Here, we present for the first time that patients with global brachial plexus avulsion injuries and lack of biological shoulder and elbow function benefit from above-elbow amputation and prosthetic rehabilitation. Read More

Ann Afr Med 2019 Oct-Dec;18(4):196-199

Department of Surgery, John F. Kennedy Memorial Hospital, Monrovia, Liberia.

Background: Amputation is one of the oldest known surgical procedures. It has been one of the modalities of applying judgment and treatment. Its method and indications has evolved over time. Read More

Plast Reconstr Surg 2019 12;144(6):1037e-1043e

From the Division of Plastic and Reconstructive Surgery and the Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Physical Medicine and Rehabilitation, Medical University of Vienna; and the Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust.

Background: Although the distal targets have been lost in proximal upper limb amputees, the neural signals for intuitive hand and arm function are still available and thus can be incorporated into more useful prosthetic function using targeted muscle reinnervation technique. In this article, the authors present their outcomes and range of indications in addition to experiences and pitfalls after 30 targeted muscle reinnervation cases at above-elbow and shoulder disarticulation level of amputation.

Methods: Thirty patients with above-elbow or shoulder disarticulation amputations were enrolled between 2012 and 2017. Read More

Mil Med 2020 03;185(3-4):444-450

Extremity Trauma and Amputation Center of Excellence, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.

Introduction: Military Service Members (SMs) with upper limb (UL) amputation have unrestricted access to occupational therapy (OT) services. Identifying OT interventions used based on clinical rationale and patient needs can provide insight toward developing best practice guidelines. The purpose of this retrospective observational study was to identify preferred OT practice patterns for U. Read More

Cureus 2019 Sep 3;11(9):e5557. Epub 2019 Sep 3.

Diabetes and Endocrinology, Peterborough City Hospital, Peterborough, GBR.

Undifferentiated pleomorphic sarcoma (UPS) is a rare tumor of mesenchymal origin affecting the hand in less than 3% of cases. A 92-year-old male reported an enlarging, painless mass on his left hand of three months duration. Examination of the hand revealed a soft, non-tender, immobile mass over the wrist joint, just proximal to his thumb. Read More

Sci Robot 2019 Jul;4(32)

Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

Targeted muscle reinnervation (TMR) amplifies the electrical activity of nerves at the stump of amputees by redirecting them in remnant muscles above the amputation. The electrical activity of the reinnervated muscles can be used to extract natural control signals. Nonetheless, current control systems, mainly based on noninvasive muscle recordings, fail to provide accurate and reliable control over time. Read More

Mil Med 2020 02;185(1-2):e244-e253

VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161.

Introduction: Little population-based research has described the transition from Department of Defense (DoD) to Department of Veterans Affairs (VA) healthcare following combat related amputations. The objectives were to describe (1) to what extent patients used either DoD only facilities, both DoD and VA facilities, or VA only facilities during the first 5 years postinjury, (2) which specific clinics were used and (3) clinic use among patients with different levels of amputation (upper versus lower), and among patients with early or late amputation.

Materials And Methods: This was a retrospective analysis of health data extracted from the expeditionary medical encounter database (EMED) and national DoD and VA databases. Read More

Am Surg 2019 May;85(5):501-504

Amputations associated with trauma carry significant morbidity in addition to risk of limb loss due to tissue damage, contamination, and risk of infection. The timing of formal amputation closure in this situation varies among surgeons, with some allowing the wound to remain open for some time after debridement, whereas others perform formal amputation and closure at the index operation if debridement is adequate. The presence of infection after closure of an amputation has the potential to result in a higher amputation (, a below-knee amputation to an above-knee amputation). Read More

PM R 2019 06 29;11(6):577-589. Epub 2019 Mar 29.

Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA.

Background: Limited population-based research has described long-term health outcomes following combat-related upper limb amputation.

Objective: To compare health outcomes following upper limb amputation with outcomes following serious upper limb injury during the first 5 years postinjury.

Design: Retrospective cohort. Read More

Stem Cell Res Ther 2019 01 11;10(1):15. Epub 2019 Jan 11.

Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.

Background: Although the mononuclear cell (MNC) transplantation could theoretically induce therapeutic angiogenesis in the patients with no-option critical limb ischemia (NO-CLI), the clinical responses to this approach are inconsistent among different clinical trials. The purpose of this study was to identify the prognostic factors of responders and develop a predictive nomogram to guide patient selection.

Methods: We retrospectively reviewed a consecutive NO-CLI cohort who received peripheral blood-derived transplantation in our center. Read More

Ann Vasc Surg 2019 Apr 28;56:357.e1-357.e4. Epub 2018 Nov 28.

Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.

Angiosarcomas developing in nonfunctioning arteriovenous fistulas in renal transplant recipients are quite rare clinical entities with very poor prognosis. Herein we present a 60-year-old male who developed an angiosarcoma in a thrombosed radiocephalic fistula 6 years after renal transplantation. The patient presented with pain and swelling at the site of a previously asymptomatic fistula. Read More

Can J Surg 2018 12;61(6):S203-S207

From the Royal Canadian Medical Service, Ottawa, Ont. (Smith, DaCambra, McAlister); and the Division of General Surgery, Western University, London, Ont. (Smith, McAlister).

Background: We have previously reported a higher than expected rate of upper-extremity amputation (UEA) in victims of an antipersonnel improvised explosive device (AP-IED) compared with a similar cohort injured by antipersonnel mines (APM). The goal of this study was to describe the rate, severity and impact of UAE caused by an AP-IED.

Methods: We analyzed a prospective database of 100 consecutive dismounted AP-IED victims with pattern 1 injuries to compare the outcomes of the cohort with UEA to that without. Read More

J Burn Care Res 2019 01;40(1):107-111

Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas.

Electrical injuries induce substantial morbidity and mortality. Amputations are often necessary to enable survival and based on tissue nonviability, development of life-threatening infection, or expected nonfunctional outcome. They analyzed occurrence and type of amputations in their institution for electrical and nonelectrical pediatric burns and the number of reconstructive operations. Read More

Sci Rep 2018 10 18;8(1):15459. Epub 2018 Oct 18.

Aix Marseille Univ, CNRS, ISM, Marseille, France.

There is an increasing need to extend the control possibilities of upper limb amputees over their prosthetics, especially given the development of devices with numerous active joints. One way of feeding pattern recognition myoelectric control is to rely on the myoelectric activities of the residual limb associated with phantom limb movements (PLM). This study aimed to describe the types, characteristics, potential influencing factors and trainability of upper limb PLM. Read More

J Vasc Surg 2019 01 29;69(1):120-128.e2. Epub 2018 Jul 29.

Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, Tex; South Texas Center for Vascular Care, South Texas Medical Center, San Antonio, Tex. Electronic address:

Background: Critical hand ischemia owing to below-the-elbow atherosclerotic occlusive disease is relatively uncommon. The aim of this study was to examine the outcomes in patients presenting with critical ischemia owing to below-the-elbow arterial atherosclerotic disease who underwent nonoperative and operative management.

Methods: A database of patients undergoing operative and nonoperative management for symptomatic below-the-elbow atherosclerotic disease between 2006 and 2016 was retrospectively queried. Read More

Rev Port Cir Cardiotorac Vasc 2017 Jul-Dec;24(3-4):179

Hospital de Santa Marta, Portugal.

Introduction: With increasing use of percutaneous vascular procedures, access complications that present to a vascular surgeon increase. The most limb-threatening condition is acute limb ischaemia. Acute limb ischaemia is the most common vascular surgical emergency. Read More

Plast Reconstr Surg 2018 06;141(6):1447-1458

Toronto, Ontario, Canada.

Prosthetic options for patients with proximal upper limb absence are limited. Current above-elbow prostheses may restore basic motor functions for crucial activities, but they are cumbersome to operate, lack sensory feedback, and are often abandoned. Targeted muscle reinnervation is a novel surgical procedure that enhances the ability of patients with above-elbow amputations to intuitively control a myoelectric prosthesis. Read More

Brain 2017 Dec;140(12):3166-3178

Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Denervation due to amputation is known to induce cortical reorganization in the sensorimotor cortex. Although there is evidence that reorganization does not lead to a complete loss of the representation of the phantom limb, it is unclear to what extent detailed, finger-specific activation patterns are preserved in motor cortex, an issue that is also relevant for development of brain-computer interface solutions for paralysed people. We applied machine learning to obtain a quantitative measure for the functional organization within the motor and adjacent cortices in amputees, using high resolution functional MRI and attempted hand gestures. Read More