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Tse T, Wang A, Antflek D, Novak C, Baltzer H
J Hand Surg Am. 2025 May 23
PMID:40411516
Abstract
The dignified disposal of limbs post-amputation is important to many cultural groups but is often not addressed. There is limited understanding from physicians and surgeons around the disposal process and its impact on patients, their beliefs, and their experiences within the health care system. In this overview, cultural and spiritual perspectives are reviewed and coupled with recommendations regarding the disposal and reclamation process. The current handling and management process of amputated parts is centered around hospital priorities. The beliefs and wishes of patients are not routinely considered, nor are the barriers to this adequately discussed. These implications affect groups with spiritual or cultural preferences that do not align with hospital standards, further exacerbating health inequity. This review provides information for health care providers surrounding the disposal of amputated parts to provide culturally sensitive and dignified approaches to patient care.
Galos P, Chevalley K, Larsen R, Sandström G, Tenhunen J
Scand J Trauma Resusc Emerg Med. 2025 May 23
PMID:40410815
Abstract
Prehospital physician-staffed services in the Nordic countries vary in crew structure, medical specialisation of crew and preparedness for major emergency surgical procedures. Performing emergency surgical procedures in prehospital settings requires equipment, training and clinical ability. This study aimed to explore the organisation of Nordic prehospital physician-staffed services and their preparedness for resuscitative thoracotomy, perimortem caesarean section and prehospital amputation.
Saleem M, Khan MS, Neyaz A, Ahmad I, Qattan MY
Naunyn Schmiedebergs Arch Pharmacol. 2025 May 23
PMID:40410552
Abstract
This prospective cohort study systematically analyzed the demographic profile, clinical characteristics, spectrum of microorganisms, and antimicrobial resistance pattern in 248 patients with diabetic foot ulcer (DFU) over 2.7 years. Most patients were male (75.4%) and had a mean age of 56.1 years, and high comorbidity rates (81% neuropathy, 77% retinopathy, and 67.7% hypertension). A combined 439 bacterial isolates were obtained, with the dominance of Gram-negative pathogens, including Escherichia coli (16.6%) and Pseudomonas aeruginosa (15.3%). Staphylococcus aureus was also the dominant Gram-positive pathogen (12.8%). Polymicrobial infections were found in 43.1% of cases, and 71% of strains were biofilm-producing. The prevalence of multidrug-resistant (MDR) was alarmingly high (67%), particularly among Escherichia coli (97.3%), Staphylococcus aureus (83.9%), and Proteus mirabilis (90.5%). MDR infections were associated with tobacco use, biofilm formation, polymicrobial infection, and clinical complications. In specific, seven bacterial types, Pseudomonas aeruginosa, Staphylococcus aureus, Providencia rettgeri, Enterococcus faecalis, Enterobacter cloacae, Pseudomonas flourescens, and Staphylococcus epidermidis, as described, were statistically associated with amputation. Beta-lactams (ampicillin, piperacillin) showed 100% resistance. Cephalosporins (ceftazidime, ceftriaxone, cefotaxime, cefepime) had resistance rates ranging from 25 to 96%. Amoxicillin-clavulanic acid showed 30 to 92.3% resistance, while piperacillin-tazobactam ranged from 7.7 to 71.4% resistance. Out of 338 Gram-negative isolates, 105 (31.1%) were ESBL producers, and molecular characterization shows blaCTX-M as the most predominant, 40 (38.1%), followed by blaSHV 20 (19.0%), and blaTEM 7 (6.7%) isolates. Methicillin and vancomycin resistance were common among Gram-positive isolates, particularly Methicillin-resistant Staphylococcus aureus (MRSA) (51.8%) and Vancomycin-resistant Enterococci (VRE) (33.3%). Despite widespread resistance, antibacterial drugs such as colistin (100%), polymyxin B (100%), linezolid (100%), and vancomycin (100%) retained efficacy. These data emphasize the significant burden of MDR infections in DFUs and emphasize the urgent actions needed for aggressive antimicrobial stewardship, early infection control, and personalized treatment approaches to prevent amputation and enhance patient outcomes.
El-Gabalawy R, Crooks M, Smith MSD, Hammond E, Gross P
JMIR Res Protoc. 2025 May 23
PMID:40409745
Abstract
Phantom limb pain (PLP) affects most people living with lower limb amputations (LLAs). Nonpharmacological interventions, such as graded motor imagery (GMI), have demonstrated promise as PLP treatments. However, GMI access is limited by low patient buy-in and long public outpatient wait times. Considering PLP has been shown to be more prevalent and severe immediately following LLA, there is an urgent need to bypass barriers to allow for prompt access to PLP interventions. In response to this need, the multidisciplinary research team in this study developed a virtual reality (VR) program that administers GMI treatment. This novel intervention may be completed independently and promptly within the postoperative acute care setting. Before conducting a randomized controlled trial, the VR-GMI program must be developed and refined through a rigorous and multistage feasibility assessment.
Kumar A, McMackin K, Tolaymat B, Batista PM, Lombardi JV
Ann Vasc Surg. 2025 May 21
PMID:40409493
Abstract
The COVID-19 pandemic temporarily halted elective and non-urgent surgeries, including revascularization, to allocate resources to address critically ill patients. Simultaneously, COVID-19-related vascular complications and increases in critical illness led to major amputation. We evaluated trends in major amputation during the pandemic, both acutely and sub-acutely, secondary to delays in revascularization.
Nekooei N, Brabender D, Park S, Bent C, Siletz A
Am J Surg. 2025 May 15
PMID:40409145
Abstract
Abdominal vascular injury (AVI) often coincides with bowel injury and abdominal contamination. Prosthetic materials may be necessary for vascular reconstruction, but outcomes are poorly understood. We examined outcomes in patients undergoing autologous vs. prosthetic open repair of AVI using a national database.
Greendyk JD, Haider SF, Allen WE, Prasath V, Chokshi RJ
Am Surg. 2025 May 23
PMID:40408460
Abstract
Hemicorporectomy, or translumbar amputation, is a radical surgical procedure in which the lower half of the body is removed. To date, 79 cases have been reported in the literature. We conducted a systematic review of the literature of articles published in peer-reviewed journals after 1990 on independent cases of hemicorporectomies. Individual case reports published before 1990 were excluded; however, a review paper from 1990 was included as a retrospective cohort and a source of comparison. Twenty-seven studies with an average follow-up period of 5.2 years reported on 40 patients who underwent hemicorporectomy from 1990 to 2021. Average age at surgery was 36.8 years, and 82.5% were male. The most common indications for the procedure were osteomyelitis of the pelvis (35%), squamous cell carcinoma (22.5%), and trauma (12.5%). Trauma had the lowest mortality rate (20%), while osteomyelitis had the highest (39%). This systematic review of 40 hemicorporectomy cases between 1990 and 2022 shows promising results, with many patients achieving significant recovery milestones, such as mobility and employment. These findings suggest that, despite its radical nature, the procedure can be a safe option for critical patients with no other feasible alternatives.
Petersen RB, Buch CD, Faergemann C, Nymark T
Dan Med J. 2025 Apr 29
PMID:40407290
Abstract
Hereditary multiple osteochondromas (HMO) is a genetic skeletal disorder caused by defects in exostosin glycosyltransferase 1 (EXT1) or 2 (EXT2) genes. It develops mainly in the growth period and causes multiple osteochondromas (OC) in the physis of the long bones, leading to discomfort and deformities. This study aimed to investigate the anatomical distribution of OC, the frequency of deformities of the lower limbs, scoliosis and surgeries performed in a cohort of patients with HMO at the time of their enrolment in a regional surveillance programme.
Jahoda M, Zanardelli M, Dhermain F, Alessi J, Armonio F
Ecol Evol. 2025 May
PMID:40406589
Abstract
Human-caused injuries can have severe consequences for cetaceans, both for the well-being of individuals and the effects at the population level. Here, we report the first case of a live fin whale in the Mediterranean Sea with completely amputated flukes, a female who suffered two separated incidents: the first one before 1996, when she lost her left lobe, and the second one, in 2019, leading to the severing of the whole tail and finally to presumed death. "Codamozza-Fluker" was regularly sighted during summer in the North-Western Mediterranean for 24 years. Entanglement and collision were both hypothesized as potential causes of her injuries. Without flukes, she traveled at least 7000 km across the Mediterranean, despite severe emaciation. Sighting records allowed tracking her from September 2019 to July 2020, providing rare evidence of large-scale movements within the Mediterranean over almost a year. Her journey, which extended as far as Syria, provides the first evidence of a fin whale from the Ligurian Sea being resighted in the Eastern Basin. This introduces a new perspective on this endangered subpopulation's movement patterns, which are crucial for effective conservation measures. The case gained widespread media attention, representing a dramatic example of usually unnoticed injuries or deaths, and contributed to raising public awareness, essential for driving focused conservation efforts. Her latest accident most likely occurred within the Pelagos Sanctuary for marine mammals, highlighting the need for more effective local protection measures, and underscoring the importance of complementing area-based conservation efforts with an ecosystem-based approach.
Tuncer O, Du Y, Michalski N, Reitzle L
J Health Monit. 2024 Jun
PMID:40406424
Abstract
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Dockienė I, Čiuplinskas M, Zagorskis R, Kontrimavičiūtė E
Front Pediatr. 2025
PMID:40406354
Abstract
Proteus syndrome (PS) is a rare, highly polymorphous and complex disorder characterized by assymetric and/or disproportional overgrowth of limbs, hamartomas and vascular deformations. Typically, the first signs of PS appear between 6 and 18 months of age, are subtle and might be overlooked. We report a case of a 17 year old boy which was first diagnozed with PS after left limb amputation in 2021 (age of 14), though retrospectively the first signs of left hand enlargement appeared at 18 months. At the age of 3 years vascular surgery of venous malformation on his left leg was performed, molecular genetic tests from blood revealed no abnormalities. At the time Klipper-Trenaunay syndrome was diagnosed according to clinical criteria. In 2021 whole exome sequencing (WES) confirmed the diagnosis of PS after the test of affected tissues after amputation. We review the role of multidisciplinary approach implicating different physicians, role of radiologist with the multiple findings in this rare pathology with high variability of clinical presentation. Considering the complications and early mortality (up to 27 years old) observed in patients we emphasizet he significance of early suspicion and diagnosis of PS and the need for symptomatic multidisciplinary team follow-up which aims to minimize the degree of disability, prophylaxis of thrombembolic events and improve quality of life.
Miyamori D, Yoshida S, Ito M
J Diabetes Investig. 2025 May 23
PMID:40405606
Abstract
COVID-19 has been linked to increased vascular complications, but its long-term impact on amputation rates is unclear. This study evaluated amputation risk post-COVID-19 using a nationwide insurance claims database in Japan.
Kaya Ş, Ünal YC, Güven N, Dündar A, Keleş ÖF
J Orthop Surg Res. 2025 May 22
PMID:40405261
Abstract
Crush syndrome is a severe condition caused by the systemic effects of rhabdomyolysis due to prolonged muscle compression. Common in disasters like earthquakes, it poses life-threatening risks, including acute renal failure, hyperkalemia, and metabolic acidosis. Although surgical interventions such as fasciotomy and amputation are critical in its management, the optimal timing and criteria remain unclear. This study investigates the impact of surgical intervention timing on crush syndrome outcomes, providing guidance through the first experimental rat model evaluating fasciotomy and amputation post-injury.
Shelar K, Salve PS, Qutub M, Tammewar S, Tatode AA
Biol Trace Elem Res. 2025 May 22
PMID:40405055
Abstract
Diabetic foot ulcers (DFUs) are a severe diabetic complication, frequently resulting in infections and amputations. The current research focuses on the development and assessment of a synergistic nano-herbal formulation based on green-synthesized silver nanoparticles and a polyherbal gel for the efficient treatment of DFUs. Silver nanoparticles (AgNPs) were green-synthesized using aqueous extracts of Tagetes erecta (Marigold) and Portulaca oleracea (Purslane). They were further blended with a polyherbal gel formulation to improve antimicrobial and wound-healing activities. AgNPs were synthesized using aqueous plant extracts and characterized through UV-Visible spectrophotometry (SPR peaks: 439 nm for T. erecta, 427 nm for P. oleracea), FT-IR (O-H stretching at 3610 cm⁻, 3687 cm⁻), XRD (semi-crystalline structure), and DLS (particle sizes: 311 nm and 304 nm, zeta potentials: -19.7 mV and -20.1 mV, respectively). Antimicrobial studies showed strong inhibition against S. aureus (21 mm, 20 mm) and K. pneumoniae (22 mm) for AgNPs. The polyherbal gel, incorporating extracts of Ficus racemosa, Emblica officinalis, Curcuma longa, Carica papaya, Terminalia bellerica, Acacia catechu, and Aloe vera, achieved 85% wound closure in diabetic rats by day 16, compared to 60% (untreated) and 95% (povidone iodine). AgNP-antibiotic combinations reached 90% healing. HbA1c levels remained unchanged, indicating glucose-independent healing. These findings suggest that AgNP-polyherbal formulations could serve as a sustainable and effective DFU treatment, enhancing antimicrobial activity and promoting tissue regeneration.
Kojima S, Tokuda T, Tanaka A, Yoshioka N, Yamaguchi K
Cardiovasc Intervent Radiol. 2025 May 22
PMID:40404999
Abstract
This study aimed to identify predictors of distal embolization following JETSTREAM™ atherectomy for calcified femoropopliteal lesions and evaluate 1-year clinical outcomes in a real-world setting.
Kunselman LF, Seaver EC
Dev Biol. 2025 May 20
PMID:40404078
Abstract
To rescue regeneration, the mechanisms underlying regeneration failure must be identified and overcome. In the annelid Capitella teleta, a transverse cut triggers asymmetric responses across the amputation plane: head fragments regenerate the tail, but tail fragments do not regenerate. We compare regeneration of head fragments (successful regeneration) to that of tail fragments (unsuccessful regeneration) using cell proliferation assays, immunolabeling, and in situ hybridization. Surprisingly, following amputation, a dynamic response of the nervous system occurs in the non-regenerating tail fragments of C. teleta that has not previously been described in annelids. Wnt/β-catenin signaling plays a conserved role in patterning the primary axis of some bilaterians during regeneration, but this role has never been demonstrated in annelids. Wnt/β-catenin pathway components are expressed in the blastema of head fragments but not at the cut site of tail fragments in C. teleta. Experimental activation of Wnt/β-catenin signaling following amputation of tail fragments (24 - 72 hr post amputation) induces expression of stem cell markers, increases cell division at the wound site, and produces differentiated muscle and hindgut. Furthermore, activation of Wnt/β-catenin signaling induces ectopic posterior identity at the amputation site, as it does in other bilaterians. Inhibition of Wnt/β-catenin signaling does not rescue head regeneration. Our results indicate that C. teleta tail fragments have latent regenerative potential that is activated by Wnt/β-catenin signaling. However, the incomplete regenerative response suggests that additional cell signaling pathways are required for this complex process. Comparing tissues with different regenerative abilities elucidates the mechanisms underlying regeneration regulation, thereby enabling the prospect of rescuing or increasing regeneration ability in regeneration-deficient tissues.
Shintani T, Nakatani E, Kaneda H, Hawke P, Obara H
Eur J Vasc Endovasc Surg. 2025 May 20
PMID:40404043
Abstract
While the prevailing practice for treating chronic limb threatening ischaemia (CLTI) is revascularisation, we have a limited understanding of disease progression in patients with CLTI who do not undergo this intervention. This study compared the prognosis of CLTI patients with tissue loss who underwent revascularisation with the prognosis of those who were managed with non-revascularisation treatment, investigating the efficacy of revascularisation in improving the outcome of CLTI patients.
Lin B, Solano A, Timaran CH, Modrall JG, Tsai S
J Vasc Surg. 2025 May 20
PMID:40404024
Abstract
Congestive heart failure (CHF) and peripheral artery disease (PAD) often coexist, with worse outcomes in patients undergoing PAD procedures. We investigated the impact of CHF on mid-term mortality and postoperative outcomes after PAD interventions.
Tillqvist H, Vuorlaakso M, Helminen M, Kiiski J, Kaartinen I
J Diabetes Complications. 2025 May 20
PMID:40403435
Abstract
The primary aim of this study was to investigate how the Clinical Frailty Scale (CFS) associates with survival of patients with diabetes after lower extremity amputation (LEA).
Goldberg A, Kerr R
Curr Opin Otolaryngol Head Neck Surg. 2025 May 2
PMID:40402691
Abstract
Auricular avulsion injuries present complex reconstructive challenges due to the intricate three-dimensional (3D) structure and vascular supply of the ear. This review examines traditional and emerging techniques in auricular trauma repair, including microsurgical advancements, digital planning, tissue engineering, and 3D bioprinting, highlighting their impact on reconstructive outcomes.