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Therapy Interventions for Upper Limb Amputees Undergoing Selective Nerve Transfers
07:59

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Published on: October 29, 2021

Reoperations following combat-related upper-extremity amputations.

Scott M Tintle1, Martin F Baechler, George P Nanos

  • 1Orthopaedic Surgery Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.

The Journal of Bone and Joint Surgery. American Volume
|September 21, 2012
PubMed
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Revision surgery for major upper-extremity amputations significantly improves prosthesis use and outcomes. Addressing complications through amputation revision leads to better results for combat-wounded personnel.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Rehabilitation Medicine

Background:

  • Major upper-extremity amputation revision rates are largely unreported in large patient cohorts.
  • High-energy trauma, particularly blast injuries, is the primary cause of these amputations in military personnel.

Purpose of the Study:

  • To determine revision rates for major upper-extremity amputations in combat-wounded personnel.
  • To evaluate the impact of surgical revision on outcomes such as prosthesis use and pain management.

Main Methods:

  • Retrospective analysis of 100 major upper-extremity amputations in 96 combat-wounded individuals.
  • Assessment of prerevision and postrevision outcomes including prosthesis use, pain, and return to duty.

Main Results:

  • 42% of residual limbs required 103 surgical revisions.
  • Transradial amputations showed higher rates of phantom limb pain and neuropathic pain medication use.
  • Prosthesis use increased from 19% to 87% after revision surgery (p < 0.0001).

Conclusions:

  • Revision amputation effectively addresses complications and persistent symptoms in major upper-extremity amputations.
  • Surgical revision leads to improved prosthesis acceptance and outcomes comparable to non-revised amputations.