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Purpose: Contraindications to replantation include severe medical or psychiatric comorbidities. Recently, authors have suggested that due to the improving therapeutic options for patients with psychiatric decompensation, this should no longer be listed as a contraindication to replantation. Despite this, authors continue to list severe psychiatric comorbidities as a contraindication to replantation. This case series and review of the literature discusses this complex topic and provides recommendations regarding the management of patients following upper extremity self-inflicted amputations., Methods: The authors present two cases of self-inflicted upper extremity amputations. The cases depict the acute management and the outcomes of these patients. The authors also reviewed the literature to present the available literature on this topic., Results: The first case is a 64-year-old male who deliberately amputated his left hand with a table saw while suffering postictal psychosis. He underwent replantation. The patient was co-managed by the surgical and psychiatric team postoperatively. The patient expressed gratitude for his replantation after being treated for his psychoneurological condition. The second case is that of a 25-year-old male who deliberately amputated his left forearm using a Samurai sword. The patient's limb was successfully replanted. In the post-anesthesia care unit, the patient experienced extreme agitation, and during this event, he reinjured the left forearm. He was again taken urgently to the operating room to revise the replantation. Once psychiatrically stabilized, the patient was thankful for the care he received., Conclusion: The management of upper extremity self-inflicted amputations is controversial and difficult to establish as this presentation is rare. We present two cases which illustrate some of the nuances in the care of these patients. Our review suggests that psychiatric diagnosis be viewed as a comorbidity and not a contraindication to replantation. Thus, an informed consent discussion should be performed with the patients and, as needed, a member of the psychiatric team in order to decide whether to replant or not., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

The abrupt onset of the situation after a traumatic amputation and the preparatory discussions following unsuccessful attempts to preserve limbs with necessary amputation require a high level of empathy, attention and well-founded information individually tailored to the affected individuals. Optimization of the treatment process can only be achieved by considering these aspects.The self-motivation and cooperation of the patient should be encouraged. To achieve this goal, the professions involved are less suitable for counseling due to a lack of personal experience, whereas so-called peers, as knowledgeable and experienced advisors, are more appropriate. This insight can be derived from existing studies. Peer counseling has increasingly been integrated into routine treatment following amputations in trauma surgery, with positive effects. It is considered guideline-compliant therapy not only in rehabilitation. Against the background of long-standing legislation, especially the UN Convention on the Rights of Persons with Disabilities and the demands of those affected by amputation, the following presentation focuses on the instrumentalization and benefits of counseling. The structures of this particular counseling option, including regular training of counselors and established implementation, are currently not necessarily given but are continuously expanding and being adapted to needs. Concrete scientific evidence regarding measurable effects and positive impacts on outcomes is pending and are presented in a current research project., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: To explore barriers and facilitators to community reintegration experienced by people following traumatic upper limb amputation (ULA)., Methods: An exploratory qualitative study was conducted with ten adults with major ULA due to trauma. Data from individual, semi-structured interviews was analysed using Braun and Clarke's reflexive thematic analysis., Results: Underlying and influencing community reintegration for participants, was a process of adjustment to the impacts of amputation on everyday function and re-establishing their identity. Participants felt social networks and peer support facilitated the return to social and community activities, as did drawing on personal attributes such as positivity, resilience and self-belief. Prosthetic devices were facilitative for community reintegration by minimising visible differences and unwanted attention through restored cosmesis and in the performance of functional tasks to fulfil social norms and meaningful roles despite issues with comfort and function. Despite the adaptation and evolution of abilities, perspectives and identities, the functional impact of ULA on everyday community activities was an ongoing challenge for all participants., Conclusion: ULA has a significant and lifelong impact on an individual's ability to complete tasks and fulfil meaningful roles in the community. Recommendations based on the study's findings will inform clinicians to support community reintegration for people following traumatic ULA.

Purpose: Traumatic upper limb amputation (ULA) is a profound injury impacting participation in activities of daily living, including those within the community setting. The objective of this work was to review literature exploring barriers, facilitators, and experiences of community reintegration in adults following traumatic ULA., Methods: Databases were searched using terms synonymous with the amputee population and community participation. Study methodology and reporting were evaluated using McMaster Critical Review Forms, with a convergent segregated approach to synthesis and configuration of the evidence., Results: A total of 21 studies met the inclusion criteria, including quantitative, qualitative and mixed-method study designs. Restoring function and cosmesis with prostheses facilitated work participation, driving and socialisation. Positive work participation was predicted by male gender, younger age, medium-high education level and good general health. Work role and environmental modifications were common, as were vehicle modifications. Qualitative findings provided insight into social reintegration from a psychosocial perspective, particularly negotiating social situations, adjusting to ULA and re-establishing identity. The review findings are limited by the absence of valid outcome measures and clinical heterogeneity across the studies., Conclusion: There is a dearth of literature on community reintegration following traumatic upper limb amputation, indicating a need for further research with strong methodological rigour.Implications for RehabilitationUpper limb amputation can restrict participation in activities in the community including work, socialisation, driving, leisure, and recreation.Clinicians can support community reintegration by addressing personal and environmental factors that both facilitate or inhibit participation in community activities.Prosthetics can be a facilitator for participation in community activities through the restoration of function and cosmesis.Clinicians can facilitate return to work through work modification recommendations or supported transitions to more suitable roles.

Introduction: Penile amputation causes severe physical and psychosocial distress. Microsurgical implementation in penile replantation is presumed to be superior to surgical repair. This assumption has been difficult to verify., Objectives: The purpose of this study was threefold: (1) to produce an updated review of penile replantation, substantiated by the largest sample size to date; (2) to appraise the comparative value of the novel PENIS Score and propose the PACKAGE Checklist, a guide for standardization of future case reports and reviews; and (3) to improve confusing terminology and recommend the standardization of vocabulary., Methods: A literature review assessed 432 full-text case reports in 20 languages and identified 123 microsurgical and 40 surgical cases of penile replantation. The novel PENIS Score stratified penile amputations based on 5 criteria: position along the shaft, extension through the penis, neurovascular repair, ischemia time and type, and severed edge condition and contamination. For the outcome measurements, a Kendall tau coefficient evaluated the association between each PENIS criterion for short-term postoperative complications and 3 outcome measures: erection, urination, and sensation., Results: Less than half of surgical reports on penile replantation are sufficiently detailed to complete all PENIS Score criteria. The viability of microsurgical and surgical replantation was equivalent at 92% and 94%, respectively. A statistically significant correlation was found between microsurgical repair and the return of sensation but not with nerve repair. Return of sensation with nerve repair was 51%, and microsurgical replantation without nerve repair was 42%; both were significantly higher than the 14% for surgical replantation. Preservation of a skin bridge was associated with a 40% reduction in severe postoperative complications., Conclusion: Microsurgical replantation is superior in return of sensation, with or without nerve repair. Implementing the PACKAGE Checklist and PENIS Score will help inform case reports and reviews., (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Individuals with traumatic limb amputation (TLA) may be at risk of depression, but evidence of increased depression after TLA from longitudinal studies has been limited. It is also unknown whether physical function, cognitive function, and employment prior to amputation affects depression risk. We aimed to examine longitudinal associations between TLA and depression in working age men, and to explore the role of pre-amputation occupational and individual characteristics. Methods: A Swedish national register-based cohort of 189,220 men born between 1952 and 1956, and who attended conscription assessments in adolescence, was followed from 1985 to 2009. Physical, cognitive, and psychological characteristics were measured at the conscription examination, and occupational information was obtained from the 1985 census. Main outcome measures were hospital inpatient and outpatient admissions for depression. Results: In total, 401 men underwent TLA; mean age at amputation was 42.5 years (SD 7.4). Cox regression produced an unadjusted hazard ratio (95% confidence interval) of 2.61 (1.62-4.21) for risk of subsequent depression associated with TLA compared with the general population. Adjustment for occupational, physical, cognitive, and psychological characteristics did not change the association much, producing a hazard ratio of 2.53 (1.57-4.08). Conclusions: TLA is associated with an increased risk of depression in men over more than two decades of follow up. Occupational and individual characteristics prior to amputation did not greatly change depression risk following amputation. We speculate that a coordinated combination of social support and medical management may help reduce persistent depression risk in men who experience amputation.

Purpose: Examining the relationship between posttraumatic stress disorder and posttraumatic stress disorder symptom clusters (re-experiencing, avoidance, hyperarousal, emotional numbing) on three substance use measures among individuals with upper limb amputation due to traumatic injury - an understudied population with high rates of posttraumatic stress disorder. Methods: Multi-site, cross-sectional design. Participants ( N   =   236) were recruited from seven prosthetic rehabilitation centres across the USA and completed measures of PTSD, alcohol use, prescription medication overuse, and illicit drug use. Results: Twenty-six percent of participants screened positive for posttraumatic stress disorder, 39% for problematic alcohol use, 12% for prescription medication overuse, and 7% for illicit drug use. No association was found between posttraumatic stress disorder or posttraumatic stress disorder symptoms clusters on problematic alcohol use. However, hyperarousal symptoms increased odds of overusing prescription medication (odds ratio   =   3.30); further, a positive screen for posttraumatic stress disorder increased odds of illicit drug use (odds ratio   =   2.95). Conclusions: These findings demonstrate the importance of assessing psychological well-being and a variety of substance use behaviours following amputation from traumatic injury. These findings may also provide clinically-relevant targets for prevention and intervention regarding prescription medication and illicit substance use, such as incorporating evidence-based treatment for posttraumatic stress disorder hyperarousal symptoms (e.g., prolonged exposure) and/or integrated treatment for posttraumatic stress-substance misuse (e.g., Seeking Safety ) into patients' long-term inpatient/outpatient rehabilitation plans.Implications for rehabilitationPosttraumatic stress disorder hyperarousal symptoms increased odds of overusing prescription medication among individuals with upper limb amputation due to traumatic injury; a positive screen for posttraumatic stress disorder increased odds of illicit drug use.Psychological assessments should be incorporated into treatment and rehabilitation plans following amputation from traumatic injury.Rehabilitation specialists should consider adding or integrating evidence-based treatment for posttraumatic stress disorder into patients' long-term rehabilitation plan to reduce risk for problematic substance use.Findings support calls by the Centre for Disease Control and Prevention to overhaul prescription medication guidelines, including the need to assess risk and address harms concerning overuse of prescription medication.

Introduction: Military service members with limb loss have unrestricted access to physical therapy (PT) services. Identifying PT interventions used based on clinical rationale and patient needs/goals can provide insight towards developing best practice guidelines. The purpose of this study was to identify preferred PT practice patterns for military service members with lower limb loss., Materials and Methods: This was a retrospective cohort study and was approved by the Naval Health Research Center (NHRC) Institutional Review Board. Data for 495 service members with lower limb loss was analyzed. Frequency of PT visits and units of treatment received were quantified in 3-month increments during the first year after injury and compared for individuals with unilateral limb loss distal to the knee (DIST), unilateral limb loss proximal to the knee (PROX), and bilateral limb loss (BILAT)., Results: A total of 86,145 encounters occurred during the first year after injury. Active treatments were included in 94.0% of all treatments, followed by manual therapy (15.1%), patient education (11.5%) and modalities (2.4%). The highest number of encounters, consisting of active and manual therapy, was received by the DIST group within the first 3 months, while after the first 3 months, the BILAT group had higher encounters and received more active and manual therapy. Utilization of patient education was higher in the PROX and BILAT groups compared to the DIST group throughout the first year after injury., Conclusions: Service members with limb loss utilize PT services often within the first year after injury. Trends of PT practice are most likely influenced by comorbidities and healing time variance between levels of amputation., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019.)

Objectives: The aim of this study was to explore determinants of psychosocial distress and pain in patients who have survived severe extremity amputation in Gaza., Setting: This study was conducted in a secondary care rehabilitation centre in Gaza, Palestine. The clinic is Gaza's sole provider of artificial limbs., Participants: We included 254 civilian Palestinians who had survived but lost one or more limb(s) during military incursions from 2006 to 2016. We included patients with surgically treated amputation injuries who attended physical rehabilitation at a specialist prosthesis centre in Gaza. Amputees with injuries prior to 2006 or non-military related injuries were excluded.We assessed their pain and psychological stress using the General Health Questionnaire (GHQ-12). We used income, amputation severity scored by proximity to torso, current employment status, loss of family members and loss of home as independent variables., Results: The amputees median age was 23 years at the time of trauma, while a median of 4.3 years had passed from trauma to study inclusion. Nine of 10 were male, while 43 were children when they were amputated (17%≤18 years). One hundred and ninety-one (75%) were unemployed and 112 (44%) reported unemployment caused by being amputated. Pain was the most frequent problem, and 80 amputees (32%) reported to suffer from daily pain. Family income was significantly correlated with the physical pain (OR=0.54, CI 0.36 to 0.80, p=0.002). Psychological distress was higher among unemployed amputees (OR=1.36, CI 1.07 to 1.72, p=0.011). We found no association between psychological distress (GHQ-scores) and the extent of the initial amputation., Conclusion: Pain and psychological distress following war-related extremity amputation of one or more limbs correlated stronger with deteriorated family economy and being unemployed than with the anatomical and medical severity of extremity amputations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The purpose of this research was to explore the association between state and trait anxiety experienced by patients who had undergone traumatic amputation and their family caregivers. The sample studied consisted of 50 hospitalized patients who had undergone traumatic amputation and 50 family caregivers. The collected data included patients' and caregivers' characteristics and the State Trait Anxiety Inventory scores. Fifty percent of patients and caregivers scored below 50 and 47, respectively (median), in trait anxiety. In terms of state anxiety, at least 50% of patients and caregivers scored below 56 and 50.5, respectively. These values indicate moderate to high levels of the impact of amputation on the trait and state anxiety of amputees and their caregivers. A positive linear correlation was found between the trait and state anxiety of the patients as well as between the trait and state anxiety of caregivers, as expected (ρ = 0.915, P < .001, and ρ = 0.920, P < .001, respectively). A statistically significant positive correlation was also observed between state patient anxiety and state anxiety of caregivers (ρ = 0.239 and P = .039) and between trait patient anxiety and trait anxiety of caregivers (ρ = 0.322 and P = .030). More specifically, as the patient's anxiety score (either trait temporary) increases, the score of the caregivers' anxiety increases and vice versa. Nurses should be aware of the association between anxiety of amputees and caregivers and, therefore, work in multidisciplinary teams to maximize clinical outcomes for patients after amputation and their families.

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., Setting: Departments of Defense (DoD) and Veterans Affairs (VA) inpatient and outpatient health care facilities., Participants: Three-hundred eighteen U.S. Service Members., Methods: Patients sustained an above elbow (AE, n = 51) or below elbow (BE, n = 80) amputation or serious arm injury without amputation (NO AMP, n = 187) in the Iraq or Afghanistan conflicts, 2001 through 2008. Injuries were coded by trauma nurses. Outcomes came from DoD and VA health databases., Main Outcome Measurements: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes., Results: Most patients were injured by blast weaponry causing serious to severe injuries. All groups had a high prevalence of physical and psychological health diagnoses. The prevalence for nearly all wound complications and many physical and psychological disorders decreased substantially after postinjury year 1. The prevalence of posttraumatic stress disorder, however, increased significantly from postinjury year 1 (20%) to 3 (36%). Pain and psychological disorders ranged from 69% to 90% of patients during postinjury year 1 and remained relatively high even postinjury during year 5 (37%-53%). After adjusting for covariates, the AE group had significantly higher odds for some physical and psychological diagnoses (eg, deep vein thrombosis/pulmonary embolism, cervical pain, osteoarthritis, obesity, and mood and adjustment disorders) relative to the BE or NO AMP groups. BE patients had significantly lower odds for osteomyelitis, and AE and BE patients had lower odds for fracture nonunion and joint disorders versus NO AMP., Conclusions: The results identify similarities and differences in clinical outcomes following combat-related upper limb amputation versus serious arm injury and can inform medical planning to improve rehabilitation programs and outcomes for these patients., Level of Evidence: III., (Published 2018. This article is a U.S. Government work and is in the public domain in the USA.)

Jordan, 26, was involved in an unfortunate motor-bike accident and consequently had to undergo a lower limb amputation. After his operation, he faces a long ordeal to regain his mobility and self-confidence. The multi-disciplinary team assists Jordan in recovering his independence., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Replantation and revascularization in the pediatric extremity has unique challenges that provide a fertile field of research and clinical experience. Children regenerate peripheral nerves rapidly, resulting in good sensory and motor function. They adapt well to functional deficits and mismatch errors of reinnervation. The technical aspects of microsurgical care in children can be challenging because the structures are small. Additional technical challenges include preservation of growth centers, prevention of vasospasm, protection of the reconstruction, and psychosocial care. Despite these challenges, children show excellent functional outcomes with minimal complications., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background:: The 2008 Sichuan Earthquake resulted in many amputees, yet due to the rare incidence, few studies have explored the rehabilitation outcomes and quality of life of bilateral lower limb amputees after major natural disasters., Objectives:: To evaluate rehabilitation outcomes of 17 young and adult bilateral lower limb amputees under the StandTall rehabilitation programme and to identify factors associated with successful functional recovery of bilateral amputees after large-scale disasters., Study Design:: Cross-sectional study., Methods:: Mobility (amputee mobility predictor), prosthesis use (Houghton Scale) and health-related quality of life (Trinity Amputation and Prosthesis Experience Scale, Short Form 12) were evaluated through questionnaires and performance-based assessments. Means of scores were compared using T-tests., Results:: Subjects with bilateral through-knee or transtibial amputations had less activity restriction ( p < 0.01) and higher mobility ( p = 0.03). Subjects using prostheses more than 50% waking time had better general adjustment ( p = 0.02) and less functional restriction ( p = 0.01). Exercise and education were associated with higher mobility ( p = 0.06) and mental quality of life, respectively ( p = 0.09)., Conclusions:: Amputation level and knee joint salvage, prosthesis use, exercise and education were associated with better rehabilitation outcomes including ambulation, adjustment and quality of life in bilateral lower limb amputees from the 2008 Sichuan Earthquake., Clinical Relevance: The study examined a unique group of traumatic bilateral lower limb amputees who were young and healthy before having traumatic amputations from a single episode of natural disaster. The factors associated with better functional recovery after the earthquake were investigated and may support future development of post-disaster rehabilitation strategies for bilateral lower limb amputees.

Background: Diseases causing disabilities lead to sexual dysfunction. However, studies that evaluate sexual functions in patients with traumatic lower limb amputations (LLA) are limited and controversial., Objective: The objective is to evaluate sexual functions in male patients with LLA and to identify factors that might contribute to sexual dysfunction. The hypothesis is that male patients with LLA would experience worse sexual and emotional functioning and consequently emotional impairment that consequently influenced the sexual function., Methods: Sixty men with traumatic LLA and 60 healthy men were assessed according to the International Index of Erectile Function (IIEF) scoring system. Emotional state was assessed by the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and the quality of life by the Short Form-36 Health Survey (SF-36)., Results: Patients had significantly lower scores in the IIEF total score and subscores in comparison with the controls. Intercourse satisfaction scores were significantly higher (p< 0.05) in patients with trans-tibial amputation than in those with trans-femoral amputation. BDI and BAI scores negatively correlated with erectile function, sexual desire, intercourse satisfaction, overall satisfaction and total IIEF scores. The mental and physical scores of SF-36 significantly correlated with some of the sub scores and IIEF total scores. The power of statistical analysis for study population was 100% according to the given effect size (α= 0.01)., Conclusion: The present study suggests that the LLA leads to impairments in the sexual function and quality of life in male patients. Also, sexual dysfunction in patients is strongly associated with emotional state, pain, level of amputation and quality of life.

Purpose Amputation is a life changing event that can significantly impact an individual's physical and mental well-being. Our objective was to review literature exploring the impact of amputation upon a person's functioning and inclusion in the workplace. Methods Medline, CINAHL, and PsycINFO were searched using keywords related to amputation, employment and community reintegration. Eligible studies were published since 2000 and one of the following study designs: randomized controlled trial, non-randomized controlled trial, retrospective study, prospective study, concurrent cohort study, or cross sectional study. Studies for civilians with amputation as well as service members and Veterans with amputation were considered for inclusion. Results The search identified 995 articles, 25 of which met inclusion/exclusion criteria and were included in the review. While strong evidence for correlations and predictors of outcomes after amputation were limited, multiple factors were identified as contributing to physical functioning and employment after amputation. Conclusions Outcomes after amputation can vary widely with many potentially inter-related factors contributing. The factors identified may also serve to inform the development of interventions aiming to improve functional performance and reintegration after amputation. Furthermore, the review highlights the need for more high quality prospective studies.

Background:  After thumb amputations, restoration of function and aesthetic can be accomplished with microvascular free toe flaps. However, many patients in clinical practice do not choose this reconstruction despite positive reported outcomes. This study aims to determine patients' perceptions with respect to free toe flaps to improve areas of informed consent., Methods:  A retrospective survey was administered to patients with thumb amputations. Participants were required to complete a questionnaire about patient demographics, the Brief Michigan Hand Questionnaire (bMHQ), the standard gamble/time trade-off questionnaires for utility scores, and a questionnaire investigating potential reasons for electing not to undergo a free toe transfer., Results:  Thirty patients were enrolled in the study wherein 53% underwent a replantation procedure, 27% a revision amputation, and 20% a delayed reconstruction. Mean normalized score on the bMHQ was recorded as 63.54. Utility questionnaires yielded mean measures of 0.8967 and 0.86 on the standard gamble and time trade-off, respectively. From 14 elements, a majority (87%) stated flap failure as a major source of concern, followed by lack of understanding of risks and benefits (80%) and prolonged hospital stay (53%). Cultural/religious beliefs, aesthetic appearance of the foot, and concerns about footwear were not reported as important reasons in 90, 80, and 79% of patients, respectively., Conclusion:  A better understanding of patients' attitudes and beliefs with respect to free toe flaps will allow surgeons to better address their concerns during informed consent. This study emphasizes the importance to discuss about failure rates, risks, and benefits of the operation and prolonged hospital stay., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

A few severe hand injuries represent a gray zone for the reconstructive surgeon, for which autologous tissue transfer and allotransplantation can yield satisfactory results, but not without downsides or morbidity.This article is written to address the dilemma of application of both techniques in those selected cases., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Background:  Traumatic amputation of one or more digits can have a serious detrimental effect on social and economic standings which can be mitigated by successful replantation. Little has been recorded on preoperative management before replantation and how this affects the outcomes of the replanted digit., Methods:  A retrospective cohort study was conducted and data collected over an 18-month period. Three protocols for preoperative management were examined: minimal (basic wound management), complete Buncke (anticoagulation, dry dressing on amputate placed on indirect ice and absence of a digital block), and incomplete (any two or three criteria from complete Buncke in addition to the minimal) protocols. Data was collected on survival rate, secondary operations, and complication rate. Function was defined by sensation, range of movement, and strength., Results:  Seventy four of 177 digits were replanted with an overall survival rate of 86.5%. The rates for minimal, incomplete, and complete protocols were 95%, 87%, and 91%, respectively, and not significantly different. The complication rate was significantly different between the complete (20%) and minimal (60%) protocols ( p  = 0.0484). Differences in sensation and grip strength were statistically significant between protocols ( p  = 0.0465 and p  = 0.0430, respectively). Anticoagulation, no digital block and dry gauze all showed reduced complication rates in comparison to their counterparts., Conclusions:  The Buncke protocol, which includes anticoagulation, no digital block, and dry gauze, was found to significantly reduce the complication rate which suggests that it prevents compromise of tissue integrity. Significant differences were found between protocols for sensation and grip strength. A higher-powered study is needed to investigate the effects of preoperative management on complication rates and functional outcomes., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Background: Service members who have experienced combat trauma with resulting amputation are at risk for compromised quality of life postamputation. Monitoring mental and physical health in amputees returning from the war is of paramount importance. This study examined changes in physical and mental health-related quality of life in service members following traumatic unilateral, transtibial amputation (TTA) during a 12-week period of rehabilitation before and after receiving a prosthesis., Method: This study is a secondary analysis from a randomized controlled trial (RCT) of military service members starting Military Amputee Rehabilitation Program (MARP) following a traumatic TTA. The study examined change in SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores as two aspects of health-related quality of life. Forty-four injured service members, aged 19 to 46, were recruited into the RCT. Participants were randomized into 12 weeks of MARP plus home neuromuscular electrical stimulation therapy (n = 23) or MARP alone (N = 21) and compared at baseline, 6, and 12 weeks on: SF-36 PCS and MCS scores. Linear mixed models examined time and group differences and their interaction for the MCS and PCS scores. A multivariate mixed model tested whether MCS and PCS scores differed., Results: For the combined rehabilitation cohort, MCS did not differ over 12 weeks (p = 0.27) with scores at week 0 of M = 56.7 (SD = 11.9) and at week 12 of M = 52.7 (SD = 11.4), similar to healthy controls (age = 25-34, M = 51.0, SD = 7.6). Scores did not differ between treatment groups (p = 0.28) with no group by time interaction (p = 0.34). The MCS significantly declined over time (p = 0.05) after adjustment for covariates. PCS improved over 12 weeks (p < 0.0001) in the total rehabilitation group with scores at week 0 of M = 34.0 (SD = 8.1) to M = 41.8 (SD = 8.4) at week 12, significantly lower than healthy controls (age = 25-34, M = 54.1, SD = 6.6). Scores did not differ between treatment groups (p = 0.89), and there was no group by time interaction (p = 0.34). An interaction between the PCS and MCS was observed such that the PCS improved over time, whereas the MCS did not significantly change (p = 0.0005)., Discussion: War-injured transtibial amputees are at risk for compromised quality of life during rehabilitation. Self-perceived physical health improved as might be expected from rehabilitation. Self-perceived mental health did not. During rehabilitation, physical healing, psychological adjustment, and lifestyle adaptation are occurring simultaneously. However, more attention may need to be directed toward mental health during rehabilitation., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)

Purpose  Penile replantation is an uncommonly performed procedure, which can alleviate physical and psychosocial sequelae of penile amputation. This study critically appraises the current literature on penile replantation. Methods  A comprehensive literature search of the Medline, PubMed, and Google Scholar databases was conducted with multiple search terms related to penile replantation. Data on outcomes, complications, and patient satisfaction were collected. Results  A total of 74 articles met inclusion criteria. One hundred and six patients underwent penile replantation, but outcome, complication, and satisfaction data were not standardized across all patients. Penile amputation most often resulted from self-mutilation or trauma. The majority were complete amputations (74.8%). Full sensation was maintained in 68.4% of patients. Most reported adequate urinary function (97.4%) and normal erection (77.5%). Skin necrosis (54.8%) and venous congestion (20.2%) were the most common complications. Urethral stricture (11.0%) and fistula (6.6%) were common urethral complications. Most (91.6%) patients reported overall satisfaction although there was a lack of patient-reported outcomes. Multivariate analysis suggested that complete amputation (β = 3.15, 95% CI 0.41-5.89, p  = 0.024), anastomosis of the superficial dorsal artery (β = 9.88, 95% CI 0.74-19.02, p  = 0.034), and increasing number of nerves coapted (β = 1.75, 95% CI 0.11-3.38, p  = 0.036) were associated with favorable sexual, urinary, and sensation outcomes. Increasing number of vessels anastomosed (β = -3.74, 95% CI -7.15 to -0.32, p  = 0.032) was associated with unfavorable outcomes. Conclusion  Although penile replantation is associated with complications, it has a high rate of satisfaction and efficacy. Coaptation of multiple nerves and anastomosis of the superficial dorsal artery should be completed., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objectives: To conduct a systematic review of community integration measures used with populations with limb trauma, amputation, or both, and to evaluate each measure's focus, content, and psychometric properties., Data Sources: Searches of PubMed and CINAHL for the terms social participation, community integration, social function, outcome assessment, wounds and injuries, and amputation/rehabilitation., Study Selection: Included English-language articles with a sample size of ≥20 adults with limb trauma or amputation. Measures were deemed eligible if they contained a majority of items related to the construct of participation as defined by the International Classification of Functioning, Disability and Health., Data Extraction: Data on internal consistency; test-retest, interrater, and intrarater reliability; content, structural, construct, concurrent, and predictive validity; responsiveness; and floor/ceiling effects were extracted from each article and confirmed by a second investigator., Data Synthesis: A total of 156 articles containing 34 measures and 94 subscales were reviewed. Psychometric properties were rated, and an overall score was calculated for each measure. Content of the highest scoring measures was examined. Scant evidence was found regarding the psychometric properties of most measures. Eight scales from 5 instruments had the strongest measurement properties: the Trinity Amputation and Prosthesis Experience (TAPES) social restriction and adjustment to limitation scales; Community Reintegration of Injured Service Members (CRIS) extent of participation and perceived limitations scales; Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) role-physical and social functioning scales; the 136-item Sickness Impact Profile (SIP) psychosocial domain scale; and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS-II) 12-item total score., Conclusions: Eights scales from 5 instruments-the TAPES, CRIS, SF-36, the 136-item SIP, and the WHODAS-II 12-item measure-had the strongest measurement properties., (Published by Elsevier Inc.)

Injuries to the hand during military combat operations, particularly from improvised explosive devices (IEDs) have a significant impact on form, function, mental health and future employment but remain underreported amidst the life and limb-threatening emergencies that garner more attention. An understanding the patterns of hand injuries encountered from IEDs is crucial to optimizing reconstruction and rehabilitation. The aim of this study was to re-evaluate hand injury sustained from IED in order to understand the clinical burden for reconstruction and direct the focus for future hand protection. We identified 484 hand injuries in 380 patients sustained as a result of IEDs among military personnel service in Afghanistan between 2006 and 2013. 53% of all surviving military personnel injured by IEDs sustain injuries to the hand. Analysis of the 103 patients who sustained injury to the metacarpal, phalanges or digital amputation revealed that the middle and ring fingers are most commonly injured. Amputation to the ring finger is strongly associated with injury to the adjacent fingers and amputations to the middle, ring and little fingers concurrently is a commonly observed pattern. The proximal phalanges of the middle and ring fingers had a strong correlation for fracture together. These findings disprove the conventional belief in an ulnar focus of injury and support the quest for a development of combat hand protection that addresses the injury pattern seen., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: The aim of this study is three fold: 1) to introduce epidemiologic data of patients with trauma-related amputations as a 10-year experience of a rehabitation center; 2) to determine comorbidities and secondary conditions of lower limb loss; 3) to determine the rehospitalization reasons for lower limb amputee patients., Materials and Methods: This retrospective study was conducted in a tertiary rehabilitation center in Turkey. Clinical and demographic data of amputees including sex, age, employment status, time since amputation, time after amputation to first hospitalization, length of hospitalization, how many times the patient was hospitalized, reason for hospitalization, stump complications, comorbid conditions, amputation level and K classifacation were documented., Results: Three hundred ninetynine patients with a mean age of 23,48±6,04 (4-74) years were included in this study. Mean duration after amputation was 119,71±68,86months. Patients were 3,43±2,53 times hospitalized. Landmine explosion was the most common etiology of amputation with 370 patients (92.7%). Below knee amputation was the most common amputation level with 230 (50,77%) amputations. 399 patients were hospitalized 1369 times and the most common hospitalization reason were stump complications (356 times, 26,00%). Spur formation (202 times) was the most common stump complications. Pyscologic disorders were the most common comorbidity with 68 patient (37,56%)., Conclusion: Patients with traumatic limb amputations are likely to experience several complications and comorbidities. Prevention of secondary conditions affecting those living with the loss of a limb is an important part of amputee rehabilitation and may prevent rehospitalization., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Amputation is a traumatic incident that entails a chain of psychological, physical, and social events. The objectives of the study are to describe the beliefs and the philosophies of life related to the experience of suffering of traumatic amputees, analyze the importance of biomedical care, and describe other forms of care used.

This article explores unique considerations that face both women living with limb loss and their health care providers. This demographic of patient has a higher rate of artificial limb rejection, thus challenging providers to address needs for cosmesis and function that varies from those of male counterparts. Health care providers for women with amputations, such as the Veterans Affairs, must evolve health care delivery, research practices, and work jointly with industry in order to meet the needs of this population., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)

Objective: To define clinical phenotypes of postamputation pain and identify markers of risk for the development of chronic pain., Design: Cross-sectional study of military service members enrolled 3-18 months after traumatic amputation injury., Setting: Military Medical Center., Subjects: 124 recent active duty military service members., Methods: Study subjects completed multiple pain and psychometric questionnaires to assess the qualities of phantom and residual limb pain. Medical records were reviewed to determine the presence/absence of a regional catheter near the time of injury. Subtypes of residual limb pain (somatic, neuroma, and complex regional pain syndrome) were additionally analyzed and associated with clinical risk factors., Results: A majority of enrolled patients (64.5%) reported clinically significant pain (pain score ≥ 3 averaged over previous week). 61% experienced residual limb pain and 58% experienced phantom pain. When analysis of pain subtypes was performed in those with residual limb pain, we found evidence of a sensitized neuroma in 48.7%, somatic pain in 40.8%, and complex regional pain syndrome in 19.7% of individuals. The presence of clinically significant neuropathic residual limb pain was associated with symptoms of PTSD and depression. Neuropathic pain of any severity was associated with symptoms of all four assessed clinical risk factors: depression, PTSD, catastrophizing, and the absence of regional analgesia catheter., Conclusions: Most military service members in this cohort suffered both phantom and residual limb pain following amputation. Neuroma was a common cause of neuropathic pain in this group. Associated risk factors for significant neuropathic pain included PTSD and depression. PTSD, depression, catastrophizing, and the absence of a regional analgesia catheter were associated with neuropathic pain of any severity., (Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.)

Introduction: In this retrospective study, the impact of age, amputation level and the cause of amputation were examined using the Hospital Anxiety and Depression Scale (HADS) and Medicare K scores of amputees with unilateral lower-limb amputation., Materials and Methods: In total, 135 patients with unilateral transfemoral (TF) or (TT) transtibial amputations were examined. All data were collected using questionnaires that were either self-administered or administered during an interview. The HADS was developed as a self-reporting questionnaire to detect adverse anxiety and depressive status. K code is used to describe the functional abilities of amputees., Results: The mean age at the time of surgery was 52.79 ± 13.08 years. The mean time since amputation was 59.20 ± 24.41 months for TT, and 60.89 ± 22.09 months for TF amputation. The HADS-A scores of the transfemoral amputation group were determined as significantly high compared to those of the transtibial group (p < 0.05). The K index of the group aged 35 years and below was significantly higher than that of the other groups (p 0.002, p 0.001, p < 0.01)., Conclusion: The data show higher HADS-A scores with traumatic transfemoral amputation. Therefore, adequate psychiatric evaluation and rehabilitation should be applied to all amputees, especially in cases of young, traumatic, transfemoral amputations., Level of Evidence: Level 3, retrospective comparative cohort study.

Objective: The objective of this study was to determine if wrestling is a safe, positive athletic option for limb-deficient individuals., Design: This descriptive study consisted of an opportunity sample of limb-deficient wrestlers, aged 5 yrs and older with at least 1 yr of experience. Participants completed a questionnaire regarding health, satisfaction, and achievements. Descriptive statistics were used for analysis., Results: Sixteen male wrestlers reported nine below-the-knee, five above-the-knee, and three below-the-elbow limb deficiencies. There were nine congenital deficiencies and seven amputations acquired during childhood. Two individuals won National Collegiate Athletic Association championships, and seven competed collegiately. All reported a positive impact on quality-of-life, 87% reported no difficulty finding acceptance with the team, and 50% experienced wrestling-related residual limb complications. Associations between (1) residual limb complications before and during wrestling and (2) skin breakdown before and during wrestling did not demonstrate statistical significance (P = 0.30 and 0.1189, respectively)., Conclusions: This study suggests that wrestling is a safe, positive sport for limb-deficient individuals, that it fosters competitive equality between impaired and nonimpaired participants, and that it has a positive impact on health and quality-of-life. The incidence of residual limb complications warrants monitoring.

The aim of this study was to establish the effect that wounds had on the rehabilitation of traumatic amputees from the military patients' perspective. In particular it established which aspects of wound healing had the greatest impact in relation to living with a wound and the effect that military cohesion had on their recovery. The study was undertaken within the interpretivistic paradigm and followed an ethnographic design using semi-structured interviews. It contributes to the theoretical understanding of rehabilitation of the combat injured as no other study has been undertaken in this area in the UK. It captured the responses of this unique group as they reach the end of their journey through rehabilitation and detailed their reflections on the challenges they had faced and overcome. Analysis revealed that complications including infection, pain, foreign bodies and further surgery prevented the wounds from healing. The participants found this frustrating and they further highlighted time as an important factor in their journey. The military environment formed a culture in which patients learned from, and were supported by, each other. This was compared to a community of practice. In conclusion suggestions were made for practice, policy and education and further research in this area., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Traumatic arm amputations can be treated with replantation or surgical formalization of the stump with or without subsequent prosthetic fitting. In the literature, many authors suggest the superiority of replantation. This systematic review compared available literature to analyze whether replantation is functionally and psychologically more profitable than formalization and prosthetic fitting in patients with traumatic arm amputation., Methods: Functional outcome and satisfaction levels were recorded of patients with amputation levels below elbow, through elbow, and above elbow., Results: Functional outcomes of 301 replantation patients and 172 prosthesis patients were obtained. In the replantation group, good or excellent functional scores were reported in 39% of above elbow, 55% of through elbow, and 50% of below elbow amputation cases. Nearly 100% of patients were satisfied with the replanted limb. In the prosthesis group, full use of the prosthesis was attained in 48% of above elbow and in 89% of below elbow amputation patients. Here, 29% of patients elected not to use the prosthesis for reasons including pain and functional superfluity. In both replantation patients and prosthesis wearers, a below elbow amputation yielded better functional results than higher amputation levels., Conclusions: Replantation of a traumatically amputated arm leads to good function and higher satisfaction rates than a prosthesis, regardless of the objective functional outcome. Sensation and psychological well-being seem the two major advantages of replantation over a prosthesis. The current review of the available literature shows that in carefully selected cases replantation could be the preferred option of treatment.

Purpose: The aim of this study was to explore how family members perceive and support young people with traumatic physical injury during the acute phase of hospital care., Methods: This study forms part of the qualitative explanatory follow-up phase of a mixed methods study. The paper reports on family members' experiences of providing support to young people 16-24 years admitted with major traumatic injury to an Australian Level 1 Trauma Centre. Semi-structured in-depth interviews with family members were conducted and transcribed verbatim. Data were managed using NVivo software, and thematically analysed., Findings: Family support was determined by how family members perceived the injury. Driven by a need to protect the injured young person, family members sought to control potential emotional impacts of injury, creating a buffer between the young person and other people including healthcare professionals. Family members safeguarded the psychological well-being of the young person, in an attempt to facilitate their transition back to independence., Conclusion: This study identifies iterative changes in family relationships and emotional and practical support provided by family members during the initial injury trajectory, extending understandings of the broader burden of injury. Key elements of family stress theory offer a useful framework for the development of anticipatory guidance for clinicians that are responsive to the emotional needs of patients and families, supporting the need for a family-centred care approach to managing major traumatic injury in young people., (Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.)

Study Design: Qualitative descriptive., Introduction: The lack of sensory feedback in today's hand prostheses has been in focus recently but the amputees' experiences need to be further investigated., Purpose: To explore forearm amputees' views of prosthesis use and sensory feedback., Methods: Thirteen unilateral congenital or traumatic forearm amputees were interviewed. The transcribed text was subjected to content analysis., Results: Prostheses both facilitate and limit occupational performance. Appearance is important for identity and blending into society. The feeling of agency regarding the prostheses is present but not that of body ownership. Future expectations concerned improved mobility, cosmetics, and sensory feedback., Conclusions: This study allows a deeper understanding of the complex relationship between a prosthetic device and the wearer. Today's prostheses allow the wearer to feel agency concerning the artificial limb but the lack of sensory feedback seems to be an important factor still blocking the achievement of body ownership of the prosthesis., Level of Evidence: Not applicable., (Copyright © 2015 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

The objective of this study was to compare the functional outcomes of zone II amputations treated with either replantation or revision amputation at our institution to better aid patients in their decision making process regarding these treatment options. We conducted a comparative retrospective study. All cases of single digit amputations received at our replantation center between 2007 and 2011 were screened for single digit zone II injuries. These patients were stratified based on the treatment received: replantation vs revision amputation. Patients were called and invited to participate in the research project. Those who accepted to enter the study were asked to complete the Quick-DASH, the Beck Depression Inventory-short form, and a custom made questionnaire. There were seventeen patients with single digit zone II replantation and fourteen patients with similar injuries who underwent revision amputation and agreed to take part in the study. Our data revealed that the duration of sick leave, occupation after injury, professional and social reintegration, discontinued activities, and self-confidence were not statistically different between the two groups. The average hospital stay and the follow-up period of replanted individuals were longer. The replantation group did not have higher levels of pain or cold intolerance, and the global functional and esthetic satisfaction levels were similar between the two groups. Also, Beck Depression Inventory and Quick-DASH scores were not statistically different. Yet, significantly more patients in the replantation group would opt to repeat the replantation than revised patients would opt for revision amputation. From a functional viewpoint, our study suggests that revision amputation is not superior to replantation in zone II single digit amputations. This is valuable information that should be given to patients when deciding on the treatment process and to insure a proper informed consent., (Copyright © 2015. Published by Elsevier Ltd.)

In a cross-sectional study, 291 out of 500 veterans with war-related bilateral lower limb amputations from Iran-Iraq war (1980-1988) accepted to participate in our study. Information related to amputees and amputated limbs were gathered and a Persian version of the Medical Outcomes Study Short Form 36 (SF-36) was filled. To evaluate the effect of amputation level on health related quality of life, we classified patients to seven types according to the functional remainder of major joints (ankles, knees, hips). 97% of patients were male and the average age at the time of injury was 20 years. The major cause of war injury was shells in 50. 54% of amputees were involved in sport activities. The most common amputation level was transtibial (48%).The major stump complaint was muscle spasm. History of being hospitalized for a psychiatric disorder was reported in 5.6%. The average SF-36 score in type 2 to type 6 were 68, 60, 60, 56, and 62, respectively. Except Energy/Fatigue domain, all the other domains were different from normal population. There was not any significant statistical correlation between amputation type and any domain of the SF-36. Type 6 amputees showed an increase in physical health domains compared with former types., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The present research aimed to determine if partners' involvement in the rehabilitative care of people who have undergone an amputation predicted their wellbeing using a quantitative, cross-sectional design. Partners of people with an amputation were contacted through amputation-related advocacy groups and asked to complete an online questionnaire. Full data were collected from 66 participants who completed demographic information and measures of perceived social support, involvement in partner's rehabilitative care, depression and posttraumatic growth. Predictors into the two regression models were chosen based on their zero-order correlations with the outcome variables. Only time since amputation and degree of prosthesis use were correlated with posttraumatic growth. Time since amputation, time in relationship and partner's involvement in rehabilitative care were negatively correlated with depression. Both models (posttraumatic growth and depression) were significant. Involvement in partner's care was an independent significant predictor for depression. More involvement in partners' rehabilitative care was a significant predictor of less depression for partners of people with an amputation. The present research provides tentative evidence in support of the planned inclusion of partners by amputation rehabilitation services. Future research is needed to determine how robust this finding is.

Background: Traumatic amputation can result in multiple physical, psychological and socio-economic sequalae. While there has been a significant increase in investment and public profile of the rehabilitation of patients who have experienced traumatic limb amputation, little is known about the prevalence of anxiety and depression, especially in the long term., Objective: To determine the association between traumatic limb amputation and anxiety and depression., Data Sources: A literature search of available databases including Cochrane, Medline, Embase, and PsycINFO was performed for relevant studies since 2002. Secondary outcomes included the effect on employment, substance misuse, relationships and quality of life., Selection Criteria: Randomised control trials, observational studies or reviews which met the inclusion, exclusion and quality criteria., Results: Levels of anxiety and depression are significantly higher than in the general population. Significant heterogeneity exists between studies making meta-analyses inappropriate. Improved rehabilitation is having a positive effect on employment rates. There appears to be no significant effect on substance abuse and relationships., Conclusions: All studies demonstrated high prevalence of anxiety and depression in post-traumatic amputees. No good prospective data exists for levels of anxiety and depression beyond two years of follow up and this should be an area of future study., (Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.)

Individuals experience multiple changes as a result of amputation. These changes not only are physical in nature but also may include psychological, financial, and comfort changes across the spectrum of an individual's life. It is important to assess the emotional responses that an individual may experience postsurgery and throughout the rehabilitation process. Grieving is a natural and normal emotional response postamputation. Grief resolution is one of the primary areas of focus in counseling amputees. This article examines various factors and strategies used in the adaptation and recovery from amputation., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The amputee gets lost in the American health care system because of fragmentation across the continuum. The journey of the diabetic patient with limb loss through the health care system is even more precarious than that of the traumatic amputee. Interventions to address these secondary conditions and improve the health and outcomes of persons with disability have focused on standard medical treatments, such as medication or physical rehabilitation therapies, often to the exclusion of psychosocial interventions. Each member of the amputee rehabilitation team plays a specific and important role in the care and recovery of the person with limb loss., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV) morphine (vs IV fentanyl) after injury was associated with reduced likelihood of posttraumatic stress disorder (PTSD). The previous results were based on military health diagnoses over 2 yr postinjury. The present study followed psychological diagnoses of patients with amputation for 4 yr using military and Department of Veterans Affairs health data. In-theater combat casualty records (n = 145) documented Glasgow Coma Scale (GCS) scores and/or morphine, fentanyl, or no opioid treatment within hours of injury. We found that (1) GCS scores were not significantly associated with PTSD; (2) longitudinal modeling using four (yearly) time points showed significantly reduced odds of PTSD for patients treated with morphine (vs fentanyl) across years (adjusted odds ratio = 0.40; 95% confidence interval = 0.17–0.94); (3) reduced PTSD prevalence for morphine (vs IV fentanyl; morphine = 25%, fentanyl = 59%, p < 0.05) was significant, specifically among patients with traumatic brain injury during the first 2 yr postinjury; and (4) PTSD prevalence, but not other disorders (e.g., mood), increased between year 1 (PTSD = 18%) and years 2 through 4 postinjury (PTSD range = 30%–32%).

The first hand allograft transplantation was performed in 1998 by a French surgeons team and has opened the era of functional allotransfers. In France, the authorized preliminary study included five patients who sustained traumatic amputation of both hands. All patients had bilateral hand allograft transplantation. Long-term results (follow-up ranging from 3 to 12 years) undoubtedly show a useful daily function, a good psychological acceptance and a physiological integration. Despite several obstacles as the need of immunosuppressive therapy for life, hand allograft transplantation is worthy of interest in some outstanding situations., (Copyright © 2013. Published by Elsevier Masson SAS.)

By presenting 2 cases of successful hand replantation with similar trauma mechanism, level of amputation and ischaemia time of an 18-year-old female patient and a 48-year-old depressive male patient, the influence of age and sociomedical status on the postoperative outcome is discussed. DASH- (disabilities of the arm, shoulder and hand) score and Biometrics E-LINK power and sensitivity measurement were used to evaluate the outcomes., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The purpose of this study was to identify the differences seen between military occupation services (MOS) in terms of amputation patterns, subsequent disabling conditions, and their ability to return to duty., Methods: A retrospective study of major extremity amputations sustained by US service members between October 1, 2001, and July 30, 2011, was performed. Data obtained from the amputation database, Joint Trauma Theater Database, and the Physical Evaluation Board Liaison Office included demographics, amputation location(s), Injury Severity Scores (ISSs), disabling conditions, disability ratings, and disposition status., Results: There were 1,221 major extremity amputees identified during the specified time frame, of which 899 had data regarding disabling conditions, ratings, and disposition. All service branches were represented. Personnel from the US Army (USA) Infantry were significantly (p < 0.0001) more likely to sustain an amputation than other MOS. The USA Infantry, the US Marine Corps Infantry and the USA Armor represented the top three specialties and accounted for more than 57% of all amputees. Approximately 89% of all service members did not return to duty, and the mean combined for all amputees was 76. USA Special Forces (USA SF) operators were significantly more likely to return to duty (p = 0.0022) and be found fit for duty (p = 0.0015) than all other MOS despite having a mean ISS (20) that was no different from those of other service members. No USA SF personnel were found to have posttraumatic stress disorder as a disabling condition., Conclusion: All amputees, regardless of MOS, are not likely to return to active duty and especially unlikely to be found fit for duty, except for members of the USA SF. The reason(s) for the increased return to duty for USA SF personnel remains unknown but a lack of posttraumatic stress disorder may be a contributing factor.