Innovations in Amputation Care

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 2444

Special Issue Editors

Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
Interests: bone anchored implants; ewing amputation; musculoskeletal oncologic surgery; patient reported outcomes analysis; rehabilitation; gait analysis; TMR, RPNI
Special Issues, Collections and Topics in MDPI journals
Department of Trauma Surgery, Medical School Hannover, Hannover, Germany
Interests: amputation surgery; peripheral nerve surgery; prosthetics; human–machine interfaces
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Due to increasing numbers of vascular and metabolic disease, continuous military conflicts worldwide, and failing former limb-salvaging reconstructions, amputation is one of the most common surgical interventions in hospital operating rooms worldwide. These numbers underline the need for developments in amputation surgery and rehabilitation. Patients’ needs to regain their body integrity and restart their daily activities after limb loss are manifold—as are their etiologies. Providing successful amputation medicine is therefore only possible in both a highly specialized but also multidisciplinary setting with an awareness of linking the interfaces between the patient, surgeons, orthopedic technicians, ergo-physio- and pain therapist as well as psychologists in a timely manner. Rehabilitation starts with a multiprofessional team in the planning of the surgery and/or fitting: informed patient consent, involving peers, appropriate postoperative care with early shaping of the residual limb, evaluation using computer-assisted gait analysis for the selection of the appropriate prosthesis, and adaption to the rehabilitation training of upcoming techniques such as motor imagery. Innovations such as targeted muscle or sensory reinnervation (TMR, TSR), bone anchored prosthesis (BAP), agonist–antagonist myoneural interface (AMI), and regenerative peripheral nerve interfaces (RPNI) are examples of the successful and innovative confluence of surgery and technology, which can be used for enhanced functionality and acceptance of the prothesis and seem to decrease amputation-related pain. Digital transformation including technologies as wearables and virtual reality might be essential in the field of amputation care to link individual patient needs with modern technical equipment and rehabilitative arrangements to finally improve the patient (-reported) outcome.

You may choose our Joint Special Issue in IJERPH.

Dr. Gerhard M. Hobusch
Dr. Jennifer Ernst
Guest Editors

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Keywords

  • bone-anchored prosthesis
  • targeted muscle reinnervation
  • amputation medicine
  • targeted sensory reinnervation
  • artificial intelligence
  • motor imagery
  • digital transformation
  • patient-reported outcome measurement

Published Papers (3 papers)

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7 pages, 706 KiB  
Case Report
Whole-Body Cryostimulation, a Complementary Treatment for Phantom Limb Syndrome: Preliminary Evidence from a Case Study
Medicina 2024, 60(1), 22; https://doi.org/10.3390/medicina60010022 - 22 Dec 2023
Viewed by 559
Abstract
Phantom limb pain (PLP) is a challenging condition affecting a significant proportion of amputees. In this article, we describe the case of a 54-year-old Paralympic athlete with phantom limb syndrome following right leg amputation and widespread sports-related enthesitic pain who underwent a whole-body [...] Read more.
Phantom limb pain (PLP) is a challenging condition affecting a significant proportion of amputees. In this article, we describe the case of a 54-year-old Paralympic athlete with phantom limb syndrome following right leg amputation and widespread sports-related enthesitic pain who underwent a whole-body cryostimulation (WBC) cycle, an emerging treatment known for its rapid pain-relieving and anti-inflammatory effects. Assessments were conducted before and after a 10-session WBC cycle, including pain and quality of life assessment and use of medications. A substantial reduction in enthesitic pain, PLP intensity, paresthesia, and tingling related to atmospheric events and improved function and quality of life were reported after the WBC cycle and lasted for two weeks. One month after WBC, the enthesitic pain following sports activity and PLP gradually returned, but with lesser intensity. Similarly, the stump’s sensitivity to atmospheric changes returned, but with lower frequency. Pain at night remained lower than before WBC, with significantly improved quality of sleep. This case study suggests that WBC could be a valuable adjuvant treatment for alleviating PLP. Controlled studies are warranted to validate the findings of this case report and elucidate the mechanisms underlying the positive effects of WBC in this condition. Full article
(This article belongs to the Special Issue Innovations in Amputation Care)
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0 pages, 2055 KiB  
Project Report
Combining Surgical Innovations in Amputation Surgery—Robotic Harvest of the Rectus Abdominis Muscle, Transplantation and Targeted Muscle Reinnervation Improves Myocontrol Capability and Pain in a Transradial Amputee
Medicina 2023, 59(12), 2134; https://doi.org/10.3390/medicina59122134 - 07 Dec 2023
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Abstract
Adding robotic surgery to bionic reconstruction might open a new dimension. The objective was to evaluate if a robotically harvested rectus abdominis (RA) transplant is a feasible procedure to improve soft-tissue coverage at the residual limb (RL) and serve as a recipient for [...] Read more.
Adding robotic surgery to bionic reconstruction might open a new dimension. The objective was to evaluate if a robotically harvested rectus abdominis (RA) transplant is a feasible procedure to improve soft-tissue coverage at the residual limb (RL) and serve as a recipient for up to three nerves due to its unique architecture and to allow the generation of additional signals for advanced myoelectric prosthesis control. A transradial amputee with insufficient soft-tissue coverage and painful neuromas underwent the interventions and was observed for 18 months. RA muscle was harvested using robotic-assisted surgery and transplanted to the RL, followed by end-to-end neurroraphy to the recipient nerves of the three muscle segments to reanimate radial, median, and ulnar nerve function. The transplanted muscle healed with partial necrosis of the skin mesh graft. Twelve months later, reliable, and spatially well-defined Hoffmann–Tinel signs were detectable at three segments of the RA muscle flap. No donor-site morbidities were present, and EMG activity could be detected in all three muscle segments. The linear discriminant analysis (LDA) classifier could reliably distinguish three classes within 1% error tolerance using only the three electrodes on the muscle transplant and up to five classes outside the muscle transplant. The combination of these surgical procedure advances with emerging (myo-)control technologies can easily be extended to different amputation levels to reduce RL complications and augment control sites with a limited surface area, thus facilitating the usability of advanced myoelectric prostheses. Full article
(This article belongs to the Special Issue Innovations in Amputation Care)
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13 pages, 3764 KiB  
Case Report
Vibrotactile Feedback for a Person with Transradial Amputation and Visual Loss: A Case Report
Medicina 2023, 59(10), 1710; https://doi.org/10.3390/medicina59101710 - 25 Sep 2023
Viewed by 949
Abstract
Background and Objectives: After major upper-limb amputation, people face challenges due to losing tactile information and gripping function in their hands. While vision can confirm the success of an action, relying on it diverts attention from other sensations and tasks. This case report [...] Read more.
Background and Objectives: After major upper-limb amputation, people face challenges due to losing tactile information and gripping function in their hands. While vision can confirm the success of an action, relying on it diverts attention from other sensations and tasks. This case report presents a 30-year-old man with traumatic, complete vision loss and transradial left forearm amputation. It emphasizes the importance of restoring tactile abilities when visual compensation is impossible. Materials and Methods: A prototype tactile feedback add-on system was developed, consisting of a sensor glove and upper arm cuff with related vibration actuators. Results: We found a 66% improvement in the Box and Blocks test and an overall functional score increase from 30% to 43% in the Southampton Hand Assessment Procedure with feedback. Qualitative improvements in bimanual activities, ergonomics, and reduced reliance on the unaffected hand were observed. Incorporating the tactile feedback system improved the precision of grasping and the utility of the myoelectric hand prosthesis, freeing the unaffected hand for other tasks. Conclusions: This case demonstrated improvements in prosthetic hand utility achieved by restoring peripheral sensitivity while excluding the possibility of visual compensation. Restoring tactile information from the hand and fingers could benefit individuals with impaired vision and somatosensation, improving acceptance, embodiment, social integration, and pain management. Full article
(This article belongs to the Special Issue Innovations in Amputation Care)
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