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This article introduces some efficient generalized class of factor-type exponential imputation techniques and their corresponding estimators using auxiliary information. Generalized ratio, product, and dual to ratio type exponential estimators are the special cases of our suggested imputation techniques. Biases and mean squared error expressions are derived up to the first order of large sample approximations. The proposed imputation techniques can be viewed as efficient extensions of the work of Singh and Horn [Compromised imputation in survey sampling. Metrika. 2000;51(3):267–276. doi: 10.1007/s001840000054], Singh and Deo [Imputation by power transformation. Statist Papers. 2003;44(4):555–579. doi: 10.1007/BF02926010], Toutenburg and Srivastava [Amputation versus imputation of missing values through ratio method in sample surveys. Statist Papers. 2008;49(2):237–247. doi: 10.1007/s00362-006-0009-4], Kadilar and Cingi [Estimators for the population mean in the case of missing data. Commun Stat Theory Methods. 2008;37(14):2226–2236. doi: 10.1080/03610920701855020], Singh [A new method of imputation in survey sampling. Statistics. 2009;43(5):499–511. doi: 10.1080/02331880802605114], Gira [Estimation of population mean with a new imputation methods. Appl Math Sci. 2015;9(34):1663–1672] and Singh et al. [An improved alternative method of imputation for missing data in survey sampling. J Stat Appl Probab. 2022;11(2):535–543. doi: 10.18576/jsap]. Our proposed estimators are compared with these estimators, including the mean, ratio, and regression imputation techniques. Thereafter, a numerical illustration and simulation study are conducted for a comparative study using real and simulated data sets, and the demonstration shows that our suggested estimators are the most efficient estimators. [ABSTRACT FROM AUTHOR]

Introduction: Electronic versions of patient-reported outcome measures (PROMs) seem to have a clear administrative logging advantage to traditional paper versions. However, most of them have not been formally evaluated for their suitability to replace paper outcome measures for assessment of individuals with lower-limb amputations. The aim of this study is to examine the usability and equivalence of electronic to paper versions of PROMs suitable for use in prosthetic clinical care and research for persons with lower-limb loss. Methods: In this cross-sectional study, 10 participants remotely completed the following PROMs online and then on paper: Orthotic and Prosthetic User Survey (OPUS), Modified Falls Efficacy Scale (MFES), Prosthetic Evaluation Questionnaire (PEQ), Patient Health Questionnaire–9 (PHQ-9), and Community Participation Indicators (CPI). Participants also answered open-ended and standardized questions regarding the usability of the electronic surveys. Wilcoxon signed rank tests, comparisons to minimum detectable change, intraclass correlation coefficients, and Bland-Altman plots were used to evaluate differences between the two survey versions, meaningful changes in scores, reliability, and systematic biases, respectively. Results: Electronic surveys had fewer missing or ambiguous responses than paper surveys; however, the PEQ Social Burdens subscale could not be evaluated due to error in the creation of the electronic survey. No significant differences were found between scores of the two versions for any of the measures, but multiple participants had meaningful changes in the Appearance and Sounds PEQ subscales. All measures demonstrated acceptable reliability between versions, except the Appearance, Perceived Response, and Sounds subscales of the PEQ. No systematic biases in scores or usability concerns were found for any measures. Conclusions: This study analysis showed that most of the electronic PROMs studied are easily used and demonstrate equivalence to the paper versions. However, the PEQ Appearance, Perceived Response, Sounds, and Social Burden subscales require further evaluation. [ABSTRACT FROM AUTHOR]

This paper presents a vibrio vulnificus Infection Patient due to above knee amputation because self-use ointment dressing admitted to the intensive care unit. From December 21, 2021 to January 21, 2022, three health problems were identified in the course of care: acute pain, body image disturbance, and a self-care deficit. Nursing care included: listening to radio music, massage to relieve acute pain; caring and asking the patient to express his thoughts; sharing the medical process of the same case through video; help with acceptance, care for the amputation wound and facing the change of body appearance; with family members and rehabilitation team to design and participate in limb rehabilitation improve self-care ability after amputation. The nursing experience described hope for providing clinical care to similar case patients. [ABSTRACT FROM AUTHOR]

In an innovative approach to active prosthetic management, this paper introduces a method for intelligent control that circumvents the necessity of expensive sensory systems directly linked to user brain activity, such as muscle signals. The prosthesis autonomously determines the appropriate timing and nature of its movements, showcasing a unique control technique. The study also involves the development and evaluation of an advanced control system, alongside the establishment of a test platform for an Active Prosthetic Knee (APK). The scope of this research spans mechanical design, sensor integration, and motor control tailored to the APK. A noteworthy outcome of this study is the ability to fabricate a durable and cost-effective active prosthetic suitable for individuals with above-the-knee amputations. The resulting prosthetic demonstrates an enhanced capability to mimic the movement of a healthy limb with greater precision, all the while minimizing the physical strain on the patient's muscles. In terms of movement decision-making, the APK relies on analyzing the motion of the unaffected leg, thus eliminating the requirement for high-priced sensory systems traditionally connected to human brain signals. The intelligent control system has shown a significant improvement in movement precision compared to conventional models, and a reduction in the strain experienced by the user, marking significant strides in active prosthetic technology. [ABSTRACT FROM AUTHOR]

Opponents of the provision of therapeutic, healthy limb amputation in Body Integrity Identity Disorder cases argue that such surgeries stand in contrast to the goal of medical practice – that of health restoration and maintenance. This paper refutes such a conclusion via an appeal to the nuanced and reflective model of health proposed by Georges Canguilhem. The paper examines the conceptual entanglement of the statistically common with the normatively desirable, arguing that a healthy body can take multiple forms, including that of an amputee, provided that such a form enables the continuing ability to initiate new norms of existence. It concludes that the practice of healthy limb amputation in cases of Body Integrity Identity Disorder is not only compatible with the goal of medicine but is potentially the only method of achieving this goal in the face of a complex and often mischaracterized disorder. [ABSTRACT FROM AUTHOR]

Vascularized Composite Tissue Allotransplantation (VCA) allows replacement of lost body parts from brain-dead donors. These surgeries are laborious, time-intensive, and require vast planning. With the advent of better immunosuppressants, VCA will increasingly play an important role in the reconstructive field. In this paper, the authors share their standard operating protocol created after much deliberation. [ABSTRACT FROM AUTHOR]

Assistive technologies (AT) perform an important social role, interacting with cultural systems to produce or hinder accessibility to biosocial environments. This interaction profoundly shapes not only how an individual body can be experienced by users but also produce and hinder accessibility to biosocial environments. AT users have historically been viewed through a medical model, which deems them disabled by their impairments and by dominant ableist narratives. Therefore, this paper serves to provide an insight into the importance of ageing with and into AT. This paper aims to investigate polio survivors' and diabetic amputees' experiences of assistive technologies in order to better understand impacts upon narrative and identity. By applying an anthropological and sociological lens, a holistic view of the experiences of polio survivor and amputee AT users is developed. This paper draws on 16 in-depth interviews with polio survivors and diabetic amputees in the United States (US) and Australia, which were analysed using an experience-centered narrative approach. Both projects were approved by ethics boards. All participants provided written consent. Five themes were identified: a) disruption to biographies, which reflected AT impact on how narratives become altered; b) impacts to autonomy, which reflected the importance of regaining previous daily activities; c) re-engaging with community life, which highlighted how AT supported participation in valued activities; d) self-perceptions of assistive technologies, which act in opposition to external perspectives and challenge ableist narratives; and e) an intergenerational comparison of new and older AT users highlights the importance of temporalities. This paper offers new perspectives on ageing with assistive technologies, with a focus on identity and narrative. The importance of this paper is to contribute to the existing literature that demonstrates the cultural implications that arise through embodiment and assistive technologies. The use of assistive technology can help individuals regain function, but the individual circumstances require consideration The use of assistive technology is a complex entanglement of bodies, environments, biographies, and imagined futures. The use of assistive technology can provide participants autonomy over their narratives and assist with maintaining their identities [ABSTRACT FROM AUTHOR]

Chronic refractory complex regional pain syndrome (CRPS) is the severest form of this condition characterised by acute pain, other painful phenomena (hyperpathia, allodynia), severe functional impairment of the affected extremity and non-responsiveness to standard treatments. This paper presents a case of a 40-year-old man suffering from this form of CRPS, in whom all treatment options, including non-standard appeared ineffective. The patient suffered from intractable pain and a completely disabled extremity was considered by him a burden, additionally affecting his daily living. After a review of the literature and informing the patient about the potential benefits and the potential risk of failure of surgery, at the request of the patient an amputation of the upper extremity was performed at the level of 1/3 distal arm. The postoperative course was uneventful, but amputation did not result in cessation of the pain which persisted in the residual limb. The presented case shows that limb amputation for chronic refractory CRPS may not give expected beneficial effect. [ABSTRACT FROM AUTHOR]

Introduction: Phantom limb pain affects 50 percent to 85 percent of patients who have had their limbs amputated, lowering their quality of life. Clinical therapies for central pain, such as mirror therapy, motor imagery, or visual feedback, might help amputee patients suffering from phantom limb pain. Objectives: To provide a general review of the efficacy of various approaches for treating phantom limb discomfort in amputee patients. Methods: The following databases were used for a computerized literature search up to March 2022: PubMed, ScienceDirect, and Google Scholar. The modified Jadad score is utilized to measure study quality in this research. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed while conducting this systematic review. Results: In all, 15 papers matched our inclusion criteria, with 5 receiving a low study quality rating and 10 receiving a good study quality rating. All the studies revealed a considerable decrease in pain; however, the patients and techniques varied. Conclusion: Mirror therapy, motor imagery, and visual feedback can alleviate phantom limb pain. However, there is a lack of scientific data to support their efficacy. Future studies should use more powerful research methodologies to investigate these medicines' short- and long-term advantages. [ABSTRACT FROM AUTHOR]

Simple Summary: Cranial cruciate ligament disease is a very common source of pelvic limb lameness in dogs, and many techniques have been used to resolve this condition. Tibial tuberosity advancement (TTA) rapid technique is a new simplified option with very good results reported. Adding a small Steinmann pin distal to the cage prevents avulsion of the tibial tuberosity by quadriceps mechanism. In this report, we describe the first modified TTA rapid technique in a dog with a contralateral amputated limb. The dog was a five-year-old mixed breed with amputated right pelvic limb and difficulty walking. The dog started to walk unassisted second day postoperative, and at three months follow-up evaluation it showed no lameness and the osteotomy was completely healed. Cranial cruciate ligament disease (CCLD) is one of the most frequent causes of hindlimb lameness in dogs. Tibial tuberosity advancement (TTA) is a common surgery performed for CCLD. A modified, simplified technique (TTA Rapid) is also reported to have very good clinical outcomes. In this paper, we report a modified TTA Rapid technique to treat a CCLD in a dog with an amputated contralateral hindlimb. A 5-year-old mixed breed dog presented with amputated right hindlimb and difficulty walking. Pain and positive drawer sign were present at manipulation of left stifle joint. Radiographic findings of the stifle joint confirmed the presence of moderate osteoarthritis associated with CCLD, and modified TTA Rapid procedure was performed. Recovery from surgery was uneventful, and the dog was able to stand by his own by the second day postoperative. At three months follow-up evaluation, the dog was free of lameness and the osteotomy site was completely healed. This paper describes the first modified TTA rapid osteotomy technique performed in a dog with a contralateral amputated hindlimb. [ABSTRACT FROM AUTHOR]

Background: The main aim of this paper is to present the feasibility of rigorously designed multiple N-of-1 design in prosthetics research. While research of adequate power and high quality is often lacking in rehabilitation, N-of-1 trials can offer a feasible alternative to randomized controlled group trials, both increasing design power at group level and allowing a rigorous, statistically confirmed evaluation of effectiveness at a single patient level. The paper presents a multiple N-of-1 trial protocol, which aim is to evaluate the effectiveness of Unity, a prosthetic add-on suspension system for amputees, on patient-reported comfort during daily activities (main outcome measure), prosthesis wearing time, perception of limb-prosthesis fitting and stump volume and functional walking parameters. Methods: Multicenter, randomized, prospective, double-blind multiple N-of-1 trial using an introduction/withdrawal design alternating Unity connected/disconnected phases of randomized length on twenty patients with unilateral transtibial amputation. The primary outcome measure is the Prosthetic Socket Comfort Score (SCS), a validated measure of comfort, administered daily by an phone app designed for the study. Secondary outcomes measures will be collected during the 50 days period of the N-of-1 trial: (1) by the same app, daily for patient-reported limb-prosthesis fitting, stump volume variation, and daily wearing time of the prosthesis; (2) by a pedometer for the number of steps per day; (3) by blind assessors in the rehabilitation center during adjustment visits for functional walking parameter (L-Test, 6-minute walk test), and by the patient for the QUEST, and ABC-S. Effectiveness of the Unity system regarding SCS and daily secondary outcome measures will be tested by randomization test. The secondary outcome measures assessed during visits in the rehabilitation center will be analyzed by Non Overlap of All pairs. An estimate of the effect on the amputee population will be generated by aggregating each individual clinical trial (N-of-1 trial) by Hierarchical Bayesian methods. Discussion: This study protocol was designed to answer the question "which device is best for THIS patient" and to conclude at a group level on the effectiveness of a new devic, using a Multiple N-of-1 trial, which is promising but underused in prosthetics research so far. Trial registration: N° ID-RCB 2020-A01309-30 Clintrial.gov : NCT04804150 - Retrospectively registered March 20th 2021. Keys messages: Multiple N-of-1 trials represent a switch in the rationale behind the choice of a medical device. Instead of selecting prosthetics based on the mean response to the device of a group of participants, multiple N-of-1 trials allow to answer the question "which device is best for THIS patient", using a rigorous, recognized, scientific methodology allowing individual results as well as group analysis. This Multiple N-of-1 trials is an approach in an ecological environment and with daily measures that will provide data closer to daily prosthetic use than trials testing device effectiveness outside of daily life; [ABSTRACT FROM AUTHOR]

Designs of active prostheses attempt to compensate for various functional losses following amputation. Integration of sensory feedback with the functional control re-enables sensory interaction with the environment through the prosthetic. Besides the functional and sensory loss, amputation induces anatomical and physiological changes of the sensory neural pathways, both peripherally and centrally, which can lead to phantom limb pain (PLP). Additionally, referred sensation areas (RSAs) likely originating from peripheral nerve sprouting, regeneration, and sensory reinnervation may develop. RSAs might provide a non-invasive access point to sensory neural pathways that project to the lost limb. This paper aims to report on the sensory input features, elicited using non-invasive electrical stimulation of RSAs that over time alleviated PLP in two upper-limb amputees. The distinct features of RSAs and sensation evoked using mechanical and electrical stimuli were characterized for the two participants over a period of 7 and 9 weeks, respectively. Both participants received transradial and transhumeral amputation following traumatic injuries. In one participant, a relatively low but stable number of RSAs provided a large variety of types of evoked phantom hand (PH) sensations. These included non-painful touch, vibration, tingling, stabbing, pressure, warmth/cold as well as the perception of various positions and movements of the phantom hand upon stimulation. Discomforting and painful sensations were induced with both mechanical and electrical stimuli. The other participant had a relatively large number of RSAs which varied over time. Stimulation of the RSAs provided mostly non-painful sensations of touch in the phantom hand. Temporary PLP alleviation and a change in the perception of the phantom hand from a tight to a more open fist were reported by both participants. The specificity of RSAs, dynamics in perception of the sensory input, and the associated alleviation of PLP could be effectively exploited by designs of future active prostheses. As such, techniques for the modulation of the sensory input associated with paradigms from interaction with the environment may add another dimension of protheses towards integrating personalized therapy for PLP. [ABSTRACT FROM AUTHOR]

This paper presents the foundation upon which the contemporary knowledge of body integrity dysphoria (BID) is built. According to the World Health Organisation's International Classification of Diseases, 11th edition (ICD-11), the main feature of BID is an intense and persistent desire to become physically disabled in a significant way. Three putative aetiologies that are considered to explain the insurgence of the condition are discussed: neurological, psychological and postmodern theories. The concept of bodily representation within the medical context is highlighted, with the concept of dysphoria, which was brought to the fore with the introduction of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and the ICD-11. Contemporary issues of "justice" are addressed to identify ethically relevant distinctions between BID and sex reassignment surgery. It is argued that there is no ethically relevant difference between the BID actor's desire for invasive surgical intervention and the wish of gender dysphoric individuals to undergo sex reassignment surgery procedures. Some BID actors self-mutilate, and this presents medical professionals with difficult choices regarding whether or not to intervene in order to satisfy the BID patient's desire. Both abstention and intervention may lead to severe ethical complications for doctors and patients despite the positive outcomes in terms of quality of life for BID individuals who manage to undergo such procedures. [ABSTRACT FROM AUTHOR]

Actuated lower limb prostheses, including powered (active) and semi-active (quasi-passive) joints, are endowed with controllable power and/or impedance, which can be advantageous to limb impairment individuals by improving locomotion mechanics and reducing the overall metabolic cost of ambulation. However, an increasing number of commercial and research-focused options have made navigating this field a daunting task for users, researchers, clinicians, and professionals. The present paper provides an overview of the latest trends and developments in the field of actuated lower-limb prostheses and corresponding technologies. Following a gentle summary of essential gait features, we introduce and compare various actuated prosthetic solutions in academia and the market designed to provide assistance at different levels of impairments. Correspondingly, we offer insights into the latest developments of sockets and suspension systems, before finally discussing the established and emerging trends in surgical approaches aimed at improving prosthetic experience through enhanced physical and neural interfaces. The ongoing challenges and future research opportunities in the field are summarized for exploring potential avenues for development of next generation of actuated lower limb prostheses. In our opinions, a closer multidisciplinary integration can be found in the field of actuated lower-limb prostheses in the future. [ABSTRACT FROM AUTHOR]

This paper provides a commentary on "Vascular amputees: A study in disappointment" (Little et al. 1974) and its significance in the development of the disability rights movement, as well as the movements for values-based medicine and person-centred health and social care. [ABSTRACT FROM AUTHOR]

The construction features of waist support products depend on current fashion trends, the specific requirements imposed on the products by potential wearers and the characteristics of the materials used and of course the methodology for developing the basic construction. In the case of people with lower limb amputations, the construction also depends on the type of prosthesis and its size. The paper presents the results of the study to optimize the construction of trousers for men with amputations in the leg. The topicality of the theme is determined by the alarming increase in the number of amputations and the increased interest of specialists in creating clothing for people with disabilities. The paper aims to identify the methodology for improving the construction of the product of trousers for people with amputations of the lower limbs, using 3D simulation. The general objective of this paper is to propose a succession of optimization of the basic pattern in order to be able to be customized according to the type of amputation. The paper presents the initial data necessary in the elaboration of a customized construction. Also presented are the stages of optimizing the construction of the pants and the simulations on the body of the avatar of the pattern, even after performing the optimization. The use of 3D software allows obtaining the wearer's avatar and assigning unique features, which are taken into account when designing custom clothing products. They also allow you to check the position of the products on the body of the avatar and modify them according to the requirements. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Archaeological, Anthropological, & Interdisciplinary Studies (JAAIS) / Revista de Arheologie, Antropologie si Studii Interdisciplinare is the property of Institute of Bioarchaeology & Ethnocultural Research (ICBE) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Interventions are medically necessary when they are vital in achieving the goal of medicine. However, with varying perspectives comes varying views on what interventions are (un)necessary and, thus, what potential treatment options are available for those suffering from the myriad of conditions, pathologies and disorders afflicting humanity. Medical necessity's teleological nature is perhaps best illustrated in cases where there is debate over using contentious medical interventions as a last resort. For example, whether it is appropriate for those suffering from body integrity dysphoria to receive healthy limb amputations. This paper explores how one's perception of medicine's goal underpins whether interventions are necessary or unnecessary, using the controversial topic of therapeutic amputation as an example. By contrasting 'classical' amputations with their more contentious counterparts, it highlights how the idea of medical necessity influences and restrains clinical decision-making. The paper starts by giving an account of body integrity dysphoria, focusing on the debate concerning elective amputation's justifiability. It then introduces Georges Canguilhem's vitalist theory of health, paying particular attention to his emphasis on adaptability. Then, this paper uses his theory as a lens through which to evaluate the appropriateness of therapeutic amputation as a medically necessary procedure. Ultimately, the paper highlights how the label of medical necessity is withheld from potential therapeutic interventions because they fail to conform to pre-established ideas of medicine's purpose and that by doing so, potential harm befalls those who are left with no effective treatments and must look for solutions in the non-clinical world. [ABSTRACT FROM AUTHOR]

Background: The treatment of neuromas with regenerative peripheral nerve interfaces (RPNI) has gained much attention in recent years. This systematic review compared the clinical outcomes of upper limb neuromas treated with free (fRPNI) versus vascularized RPNI (vRPNI). Methods: This systematic review was performed in accordance with PRISMA guidelines. The PubMed database was searched for relevant studies published between August 2016 and May 2023. The search term "RPNI" was used. Data including patient demographics, type of RPNI performed, mean pain duration prior to RPNI, post-operative follow-up period, the reduction in neuroma pain scores after RPNI and post-operative complications were extracted independently by two authors and recorded using standard computer software for data processing. Results: Of 43 papers identified, only four fulfilled the inclusion criteria. This provided data for upper limb neuromas in 32 patients where a total of 83 RPNIs (22 vascularized) were performed. The means for patient age, duration of neuroma pain, length of reported postoperative follow-up, and reduction in neuroma pain scores were 44.0 years, 3.6 years, 12.2 months and 86% respectively. Conclusions: The current evidence suggests that either fRPNI or vRPNI may be useful for treating upper extremity neuromas, both prophylactically and secondarily. However, the heterogeneity and inconsistencies in data reporting are such that further studies are required to compare clinical outcomes between fRPNI and vRPNI to determine if one is superior to the other. Level of Evidence: Not gradable. [ABSTRACT FROM AUTHOR]

Research highlights the differences and unique experiences of military veterans experiencing amputation compared to civilians. This review aimed to synthesise qualitative research exploring the experience of amputation and rehabilitation among existing or previous members of the military. A systematic search of six databases (PsycINFO, AMED, MEDLINE, CINAHL, Web of Science and Scopus) was undertaken in March 2022. The results of 17 papers reporting 12 studies published between 2009 and 2022 were synthesised using a meta-ethnographic approach to generate new interpretations reflecting the experiences of members of the military who have experienced limb loss. Three themes were developed from the data: (1) Making the physical and psychological transition to life after amputation; (2) The role of the military culture in rehabilitation; and (3) The impact of relationships and the gaze of others during rehabilitation and beyond. Military veterans with limb loss experience difficulties in navigating civilian healthcare systems and gaining appropriate support away from the military. Rehabilitation professionals, with psychological training or mentoring, involved in the care of military veterans following amputation could offer psychological support during the transition to civilian life and targeted therapies to veterans experiencing high levels of pain, and facilitate peer support programmes. Identify at an early stage of rehabilitation those veterans at risk for poorer adjustment, by examining their propensity or not to adopt goal pursuit and goal adaptation strategies Offer psychological support prior to and after the transition to civilian life Target psychological therapies, such as Cognitive Behavioural Therapy and Acceptance and Commitment Therapy, to veterans who are experiencing high levels of pain Encourage peer support programmes and provide support and training to peer mentors [ABSTRACT FROM AUTHOR]

Background: Edentulous sites with limited horizontal tooth‐implant distance pose a challenge to clinicians. This case report describes root amputation of an adjacent compromised molar to maintain an optimal tooth‐implant distance Methods and Results: A 41‐year‐old female was referred for extraction and implant placement to replace her left, maxillary second premolar (#13), which had been diagnosed with a vertical root fracture. Extraction and ridge preservation of #13 was completed without complication. The 4‐month postsurgical clinical examination revealed a narrow mesial‐distal distance (5.69 mm) of the edentulous space (#13), which was influenced by the degree of divergence of the mesial buccal root of tooth #14. Cone‐beam computed tomography (CBCT) analysis verified a periapical lesion on the mesial‐buccal root of tooth #14. The amputation of the endodontically compromised mesial‐buccal root of #14 was treatment planned to provide space and facilitate placement of a standard diameter implant without compromising the implant or adjacent teeth. Crestal bone levels were verified and maintained at the 1 year postoperative follow‐up. Conclusion: The findings of the case report demonstrate how root amputation of a compromised molar is an alternative solution for managing spatial limitations in contemporary implant dentistry. More studies are required to assess the reliability and long‐term success of this approach. Key points: Why is this case new information?There is insufficient evidence on the long‐term efficacy of narrow‐diameter implants. Clinical treatment guidelines are not sufficiently available.This paper presents an alternative approach to managing a specific scenario where mesial‐distance distance is limited using root amputation of an adjacent compromised tooth. What are the keys to successful management of this case?Comprehensive diagnosis and stringent case selectionMultidisciplinary treatment planningEvidence‐based decision making What are the primary limitations to success in this case?Very specific clinical application; adjacent compromised toothLong‐term follow up is required [ABSTRACT FROM AUTHOR]

Objective Pathology can provide crucial insights into the etiology of disease. The goal of this review is to evaluate the rigor of histopathology reports of Complex Regional Pain Syndrome (CRPS). Methods A systematic search of multiple databases identified papers that described amputation for CRPS with pathology findings. Control pathology articles were randomly chosen from the same journals. Landmark articles in Surgical Pathology were previously identified. Papers were categorized by the use of histology: Anatomic (microscopic description), Diagnostic (binary result), and Substrate (special studies only). A novel Histopathology Score assigned 1 point for each of 10 History elements and 15 Pathology elements. All articles were scored and analyzed by appropriate statistics. Results The search identified 22 CRPS, 50 Control and 50 Landmark articles. Multivariable analysis of the Pathology Score showed a significantly higher score for Anatomic vs Non-Anatomic papers (Incidence Rate Ratio (IRR) 1.54, P  < .001) and Landmark vs CRPS articles (IRR 1.39, P value.003). CRPS papers reported some elements infrequently: diagnostic criteria (31.8%), routine stain (50%), any clinic-pathologic correlation (40.9%), and sample size >2 (27.3%). Conclusions The Pathology Score is a useful quality assessment tool to evaluate studies. As expected, Anatomic papers scored significantly higher than Non-Anatomic papers. CRPS papers had small sample sizes (median 1) and infrequent reporting of diagnostic criteria, routine stain, any clinical pathologic correlation. These particular elements are crucial for analyzing and reviewing pathologic features. The analysis explains why it is quite difficult to write a meaningful systematic review of CRPS histology at this time. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a global pandemic, especially in Southeast Asia. Diabetic foot infection (DFI) is a common complication of this condition and causes significant morbidity and mortality in those affected. There is a lack of locally published data on the types of microorganisms and empirical antibiotics being prescribed. This paper highlights the importance of local microorganism culture and antibiotic prescription trends among diabetic foot patients in a tertiary care hospital in central Malaysia. This is a retrospective, cross-sectional study of data taken from January 2010 to December 2019 among 434 patients admitted with diabetic foot infections (DFIs) using the Wagner classification. Patients between the ages of 58 and 68 years old had the highest rate of infection. Pseudomonas Aeruginosa, Proteus spp., and Proteus mirabilis appeared to be the most isolated Gram-negative microorganisms, and Staphylococcus aureus, Streptococcus agalactiae, and MRSA appeared to be the most common Gram-positive microorganisms. The most common empirical antibiotics prescribed were ampicillin/sulbactam, followed by ciprofloxacin and ceftazidime, and the most common therapeutic antibiotics prescribed were ampicillin/sulbactam, ciprofloxacin, and cefuroxime. This study could be immensely pertinent in facilitating future empirical therapy guidelines for treating diabetic foot infections. [ABSTRACT FROM AUTHOR]

Trials for therapies after an upper limb amputation (ULA) require a focus on the real-world use of the upper limb prosthesis. In this paper, we extend a novel method for identifying upper extremity functional and nonfunctional use to a new patient population: upper limb amputees. We videotaped five amputees and 10 controls performing a series of minimally structured activities while wearing sensors on both wrists that measured linear acceleration and angular velocity. The video data was annotated to provide ground truth for annotating the sensor data. Two different analysis methods were used: one that used fixed-size data chunks to create features to train a Random Forest classifier and one that used variable-size data chunks. For the amputees, the fixed-size data chunk method yielded good results, with 82.7% median accuracy (range of 79.3–85.8) on the 10-fold cross-validation intra-subject test and 69.8% in the leave-one-out inter-subject test (range of 61.4–72.8). The variable-size data method did not improve classifier accuracy compared to the fixed-size method. Our method shows promise for inexpensive and objective quantification of functional upper extremity (UE) use in amputees and furthers the case for use of this method in assessing the impact of UE rehabilitative treatments. [ABSTRACT FROM AUTHOR]

An external hemipelvectomy (hindquarter amputation) is a major mutilating amputation that includes the lower extremity and half of the pelvic rim. It is rarely performed due to its mutilating character and the technical difficulties involved. The main indications for the operation include sarcomas and extensive trauma. In this paper, the authors discuss the historical aspects and current status of this rare operation, as well as its role in the oncological approach to sarcomas. [ABSTRACT FROM AUTHOR]

There are three families of solutions to the traditional Amputation Paradox: Eliminativism, Contingent Identity Theories, and Theories of Coincident Entities. Theories of Coincident Entities challenge our common understanding of the relation between identity and parthood, since they accept that two things can be mereologically coincident without being identical. The contemporary discussion of the Amputation Paradox tends to mention only one theory of Coincident Entities, namely the Constitution View, which violates the mereological principle of Extensionality. But in fact, there is another theory, namely the Unique Part View, which violates another mereological principle (the Weak Supplementation Principle). In this paper, I argue that the contemporary focus on the Constitution View is unmotivated, at least when we are confronted with the Amputation Paradox, and that a balanced comparison of the two views (as solutions to this specific paradox) should favour the Unique Part View. [ABSTRACT FROM AUTHOR]

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The Foot in Diabetes UK Zero All Preventable (ZAP) Amputations group is dedicated to minimising the occurrence of preventable lower limb amputations. This position statement aims to address the existing gap in delivering foot care services for individuals with diabetes and emphasises the critical necessity of prompt access to specialised foot care services to prevent delays and missed appointments. Moreover, it highlights the individual factors that can hinder or impede people with diabetes from seeking appropriate and timely foot care, encompassing psychological challenges and limitations of health literacy. Additionally, this paper explores recent advances in psychological strategies to mitigate the impact of distress on diabetes foot care. [ABSTRACT FROM AUTHOR]

To systematically review literature on nutritional intake, nutritional status and nutritional interventions, and to study their association with short- and long-term clinical outcomes in people with a major dysvascular lower limb amputation. PubMed, Ovid, CINAHL, and The Cochrane Library were searched. Studies were included if nutritional intake, nutritional status, or nutritional interventions in people with a major dysvascular lower limb amputation were analyzed. Of the 3038 unique papers identified, 30 studies were included. Methodological quality was moderate (1 study) or weak (29 studies). Limited information was available on nutritional intake (2 studies) and nutritional interventions (1 study). Nutritional intake and nutritional status were assessed by diverse methods. The percentage of people with a poor nutritional status ranged from 1% to 100%. In some studies, measures of poor nutritional status were associated with adverse short- and long-term clinical outcomes. The percentage of people with a poor nutritional status is inconclusive in the major dysvascular lower limb amputation population, because of the heterogeneity of the assessment methods used. Some included studies reported a negative association between poor nutritional status and clinical outcomes. However, these results should be interpreted with caution, because of the limited quality of the studies available. Studies high in methodological quality and high in hierarchy of evidence are needed. The proportion of people with a poor nutritional status in the major dysvascular lower limb amputation population is inconclusive. Poor nutritional status seems to affect clinical outcomes negatively. More uniformity in assessment of malnutrition in the major dysvascular lower limb amputation population is needed. [ABSTRACT FROM AUTHOR]

Introduction: Over the past 20 years, military medicine made great strides in the medical management of traumatically injured patients. Significant advancements were made in the treatment and rehabilitation after limb loss. These advancements can be attributed to the large number of complex patients presenting to military treatment facilities and the demand for medical professionals to provide care to patients with complex injuries and multiple traumatic amputations. The concern now is to maintain the skills needed to be prepared for the next conflict. To meet this demand, the Extremity Trauma and Amputation Center of Excellence (EACE) initiated the documentation of knowledge, skills, and abilities (KSAs) to ensure that the skill sets needed to treat this unique population are not lost. The EACE developed KSAs to sustain advanced clinical practice for physical therapists, occupational therapists, and prosthetists and is in the process of developing KSAs for orthotists and physical medicine physicians. The learning objectives [terminal and enabling learning objectives (TLOs and ELOs)] derived from each set of KSAs will drive curricula development for enduring education, residencies, and fellowships. This article describes the KSAs and learning objectives for advanced physical therapist competencies in amputation care. Methods: Clinical subject matter experts (SMEs) convened from the Department of Defense (DoD) Advanced Rehabilitation Centers (ARCs) to draft the initial KSAs. All experts had specific expertise in treating individuals with highly complex lower and upper limb amputation. In a quasi-Delphi methodology, the initial draft KSAs underwent five cycles of review and comment by an additional 15 DoD, Veterans Affairs, and civilian institution experts from clinical practice, education, and research. The consensus KSAs were then transcribed into learning objectives with collaboration between clinical subject matter experts and doctoral-level educators. Results: The final program document has 21 instructional modules with 30 TLOs and 157 ELOs. Conclusion: The KSAs and the learning objectives describe the skills expected of an advanced practice physical therapist treating patients with traumatic limb loss. Weaknesses of this document include the focus on traumatic amputation and military specific needs. However, many of the central advanced practices are universal to all physical therapists working in amputation. Thus, this document should serve as a starting point and can evolve to include dysvascular, oncology, and other etiologies. To our knowledge, this is the first paper to describe the KSAs for the advanced practice physical therapist working with traumatic limb loss population. This work will form the framework for physical therapist advanced practice training programs. [ABSTRACT FROM AUTHOR]

Objective: We set out to estimate healthcare costs of diabetes complications in the year of first occurrence and the second year, and to quantify the incremental costs of diabetes versus non-diabetes related to each complication. Methods: In this cohort study, people with diabetes (n = 45 378) and their age/sex propensity score matched controls (n = 90 756) were identified from a linked dataset in Tasmania, Australia between 2004 and 2017. Direct costs (including hospital, emergency room visits and pathology costs) were calculated from the healthcare system perspective and expressed in 2020 Australian dollars. The average-per-patient costs and the incremental costs in people with diabetes were calculated for each complication. Results: First-year costs when the complications occurred were: dialysis $78 152 (95% CI 71 095, 85 858), lower extremity amputations $63 575 (58 290, 68 688), kidney transplant $48 487 (33 862, 68 283), non-fatal myocardial infarction $30 827 (29 558, 32 197), foot ulcer/gangrene $29 803 (27 183, 32 675), ischaemic heart disease $29 160 (26 962, 31 457), non-fatal stroke $27 782 (26 285, 29 354), heart failure $27 379 (25 968, 28 966), kidney failure $24 904 (19 799, 32 557), angina pectoris $18 430 (17 147, 19 791), neuropathy $15 637 (14 265, 17 108), nephropathy $15 133 (12 285, 18 595), retinopathy $14 775 (11 798, 19 199), transient ischaemic attack $13 905 (12 529, 15 536), vitreous hemorrhage $13 405 (10 241, 17 321), and blindness/low vision $12 941 (8164, 19 080). The second-year costs ranged from 16% (ischaemic heart disease) to 74% (dialysis) of first-year costs. Complication costs were 109–275% higher than in people without diabetes. Conclusions: Diabetes complications are costly, and the costs are higher in people with diabetes than without diabetes. Our results can be used to populate diabetes simulation models and will support policy analyses to reduce the burden of diabetes. What is known about the topic? Most of the costs related to diabetes are due to management of complications. What does this paper add? Diabetes complication treatment required substantial healthcare resources, even after the first year of occurrence. Costs of treating complications are higher for people with diabetes versus those without. What are the implications for practitioners? Complications identified as key drivers should be preferentially targeted to reduce diabetes burden. Our results can be used as input for economic models to simulate the costs associated with the progression of diabetes and to assess the cost-effectiveness of interventions that reduce complications. [ABSTRACT FROM AUTHOR]

The presented paper aims to design 3D templates of the sciatic muscle and thigh to simplify and speed up the process of modelling TF (transfemoral) sockets using the CAD/CAM method. A proposal for a general procedure for modelling the proximal part of the TF socket and a thorough description of the proximal part and the types of sockets that are used is presented. Ten individual scans of positives of TF amputated limbs were obtained from which ten mounting ring templates were designed via CAD modelling in the Autodesk Meshmixer software. In the last step a production simulation was generated in PrusaSlicer software for the overall price evaluation. [ABSTRACT FROM AUTHOR]

Background: Non-traumatic lower limb amputation rates are rising worldwide, resulting in increased hospitalisations and use of rehabilitation services. This study aimed to identify key comorbidities associated with prolonged length of stay or decreased functional gain for episodes receiving inpatient rehabilitation following non-traumatic lower limb amputation. Methods: Prospectively collected data submitted to the Australasian Rehabilitation Outcomes Centre were analysed. The cohort comprised episodes for patients (aged ≥18 years) discharged from inpatient rehabilitation between 1 July 2013 and 30 June 2018 following a non-traumatic lower limb amputation. Results: The cohort included 5074 episodes with an average age of 66.3 years and the majority being male (71.7%). Comorbidities affecting the ability to participate in rehabilitation were reported for 65.4% of episodes, most commonly diabetes mellitus (50.3%), cardiac disease (33.5%), and respiratory disease (10.1%). These comorbidities were associated with a prolonged length of stay and reduced functional improvement. Conclusion: This study showed comorbidities contribute to prolonged length of stay and poorer functional outcomes among those undergoing inpatient rehabilitation following non-traumatic lower limb amputation. Future research should focus on strategies to address these comorbidities to help improve patient outcomes and reduce healthcare costs. What is known about the topic? It is known that the presence of comorbidities contributes to lower limb amputation; however, the effect that comorbidities have on inpatient rehabilitation outcomes is not well reported. What does this paper add? This study identified five comorbidities (diabetes mellitus, cardiac disease, respiratory disease, renal failure with dialysis, and mental health problems) associated with prolonged length of stay and decreased functional outcomes following inpatient rehabilitation for non-traumatic lower limb amputation. What are the implications for practitioners? Our findings suggest practitioners should focus on strategies to address these comorbidities to help improve functional outcomes, reduce length of stay, and reduce healthcare costs. [ABSTRACT FROM AUTHOR]

Atherosclerosis is a multifactorial, lipoprotein-driven condition that leads to plaque formation within the arterial tree, leading to subsequent arterial stenosis and thrombosis that accounts for a large burden of cardiovascular morbidity and mortality globally. Atherosclerosis of the lower extremities is called peripheral artery disease and is a major cause of loss in mobility, amputation, and critical limb ischemia. Peripheral artery disease is a common condition with a gamut of clinical manifestations that affects an estimated 10 million people in the United States of America and 200 million people worldwide. The role of apolipoprotein B-containing lipoproteins, such as LDL and remnant lipoproteins in the development and progression of atherosclerosis, is well-established. The focus of this paper is to review existing data on lipid-lowering therapies in lower extremity atherosclerotic peripheral artery disease. [ABSTRACT FROM AUTHOR]

For people with amputated lower limbs, it is imperative to make high-performance prostheses that reproduce, as accurately as possible, the functions of the amputated limb. In this case, a preliminary study of the lower limbs from a kinematic and dynamic point of view is necessary. This paper proposes a prosthesis design and a system for acquiring the information needed to determine the stepping phase kinematic and dynamic parameters of the legs. This system consists of a sensory system attached to the legs and a acquisition data unit built around a microcontroller. The sensory system is based on a sensory system for determining the weight distribution on the sole, made of resistive pressure sensors. The sensory system will be subjected to measurement repeatability and homogeneity tests to evaluate and validate the accuracy and error of the proposed solution. The data obtained by the sensory system is transmitted in real-time, via wi-fi, to a computer system for interpretation. After processing and interpreting the data using standard data sets for comparison, the position of the legs, the type of gait and the phase of movement can be determined. Constructively, the system is configurable and can be adapted to any person, male or female, regardless of shoe size. [ABSTRACT FROM AUTHOR]

Diabetic foot lesions are common lesions that can occur in other diseases, which are manifested mainly in the diabetic patient. These lesions can cause severe changes in a diabetic patient. In this paper, we reviewed the literature, exemplified by our own case study, in which we described each lesion separately, emphasizing its particularities in the case of the diabetic patient. Early recognition of diabetic foot lesions is extremely important for both the diabetologist and the general practitioner, as this can save the patient from amputation. The shorter the time from detection of the lesion to the initiation of treatment, the greater the chances of a cure. [ABSTRACT FROM AUTHOR]

Drawing on David Mitchell and Sharon Snyder's concept of narrative prosthesis and Kathryn Allan's Disability in Science Fiction, this article examines the role of the prosthesis in Marvel Cinematic Universe (MCU), arguing that the cyborg limbs of prosthecized superheroes enable narratives of identity, rebirth, degeneration, and transcendence, serving as overdetermined – yet open – signifiers while also remaining stubbornly material in their techno-capitalist cycle of production, obsolescence, destruction, and endless upgrading. Specifically, the paper interprets the MCU's use of the superheroic prosthesis as an attempt to reach closure regarding the threat to the ideology of ability posed by the figure of the disabled superhero, an attempt that inevitably ends in failure that results in the graphic destruction and eventual replacement of the prosthesis. Analysis of the prosthesis in the MCU reveals a seemingly inevitable cycle in which the superheroic prosthesis acts as a lightning rod for this failure of resolution, with its destruction serving as both the titillation and vicarious horror that often accompanies depictions of disablement as well as a plot device through which narrative tension is generated as the disabled character must be re-prosthecized to begin the cycle anew. [ABSTRACT FROM AUTHOR]

Most biomechanical research has focused on level-ground walking giving less attention to other conditions. As a result, most lower limb prosthesis studies have focused on sagittal plane movements. In this paper, an ESR foot is presented, of which five different stiffnesses were optimized for as many weight categories of users. It is characterized by a spherical ankle joint, with which, combined with the elastic elements, the authors wanted to create a prosthesis that gives the desired stiffness in the sagittal plane but at the same time, gives flexibility in the other planes to allow the adaptation of the foot prosthesis to the ground conditions. The ESR foot was preliminarily tested by participants with transfemoral amputation. After a brief familiarization with the device, each participant was asked to wear markers and to walk on a sensorized treadmill to measure their kinematics and kinetics. Then, each participant was asked to leave feedback via an evaluation questionnaire. The measurements and feedback allowed us to evaluate the performance of the prosthesis quantitatively and qualitatively. Although there were no significant improvements on the symmetry of the gait, due also to very limited familiarization time, the participants perceived an improvement brought by the spherical ankle joint. [ABSTRACT FROM AUTHOR]

Abstract Background The main aim of this paper is to present the feasibility of rigorously designed multiple N-of-1 design in prosthetics research. While research of adequate power and high quality is often lacking in rehabilitation, N-of-1 trials can offer a feasible alternative to randomized controlled group trials, both increasing design power at group level and allowing a rigorous, statistically confirmed evaluation of effectiveness at a single patient level. The paper presents a multiple N-of-1 trial protocol, which aim is to evaluate the effectiveness of Unity, a prosthetic add-on suspension system for amputees, on patient-reported comfort during daily activities (main outcome measure), prosthesis wearing time, perception of limb-prosthesis fitting and stump volume and functional walking parameters. Methods Multicenter, randomized, prospective, double-blind multiple N-of-1 trial using an introduction/withdrawal design alternating Unity connected/disconnected phases of randomized length on twenty patients with unilateral transtibial amputation. The primary outcome measure is the Prosthetic Socket Comfort Score (SCS), a validated measure of comfort, administered daily by an phone app designed for the study. Secondary outcomes measures will be collected during the 50 days period of the N-of-1 trial: (1) by the same app, daily for patient-reported limb-prosthesis fitting, stump volume variation, and daily wearing time of the prosthesis; (2) by a pedometer for the number of steps per day; (3) by blind assessors in the rehabilitation center during adjustment visits for functional walking parameter (L-Test, 6-minute walk test), and by the patient for the QUEST, and ABC-S. Effectiveness of the Unity system regarding SCS and daily secondary outcome measures will be tested by randomization test. The secondary outcome measures assessed during visits in the rehabilitation center will be analyzed by Non Overlap of All pairs. An estimate of the effect on the amputee population will be generated by aggregating each individual clinical trial (N-of-1 trial) by Hierarchical Bayesian methods. Discussion This study protocol was designed to answer the question “which device is best for THIS patient" and to conclude at a group level on the effectiveness of a new devic, using a Multiple N-of-1 trial, which is promising but underused in prosthetics research so far. Trial registration N° ID-RCB 2020-A01309-30 Clintrial.gov : NCT04804150 - Retrospectively registered March 20th 2021.

A transfemoral prosthesis restores any limb amputated above the knee. Designing and developing a transfemoral prosthesis that is consistent with human performance is a tough task. While prosthetic components are widely available in the market, ongoing research is being conducted to develop parts that would restore the lost capability, taking into account numerous social, economic, and technological considerations. The present paper provides a comprehensive review about the mechanical aspects and performance of transfemoral prosthesis in recent years based on the research findings on materials, manufacturing methods, and evaluations for suitability of the prostheses. The fundamental terminologies as well as technical advancements are covered in order to impart a better knowledge in the area of Lower Limb prostheses. This review also provides a concise description on the role of computers, advanced software packages, sensors, and other hardware components for the design, fabrication, and testing of transfemoral prosthetic devices in the current environment. The current state of lower limb prostheses and future research opportunities are summarized to address upcoming challenges. Based on survey of various research works, adapting modern technology may aid in the development of functional and cost-efficient prosthetic components with superior safety, comfort, and quality. [ABSTRACT FROM AUTHOR]

Although the heart is one of the most important organs for animal survival, its regenerative capacity varies among animal species. Notably, adult mammals cannot regenerate their hearts after damage such as acute myocardial infarction. In contrast, some vertebrate animals can regenerate the heart throughout their lives. Cross‐species comparative studies are important to understand the full picture of cardiac regeneration in vertebrates. Among the animal species able to regenerate the heart, some urodele amphibians, such as newts, possess a remarkable capacity for this process. Standardized methods of inducing cardiac regeneration in the newt are needed as a platform for studies comparing newts and other animal models. The procedures presented here describe amputation and cryo‐injury techniques for the induction of cardiac regeneration in Pleurodeles waltl, an emerging model newt species. Both procedures consist of simplified steps that require no special equipment. We additionally show some examples of the regenerative process obtained using these procedures. This protocol has been developed for P. waltl. However, these methods are also expected to be applicable to other newt and salamander species, facilitating comparative research with other model animals. [ABSTRACT FROM AUTHOR]

[Display omitted] • This review identified key concepts describing decision-making for amputation. • Ninety-four papers were identified for inclusion in this review. • International Classification of functioning, Disability and Health framework used. • Personal and lifestyle factors are important considerations for amputation. • A biopsychosocial approach to decide if amputation would improve quality of life. Living with a diabetes-related foot ulcer has significant lifestyle impacts. Whilst often considered a last resort, amputation can overcome the burden of ulcer management, for an improved quality of life. However, limited research has been conducted to understand how the decision to amputate is made for people with a chronic ulcer when amputation is not required as a medical emergency. Therefore, the aim was to identify and map key concepts in the literature which describe the decision-making for diabetes-related amputations. This review followed Arksey and O'Malley's PRISMA scoping review framework. Five electronic databases and grey literature were searched for papers which described clinical reasoning and/or decision-making processes for diabetes-related amputation. Data were extracted and mapped to corresponding domains of the World Health Organisation's International Classification of functioning, Disability and Health (ICF) framework. Ninety-four papers were included. Personal factors including emotional wellbeing, quality of life, and treatment goals are key considerations for an elective amputation. It is important to consider an individual's lifestyle and personal circumstances, as well as the pathology when deciding between amputation or conservative management. This highlights the importance of a holistic and shared decision-making process for amputation which includes assessment of a person's lifestyle and function. [ABSTRACT FROM AUTHOR]

Aims Amputation is a procedure in which an unhealthy limb or a part of it is cut because it is dangerous, or useless or disrupts life. This procedure in itself is considered a crippling procedure, yet it is also a life-saving procedure. This study aimed to compare the causes of amputation in Iraqi subjects for five years (2016-2020]. Instruments & Methods In this retrospective cross-sectional study, 758 amputated patients were investigated from 1st day of 2016 to the last day of 2020 at Al-Hariri Hospital for Surgical Specialty. Findings The rate of amputation in 2020, 2019, 2018, 2017, and 2016 was 6%, 6%, 4%, 3%, and 2% of total admitted cases, respectively. The highest cause of amputation in 2020 was diabetes mellitus (18%) and mostly in males. Diabetes mellitus and vascular ischemia in both sexes were 18% of total amputated cases in 2019. Trauma was 23% of total amputated cases in 2018,57% in 2017, and 64% in 2016. Conclusion The rate of amputation is not so high. There is a significant association between amputation and gender, age, occupation, and the cause of amputation. There is no significant relationship between amputation and the hospital stay, the parts are either lower or upper, and the side is either left or right. Regarding the indications of amputation, the highest cause of amputations changes every year. [ABSTRACT FROM AUTHOR]