BACKGROUND: Bite injuries, particularly those involving the hands, present a significant medico-legal challenge, often leading to complications and frequent emergency department visits. Dog and cat bites, especially among children, are major contributors to infections due to the complex anatomy of the hand, which predisposes it to severe infections even from minor bites. Capnocytophaga canimorsus, found in the oral cavity of dogs and cats, is particularly concerning due to its potential to cause severe infections. Prompt and appropriate treatment is essential to mitigate these risks. Managing such injuries poses significant challenges, necessitating clear guidelines for reporting and safety measures. This article highlights the urgent need for additional research, support, and education, particularly focusing on children, along with the development of international guidelines to improve outcomes for patients.
METHODS: A case study of a sixteen-year-old girl who had her left forearm amputated due to a rottweiler bite is presented. Despite initial attempts at replantation, complications led to the decision for amputation.
CONCLUSIONS: This case underscores the challenges in managing severe dog bite injuries, emphasizing the importance of prompt assessment, thorough debridement, and proper wound management to minimize complications. Additionally, psychological evaluation and treatment are crucial for patients and parents following such traumatic events. From a medical standpoint, this case highlights the importance of monitoring inflammatory markers, appropriate surgical priorities, and the need for psychological support. Prevention of dog bites is crucial, requiring increased awareness among public authorities and dog owners. Clear guidelines for reporting dog bites are essential, but further research is needed to improve their comprehensiveness and effectiveness.

Functional impairment, absence, or traumatic loss of the thumb is associated with considerable morbidity. A fully functioning thumb is estimated to account for 40% of hand function. An array of options exists for thumb reconstruction, and the intervention selected must be tailored to each individual patient. Pollicization is a powerful and elegant operation that can dramatically improve function for many patients. However, the surgeon and patient must be keenly aware that pollicization does not construct a \"normal\" thumb. Herein, we present a stepwise approach to treatment, including surgical nuances, alternatives to pollicization, complications, and outcomes.

Traumatic thumb injuries significantly affect overall hand function and may result in considerable disability. Reconstructing the traumatized thumb requires a detailed preoperative assessment of the defect and evaluation of the patient\'s social history and medical comorbidities. Reconstructive techniques can be stratified by the level of thumb injury. The goals of thumb reconstruction are to restore length, stability, mobility, and sensibility. This article reviews reconstructive principles and operative techniques for reconstructing the traumatized thumb.

There have been dwindling numbers of replantations in the United States. Despite the advocacy for centralization in hand trauma, the fundamental landscape and attitudes of surgeons toward replantation have remained lackluster. There is growing and substantial evidence to demonstrate the superior outcomes of replantation in comparison to revision amputation in most scenarios. This article aims to delve into the factors contributing to the decreasing numbers of replantations and proposes strategies to overcome this issue.

The primary goal is to preserve thumb integrity and functionality to the greatest extent possible, even in cases involving very small amputated parts. In this article, we present a case in whom the seemingly non-replantable dorsal skin-nail composite tissue of the thumb could be successfully replanted with a single artery anastomosis. No additional procedures were required, and complete recovery was achieved. In conclusion, given the unique vascular structure of the thumb, all amputated parts should be carefully evaluated for replantation. Replanting a partially amputated finger yields superior functional and cosmetic outcomes compared to any reconstructive method.

OBJECTIVE: Amputations are a common surgical procedure resulting from trauma during earthquakes, leading to severe disability. This study aims to investigate surgical outcomes specific to amputations that occurred in Adıyaman after the Kahramanmaraş earthquakes.
METHODS: This descriptive study included amputees who presented to Adıyaman University Training and Research Hospital. Between March 6, 2024 and March 29, 2024, amputees were contacted by phone and asked the questions in the form. Data analyzed included demographic information, number and level of amputated extremities, phantom limb pain, stump infection, extrication time, time to initiation of rehabilitation, number of revision, and whether a prosthesis was fitted.
RESULTS: The study reached 75 amputees. The mean age was 37.9 ± 19.2, and the most frequently amputated age group was adults. Stump infection was observed in 40 amputees (53.3%), phantom limb pain in 47 (62.6%), and revision in 29 (38.7%). The median extrication time was 36 h and initiation of rehabilitation time was 45 days. It was noted that 35 amputees (62.5%) used prostheses. A statistically significant relationship was found between fasciotomy and stump infection (p = .000). Infection was detected in 65% of those who underwent fasciotomy.
CONCLUSIONS: Earthquake-related amputations most frequently affected the adult age group and primarily involved lower extremity amputations, such as transfemoral and transtibial amputations. Phantom limb pain, need for revision, and infection are common in earthquake-induced amputations. Delayed fasciotomy increases the risk of stump infection. The data obtained in this study will help plan local health services to coordinate amputation care in disasters.

BACKGROUND: Continuous extracorporeal perfusion (ECP), or machine perfusion, holds promise for prolonged skeletal muscle preservation in limb ischemia-reperfusion injury. This study aimed to extend the amputation-to-replantation time window from currently 6 hours to 33 hours using a 24-hour ECP approach.
METHODS: Six large white pigs underwent surgical forelimb amputation under general anesthesia. After amputation, limbs were kept for 9 hours at room temperature and then perfused by 24-hour ECP with a modified histidine-tryptophan-ketoglutarate (HTK) solution. After ECP, limbs were orthotopically replanted and perfused in vivo for 12 hours. Clinical data, blood, and tissue samples were collected and analyzed.
RESULTS: All 6 forelimbs could be successfully replanted and in vivo reperfused for 12 hours after 9 hours of room temperature ischemia followed by 24 hours ECP. Adequate limb perfusion was observed after replantation as shown by thermography and laser Doppler imaging. All pigs survived without severe organ failure, and no significant increase in inflammatory cytokines was found. Macroscopy and histology showed marked interstitial muscular edema of the limbs, whereas myofiber necrosis was not evident, implying the preservation of muscular integrity.
CONCLUSIONS: The use of a 24-hour ECP has successfully extended limb preservation to 33 hours. The modified histidine-tryptophan-ketoglutarate perfusate demonstrated its ability for muscle protection. This innovative approach not only facilitates limb replantation after combat injuries, surmounting geographical barriers, but also broadens the prospects for well-matched limb allotransplants across countries and continents.

UNASSIGNED: The decision-making process for lower limb replantation involves several critical factors, such as age, comorbidities, ischemia time, type of injury, and psychosocial considerations. Advances in microsurgical techniques have led to a greater focus on enhancing functionality through limb salvage. To improve functional outcomes, it is essential to gain a better understanding of the current challenges in reconstruction and address them in future cases. Objective functional analysis of lower extremity replantation cases holds the potential to guide us in this endeavor. In this report, we present a lower limb replantation case with a 10-year follow-up, including objective functional evaluation with gait analysis.

METHODS: An overall healthy 48-year-old man suffered a left foot mangled crush injury resulting in a post-transmetatarsal amputation and subsequently developing a painful neuroma on the plantar surface of the foot. To avoid the zone of injury, targeted muscle reinnervation was used to treat the neuroma by coapting the tibial nerve to the motor point of the flexor hallucis longus (FHL) muscle. At 1-year follow-up, the patient reported no pain at rest, returned to work, and could ambulate with an orthosis for 30 minutes.
CONCLUSIONS: Rare tibial nerve coaptations to the FHL could serve as a treatment option for patients with neuromas in traumatic postmetatarsal amputation.

The abrupt onset of the situation after a traumatic amputation and the preparatory discussions following unsuccessful attempts to preserve limbs with necessary amputation require a high level of empathy, attention and well-founded information individually tailored to the affected individuals. Optimization of the treatment process can only be achieved by considering these aspects.The self-motivation and cooperation of the patient should be encouraged. To achieve this goal, the professions involved are less suitable for counseling due to a lack of personal experience, whereas so-called peers, as knowledgeable and experienced advisors, are more appropriate. This insight can be derived from existing studies. Peer counseling has increasingly been integrated into routine treatment following amputations in trauma surgery, with positive effects. It is considered guideline-compliant therapy not only in rehabilitation. Against the background of long-standing legislation, especially the UN Convention on the Rights of Persons with Disabilities and the demands of those affected by amputation, the following presentation focuses on the instrumentalization and benefits of counseling. The structures of this particular counseling option, including regular training of counselors and established implementation, are currently not necessarily given but are continuously expanding and being adapted to needs. Concrete scientific evidence regarding measurable effects and positive impacts on outcomes is pending and are presented in a current research project.
UNASSIGNED: Das abrupte Einsetzen der Situation nach einer traumatischen Amputation und die vorbereitenden Gespräche nach frustranem Erhaltungsversuch bei Gliedmaßenverletzung mit notwendiger Amputation erfordern ein hohes Maß an Empathie, Zuwendung und fundierten Informationen, die individuell für die Betroffenen aufgearbeitet sein müssen. Eine Optimierung des Behandlungsablaufes kann nur unter Beachtung dieser Aspekte erreicht werden. Die eigene Motivation und Mitarbeit sollen bei den Patientinnen und Patienten gefördert werden. Um dieses Ziel zu erreichen, eignen sich für die Beratung aus Ermangelung eigener Erfahrung weniger die beteiligten Professionen als viel mehr sog.Peers, die als kundige und selbsterfahrene Berater fungieren können. Diese Erkenntnis lässt sich aus vorhandenen Studien ableiten. Die Peerberatung (das Peer Counseling) konnte in der Unfallchirurgie zunehmend und mit positiven Effekten als ein gesondertes Instrument in die alltägliche Behandlung nach Amputation integriert werden. Sie gilt als leitliniengerechtes Verfahren nicht nur in der Rehabilitation. Vor dem Hintergrund langjährig gültiger Gesetzgebungen, insbesondere der UN-Behindertenrechtskonvention, und den Forderungen der von Amputation Betroffenen werden im vorliegenden Beitrag die Instrumentalisierung und der Nutzen der Beratung in den Fokus genommen. Die Strukturen dieser besonderen Beratungsoption, auch mit regelmäßiger Schulung der Berater, sowie der etablierte Einsatz sind derzeit nicht selbstverständlich gegeben, werden aber stetig ausgebaut und den Bedürfnissen angepasst. Ausstehend sind konkrete wissenschaftliche Nachweise über messbare Effekte und positive Auswirkungen auf das Outcome, die in einem aktuellen Forschungsvorhaben dargestellt werden.