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Patients with amputations often fail to tolerate conventional sockets resulting in complications that cause pain, skin breakdown, and improper prosthesis fit. Osseointegration allows direct attachment of an external prosthesis to the skeleton providing enhanced biomechanical advantage as well as rehabilitation potential to the patient. Multiple percutaneous implant systems exist with varying level of clinical use internationally. The purpose of this chapter is to review the history of osseointegration, osseointegration technique, implant examples, published research, and reported outcomes.

Trauma is the main cause of physical loss of an eye by evisceration or enucleation of the globe. Immediate or early removal of an eye may be required, or removal of the globe may be undertaken as a secondary procedure. From a cosmetic viewpoint, the aim of reconstructive surgery is to create a healthy cavity within the orbit to support an implant or external prosthesis and to minimise any asymmetry with the opposite eye, using a pain-free implant/prosthesis. Choice of implant depends mostly on the surgeon’s preferences and its cost. These are discussed.

This case series present the surgical management of cases with severe contracted sockets using a split-skin-graft wrapped conformer. Eight patients with severely contracted anophthalmic sockets underwent surgery. The surgical technique is described and a chart review was performed to collect patient data pre- and postoperatively. Preoperatively, all patients had grade 3 or 4 contracted sockets with shallow or obliterated fornices and patients were unable to retain an external prosthesis in place. Donor material was harvested from the supraclavicular area. The split-skin-graft was successfully performed in all cases without fornix-deepening sutures. All patients underwent a significant improvement of socket contracture enabling retention of the prosthesis and were satisfied with the outcomes. The split-skin-graft wrapped conformer is a rapid and less surgically challenging option to correct severe contracted anophthalmic sockets.

Osseointegration is a surgical approach that permitted the direct attachment of an external prosthesis to the skeleton in some select patients with amputation, who had failed to tolerate conventional sockets, thereby obviating related issues such as discomfort, skin breakdown, and poor fit. In this specific population, osseointegration offers the potential for enhanced biomechanical advantage and rehabilitative potential. Multiple percutaneous implant systems exist for clinical use internationally, each attempting to create a stable bone-implant interface while avoiding complications such as infection and loosening. Prospective clinical trials are now underway in the United States. This article will review the history and biology of osseointegration, indications and contraindications for use of currently available implant systems, and reported outcomes. Future directions of orthopaedic osseointegration technology, including electronic systems capable of biomimetic bidirectional volitional motor control of, and sensory/proprioceptive feedback from, external prosthetic devices, will also be discussed.

Osseointegration (OI) is the direct anchorage of a metal implant into bone, allowing for the connection of an external prosthesis to the skeleton. Osseointegration was first discovered in the 1960s based on the microscopic analysis of titanium implant placed into host bone. New bone was observed to attach directly to the metal surface. Following clinical investigations into dentistry applications, OI was adapted to treat extremity amputations. These bone anchored implants, which penetrate the skin and soft tissues, eliminate many of the challenges of conventional prosthetic sockets, such as poor fit and suspension, skin breakdown, and pain. Osseointegrated implants show promise to improve prosthesis use, pain, and function for amputees. The successful process of transcutaneous metal integration into host bone requires three synergistic systems: the host bone, the metal implant, and the skin-implant interface. All three systems must be optimized for successful incorporation and longevity of the implant. Osseointegration begins during surgical implantation of the metal components through a complex interplay of cellular mechanisms. While implants can vary in design-including the original screw, press fit implants, and compressive osseointegration-they face common challenges to successful integration and maintenance of fixation within the host bone. Overcoming these challenges requires the understanding of the complex interactions between each element of OI. This review outlines (a) the basic components of OI, (b) the science behind both the bone-implant and the skin-implant interfaces, (c) the current challenges of OI, and (d) future opportunities within the field.

Drug-coated balloon (DCB) is a relatively novel device for coronary and peripheral artery disease management [1]. It consists in a conventional balloon angioplasty covered by an antiproliferative drug. This technology allows to bring high concentration of an antiproliferative drug with rapid local delivery without the implantation of an external prosthesis like a metal stent or a scaffold, technologies associated with some late-occurring thrombotic events. In this light, the shorter dual antiplatelet therapy (DAPT) duration usually required with DCB may be an advantage because it warrants a reduced bleeding risk, especially in high-risk and compromised patients.

PURPOSE The aim of thhis study was to present the outcomes of postauricular split-medium thickness skin graft (SMTSG) to treat anophthalmic sockets with contracted fornices. METHODS This case series enrolled patients with grade 2 or 3 anophthalmic sockets between 2015 and 2016. Data were collected on patient demographics, objective and subjective parameters preoperatively and 180 days postoperatively. Success of the surgery was graded on the height of the graft, the depth of the superior and inferior fornices, and presence/abscence of lagophthalmos, entropion, and ability to retain an external prosthesis. RESULTS Eighteen patients were enrolled with a mean age of 35.9 ± 18 years. The median height of the graft was 22 mm (25% quartile = 18.75) when removed and 20 mm (25% quartile = 16) postoperatively. The median depth of the superior fornix was 6.5 mm (25% quartile = 4.5 mm) preoperatively and 10 mm (25% quartile = 8 mm) postoperatively (P = 0.5). The median inferior fornix depth was 7 mm (25% quartile = 3.5 mm) preoperatively and 8 mm (25% quartile = 5 mm) (P = 0.27) postoperatively. Preoperatively, there were 13 (72.2%) patients with lagophthalmos, 10 (44.4%) with entropion, 3 (37.5%) with poor prosthesis retention, and 5 (62.5%) who were unable to retain the prosthesis. Postoperatively, 7 (38.9%) patients had lagophthamos, 1 (5.6%) had entropion, and all the patients could retain the prosthesis. None of the sockets had a foul odor postoperatively. CONCLUSIONS Postauricular SMTSG achieves successful outcomes for the treatment of contracted anophthalmic sockets, reshaping the anterior socket surface and deepening the fornices.

Prosthetic devices allow people with lower limb amputation to recover their autonomy. Currently, this autonomy is limited in several everyday life situations such as walking on a slope or in stairs. Embedded sensors, frequently integrated inside the prostheses, record kinematic and dynamic data during locomotion. In this context, this PhD thesis aims to contribute to the development of methods for the processing of data provided by these technologies to quantify and improve the adaptation of the prosthesis to the environment. These methods were applied and evaluated in the context of the use of a new prosthetic knee-ankle system controlled by microprocessor (SPCM) developed by Proteor to facilitate the locomotion in situations such as slope or downstairs walking for people with above knee amputation. The first part of the work was devoted to the quantification of the adaptations allowed by the SPCM in different situations of daily life (flat, slope, staircase). The second part of the thesis focused on the estimation of gait parameters (walking speed and slope inclination) and the classification of 4 everyday life situations (flat, slope ascent and descent, stair descent) using machine learning algorithms that can be computed by the SPCM in real time. The body of this work will make it possible to better quantify the user real life activity. This quantification could help the user or the medical team in the activity monitoring but also the manufacturer to improve the adaptation of the prosthetic components to the environment and to verify the SPCM actual use., L’appareillage permet à aux personnes amputées de membre inférieur de retrouver une autonomie de déplacement. Actuellement, cette autonomie est limitée dans certaines situations de la vie courante comme la marche en pente ou en escalier. Des capteurs dits embarqués sont de plus en plus souvent intégrés dans les prothèses et permettent d’enregistrer des informations cinématiques et dynamiques au cours de la locomotion. Dans ce contexte, l’objectif de la thèse est de contribuer au développement de méthodes de traitement des données issues de ces technologies pour quantifier et améliorer l’adaptation de la prothèse à l’environnement. Ces méthodes ont été mises en œuvre et évaluées dans le cadre de l’utilisation d’un nouveau système prothétique contrôlé par microprocesseur de genou-cheville (SPCM), développé par la société Proteor et visant à faciliter la locomotion des personnes amputées au-dessus du genou dans les situations de pente ou de descente d’escalier. La première partie de cette thèse a été consacrée à la quantification des adaptations permises par le SPCM au cours de la locomotion dans différentes situations de la vie courante (plat, pente, escalier). La deuxième partie de la thèse s’est intéressée à développer des estimations de paramètres de la marche (vitesse de marche et inclinaison de la pente) et à la classification de 4 situations de la vie courante (plat, montée et descente de pente, descente d’escalier) à l’aide d’algorithmes d’apprentissage automatique pouvant être calculé par le SPCM en temps réel. L’ensemble de ces travaux permettra de mieux quantifier l’activité réelle de l’utilisateur. Cette quantification pourrait aider l’utilisateur ou l’équipe médicale pour le suivi d’activité mais aussi le constructeur pour améliorer l’adaptation des éléments prothétiques à l’environnement rencontré et pour vérifier l’utilisation réelle du SPCM.

Made available in DSpace on 2018-11-26T17:55:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-09-01 Purpose: To evaluate the outcomes of dermis-fat graft procedure for orbital volume replacement in anophthalmic socket. Methods: A retrospective chart review was performed studying all dermis-fat graft surgeries done at King Khlaed Eye Specialist Hospital in the last 10-year period. Sixty-two anophthalmic socket carriers underwent dermis-fat graft during the study period. Data were collected on characteristics of the patients, postoperative complications, cosmesis, and functional results such as the ability to hold an external prosthesis. Results: Mean age of the patients included in the study was 34.2 +/- 9.7 years. There were 38.7% of patients with grade 3 anophthalmic socket, 64.5% of patients had an acquired anophthalmic socket, and dermis-fat graft was performed as a secondary procedure in 61.3% of patients. Postoperative complications included lagophthalmos (22.6%), graft necrosis (17.7%), pyogenic granuloma (12.9%), decreased graft size (12.9%), malpositioned lids (3.2%), and volume deficiency (3.2%). The prosthesis was held in place in 49 patients (79%) preoperatively and in 55 patients (88.7%) postoperatively. Conclusion: Dermis-fat graft is an excellent option for congenital or acquired as well as primary or secondary anophthalmic sockets, with or without contraction. The outcomes are favorable, and complications are rare. Rio Hortega Univ Hosp, Dept Ophthalmol, Dulzaina St 2, Valladolid 47012, Spain King Khalid Eye Specialist Hosp, Riyadh, Saudi Arabia Univ Estadual Paulista, Dept Ophthalmol, Fac Med Botucatu, Botucatu, SP, Brazil Univ Estadual Paulista, Dept Ophthalmol, Fac Med Botucatu, Botucatu, SP, Brazil

Due to the increase in life expectancy and the advances in techniques for detecting breast cancer, the number of women diagnosed with breast disorders has increased. The method commonly used for diagnosis is mammography, which has some limitations. Recent studies indicate that using infrared images has the potential to detect early neoplasms, since such images can detect changes in the surface temperature of the breast. This paper puts forward a methodology based on thermographic images for developing a reliable three-dimensional model of patients' breasts. By using this geometry, numerical simulations could be performed to determine temperature profiles, which were combined with data on temperatures measured by thermography, thus enabling thermophysical properties of mammary tissue and pathologies to be estimated. The model was developed using the breast profile curve obtained from the thermographic image and by adapting volumes of an Ortho Pauher external prosthesis. After sensitivity analyses, the Sequential Quadratic Programming (SQP) method was used to estimate the thermal conductivities of glandular and nodule tissues, using the maximum temperature in the lesion region as measured by the thermographic image. The results were compared with those of other authors and the values were measured by infrared camera, thereby validating the calculations reported.

Percutaneous osseointegrated prosthetics (POP), which consist of a metallic post attached to the bone that extends outward through the skin to connect to an external prosthesis, have become a clinically relevant option to replace the typical socket-residual limb connection. POP devices offer several advantages such as mechanical off-loading of soft tissues, direct force transfer to the musculoskeletal system, greater proprioception, and overall improvement in limb kinesis compared to a socket system. However, POP devices create several challenges including epidermal downgrowth, increased infection risk, and mechanical tearing at the skin-implant interface. To address these issues, biomimetic surfaces and coatings have been developed in an attempt to create an infection-free and cohesive interface between POP devices and skin. The fingernail is a prime example of a natural system with a skin interface that is both mechanically and biologically stable. Exploiting keratins’ previously demonstrated tissue compatibility and creating a biomimetic coating for POP devices that can imitate the human fingernail, and demonstrating its ability to promote a stable interface with skin tissue is the goal of this work. Silane coupling aided in producing a coating on titanium substrates consisting of human keratin proteins. Several combinations of silane and keratin derivatives were investigated, and in general showed a nano-scale coating thickness that supported skin cell (i.e. fibroblast and keratinocyte) adhesion. Initial enzyme-mediated degradation resistance was also demonstrated, but the coatings appeared to degrade at long time periods. Importantly, keratinocytes showed a stable phenotype with no indication of wound healing-like activity. These data provide justification to further explore keratin biomaterials for POP coatings that may stabilize the implant-skin interface.

The ReAbility Project is a solution that provides an alternative to wheelchair mobility for people with serious disabilities of the lower limbs, such as paraplegics, allowing them to stand and walk once again. This solution is achieved by utilizing an instrument called an “exoskeleton”.

BACKGROUND: The reconstruction of complex pelvic trauma or developmental bone abnormalities is challenging as it involves in-depth understanding of a complex three-dimensional structure. Advances in medical imaging and rapid prototyping allow for detailed pre-operative planning and manufacture of planning models, custom jigs and prostheses to make this type of surgery manageable with good results. METHODS: We report the reconstruction of a hip and proximal femur using planning models, jigs and custom prostheses produced by rapid prototyping methods. These tools helped to solve a complex problem and produced a good functional result for the patient RESULTS: In this case report the patient underwent the reconstruction of her right hip joint. She was unable to mobilise well independently prior to the surgery. The surgery provided her with a stable and functional hip joint. This allows her to mobilise independently with an external prosthesis. One year down the line she has a Fair MSTS score (14 of 30) CONCLUSION: Advances in medical imagining and rapid prototyping have produced planning and operative tools with which surgeons are able to solve complex problems safely and with good result. This technology has widespread use not only in orthopaedics but other surgical disciplines, and with increasing availability and improved cost effectiveness will be used more frequently in the future. Level of evidence: Level V (case report)

To minimize radial compliance mismatch between native arteries and vascular prostheses over the entire blood pressure range, a biomimetic woven prosthesis sample with a bilayer wall has been developed. Poly(trimethylene terephthalate) (PTT) filaments were used as the circumferential yarns in the inner layer to increase the radial compliance of the inner wall, and poly(ethylene terephthalate) (PET) filaments formed the outer layer to provide a strong and more rigid external prosthesis wall. The two layers were joined together axially along the sample's length by a stitched weave. By means of a special weave design, the cross‐section of the tubular sample included a circumferentially crimped outer layer woven around the inner layer. This bilayer wall structure allowed only the inner layer of the sample to deform radially under small loads equivalent to low normal physiological (diastolic) blood pressures. As the load increased, the inner layer stretched until it came into contact with the outer layer. At hi...

The main objectives of enucleation, evisceration or secondary orbital implants are to replace orbital volume and obtain good motility and adaptation of the implant and the external prosthesis. We describe our experience using autologous dermis graft sutured to Tenon and conjunctiva following evisceration, enucleation and any reconstruction requiring either a primary or secondary orbital implant, even those with large tissue loss.A retrospective case series of patients who received an autologous dermis graft to assist in closure of a Tenon's capsule and conjunctiva at the time of placement of secondary orbital implants or evisceration or enucleation with fornices retraction or tension in tissues. We also describe how and from where to take the dermis graft.72 patients were included and all received orbital porous polyethylene implants: 28 patients had secondary orbital implants, 36 patients had evisceration and 8 patients had enucleation. Implant size was 20 mm in most cases, but went to 22 mm. Follow-up ranged from 3 to 36 months. No intraoperative complications were observed in donor or receptor area. 8 cases had incipient ischemia of the dermis graft, but were treated and resolved with autologous serum.Implant exposure is due to bad surgical technique, an inadequate implant size or excessive tension on the suture. Dermis autologous graft allows moving the orbital implant anteriorly because it replaces surface to suture Tenon and conjunctiva without tension, so a good adaptation of a thinner external prosthesis is possible, resulting in better motility.

Modeling in vivo (on Wistar rats) was carried out by the method of complete integration of the prosthesis of an amputated extremity with a residuum; in this procedure the prosthesis is fixed to the residuum with a metal pylon one end of which is implanted into the bone of the residuum, while the other end traverses the residuum tissues and skin 5–7 cm above the residuum surface. This procedure includes not only successful implantation in the residuum bone, but also the possibility that the pores in the metal pylon can be filled with skin cells in the area of the pylon which traverses the tissues of the residiuum. The porous titanium pylon was implanted into the bone of experimental animals with amputated extremities. Penetration of bone and skin cells into the pores of the studied material was demonstrated, which provides tighter fixation in the bone and shows promise for the development of a natural cutaneous barrier to infection.

This study evaluated patient's satisfaction with immediate breast reconstruction (IBR) with silicone prosthesis. Special attention is paid to the differences in satisfaction, and specific prosthesis related complaints of IBR after prophylactic and oncological mastectomy. All women who were operated on between April 1995 and May 1999 at the Erasmus Medical Centre, Daniel den Hoed Cancer Centre received 1 year following operation a self-report questionnaire, concerning their perceived advantages of and satisfaction with IBR, their prosthesis-related complaints and various psycho-social variables. The most important perceived advantage of IBR was not to have to wear an external prosthesis (95%). Despite the fact that one third of the patients had specific prosthesis related complaints, 80% was satisfied with IBR and 88% would do it again. There was no significant difference in satisfaction between the prophylactic and the cancer group. Overall satisfaction is mostly influenced by cosmetics (r = − 0.58), info...

As many as 90% of women who have undergone mastectomy or lumpectomy for breast cancer surgery will choose to wear a breast prosthesis. To date, there has been little systematic exploration of experiences and preferences related to wearing external breast prostheses, especially with new products. For this qualitative descriptive study, 24 women were interviewed regarding their perspectives about the conventional breast prosthesis and 19 about their perspectives regarding a newly available custom-designed breast prosthesis. Women spoke about difficulties obtaining information regarding available breast prostheses options; the awkwardness of being measured and fitted for a prosthesis, especially with seemingly untrained staff; challenges in wearing an external prosthesis; and how a prosthesis can foster increased confidence, enhanced body image and self-esteem, and a sense of normalcy. All recommended that women must make an individual decision about wearing a breast prosthesis and emphasized how important it is to have information about options early in the cancer journey. The study findings can guide oncology nurses in educating women about breast prostheses.

The use of foreign materials to be used as implants within or outside the human body is not new. There are reports of more than 2000 years old which indicate the replacement of bone material in order to repair seriously damaged tissues. In the mid-nineteenth century it was attempted to repair human body parts using the materials available according to the technological advance of the time, unfortunately, these materials were mainly based on copper or bronze, suffering severe corrosion within the human organism's environment, and causing infections that also endangered the lives of patients. For this reason the prostheses used were basically external. Over the years (the late nineteenth and early twentieth century) were made several attempts to use different materials such as gold, glass and new alloys with better results. Advances in polymer chemistry and the development of new alloys in modern metallurgy during the second half of the twentieth century gave rise to a variety of materials for reconstruction and replacement of some tissues inside and outside the human body. In the case of ceramic materials, the development of modern technologies has led to new materials with chemical, physical and mechanical properties that make them an excellent choice for applications in dental and orthopedic implants. There are many ways to define a biomaterial, which has not been easy given the breadth of the term. In the European Society for Biomaterials Consensus Conference in 1986, was given the following definition: “Biomaterial is a material or substance, whether used alone or in making a medical device designed to interact with human tissues to monitor body functions or to treat pathological conditions of the same” (Mattox, 1992; Ravaglioli & Krajewski, 1992). A synonym for this is "biomedical material". All definitions include the word "material", which usually indicates a solid consistency substance used to manufacture an object, which may consist of living or nonliving materials. If the material is alive, then is called "graft" and those non-living, placed inside the body, are called "implants". With a more limited meaning, the so-called "prostheses" can be considered as "endoprostheses", if they are contained entirely within the body, or "exo-prosthesis"(or "external prosthesis") if they are completely out. In other hand, the "biocompatibility" of a biomaterial is defined as their ability to successfully fulfill a specific application, with an appropriate response of the host. That is, the biocompatibility means more than the fact that a material is not harmful in the body; it

The limitation of current prostheses is not the devices themselves but rather the lack of sufficient independent control sources. A system capable of reading intra muscular EMG signals would greatly increase the number control sources available for prosthesis control. We are developing a multichannel/multifunction prosthetic hand/arm controller system capable of receiving and processing signals from up to sixteen implanted bipolar differential electromyographic (EMG) electrodes. An external prosthesis controller will decipher user intent from telemetry sent over a transcutaneous magnetic link by the implanted electrodes. The same link will provide power for the implanted electrodes. This paper describes some of the technical aspects of the implant and telemetry design.

We are developing a multichannel/multifunction prosthetic hand/arm controller system capable of receiving and processing signals from up to sixteen Implanted MyoElectric Sensors (IMES). A BION/spl reg/ II package will house the implantable electrode electronics and associated circuitry. An external prosthesis controller will decipher user intent from telemetry sent over a transcutaneous magnetic link by the implanted electrodes. The same link will provide power for the implanted electrodes. Development of such a system will greatly increase the number of control sources available to amputees for control of their prostheses. This will encourage the design and fitting of more functional prostheses than are currently available.

This study evaluated patients’ motivations for, and satisfaction with, the treatment and information of immediate breast reconstruction (IBR) with a silicone prosthesis. It studied satisfaction more deeply by relating it to the quality of life, body-image and sexual functioning. Seventy-three patients who received mastectomy, followed by IBR with a subpectoral silicone prosthesis, completed a self-report questionnaire concerning their motivations for, perceived advantages of and satisfaction with IBR, the information received, quality of life, body image, and sexual functioning. Despite the fact that 50% of the reconstructions resulted in complications or complaints, 70% of the women were satisfied with the reconstruction and only 12% would never choose IBR again. Satisfaction was strongly correlated with the need for information. The higher the patient’s expectations, the higher their need for information. The most common perceived advantage of IBR was the avoidance of an external prosthesis. A majority of patients were satisfied with the breast reconstruction. However, a sizeable proportion needed more information about breast reconstruction and the use of the silicone prosthesis. To avoid too high expectations more attention should be given to possible complications and the moderate cosmetic results.

Chest wall resection (CWR) is occasionally required in cancer patients and may cause significant functional deficits. We report an instance where a rigid orthotic device was useful in rehabilitation. Such custom-made devices can improve the quality of life for cancer patients.

Congenital external ear anomalies can lead to severe psychological problems in children. These defects can be corrected by splinting in the first five days following the birth of the child, avoiding psychological problems and those arising from surgical treatment. An external prosthesis of flexible wire covered with a silicon tube is used. These are attached with surgical tape and are kept on for 2–3 weeks. This treatment has been performed on 45 external ears having several types of anomaly. In the cases reviewed the results were 70% good and 30% mediocre. This treatment is simple, atraumatic and gives good permanent results for most protruding ears, lop ears, Stahl's ears and lobe evertion, and mediocre results in all the cup ears. If used more frequently, it would avoid, to a large extent, the need for later surgical treatment and possible psychological, physical and financial problems for the patient and family.

Self-completion theory helps explain the striving toward wholeness associated with the use of an external prosthesis or breast reconstruction. This paper ad dresses variations in post-mastectomy women's perceptions of physical com pleteness, as revealed by personal strategies of breast reconstruction and pros thesis usage. In the present investigation, women who had had reconstruction tended to be younger, employed, and to have more years of education compared to women who did not. Women who had had reconstructive surgery were more concerned about their sexuality, appearance, and social relationships. They were less satisfied with their appearance than those who did not have reconstruction. Prosthesis use and satisfaction were related factors, with younger and better educated women more likely to use the prosthesis. Greater satisfaction with one's prosthesis related significantly to the expertise of the prosthesis fitter.

Two types of abnormally small eye Sockets are described: (1) True contracted Sockets following injury or subconjunctival fibrosis, (2) Congenitally underdeveloped Sockets. Indications for surgery in both types are outlined. The use of an external prosthesis without further surgery is considered.

One method of providing an artificial limb for an amputee might be to attach the external prosthesis directly to the skeleton but a major problem is the behavior of the tissues at the point where the prosthesis penetrates the skin surface. Preliminary experiments have been carried out using small flexible implants in porcine skin to study the principles involved. It is confirmed that the epidermis grows down into the dermis around the nonporous materials and the implant-skin junction is unstable and readily becomes infected. It was found that polytetrafluorethylene with pores of 10 μm diameter and hydron sponge with pores of 40 μm diameter became invaded by fibrous tissue and this appeared to prevent the migration of epidermis alongside the implants and a stable ring of epidermal tissue was formed near the skin surface. A review of other situations where epidermal migration is taking place suggests that epidermis is able to migrate through damaged collagenous tissue, possibly with the help of leucocytic enzymes, but that epidermal cell movement is halted when the epidermal sheet is confronted by heathly collagen bundles.

Prosthetic devices allow people with lower limb amputation to recover their autonomy. Currently, this autonomy is limited in several everyday life situations such as walking on a slope or in stairs. Embedded sensors, frequently integrated inside the prostheses, record kinematic and dynamic data during locomotion. In this context, this PhD thesis aims to contribute to the development of methods for the processing of data provided by these technologies to quantify and improve the adaptation of the prosthesis to the environment. These methods were applied and evaluated in the context of the use of a new prosthetic knee-ankle system controlled by microprocessor (SPCM) developed by Proteor to facilitate the locomotion in situations such as slope or downstairs walking for people with above knee amputation. The first part of the work was devoted to the quantification of the adaptations allowed by the SPCM in different situations of daily life (flat, slope, staircase). The second part of the thesis focused on the estimation of gait parameters (walking speed and slope inclination) and the classification of 4 everyday life situations (flat, slope ascent and descent, stair descent) using machine learning algorithms that can be computed by the SPCM in real time. The body of this work will make it possible to better quantify the user real life activity. This quantification could help the user or the medical team in the activity monitoring but also the manufacturer to improve the adaptation of the prosthetic components to the environment and to verify the SPCM actual use., L’appareillage permet à aux personnes amputées de membre inférieur de retrouver une autonomie de déplacement. Actuellement, cette autonomie est limitée dans certaines situations de la vie courante comme la marche en pente ou en escalier. Des capteurs dits embarqués sont de plus en plus souvent intégrés dans les prothèses et permettent d’enregistrer des informations cinématiques et dynamiques au cours de la locomotion. Dans ce contexte, l’objectif de la thèse est de contribuer au développement de méthodes de traitement des données issues de ces technologies pour quantifier et améliorer l’adaptation de la prothèse à l’environnement. Ces méthodes ont été mises en œuvre et évaluées dans le cadre de l’utilisation d’un nouveau système prothétique contrôlé par microprocesseur de genou-cheville (SPCM), développé par la société Proteor et visant à faciliter la locomotion des personnes amputées au-dessus du genou dans les situations de pente ou de descente d’escalier. La première partie de cette thèse a été consacrée à la quantification des adaptations permises par le SPCM au cours de la locomotion dans différentes situations de la vie courante (plat, pente, escalier). La deuxième partie de la thèse s’est intéressée à développer des estimations de paramètres de la marche (vitesse de marche et inclinaison de la pente) et à la classification de 4 situations de la vie courante (plat, montée et descente de pente, descente d’escalier) à l’aide d’algorithmes d’apprentissage automatique pouvant être calculé par le SPCM en temps réel. L’ensemble de ces travaux permettra de mieux quantifier l’activité réelle de l’utilisateur. Cette quantification pourrait aider l’utilisateur ou l’équipe médicale pour le suivi d’activité mais aussi le constructeur pour améliorer l’adaptation des éléments prothétiques à l’environnement rencontré et pour vérifier l’utilisation réelle du SPCM.

Of 300 women who had mastectomy for breast carcinoma, 278 (93 percent) responded to a questionnaire about how well they accepted loss of a breast. Of those responding, 73 percent stated that they had no appreciable adverse reaction to the extent of the operation. Twenty patients (7 percent) cited major work, social or sexual problems resulting from mastectomy. Among the 20, sexual problems —cited by 85 percent—predominated. Four (1 percent) of the 278 patients expressed major dissatisfaction with the cosmetic result of an external prosthesis. Two of these patients and four others had surgical reconstruction of the breast, which was satisfactory in five.