Posttraumatic stress disorder and its related factors in burn injury and digit amputation

This study examined the relationship of physical factors including physical functioning and cosmesis to posttraumatic stress disorder (PTSD) symptoms in patients with burn injury and in patients with digit amputation; posttraumatic stress symptoms and depression in mothers of children with burn injuries from falling into bathtubs of hot water. The study comprised 56 patients with burn injury and 26 patients with digit amputation, and 16 children with burn injury and their mothers. Prevalence rates of PTSD and major depression were 33.9 and 7.1%, respectively, in burn-injured patients and 18.5 and 7.4%, respectively, in patients with digit amputation. Regardless of the severity of the burn injury, such as percentage of total body surface burned, females with cosmetic disfigurement exhibited PTSD symptoms, in particular avoidance and emotional numbing. For digit amputation, regardless of the degree of physical functioning after replantation such as motion and sensation, females with cosmetic disfigurement exhibit PTSD symptoms, in particular avoidance and emotional numbing. These findings suggest that in female victims the degree of cosmetic disfigurement is related to the manifestation of PTSD symptoms of avoidance and emotional numbing. Prevalence rates of PTSD and major depression were 6.3 and 0%, respectively, in children with burn injury and 12.5 and 18.8%, respectively, in their mothers. For three PTS symptoms (i.e. intense distress at a similar event, restricted range of affect, and hypervigilance), prevalence rates were significantly higher for mothers than for children. The three PTS symptoms of their mothers were significantly and positively correlated with severity of guilt feelings. Compared with burn-injured children, the mothers are prone to PTS symptoms mixed with guilt feelings.     

Psychiatric aspects of replantation surgery

The surgical literature on replant patients was reviewed and reports of psychiatric complications were noted. Data for this study were obtained from semistructured psychiatric interviews administered to 30 replant patients within a few days of admission. In addition, 24 of the patients received two or more follow-up interviews. Thirty-three percent of the patients showed evidence of preaccident psychopathology; 20% suffered from a substance use disorder. Fifty percent of the patients reported a stressful life event within the year antedating the accident. Sixty percent of the patients were assessed as warranting psychiatric intervention. The presence of preaccident psychopathology, family or marital dysfunction, previous psychiatric history, and a stressful life event were all positively associated with the occurrence of an adverse postoperative emotional reaction. Case material is presented to illustrate specific psychological issues of replantation surgery, such as those concerning body image and the disruption to body integrity. Suggestions for further research are given.     

Quality of Life Following a Lower Limb Amputation in Diabetic Patients: A Longitudinal and Multicenter Study

Objective: Lower limb amputation (LLA) leads to several emotional and physical sequelaes that have a negative impact on individuals` life. The objectives of this study were: 1) to analyze the relationship between emotional reactions (anxiety, depression and traumatic stress symptoms) and functionality level, before and after a LLA due to diabetic foot ulcer, and mental/physical quality of life; and 2) to analyze the mediator role of social support between emotional reactions and mental/physical quality of life. Method: A multicenter, longitudinal study with four time assessments: before the surgery, one month, six months, and ten months after surgery, including 206 individuals hospitalized with diabetic foot ulcer indicated for a LLA. The instruments used were the following: Revised Impact of Event Scale; Barthel Index; Hospital Anxiety and Depression Scale and SF-36. Results: Anxiety symptoms before surgery and depression symptoms one month after surgery contribute to Mental Component Score (MCS) ten months after surgery. The level of functionality before and one month after surgery, traumatic stress symptoms one month after surgery as well as satisfaction with social support six months after surgery contribute to the Physical Component Score (PCS), ten months after surgery. Social support was a mediator between traumatic stress symptoms one month after surgery and PCS ten months after surgery. Conclusion: Identifying risk variables and the extent to which and when they affect mental/physical quality of life, will help to develop appropriate psychological interventions to promote quality of life in this population.     

12例17个断指再植全部成活的护理体会

目的 探讨断指再植患者科学的护理方法,提高断指再植手术的成功率.方法 对12例断指再植患者进行精心的术前护理、术后护理和正确的康复训练指导.结果 12例断指再植患者,共17个手指,全部再植成活,出院后随访3～6个月,12例患者手指功能均恢复良好.结论 合理、有效的护理观察以及正确的康复指导是提高断指再植手术成功率的重要保障.     

Emotional aspects of arm or leg amputation in children

A clinical study of nine children between the ages of 4 and 15, who had undergone arm or leg amputation is presented. The emotional reactions of all those involved - the child, family, and the treatment team - are described. Amputation creates extreme stress in all participants in the procedure. Some similarities were found in the defensive mechanisms and stages experienced by the child, the family and the members of the treatment team.     

自体颅骨深低温保存与再植49例分析

目的 探讨自体颅骨深低温保存再植于颅骨缺损的手术时机、方法.方法 回顾分析我院49例采用自体颅骨深低温保存进行修补的颅骨缺损患者的临床资料.结果 无1例死亡,无1例发生排斥反应,仅3例出现颅内感染、头皮下积液,发生率为6.12%.结论 把握手术时间窗,采用自体颅骨深低温保存行颅骨修补可减少并发症,获得良好预后.     

Conduction study of digital nerve function recovery following toe-to-digit transplantation and a comparison with digit-to-digit replantation

Recovery of digital nerve function following toe-to-digit transplantation was studied by nerve conduction in 16 patients, and a comparison was made with digit-to-digit replantation in 7 patients. For toe transplantation and digit replantation, the mean interval between injury and surgery was 7 months and 8 h, respectively, while the mean interval between surgery and study was 39 months and 25 months, respectively. Sensory nerve action potentials (NAPs) from digital nerve stimulation were recorded at the wrist and the elbow, whereas mixed NAPs from median nerve stimulation at the wrist were recorded at the elbow. Sensory NAPs from stimulation of the transplanted toe were detectable in 14 patients and showed reduced amplitude, prolonged latency, and slowed conduction velocity. There was retrograde amplitude reductiond in the median nerve and in the proximal segment of the digital nerve. Sensory NAPs from the replanted digit were not different from those of to normal digit, nor was a retrograde effect observed. The present data indicate that digital nerve function recovery was incomplete in toe transplantation and nearly complete in digit replantation. The reasons for the differences in recovery following two types of nerve repair are discussed. © John Wiley & Sons, Inc.     

Psychophysiological contributions to phantom limbs.

Recent studies of amputees reveal a remarkable diversity in the qualities of experiences that define the phantom limb, whether painless or painful. This paper selectively reviews evidence of peripheral, central and psychological processes that trigger or modulate a variety of phantom limb experiences. The data show that pain experienced prior to amputation may persist in the form of a somatosensory memory in the phantom limb. It is suggested that the length and size of the phantom limb may be a perceptual marker of the extent to which sensory input from the amputation stump have re-occupied deprived cortical regions originally subserving the amputated limb. A peripheral mechanism involving a sympathetic-efferent somatic-afferent cycle is presented to explain fluctuations in the intensity of paresthesias referred to the phantom limb. While phantom pain and other sensations are frequently triggered by thoughts and feelings, there is no evidence that the painful or painless phantom limb is a symptom of a psychological disorder. It is concluded that the experience of a phantom limb is determined by a complex interaction of inputs from the periphery and widespread regions of the brain subserving sensory, cognitive, and emotional processes.     

深低温冷藏自体颅骨再植的临床研究

目的：探讨颅骨成形不同材料及方法的优缺点及此法的临床处理方法,方法：临床资料回顾性分析并结合献进行讨论。结果：56例深低温冷藏自体颅骨再植均无并发症,随访部分达骨性愈合,均无骨吸收现象。结论：此法优于其它修补材料及方法。     

Recovery of sympathetic skin responses after digit-to-digit replantation and toe-to-digit transplantation in humans

Sympathetic skin response was utilized to study recovery of sudomotor function in 8 patients who had digit-to-digit replantation and 9 patients who had toe-to-digit transplantation. Sympathetic skin responses evoked by median nerve stimulation or magnetic stimulation of the neck were recorded from the tip of the replanted digits or transplanted toes. The contralateral normal fingers served as controls. The mean intervals between surgery and study were 33 and 37 months, respectively, for digit replantation and toe transplantation. In normal subjects, the sympathetic skin responses recorded from the fingertip were abolished by local anesthesia or cooling of the finger, while those recorded from the palm were not affected. Ischemia of the finger only transiently affected the digit sympathetic skin responses. These data indicate that the digit responses were locally generated and mediated by unmyelinated fibers. After digit replantation, the palm and digit sympathetic skin responses were not different between replanted and normal sides. After toe transplantation, palm sympathetic skin responses were normal, but digit ones had prolonged latency and reduced amplitude. The present findings suggest that recovery of sympathetic sudomotor activity can be nearly complete in digit replantation but less satisfactory in toe transplanatation.     

Multiple cranial burr holes as an alternative treatment for total scalp avulsion

Background  

Total scalp avulsion is a devastating injury in clinical practice. It often occurs in female adults, being rare in children. The standard treatment for scalp avulsion is microsurgical replantation, when feasible. Coverage becomes a major problem when replantation fails or is contraindicated, resulting in significant morbidity and requiring multiple procedures. In this article, in addition to reviewing the literature, we report a historical method for obtaining skin coverage after failure of replantation.     

几丁糖对大鼠股动脉吻合口通畅率的影响

背景：几丁糖在预防术后组织粘连方面疗效确切,但在断指再植术后能否应用,其对血管吻合口的愈合是否有影响,国内外文献较少提及。 目的：观察医用几丁糖对成年大鼠股动脉吻合口通畅率的影响。 方法：离断SD大鼠双侧股动脉,左侧为实验组,右侧为对照组,显微镜下吻合双侧股动脉,所有吻合动脉即时通畅率达100%,且为同一人操作,吻合后,实验组吻合口周围均匀涂布医用几丁糖1滴,对照组不涂。分别观察术后7,14,21,28 d大鼠吻合口的通畅情况,吻合口口径、吻合口周围有无感染、周围粘连情况及病理切片观察吻合口内皮细胞覆盖情况。 结果与结论：术前、术后吻合口管径无明显变化,实验组和对照组吻合口周围均无明显感染,实验组吻合口周围粘连较对照组轻,吻合口总体通畅率实验组为96%,对照组为89%,差异无显著性意义。术后各个时间段实验组、对照组内皮细胞覆盖情况差异无显著性意义。提示医用几丁糖的放置不影响大鼠股动脉吻合口的总体通畅率。     

应用人工假体及复合大段异体骨移植治疗不同位置胫骨恶性骨肿瘤

目的：回顾性分析39例胫骨恶性肿瘤患者的临床资料，探讨不同部位的胫骨恶性骨肿瘤采用适合的保肢术式。 方法：选择1999-01/2007-03云南省肿瘤医院骨科收治的胫骨恶性肿瘤手术患者39例，按肿瘤分布上、中、下段不同部位采用瘤段切除+异体骨关节移植，旋转轴心式铰链型人工膝关节置换，大段异体骨关节移植+旋转轴心式铰链型人工膝关节复合移植，大段骨灭活再植术，半膝关节移植术等术式治疗。术后随访≥ 2年，记录5年生存率，观察并发症，材料宿主反应，并按Mankin标准评价功能结局。 结果：39例胫骨恶性肿瘤患者中10例术后6个月~2.2年内因肿瘤全身性转移而死亡，28例存活，5年存活率为74%。存活者中，4例因局部复发而截肢，1 例复发者行瘤段截除大段异体骨植骨融合术后治愈。功能结局为优者20例，良8例，中6例，差5例，患者术后满意率72%。 结论：对胫骨恶性骨肿瘤应当根据肿瘤类型、部位等采用最佳的保肢术式，才能达到最好的临床效果。应用人工假体以及复合大段异体骨移植术效果优于自体骨灭活再植。     

Current perception thresholds in toe-to-digit transplantation and digit-to-digit replantation

Recovery of digital nerve function in toe-to-digit transplantation and digit-to-digit replantation was evaluated by transcutaneous constant current sine wave stimulation at 5-, 250-, and 2000-Hz frequencies to determine the current perception thresholds (CPT). For toe transplantation and digit replantation, the mean interval between injury and surgery was 9 months and 7 h, respectively, while the mean interval between surgery and CPT study was 52 months and 20 months, respectively. Control CPTs evoked by three frequency stimuli were obtained from contralateral corresponding normal finger and normal toe. Normal finger had significantly lower 250- and 2000-Hz CPTs than normal toe, but the 5-Hz CPT was not different between them. Replanted digit achieved nearly complete recovery of these three frequency CPTs when compared to normal finger. In toe transplantation, 2000-Hz CPT was comparable to normal finger, while 5- and 250-Hz CPTs were comparable to normal toe. The present findings suggest that the transplanted toe was intermediate between normal finger and normal toe, but more like normal toe than normal finger with regard to detection thresholds of the current-evoked sensation. © 1996 John Wiley & Sons, Inc.     

Memory, emotional and vocational impairments before and after anterior temporal lobectomy for complex partial seizures

PURPOSE: To assess the pre- and postsurgical frequency of memory, emotional, and vocational impairments in patients who underwent anterior temporal lobectomy (ATL), and to assess the relationship between emotional disturbance and memory abilities after ATL. METHODS: Retrospective analysis of data was performed on 90 patients with medically intractable complex partial seizures who underwent ATL between 1981 and 2003. Patients were evaluated an average of 5 months before surgery and 11.3 months after surgery. RESULTS: A moderate to high frequency of memory impairment (44.4%; verbal or nonverbal), emotional disturbance (38.9%) and unemployment (27.8%) existed in the same individuals both before and after surgery. There were small to moderate rates of new onset memory (18.9%), emotional (11.1%), and vocational (7.8%) difficulties after surgery often regardless of seizure control outcome. Patients who underwent left-ATL and had emotional disturbance after surgery had the lowest verbal memory test scores. CONCLUSIONS: Results highlight the importance of taking into account emotional status when assessing memory abilities after ATL. Results replicate the finding of moderate to high frequencies of memory impairment, emotional disturbance, and unemployment both before and after ATL. Results provide support for the rationale that cognitive, psychiatric and vocational interventions are indicated to mitigate the problems that exist before and persist after ATL.     

60Coγ射线辐照神经移植后神经传导速度观察

目的 探讨变性神经移植后神经传导速度情况. 方法 将30只大鼠分为实验组、对照组和正常组,实验组将60Coγ射线先期辐射处理后的兔自体神经原位再植,对照组切除后不经辐射直接自体再植,正常组不做任何处理.再植术后4月、6月和8月分别对3组大鼠行电生理检查,观察神经传导速度. 结果术后4月实验组的神经传导速度[(47.047±1.203)m/s]与正常组[(92.156±6.456)m/s]、对照组[(54.717±4.139)m/s]比较差异均有统计学差异(P<0.05);而术后6月和8月实验组与正常组、对照组比较,差异无统计学意义(P>0.05). 结论 长段自体神经(约3cm)经60Coγ射线先期处理后再植,神经传导速度可逐渐恢复正常.     

60Coγ射线辐照神经移植后神经传导速度观察

目的 探讨变性神经移植后神经传导速度情况. 方法 将30只大鼠分为实验组、对照组和正常组,实验组将60Coγ射线先期辐射处理后的兔自体神经原位再植,对照组切除后不经辐射直接自体再植,正常组不做任何处理.再植术后4月、6月和8月分别对3组大鼠行电生理检查,观察神经传导速度. 结果术后4月实验组的神经传导速度[(47.047±1.203)m/s]与正常组[(92.156±6.456)m/s]、对照组[(54.717±4.139)m/s]比较差异均有统计学差异(P<0.05);而术后6月和8月实验组与正常组、对照组比较,差异无统计学意义(P>0.05). 结论 长段自体神经(约3cm)经60Coγ射线先期处理后再植,神经传导速度可逐渐恢复正常.     

60Coγ射线辐照神经移植后神经传导速度观察

目的 探讨变性神经移植后神经传导速度情况. 方法 将30只大鼠分为实验组、对照组和正常组,实验组将60Coγ射线先期辐射处理后的兔自体神经原位再植,对照组切除后不经辐射直接自体再植,正常组不做任何处理.再植术后4月、6月和8月分别对3组大鼠行电生理检查,观察神经传导速度. 结果术后4月实验组的神经传导速度[(47.047±1.203)m/s]与正常组[(92.156±6.456)m/s]、对照组[(54.717±4.139)m/s]比较差异均有统计学差异(P<0.05);而术后6月和8月实验组与正常组、对照组比较,差异无统计学意义(P>0.05). 结论 长段自体神经(约3cm)经60Coγ射线先期处理后再植,神经传导速度可逐渐恢复正常.     

Functional recovery in primates with brachial plexus injury after spinal cord implantation of avulsed ventral roots.

Intraspinal replantation of avulsed spinal nerve roots as a surgical treatment for motor deficits after severe brachial plexus injury was investigated in primates. Under general anaesthesia hemi-laminectomy was performed in cynomolgus monkeys (Macaca fascicularis). Ventral roots within the brachial plexus were then avulsed by traction and subsequently implanted into the ventrolateral aspect of the spinal cord. No dysfunction in the long fibre tracts was seen following surgery. Postoperatively there was a flaccid paralysis of the arm on the lesioned side. Severe atrophy developed within 5-7 weeks in the muscles supplied by the avulsed roots and EMG revealed denervation activity. Two to three months after surgery there were EMG signs of reinnervation, which were shortly followed by evidence of clinical recovery. A gradual improvement in the function of the affected arm occurred and the animals' motor behaviour normalised. One year after surgery there was a full range of motion in the arm, but the EMG activity in the reinnervated muscles at maximal force was reduced. Tracing of regenerated motor neurons with horseradish peroxidase (HRP) injected into the biceps muscle revealed retrogradely labelled motor neurons confined to the ipsilateral ventral horn. It was concluded that intraspinal replantation of avulsed ventral roots in primates significantly promotes motor recovery in the muscles supplied by the lesioned spinal cord segments.     

60Coγ射线辐照神经移植后神经传导速度观察

目的 探讨变性神经移植后神经传导速度情况. 方法 将30只大鼠分为实验组、对照组和正常组,实验组将60Coγ射线先期辐射处理后的兔自体神经原位再植,对照组切除后不经辐射直接自体再植,正常组不做任何处理.再植术后4月、6月和8月分别对3组大鼠行电生理检查,观察神经传导速度. 结果术后4月实验组的神经传导速度[(47.047±1.203)m/s]与正常组[(92.156±6.456)m/s]、对照组[(54.717±4.139)m/s]比较差异均有统计学差异(P<0.05);而术后6月和8月实验组与正常组、对照组比较,差异无统计学意义(P>0.05). 结论 长段自体神经(约3cm)经60Coγ射线先期处理后再植,神经传导速度可逐渐恢复正常.