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Three-Year Activity Report of the Replantation Service for Amputation of the Hand in Poland

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Żyluk A., Jabłecki J., Romanowski L., Mazur A.
Polish Journal of Surgery
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2012
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vol. 84
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issue 11
574-581
EN
A permanent on-call service for hand amputation (Replantation Service) was established in 2010 as the initiative of the Council of Polish Society for Surgery of the Hand. It is run by three qualified hand centres in Trzebnica, Poznań and Szczecin. The aim of the study was to present a summary of the almost three-year activity of this service. Material and methods. Over this period, a total of 435 cases of total amputations, subtotal amputations and other severe injuries to the hand were referred. Of these, 290 referrals (67%) were accepted and 141 (33%) rejected. Among accepted, there were 100 total (34%) and 113 subtotal (39%) amputations; 81 patients had other, severe hand injuries, such as crush, degloving and extensive wounds involving all tissues. Results. Young and middle-age males constituted the majority of patients with the mean age of 42 years (range 2-82). The most common injury was amputation of several digits (including thumbs) in one patient - 141 cases (48%), followed by amputations from the metacarpal- to the proximal forearm level -115 (39%) and elbow/arm level - 9 cases (3%). Niniteen patients (6%) had multi-level amputation or injury of the involved extremity. Replantation of the completely amputated extremity was performed in 83 patients (28%), revascularization in 95 (32%) and in 59 (20%) primary repair of the complex injuries. In 23 cases, the repair of tissue defects was performed with flaps, mostly with greater omentum. Survival rate was of 84% for replantations and 88% for revascularizations. Conclusion. Establishing of the Replantation Service constituted a significant progress in organization of the management of the most severest upper limb injuries.
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Effects of Body Movement on the Reliability of a Portable Gas Analysis System

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Keefer D. J.
Human Movement
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2013
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vol. 14
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issue 1
82-86
EN
Purpose. The purpose of this investigation was to determine the effect of body movement on the ability of a portable telemetric gas analysis device, the Cosmed K4b2, to produce a reliable measure of walking oxygen consumption (VO2). Methods. Thirteen adults were asked to report to a laboratory for three test sessions. During Session 1, participants were familiarized with the data collection procedures and completed a 15-min treadmill accommodation. In Sessions 2 and 3, each participant completed four 5-min treadmill walking trials at 1.8 m · sec-1 under different experimental conditions while VO2 was collected using the portable system. The four conditions were used to manipulate the portable metabolic system to mimic different types of movement. Results. Data analysis revealed no significant differences (p = 0.070) amongst VO2 values across all four experimental conditions during Sessions 2 and 3. Between-day coefficients of variation for the mean VO2 values of the four conditions ranged from 2.7% to 3.8%, with the highest level of variation occurring whilst the unit was strapped to the participant’s chest. Conclusions. Viewed collectively, the Cosmed K4b2 may produce reliable measures of VO2 in adult participants during treadmill walking who exhibit little vertical oscillation. However, future research is necessary to determine if the K4b2 is a valid instrument for collecting VO2 data if excessive body movement in the vertical direction can affect the data collection instrumentation.
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An Assessment of the Usefulness of Patient Evaluation Measure Questionnaire as an Outcome Measure after Carpal Tunnel Surgery

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Piotuch B., Żyluk A.
Polish Journal of Surgery
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2010
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vol. 82
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issue 6
347-353
EN
Outcome assessment of carpal tunnel release has relied upon objective measurements including grip strength and sensory testing as well as subjective parameters such as relief from pain and improvement of hand function. The latter can be obtained by the use of standardized questionnaires.The aim of the study was to assess the usefulness of Patient Evaluation Measure (PEM) questionnaire as an outcome measure after carpal tunnel surgery.Material and methods. Fifty patients, 43 women and 7 men with an average age of 55 years with carpal tunnel syndrome received mini-invasive carpal tunnel release. Patients were examined before the operation, and at 1 and 6 months after, according the same protocol. They had measured a total grip and key-pinch strengths and sensation by the filament test. They completed also the PEM questionnaire. The following parameters of the questionnaire were determined: responsiveness, concurrent validity and internal consistency.Results. Over a half-year follow-up, the sensation improved statistically significantly during the first month after operation. Power of the hand decreased initially comparing to baseline values, following by further gradual increasing throughout the follow-up. PEM scores showed continuous improvement of the hand status at each assessment. The PEM questionnaire showed excellent responsiveness to change of considered parameters, comparing to baseline values. The PEM showed also high concurrent validity with total grip and pinch strengths, as well as with Sensory Index, but only at 6 months assessment. However, the PEM showed a discordance with total grip and key-pinch strength at 1 month assessment. The instrument showed excellent internal consistency.Conclusion. The PEM questionnaire is, with some exceptions, a good and useful instrument for outcome measurement after carpal tunnel treatment surgery.
4
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Three-year (2017-2019) activity report of the Replantation Service for hand amputations in Poland

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Żyluk A., Chrapusta A., Jabłecki J., Romanowski L., Mazurek T., Domanasiewicz A.
Polish Journal of Surgery
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2021
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vol. 93
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issue 2
26-32
EN
This article summarises activity of the Replantation Service for hand amputations in Poland in years 2017-2019. Over this period a total of 551 cases of total and subtotal amputations as well as other complex injuries to the hand were referred to the referenced centres. Of these, 330 referrals were accepted and 221 rejected, for various reasons. Among these accepted, there were 165 total (50%) and 131 subtotal (40%) amputations; 34 patients (10%) had other severe hand injuries. Vast majority of the patients constituted young and middle-age males. The most common was amputation of several digits and thumbs - a total of 251 cases (76%), followed by transmetacarpal - 30 (9%), forearm - 23 (7%) and wrist - 20 (6%) amputations. Replantation of amputated extremity was performed in 138 patients (42%), revascularization in 98 (30%) and in 45 (14%) primary repair of the complex injuries. In 26 cases (8%), coverage of tissue defects was performed, and in 23 (7%) primary terminalization. Survival rate was of a mean of 65% for replantations and 85% for revascularizations. Comparing to the previously reported period 2013-2017, the number of treated patients was similar, but structure of injuries differed: number of digital amputations increased (of 22 cases), whereas number of proximal amputations (hand, forearm and arm) significantly dropped (of 50 cases). The importance of Replantation Service, an informal structure, in saving limbs of severely mutilated patients was emphasised.
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Three-year (2014-2016) activity report of the Replantation Service for hand amputations in Poland

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Żyluk A., Chrapusta A., Jabłecki J., Romanowski L., Mazurek T.
Polish Journal of Surgery
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2018
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vol. 90(4)
1-5
EN
The paper summarizes 32 months (January 2014 – August 2016) of activity of the Replantation Service for hand amputation in Poland. Over this period a total of 568 cases of total and subtotal amputations as well as other complex injuries to the hand were referred. Of these, 354 referrals (62%) were accepted and 214 (38%) rejected. Among accepted, there were 167 total (47%) and 142 subtotal (40%) amputations; 45 patients (13%) had other severe hand injuries. Vast majority of the patients constituted males aged a mean of 39 years. The most common injury was amputation of several digits in one patient, and thumb amputation – a total of 229 cases (65%), followed by transmetacarpal and wrist amputations – 92 (30%) and forearm/arm amputations – 33 cases (9%). Replantation of amputated extremity was performed in 141 patients (40%), revascularization in 145 (41%) and in 29 (8%) primary repair of the complex injuries. In 27 cases (8%), a coverage of the tissue defects, and in 12 (3%) primary terminalization was performed. Survival rate was of 78% for replantation and revascularization. Comparing to the period 2010–2012, an increase in number of treated patients (of n = 64 cases), in number of amputations (of 96 cases) and in number of amputated digits (of 88 cases) were noted. The activity report shows importance of Replantation Service, an informal structure, in saving limbs of severely mutilated patients.
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