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Article
REFASHIONING OF AMPUTATION STUMP

Author: Omer Ali Rafiq Barawi
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2005 Volume: 11 Issue: 1 Pages: 116-123
Publisher: Basrah University جامعة البصرة

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Abstract

This is a prospective study was done on one hundred patients with late complications of the amputated stump between may 2001-2004 in Vincent Orthopedic center in Sulaimanya. There were eighty men and twenty women, their age range from seventeen to sixty years. Fifty patients with infected stump range from abscess formation in fifteen cases, infected epidermoid cysts in five cases to fissuring and ulceration of stump in thirty cases. Fifteen patients with painful neuromas attached to the scar tissue. Ten patients with below knee amputation had knee flexion deformity. Nine patients with below knee amputation with prominent bones compressing the skin of the stumps the fibula were long and the anterior edge of the tibia compressing the skin. Fifteen patients with loose cushion of muscles. One patient with recurrent infected above ankle amputation stump superadded by squamous cell carcinoma. All patients were treated by refashioning of the amputation stump, except one with squamous cell carcinoma.

Keywords

AMPUTATION --- STUMP


Article
Predictive values of risk factors in management of diabetic foot

Authors: Safa M..Al-Obaidi صفاء العبيدي --- Amine Mohammed Bakkour --- Salah Mahdi Tajer
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2007 Volume: 49 Issue: 1 Pages: 37-43
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Outcome of management of patients with diabetic foot is difficult to predict. Assessmentof variables in history , examination and investigations were analyzed with outcome of management andwhether can be assigned as prognostic factors .Methods: prospective study of 300 patients with diabetic foot in Baghdad teaching hospital duringthe period from April 2000 to March 2004,certain criteria was taken in history and examination, thesewere investigated and treated either by conservative procedure or amputation.Results: most common age group was 50-59 years ( 33.3%). The male to female ratio was 2:1.Conservative debridement was performed in ( 60%) of patients while amputation was employed in(40%). amputation was performed in 604 in patient above 60 years and in(75%) of patients who haddiabetic foot lesions for > 2 weeks,and in 90% of smokers for 10 years or more. Amputation wasneeded in (71%) in those who had history of previous ulceration and 72.5% of patients who hadpositive history of previous amputation. Amputation was needed in (88%) of those who had theirtemperature >38°C. in (91%) of patients who had diabetic foot lesion of Wagner grade>III and 91%.patients with X-ray findings of osteomyelitis.Conclusions: Highly significant association was found between amputation with following variable ,smokers > 10 years, patients with a temperature of > 38°C, Hypertension > 140/90 mmHg Wagnergrade > III, white blood cell count of > 20,000/cc and positive foot X-ray findings. Slightsignificant association of amputation and the following variables: Age >60 years, duration of footlesion >2 weeks, history of previous amputation, previous ulceration, negative pedal pulses, deformedfeet and patients who had impaired normal vision.


Article
Frequency and Acceleration Measurement for the Above Knee Prosthetic Limb and its Comparison with the Healthy Limb
قياس التردد والتعجيل في طرف صناعي لبتر فوق الركبة ومقارنتة مع الطرف السليم

Authors: Jumaa S. Chiad --- Bashar A. Bedaiwi
Journal: Journal of Engineering and Sustainable Development مجلة الهندسة والتنمية المستدامة ISSN: 25200917 Year: 2012 Volume: 16 Issue: 4 Pages: 438-452
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Comfort, stability, weightiness, stiffness, flexibility, toughness and cost are the most important goals during which all researchers try to reach. In this work, the first challenge is to design and manufacture vibration measurement system which consists of a shaker ,cam, motors, speed varitor and accelerometer. This system is used to measure displacement ,velocity ,acceleration and frequency in amputation joint in the whole body in the selected eleven points with four speed motor (500,600,700 and 800 rpm).The amputee case study is of age, weight, length and the residual amputee limb of 28 years, 75kg, 175cm and 38 cm respectively. The amputee lost his lower limb due to a car accident since 2002.Results show that the value of acceleration and frequency increases when motor speed increases. While the acceleration and frequency decreases when accelerometer position from the shaking table increases . Moreover , the acceleration values for prosthetic limb will be more than of the healthy limb with percent of about (10.3,8.1,8.4,11.6,2.7,6.8)% for foot, ankle, leg, knee, thigh and hip respectively. While the acceleration values of artificial limb with liner are less than those of artificial limb without liner with (7.8,0.86,23.05,1.01,2.6 and 5.04)% for foot, ankle, leg, knee, thigh and hip respectively .Finally ,the frequency results show that the frequency values of the prosthetic limb will be more than of the healthy limb with percent of about ( 65.5,63.8,60.2,60,54.5,46.9)% for foot, ankle, leg, knee, thigh and hip respectively. Also the frequency values of the prosthetic limb with liner are less than of prosthetic limb without liner with (14.02,3.2,4.8.6.7,10.5and 9.3)% for foot, ankle, leg, knee, thigh and hip respectively.

الراحة ,الاتزان ,الوزن ,المتانة,المرونة والكلفة هذة اهم الاهداف التي يحاول الباحثون الوصول اليها. في هذا العمل كان التحدي الاكبر هو تصميم وتصنيع منظومة لقياس التردد والتعجيل للطرف الصناعي لبتر فوق الركبة تلك المنظومة تالفت من منضدة اهتزازية,كامة,ماطور,منظم سرعة ومتحسس تعجيل بهدف قياس البيانات الاهتزازية لاربع سرع (800,700,600,500) دورة في الدقيقة لاحد عشر موقع تبعد من ارضية الاهتزاز صعودا للطرفين الصناعي والسليم لمعوق بترت ساقة اثناء حادث مروري منذ العام 2002 ,كتلة وطول وعمر وطول البتر للمعوق كانت 75 كيلو غرام , 175سم, 28 سنة و38 سم على التوالي.النتائج اظهرت انة كلما زادت السرعة الدورانية لماطور الاهتزاز كلما زاد التعجيل والتردد لكل النقاط الاحد عشر التي تم تثبيت المتحسس فيها , بينما اظهرت النتائج انة كلما ابتعدنا من ارضية السطح الاهتزازي صعودا للطرف الصناعي والسليم كلما انخفضت قيم التعجيل والتردد .نتائج التعجيل اظهرت انة بمقارنة قيم التعجيل للطرف الصناعي نسبة للطرف السليم فان قيم التعجيل تزداد بنسب ( 10.3,8.1,8.4,11.6,2.7,6.8)% لكل من القدم,الكاحل,الساق, الركبة , الفخذ والورك على التوالي , بينما اظهرت المقارنة بين الطرف الصناعي بالبطانة المرنة مع الطرف الصناعي بدون بطانة مرنة فان التعجيل للطرف بالبطانة المرنة تكون اقل من نظيرتها في الطرف الصناعي بدون بطانة مرنة بنسب (7.8,0.86,23.05,1.01,2.6 and 5.04)% لكل من القدم,الكاحل,الساق, الركبة , الفخذ والورك على التوالي. واخيرا اظهرت نتائج التردد انة بمقارنة قيم التردد للطرف الصناعي نسبة للطرف السليم فان قيم التردد تزداد بنسب ( 65.5,63.8,60.2,60,54.5,46.9)% لكل من القدم,الكاحل,الساق, الركبة , الفخذ والورك على التوالي , بينما اظهرت المقارنة بين الطرف الصناعي بالبطانة المرنة مع الطرف الصناعي بدون بطانة مرنة فان التردد للطرف بالبطانة المرنة تكون اقل من نظيرتها في الطرف الصناعي بدون بطانة مرنة بنسب (14.02,3.2,4.8.6.7,10.5and 9.3)% لكل من القدم,الكاحل,الساق, الركبة , الفخذ والورك على التوالي


Article
EVALUTION OF BILATERAL V-Y ROTATION ADVANCEMENT FLAPS FOR TREATMENT OF FINGERTIP AMPUTATION

Authors: Jabir Raheem Hameed --- Roaa Hamed Mahmood
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2019 Volume: 25 Issue: 1 Pages: 66-73
Publisher: Basrah University جامعة البصرة

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Abstract

EVALUTION OF BILATERAL V-Y ROTATION ADVANCEMENT FLAPS FOR TREATMENT OF FINGERTIP AMPUTATION Jabir Raheem Hameed* and Roaa Hamed Mahmood@*MB, ChB, FICMS, Consultant Plastic and Reconstructive Surgeon, Al-Sadr Teaching Hospital, Basrah. @MB, ChB, Candidate of CABHS, Plastic and Reconstructive Surgery, Al-Sadr Teaching Hospital, Basrah, IRAQ. Abstract Fingertip amputation is the most common injury of the upper limb. The goals of treating it are; covering the defect, achieve sensibility, preserving the length of the finger by using durable coverage, obtaining the satisfactory aesthetic appearance and allow the patient for faster return to work. This study aimed to evaluate the use of bilateral V-Y rotation advancement flaps for the management of fingertip amputations with exposed bones and to assess the functional and aesthetic outcome. Between January 2017 and August 2018, bilateral V-Y rotation advancement flaps was performed on eleven male patients, average age 32 years, whose fingertip amputation with variable planes and zones. Patients were followed-up for at least 6-12 months. Twenty two flaps were made on 11 fingers, there was no partial or total flap loss. Patients had neither cold intolerance nor scar hypersensitivity, no obvious hook nail deformity apart of one patient. Because flap have neurovascular bundle inside it, so no change in sensation or perfusion occur postoperatively. In conclusion, the V-Y rotation advancement flap is simple, single stage operation that is optimum for surgical reconstruction of any fingertip injury. It provides a good contour, finger pulp coverage and acceptable appearance. Keywords: Fingertip. Amputation, Pulpa, V-Y flap, Reconstruction.


Article
DESIGN AND MANUFACTURING OF PROSTHETIC BELOW KNEE SOCKET BY MODULAR SOCKWT SYSTEM
تصميم وتصنيع وقب أسفل الركبة بطريقة Modular Socket System

Authors: Ikram R. Abd Al-razaq --- Kadhim Kamil Resan --- Yasir Khalil Ibrahim
Journal: Journal of Engineering and Sustainable Development مجلة الهندسة والتنمية المستدامة ISSN: 25200917 Year: 2016 Volume: 20 Issue: 2 Pages: 147-162
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

The large numbers of terrorist attacks and the difficulty of the situations in Iraq led to the rise of the amputees numbers. However, typically 80% of the amputations are trans-tibial (below knee (BK) lower limb amputations).This research included the fabrication of a new type of socket by a new method (modular socket system)(MSS) that used direct lamination on residual limb of patients. Socket materials were subjected to tensile and creep(500 C) in order to determine their mechanical properties. Creep test data were analyzed in order to obtain time dependent creep compliance using the standard linear solid (the zener) model, the socket failure characteristics at room temperature and at high temperature (500 C ) were determined by fatigue testing. Interface pressure between the socket and the residual limb was calculated using F-Socket software; In addition, a numerical method was used by applying the program ANSYS 15.The present work aim to study the experimental, theoretical and numerical results of tests and compared with the results of other reference. The experimental results show the specimens that manufactured by (MSS) have higher yield stress, medium young modulus, higher resistance to creep and low temperature effect on the S-N curve, where the reducing rate of S-N curve in the presence of temperature of group A( 4.5%) compared with group C in which reducing rate (50%). Theoretical results of groups A, B show the creep compliance increased at first at rate (200 % , 11% )respectively but after (50 min.) the creep compliance become constant, The numerical results show that the safety factor of groups A and C decreased at rate (47.6% ,43% )respectively with the temperature effect. From this work was concluded that the (MSS) is the best and fast manufactured process.

أدت الهجمات الارهابية الكبيرة وصعوبة الاوضاع في العراق الى ارتفاع اعداد المبتورين , عادةً 80 % من عمليات البتر هيبتر الطرف السفلي )تحت الركبة( . وهذا البحث تضمن تصنيع وقب جديد باستخدام طريقة جديدة ) Modular Socket System )( MSS ( والتي تستخدم بشكل مباشر على الطرف المتبقي للمبتورة اطرافهم . مواد الوقب خضعت لاختبار الشد والزحف في درجة حرارة( 50 درجة( من اجل تحديد خواصها الميكانيكية . وتم تحليل بيانات اختبار الزحف للحصول على مطاوعة الزحف في اي وقت باستخدامنموذج ) زينير(. تم ايجاد خصائص فشل الوقب بدرجة حرارة الغرفة وبدرجات حرارة عالية ) 50 درجة( باستخدام فحص الكلال. وتمحساب الضغط الموجود بين الوقب والطرف المتبقي باستخدام برمجيات F-Socket , وبالإضافة لذلك ,قد استخدمت الطريقة العددية عن طريق تطبيق برنامج الانسز 15 .الهدف من العمل دراسة النتائج العملية والنظرية والعددية للاختبارات ومقارنتها مع مصادر اخرى.نتائج العملي بينت ان العينات المصنوعة بطريقة ) MSS ) لها اجهاد خضوع عالي, معامل مرونة متوسط ,مقاومة عالية للزحف وتأثيرقليل لدرجة الحرارة على مخطط ( S-N (حيث ان نسبة النقصان بوجود الحرارة للمجموعة A كانت ) (4.5% مقارنة مع المجموعة Cحيث كانت نسبة النقصان ) (50% , النتائج النظرية للمجموعة A و B اثبتت ان معامل الزحف يزداد بالبداية بنسبة ) (11% ,200% علىالتوالي وبعد ) 50 دقيقة( معامل الزحف يبقى ثابت , النتائج العددية اثبتت ان معامل الامان للمجموعة A و C يقل بنسبة ( (43%, 47.6%على التوالي بوجود درجة الحرارة. من هذا العمل استنتجنا ان طريقة ) MSS ( افضل واسرع طريقة تصنيع


Article
Primary Below Knee Amputation in the Management of Compound Comminuted Fracture Lower Tibia and Fibula Due to High Velocity Missile Injury Associated with Bone Loss and Tibial Nerve Injury

Author: Ali Bakir Al-Hilli
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 4 Pages: 290-294
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Compound comminuted fractures of lower tibia and fibula are very common in Iraq these days due to missile injuries (bullets and blasts), it could be associated with bone loss and neurovascular injury this will interfere with the patients rehabilitation and leads to major social and economic burden on the patient, , his family and the community.OBJECTIVE:To prove that primary below knee amputation in management of compound comminuted fracture lower tibia and fibula due to high velocity missile injury and complete tibial nerve injury is superior to limb salvage.PATIENT AND METHODS:This is a prospective comparative study including 25 patients age 30-60 years presented to the emergency department in Medical City with a history of missile injury during the period 2005-2007 they had compound comminuted fractures of lower tibia and fibula (Gustilo grade II, III) all of them had different degrees of bone loss (more than 5 cm) and all of them had complete tibial nerve injury and 10 of them had associated posterior tibial artery injury which is irreparable. We divided our patients in to two groups the first one (9 patients four of them had also associated vascular injury) we did primary below knee amputation, while the second group (16 patients six of them had vascular injury) who refused amputation we did wound exsion and application of external fixation. Both groups followed up clinically and radiologically for one year.RESULTS:Group I the patients rehabilitated early and a prosthesis were used after one and a half month and the patients return to their original work or changing their work and have almost normal life, group II all of them had prolonged course of treatment with economic and social problems.CONCLUSION:Primary below knee amputation is a very good option for patients with history of compound comminuted fractures of lower tibia and fibula (grade II and III) associated with bone loss and tibial nerve injury. Decreasing rehabilitation time and early return back to work also less cost and less social problems.


Article
Non-Traumatic Lower Extremity Amputation (The Common Causes)……………………………………….

Author: Dr. Mahdi A. Abdul Hussein
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2009 Volume: 2 no.6, 7 Issue: 4 Pages: 479-485
Publisher: Kerbala University جامعة كربلاء

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Abstract

objective:Lower Extremity Amputation (LEA): is defined as the complete loss in the transverseplane of any part of the lower limb, and categorized as(1): (1) Minor (i.e. at or below theankle joint). (2) Major (i.e. above the ankle joint).Method & patients:The aim of this study is to determine the common causes of non-traumaticL.E.A. It is a retrospective study of (138) patients, with 149 lower limbs treated by amputationfor different causes in Al-Hussein general and Al-Abass private hospitals in Karbala, in theperiod between Sep, 2002 through Sep, 2007, excluding cases due to trauma, military and armyattacks.Results: Diabetes is a major risk factor for LEA and form (78.5 %) of cases with differentpresentations. The important risk factors were infected deep ulcer in neuropathic foot (26 cases),late stages of infected foot (38 cases) and arteriosclerosis (51 cases) presented as gangrene in onetoe or more. Patients with loss of protective sensation, loss of education and preventive programand neglect the ulcer or mild injury to complicate and presented in late stages end withamputation. Non-diabetic peripheral vascular disease (17%) is the 2nd cause; it is eitherarteriosclerosis or Beurger disease. Other rare causes were primary malignant bone tumor (3%)and other miscellaneous causes such as non-diabetic chronic osteomylitis (1.5%). Minoramputations were 61 limbs (i.e.41%) but major amputations were 88limbs (59 %). (19) Patientsfrom diabetic group had history of previous major amputations in the same side or other limb,and (11) of them done during the study period, so considered as risk factor.Conclusion:Diabetic foot is the most common cause of LEA, and reduction in the number ofamputation can be achieved if the patient is directed to foot-care programs. The diabetics needcomprehensive care, included good endocrine control, education on endocrine control, yearlyfoot screening by multidisciplinary foot-care team. The patients should instructed to paymeticulous attention to foot wear, foot hygiene, to cutting nail and daily foot inspection toreducing the risk of an injury that can lead to heel ulcer and amputation.


Article
Phantom Limb and pain after traumatic lower extremity amputation.
الاحساس بالالم في الطرف الشبح (الوهمي) بعد عمليات بتر الطرف السفلي بسبب الحوادث والاصابات

Author: Adnan H. Hnoosh عدنان حسين حنوش
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2014 Volume: 56 Issue: 1 Pages: 57-61
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Pain after amputation is a common squeal, patients often have a phantom limb sensation too, which can be painful or painless.Objectives: This study describes the sensations and pain reported by patients after traumatic amputation of unilateral lower limb as well as the incidence and epidemiology of those sensations.Patients and methods: A retrospective study of 118 patients who underwent lower limb amputation due to trauma. Patients scheduled for interview by means of a standard questionnaire and examined, days, weeks, months, years, after surgery about limb pain, phantom limb sensations, stump pain, back and shoulder pain .Results: Statistical analysis revealed that the incidence of non-painful sensation was the commonest and more frequent than phantom limb pain. Back pain disturbing the amputee more than phantom limb pain. Phantom pain was significantly less common in patients with below knee amputation than above it.Conclusion: Phantom limb pain and shoulder and back pain problems warranting further clinical attention and analysis.Key word: phantom limb. lower limb amputation . residual limb pain.

الخلاصة:دراسة سريرية لظاهرة الطرف الشبح (الوهمي) و ما يصاحبه من الم في الطرف السفلي المبتور نتيجة الاصابات.الغرض من الدراسة : لتقييم معدلات ونسب الاحساس بالالم في الطرف السفلي المبتور عند الجرحى بعد البتر ودراسة انواع الالام والاحاسيس الاخرى المصاحبة كالم الظهر والكتف.المرضى واسلوب البحث : اجريت الدراسة على مائة وثمانية عشر مريضا ممن بتر لهم طرف سفلي واحد نتيجة الاصابات وعبروا عن احساسهم بالالم اوالشعور بوجود الطرف فعليا بعد العملية وفي فترات متفاوتة من خلال استبيان شامل يتسائل عن شدة ودرجة الازعاج وتكرار الالم في الطرف المبتور , واستيضاح عن الم الكتف والظهر المصاحبين.النتائج : اظهرت الدراسة ان الاحساس الغير مؤلم في الطرف المفقود اكثر شيوعا من الم الطرف المبتور. والشعور بوجود الطرف بعد البتر والم الظهر شائع ايظا. الم الظهر هو الاكثر ازعاجا من الالم الوهمي واظهرت النتائج ان الالم الوهمي مصاحب للبتور فوق الركبة اكثر مما تحتها او يكاد ينعدم عند البتر من خلال مفصل الورك.الاستنتاج : ان الالم الذي قد يدوم لسنوات في الطرف المبتور او الاحساس فيه والم الظهر يتوجب رعايتهم عند المرضى الذين بتر لهم طرف سفلي واحد.مفتاح الكلمات : الم الطرف الوهمي (الشبح) . الاحساس بالطرف المبتور . بتر فوق او تحت الركبة.


Article
Penile lengthening in a child sustained amputation during mass circumcision: A case report
أصيب إطالة القضيب في طفل بتر أثناء ختان جماعي: تقرير حالة

Author: Azzawi M. Hadi
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2008 Volume: 2 Issue: 142 Pages: 120-121
Publisher: Tikrit University جامعة تكريت

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Abstract

Four years old boy sustained mass circumcision when he was 2 year old resulted in amputation of the glans penis and part of the penile shaft. The child present with penile stump just few millimeters above the pubic skin with urethral meatus located at the penoscrotal junction. Fig(1)
We did mobilization of the corpora by detachment of the suspensory ligament through half circumferential incision at the dorsal penile aspect. This incision extended as U shape incision ventrally to the scrotum. We cover the degloved penile shaft with skin flaps taken bilaterally from the pubic skin. Other flap taken from the scrotum to cover an other defect that remains at the ventral area. Fig (2,3,4). Hypospadias left to be performed in a second stage 3 months later.

أصيب فتى من العمر أربع سنوات ختان جماعي عندما كان 2 عاما أسفرت عن بتر حشفة القضيب وجزء من جذع القضيب. الحاضر طفل مع الجذع القضيب ملليمترات قليلة فوق جلد العانة مع الصماخ مجرى البول التي تقع في تقاطع صفني. الشكل (1)
ونحن لم حشد المجاميع من قبل مفرزة من الرباط المعلق من خلال شق 1/2 كفافي في جانب القضيب في ظهري. هذا شق شق توسيع نطاقها حسب شكل U البطني إلى كيس الصفن. نحن تغطي رمح degloved القضيب مع اللوحات الجلد اتخذت ثنائيا من الجلد العانة. رفرف غيرها من التدابير المتخذة من كيس الصفن لتغطية الخلل الأخرى التي لا تزال في منطقة بطني. الشكل رقم (2،3،4). غادر مبال تحتاني التي يتعين القيام بها في مرحلة ثانية بعد 3 أشهر.

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