About this Research Topic
There are 185,000 new amputations of the lower extremities each year just in the United States. The current estimated population of Americans living with an amputation is of approximately 2 million and it is projected that it will be 3.6 million by the year 2050. Other countries present similar trends. The most common causes of amputation include peripheral vascular disease (PVD and diabetes) while trauma events (motor vehicle or motorcycle collisions and machinery work related injuries) represent 45% of the cases. Amputations for oncologic reasons account for only 2% of the cases.
Despite the high prevalence of amputations and the increasing number of patients needing one, it is not until recent years that surgical techniques started to evolve and improve patient clinical outcomes that were simply considered part of the standard of patients undergoing amputations. Nerve pain, phantom limb syndrome and phantom limb pain, irritation of the skin by the socket and issues with socket use in above the knee amputation are some of examples of the “accepted” outcome.
Recent techniques such as osseous-integration have become available and have proved to have a significant impact in addressing issues related to socket fixation, wearability and prosthetic use as “a socket” is not needed with this type device. The ability to use the fixture in a very short segment of bone has also expanded the number patients with transfemoral amputations whom can benefit from the use of a prosthetic. Additionally, gait parameters have been optimized and metabolic expenditure as well as oxygen consumption have proved to decrease in a significant clinical manner with the use of osteointegration devices.
Another recent change is the evolution in the paradigm of nerve endings management after amputations. The concept of transection without reconstruction has proved to fail and be a cause of chronic neuropathic and phantom limb pain. New techniques in nerve reconstruction such as TMR (targeted muscular reinnervation) have demonstrated to reduce and address these neuropathic pain issues. Not only patients report less pain, but also use less pain medications and use more their prothesis. The benefit of TMR has been proved in different studies including a prospective controlled randomized trial that was closed early due to the significant clinical benefit of TMR in amputees.
Through this recent changes it has become evident that multidisciplinary groups are the best way to treat this patient population and advance the field. These new advances have also revealed how limited our instruments of evaluation for function, pain and quality of life are limited and poorly congruent in amputees.
Overall, amputations continue to be a needed procedure and the number of patients requiring it is also on the raise. We invite authors to participate with research focusing in the changes and evolution of amputation transforming it from an ablative procedure into a functional reconstruction technique.
Special focus will be given but not restricted:
- Nerve reconstruction techniques in amputations of the upper and lower extremity
- Osteointegration in amputations of the upper and lower extremity
- Advances and modification in surgical techniques in amputations, turnup- tibia plasty, rotationplasty and myoelectric reconstruction for powered devices.
- Rehabilitation protocols and techniques in patients treated with amputations using traditional techniques and newer such as TMR and osseous integration.
- The use of custom-made implants, megaprothesis and orthopedic implants in the reconstruction of functional amputations.
- Plastic surgery techniques in the management of soft-tissues in residual limbs after primary and revision amputations
- Patient reported outcomes, validation and creation of new instruments of evaluation that truly and objectively evaluate function in amputees
- Evaluation and creation of mechanisms for multidisciplinary approach in the management and clinical follow up of patients with amputations
- Advances in engineering and myoelectric interface optimization through computer chip technology and the combination of TMR and Osteointegration for higher function automated prostheses.
Despite the high prevalence of amputations and the increasing number of patients needing one, it is not until recent years that surgical techniques started to evolve and improve patient clinical outcomes that were simply considered part of the standard of patients undergoing amputations. Nerve pain, phantom limb syndrome and phantom limb pain, irritation of the skin by the socket and issues with socket use in above the knee amputation are some of examples of the “accepted” outcome.
Recent techniques such as osseous-integration have become available and have proved to have a significant impact in addressing issues related to socket fixation, wearability and prosthetic use as “a socket” is not needed with this type device. The ability to use the fixture in a very short segment of bone has also expanded the number patients with transfemoral amputations whom can benefit from the use of a prosthetic. Additionally, gait parameters have been optimized and metabolic expenditure as well as oxygen consumption have proved to decrease in a significant clinical manner with the use of osteointegration devices.
Another recent change is the evolution in the paradigm of nerve endings management after amputations. The concept of transection without reconstruction has proved to fail and be a cause of chronic neuropathic and phantom limb pain. New techniques in nerve reconstruction such as TMR (targeted muscular reinnervation) have demonstrated to reduce and address these neuropathic pain issues. Not only patients report less pain, but also use less pain medications and use more their prothesis. The benefit of TMR has been proved in different studies including a prospective controlled randomized trial that was closed early due to the significant clinical benefit of TMR in amputees.
Through this recent changes it has become evident that multidisciplinary groups are the best way to treat this patient population and advance the field. These new advances have also revealed how limited our instruments of evaluation for function, pain and quality of life are limited and poorly congruent in amputees.
Overall, amputations continue to be a needed procedure and the number of patients requiring it is also on the raise. We invite authors to participate with research focusing in the changes and evolution of amputation transforming it from an ablative procedure into a functional reconstruction technique.
Special focus will be given but not restricted:
- Nerve reconstruction techniques in amputations of the upper and lower extremity
- Osteointegration in amputations of the upper and lower extremity
- Advances and modification in surgical techniques in amputations, turnup- tibia plasty, rotationplasty and myoelectric reconstruction for powered devices.
- Rehabilitation protocols and techniques in patients treated with amputations using traditional techniques and newer such as TMR and osseous integration.
- The use of custom-made implants, megaprothesis and orthopedic implants in the reconstruction of functional amputations.
- Plastic surgery techniques in the management of soft-tissues in residual limbs after primary and revision amputations
- Patient reported outcomes, validation and creation of new instruments of evaluation that truly and objectively evaluate function in amputees
- Evaluation and creation of mechanisms for multidisciplinary approach in the management and clinical follow up of patients with amputations
- Advances in engineering and myoelectric interface optimization through computer chip technology and the combination of TMR and Osteointegration for higher function automated prostheses.
Keywords: Amputation, Rehabilitation, Interventions, Osteointegration, Nerve Reconstruction Techniques, Surgery
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
