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Treatment of Infections Associated with Surgical Implants

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Prosthetic fitting, use, function, and satisfaction are important rehabilitation goals following lower-limb amputation. This study prospectively examined these outcomes in a cohort of individuals who underwent lower-limb amputation secondary to peripheral vascular disease and/or diabetes. A wide range of demographic, psychosocial, and comorbid medical data were evaluated at baseline in the perioperative period, which enabled an assessment of possible contributing factors and their effect on these outcomes. This cohort of subjects was then followed for a year following amputation by utilizing a wide spectrum of objective and validated self-report outcome measures. These study design characteristics make this investigation unique compared to prior studies examining similar outcomes following dysvascular lower-limb amputation [1–11].

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A Comparison of Balloon-Expandable-Stent Implantation …

A is an artificial limb that replaces an arm missing below the elbow. Two main types of prosthetics are available. Cable operated limbs work by attaching a harness and cable around the opposite shoulder of the damaged arm. The other form of prosthetics available are arms. These work by sensing, via , when the muscles in the moves, causing an artificial hand to open or close. In the prosthetic industry a trans-radial prosthetic arm is often referred to as a "BE" or below elbow prosthesis.

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A is an artificial limb that replaces a leg missing below the knee. Transtibial amputees are usually able to regain normal movement more readily than someone with a transfemoral amputation, due in large part to retaining the knee, which allows for easier movement. In the prosthetic industry a trans-tibial prosthetic leg is often referred to as a "BK" or below the knee prosthesis.

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A Comparison of Balloon-Expandable-Stent …

Providing a satisfactory, functional prosthesis following lower-limb amputation is a primary goal of rehabilitation. The objectives of this study were to describe the rate of successful prosthetic fitting over a 12 mo period; describe prosthetic use after amputation; and determine factors associated with greater prosthetic fitting, function, and satisfaction. The study design was a multicenter prospective cohort study of individuals undergoing their first major lower-limb amputation because of vascular disease and/or diabetes. At 4 mo, unsuccessful prosthetic fitting was significantly associated with depression, prior arterial reconstruction, diabetes, and pain in the residual limb. At 12 mo, 92% of all subjects were fit with a prosthetic limb and individuals with transfemoral amputation were significantly less likely to have a prosthesis fit. Age older than 55 yr, diagnosis of a major depressive episode, and history of renal dialysis were associated with fewer hours of prosthetic walking. Subjects who were older, had experienced a major depressive episode, and/or were diagnosed with chronic obstructive pulmonary disease had greater functional restriction. Thus, while most individuals achieve successful prosthetic fitting by 1 yr following a first major nontraumatic lower-limb amputation, a number of medical variables and psychosocial factors are associated with prosthetic fitting, utilization, and function.

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To determine prosthetic use, subjects were asked at 4 and 12 mo if they had been fitted with a prosthesis. For those who had been fitted, they were asked, "On average, how many hours per day are you wearing your prosthesis?" and "On average, how many hours per day are you walking with your prosthesis?" We measured prosthetic function and satisfaction using the Trinity Amputation and Prosthesis Experience Scales (TAPES) at 12 mo only because only half of the subjects were fitted with a prosthesis at 4 mo (vs >90% at 12 mo). The TAPES includes nine subscales measuring psychosocial outcomes, activity restriction, prosthetic satisfaction, pain, and general health [22]. The activity restriction subscale is further divided into an athletic activity restriction, functional restriction, and social restriction–the higher the score, the higher the restriction, with scores ranging from 0 to 8. The prosthetic satisfaction subscale of the TAPES is divided further into aesthetic satisfaction (range: 4–20), weight satisfaction (range: 1–5), and functional satisfaction (range: 5–25) subscales. The aesthetic satisfaction subscale reflects contentment with cosmetic characteristics. The functional satisfaction subscale includes the areas of prosthetic usefulness, reliability, fit, comfort, and overall satisfaction. The weight satisfaction score is determined by only one question based on satisfaction with the weight of the prosthesis. Higher scores on these subscales are indicative of greater prosthetic satisfaction.