Limb fitting for quadruple amputees

Abstract

Background: We report our experiences of prosthetic fitting in quadruple amputees. Two patients underwent quadruple amputation after suffering from disseminated intravascular coagulation in conjunction with pneumococcemia with purpura fulminans. Case Description and Methods: The first patient, a 52-year-old man, underwent bilateral transradial, left transtibial, and right transfemoral amputation, and the second patient, a 62-year-old man, underwent bilateral transradial and bilateral transfemoral amputation, both for symmetrical peripheral gangrene subsequent to septic shock. Findings and Outcomes: The amputations were accompanied by skin damage due to ischemic tissue changes both on the stumps and on the nose and/or lips. The combination of the intensive prosthetic rehabilitation program and supportive medical care led to completely independent functioning, including driving a car, with the use of four prosthetic limbs and a wheelchair in both cases. Conclusion: Early initiation of a multidisciplinary approach can properly address impairments and minimize future disability. Clinical relevanceWe have reported our experience of limb fitting in two patients who had undergone quadruple amputation after suffering peripheral gangrene. Appropriate limb fitting that provides support in daily activities can address impairments and minimize disability.

Four limb amputations due to peripheral gangrene from inotrope use – Case report and review of the literature

“…Park also concluded that DIVC is a risk factor that increase the likelihood of SPG induction by dopamine [12] . Streptococcal pneumoniae was the underlying culprit in some case series [6,7] of peripheral gangrene. Johansen et al [7] discussed the possibility that the pathogenesis of peripheral gangrene associated with pneumococcal sepsis may not be iatrogenic as only 2 out of his 10 patients with pneumococcal sepsis-associated peripheral ischemic received vasopressor therapy.…”

“…Multiple limb amputations are uncommon and can be caused by metabolic disorders such as crygoglobulinemia [1] , burns [2–4] , purpura fulminans [5–7] , and drug use such as cocaine [8] . Inotropes such as dopamine have been frequently used in the treatment of hypotension, and its effectiveness in treating cardiogenic, septic, and traumatic shock is firmly established.…”

Life without limbs

“…These case examples have included a young girl with congenital limb loss being able to dress herself, 7 a 30-year-old male returning to skiing and trekking activities, 4 a 52-year-old male able self-propel a manual wheelchair and independently don prosthetics and a 62-year-old male able to feed himself, drive a car and self-inject insulin. 1 Each person with quadruple limb loss faces unique circumstances, challenges, abilities and aspirations. All of the previously published cases of quadruple amputation have residual limbs longer than those of CX, and all but the young girl have residual upper limbs able to meet for opposition and object manipulation.…”

“…His upper limbs are not long enough to meet and provide no opportunity for opposition or stabilization of objects in daily tasks. Causes of quadruple amputation are usually congenital limb deficiencies, trauma (in particular electrocution) or advanced renal failure 1 and are fortunately very rare. Quadruple amputations pose difficulties for every daily life task, 2 the equivalent of a cervical spinal cord lesion.…”

“…3 Recovery and rehabilitation following four-limb amputation is reported only in case study format in the literature due to the rarity of these circumstances. 1,[4][5][6][7] Resources for the quadruple amputee are limited; hence, this case report is presented as a guide to current technology options for others.…”