The Experts below are selected from a list of 315 Experts worldwide ranked by ideXlab platform
Jonathan C. Clasper - One of the best experts on this subject based on the ideXlab platform.
-
The Injury Mechanism of Traumatic Amputation
Frontiers in Bioengineering and Biotechnology, 2021Co-Authors: Iain A. Rankin, Thuy-tien Nguyen, Louise Mcmenemy, Jonathan C. Clasper, Spyros D. MasourosAbstract:Traumatic Amputation has been one of the most defining injuries associated with explosive devices. An understanding of the mechanism of injury is essential in order to reduce its incidence and devastating consequences to the individual and their support network. In this study, Traumatic Amputation is reproduced using high-velocity environmental debris in an animal cadaveric model. The study findings are combined with previous work to describe fully the mechanism of injury as follows. The shock wave impacts with the casualty, followed by energised projectiles (environmental debris or fragmentation) carried by the blast. These cause skin and soft tissue injury, followed by skeletal trauma which compounds to produce segmental and multifragmental fractures. A critical injury point is reached, whereby the underlying integrity of both skeletal and soft tissues of the limb has been compromised. The blast wind that follows these energised projectiles completes the Amputation at the level of the disruption, and Traumatic Amputation occurs. These findings produce a shift in the understanding of Traumatic Amputation due to blast from a mechanism predominately thought mediated by primary and tertiary blast, to now include secondary blast mechanisms, and inform change for mitigative strategies.
-
Traumatic Amputation FROM EXPLOSIVE BLAST: EVIDENCE FOR A NEW INJURY MECHANISM
2018Co-Authors: Singleton J.a.g., I Gibb, Bull A.m.j., Jonathan C. ClasperAbstract:The mechanism of Traumatic Amputation (TA) from explosive blast has traditionally been considered to be a combination of blast wave induced bone injury – primary blast - followed by limb avulsion from the blast wind – tertiary blast. This results in a transosseous TA, with through joint Amputations considered to be extremely rare. Data from previous conflicts has also suggested that this injury is frequently associated with a non-survivable primary blast lung injury (PBLI), further linking the extremity injury to the primary blast wave. However, our current experience in the Middle East would suggest that both the mechanism of TA and the link with fatal primary blast exposure need to be reconsidered. The aim of this study was to analyse the injury profile of the current cohort of TA fatalities to further investigate the underlying blast injury mechanism and to allow hypotheses on injury mechanisms to be developed for further analysis.With the permission of the coroners, 121 post-mortem CT (PMCT) scans of ...
-
BLAST-MEDIATED Traumatic Amputation: EVIDENCE SUGGESTING A NEW INJURY MECHANISM
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: Jag Singleton, A.m.j. Bull, I Gibb, Jonathan C. ClasperAbstract:Recent evidence suggests that both the accepted mechanism of blast-mediated Traumatic Amputation (TA) (shockwave then blast wind exposure) and the link with fatal shockwave exposure merit review. Searching UK military prospectively gathered trauma registry data and post mortem CT (PM-CT) records identified casualties from August 2008 to August 2010 with blast-mediated TAs. TA level and associated injuries were recorded. Data on pre-debridement osseous and soft tissue injuries were only consistently available for fatalities through PM-CT imaging. 146 Cases (75 survivors and 71 fatalities) with 271 TAs (130 in survivors and 141 in fatalities) were identified. Through-joint TA rate in fatalities was 34/141 (24.1%). PM-CT analysis demonstrated only 9/34 through joint TAs with contiguous fractures in the immediately proximal long bone/limb girdle. 18/34 had no fracture, and 7/34 had a non-contiguous fracture. The previously reported link between TA and blast lung injury was not present, calling into question the significance of shockwaves in generating blast-mediated TAs. Furthermore, contemporary blast injury theory cannot account for the high prevalence of through joint TAs (previously published rate 1.3%). The proportion of through joint TAs with no associated fracture or a non-contiguous fracture (74%) is supportive of pure flail as a mechanism for blast-mediated TA.
-
Blast-mediated Traumatic Amputation: evidence for a revised, multiple injury mechanism theory.
Journal of the Royal Army Medical Corps, 2014Co-Authors: James A G Singleton, I Gibb, Anthony M. J. Bull, Jonathan C. ClasperAbstract:Introduction The accepted mechanism of blast-mediated Traumatic Amputation (TA) is blast wave induced fracture followed by limb avulsion from the blast wind, generating a transosseous Amputation. Blast-mediated through-joint TAs were considered extremely rare with published prevalence Methods A trauma registry (UK Joint Theatre Trauma Registry) and postmortem CT (PM-CT) database were used to identify casualties (survivors and deaths) sustaining a blast-mediated TA in the 2 years from August 2008. TA metrics and associated significant injuries were recorded. Detailed anatomical data on extremity predebridement osseous and soft tissue injuries were only consistently available for deaths through comprehensive PM-CT imaging. Results 146 cases (75 survivors and 71 deaths) sustaining 271 TAs (130 in survivors and 141 in deaths) were identified. The lower limb was most commonly affected (117/130 in survivors, 123/141 in deaths). The overall through-joint TA rate was 47/271 (17.3%) and 34/47 through-joint injuries (72.3%) were through knee. More detailed anatomical analysis facilitated by PM-CT imaging revealed only 9/34 through-joint TAs had a contiguous fracture (ie, intra-articular involving the joint through which TA occurred), 18/34 had no fracture and 7/34 had a non-contiguous (ie, remote from the level of TA) fracture. No relationship between PBLI and TA was evident. Conclusions The previously reported link between TA and PBLI was not present, calling into question the significance of primary blast injury in causation of blast mediated TAs. Furthermore, the accepted mechanism of injury can9t account for the significant number of through-joint TAs. The high rate of through-joint TAs with either no associated fracture or a non-contiguous fracture (74%) is supportive of pure flail as a mechanism for blast-mediated TA.
-
Traumatic Amputation FROM EXPLOSIVE BLAST: EVIDENCE FOR A NEW INJURY MECHANISM
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: James A G Singleton, I Gibb, A.m.j. Bull, Jonathan C. ClasperAbstract:The mechanism of Traumatic Amputation (TA) from explosive blast has traditionally been considered to be a combination of blast wave induced bone injury – primary blast - followed by limb avulsion from the blast wind – tertiary blast. This results in a transosseous TA, with through joint Amputations considered to be extremely rare. Data from previous conflicts has also suggested that this injury is frequently associated with a non-survivable primary blast lung injury (PBLI), further linking the extremity injury to the primary blast wave. However, our current experience in the Middle East would suggest that both the mechanism of TA and the link with fatal primary blast exposure need to be reconsidered. The aim of this study was to analyse the injury profile of the current cohort of TA fatalities to further investigate the underlying blast injury mechanism and to allow hypotheses on injury mechanisms to be developed for further analysis. With the permission of the coroners, 121 post-mortem CT (PMCT) scans of UK Armed Forces personnel who died following an IED blast were analysed. All orthopaedic injuries were identified, classified and the anatomical level of any associated soft tissue injury noted. PMCT evidence of PBLI was used as a marker of significant primary blast exposure. 75/121 (62%) sustained at least 1 TA, with 138 TAs seen in total. 31/138 (22%) were through joints, with through knee Amputations most common (23/31, 74%). Only 7/31(23%) through joint Amputations had an associated fracture proximal to and contiguous with the Amputation site. The soft tissue injury profile of through joint and transosseous TAs were not significantly different (p=0.569). When fatality location was considered (i.e. mounted or dismounted), no overall relationship between PBLI and TA was evident. The two pathologies were not seen to consistently occur concurrently, as has been previously reported. The accepted mechanism for Traumatic Amputation following explosive blast does not adequately explain the significant number of through joint TAs presented here. The previously reported link between TA and PBLI in fatalities was not supported by this analysis of modern combat blast fatalities. Lack of an associated fracture with the majority of through joint TAs in conjunction with a lesser contribution of primary blast may implicate flail and periarticular soft tissue failure as a potential injury mechanism. Analysis of through joint TA incidence and associated injuries in survivors is now indicated. Case studies within the fatality dataset may facilitate generation of injury mechanism hypotheses. To further investigate the injury mechanism, work is required to understand osseous, ligamentous and other soft tissue behaviour and failure at high strain rates. This should allow characterisation and modeling of these injuries and inform mitigation strategies.
Manlio Basílio Speranzini - One of the best experts on this subject based on the ideXlab platform.
-
Total reconstruction of the auricle after Traumatic Amputation.
Plastic and reconstructive surgery, 1994Co-Authors: Marco Williams Baena Destro, Manlio Basílio SperanziniAbstract:We report a technique of auricular replantation used in a case of Traumatic Amputation. The principal difficulties encountered in this type of replantation are mentioned, and ways of avoiding them are suggested. All the skin of the ear was removed except for that of the anterior surface of the conch. At this site, the cartilage received small, multiple perforations to allow for nutrition of the corresponding skin. The remainder of the auricular cartilage was covered by a skin flap undermined from the mastoid region. Three months later, the retro-auricular region was freed and covered with a total skin graft taken from the right supraclavicular region. On the basis of the satisfactory results obtained, we discuss the intention and the technical details of the method and possible contraindications.
Tsu-min Tsai - One of the best experts on this subject based on the ideXlab platform.
-
Multiple toe transfer and sensory free flap use after a Traumatic Amputation of multiple digits. Surgery done in a single setting: a case study.
Microsurgery, 2011Co-Authors: David W Galpern, Tsu-min TsaiAbstract:Crush avulsion injuries to the hand with concomitant Traumatic Amputation of multiple digits can be a devastating injury to the patient. These injuries have multiple issues occurring under emergency conditions. When feasible, replantation of the multiple digits is optimal, but in many cases, it is not possible. Because of the crushing force on the digits, they are not viable candidates for replantation. The usual course of treatment for these patients is a two stage procedure, usually involving a groin flap. Here, we present the case of a patient who had a left hand skin avulsion of the whole palm and P1 of index, long, ring and small fingers. The left index finger had a complete Amputation at the P2 level, the long, ring and small fingers all had complete Amputations at the P1 level. This injury was dealt with by a left foot second and third toe transplant, a sensory free flap from the left big toe and a fourth toe microvascular free transfer to the left hand. The remainder of the defect was managed with a 10 × 14 cm reversed radial forearm flap and a combination of full and split thickness skin grafts. The procedure was performed in a single operation, obviating the need for a second surgery. This procedure optimized the patient's outcome during a single setting, making it an ideal choice in an emergency setting.
Kenneth I. Glassberg - One of the best experts on this subject based on the ideXlab platform.
-
Circumcision: Successful Glanular Reconstruction and Survival Following Traumatic Amputation
The Journal of urology, 1996Co-Authors: Joel Sherman, Joseph G. Borer, Mark Horowitz, Kenneth I. GlassbergAbstract:AbstractPurpose: Circumcision remains the most common operation performed on male individuals in the United States. Unfortunately various complications may occur during circumcision ranging from trivial to tragic. We report 7 cases of Traumatic Amputation of the glans penis and/or urethra during circumcision. In addition, errors in circumcision technique as probable mechanisms of injury, principles of repair and limits of tissue viability are discussed.Materials and Methods: The medical records of 7 patients who underwent Traumatic circumcision Amputation of the glans penis and/or urethra were reviewed. Glanular Amputation occurred in 6, 8-day-old neonates during ritual circumcision and in 1, 5-month-old infant circumcised by a physician.Results: Excised glanular tissue remained viable up to 8 hours after injury. Followup ranged from 8.5 to 108 months. All patients had an acceptable cosmetic result. No long-term complications developed in the 8-day-old group but a distal urethral fistula formed in the 5-m...
J B Hull - One of the best experts on this subject based on the ideXlab platform.
-
Pattern and mechanism of Traumatic Amputation by explosive blast
Journal of Trauma-injury Infection and Critical Care, 1996Co-Authors: J B Hull, G. J. CooperAbstract:The mechanism of Traumatic Amputation of limbs by explosion is presented. A survey of blast casualties from Northern Ireland revealed that Amputations through joints were very uncommon--the principal site was through the shaft of the long bones. Computer modelling of a bone exposed to blast forces reinforced the hypothesis developed from the casualty survey, that the primary mechanism of the bone injury was the direct coupling of the blast wave into the tissues. The fracture occurs from the resulting axial stresses in the bone, prior to limb flailing from the gas flow over the limb. The gas flow completes the Amputation. Field trials employing a goat hind limb model have confirmed the hypothesis. Having identified the mechanism, concepts to develop protective clothing may now be proposed.
-
Pattern of injury in those dying from Traumatic Amputation caused by bomb blast
The British journal of surgery, 1994Co-Authors: J B Hull, G. W. Bowyer, G. J. Cooper, Jack CraneAbstract:Traumatic Amputation of limbs caused by bomb blast carries a high risk of mortality. This paper describes 73 Amputations in 34 deaths from bomb blast in Northern Ireland. The principal aim was to determine the sites of Traumatic Amputation to provide a biophysical basis for the development of protective measures. Few Amputations were through joints; nearly all were through the bone shafts. The most common site in the tibia was the upper third. The distribution of femoral sites resulting from car bombs differed from that characterizing other types of explosion. For car bombs the principal site of Amputation was the upper third; for other types of device it was the lower third. It is concluded that flailing is not a notable contributor to limb avulsion. The pattern of Amputation is consistent with direct local pressure loads leading to bone fracture; the Amputation itself is a secondary event arising from the flow of combustion products.
-
Traumatic Amputation by explosive blast: pattern of injury in survivors.
The British journal of surgery, 1992Co-Authors: J B HullAbstract:Explosive blast causes a pattern of injury including primary blast lung, secondary fragment injury and Traumatic Amputation of limbs. Major Traumatic Amputation is rare in survivors of bomb blast but common in those who die. The mechanism of such injury has not been previously determined, but must be established if protective measures are to be developed for members of the armed forces. The nature of 41 Traumatic Amputations in 29 servicemen who survived to reach medical care after blast injury was investigated to determine the anatomical level of Amputation and the pattern of soft tissue damage. Joints were an infrequent site of Amputation and the tibial tuberosity was a particularly frequent site of lower-limb severance. Comparison of the pattern of injury was made with that seen in ejecting fast-jet pilots, who frequently suffer major flailing injury; there appears to be a substantially different injury distribution. The accepted mechanism of Traumatic Amputation, avulsion by the dynamic overpressure, is challenged; it is suggested that the shockwave resulting from an explosion is capable of causing at least bone disruption in a limb.
