Amputee Rehabilitation in a Patient with Earthquake-Associated Rhabdomyolysis

Abstract

Earthquakes can cause many injuries depending on their severity. Amputation also has a very important place among these injuries. Especially severe damage to arteries, nerves, skin and bone, prolonged ischemia, and unsuccessful fasciotomy are the leading causes of amputation after an earthquake. After surgery, important complications can be seen in these people that may affect their functional level. In order to prevent these complications, physiotherapy, and rehabilitation applications should be started as early as possible. Pain, edema, and contractures, which are frequently seen after surgery, affect the adaptation of the person to the prosthesis and thus the functional level. Although there are many physiotherapy and rehabilitation interventions in order to manage these complications after amputation, there is no consensus in the literature. For this reason, it is important to examine the current rehabilitation approaches to be applied after amputation. In this context, this review aimed to examine the current rehabilitation practices in the early period after amputation, to create a roadmap for clinicians, and to contribute to the current literature.

Keywords

• Earthquake
• amputation
• pain
• edema
• physical therapy modalities.

Depremle İlişkili Rabdomiyaliz Geçiren Hastada Ampute Rehabilitasyonu

Abstract

Depremler şiddetlerine göre pek çok yaralanmaya sebep olabilmektedirler. Amputasyon da bu yaralanmaların içerisinde oldukça önemli bir yere sahiptir. Özellikle arter, sinir, cilt ve kemikte şiddetli hasar, uzamış iskemi ve başarısız fasiyotomi deprem sonrası önde gelen amputasyon sebeplerindendir. Cerrahi sonrası bu kişilerin fonksiyonel düzeyini etkileyebilecek önemli komplikasyonlar görülebilmektedir. Bu komplikasyonların önlenebilmesi açısından fizyoterapi ve rehabilitasyon uygulamalarına mümkün olan en erken süreçte başlanılması gerekmektedir. Özellikle cerrahi sonrası sıklıkla görülen ağrı, ödem ve kontraktürler kişinin proteze adaptasyonunu ve dolayısıyla fonksiyonel düzeyini etkilemektedir. Amputasyon sonrası bu komplikasyonların yönetilebilmesi adına pek çok fizyoterapi ve rehabilitasyon müdahalesi bulunmakla birlikte literatürde bir fikir birliği bulunmamaktadır. Bu sebeple amputasyon sonrası uygulanacak güncel rehabilitasyon yaklaşımlarının incelenmesi önemlidir. Bu kapsamda, bu derleme; amputasyon sonrası erken dönemdeki güncel rehabilitasyon uygulamalarını incelemeyi, klinisyenlere bir yol haritası oluşturmak ve mevcut literatüre katkı sağlamayı amaçlamaktadır.

Keywords

• deprem
• amputasyon
• ağrı
• ödem
• fizik tedavi modaliteleri

Thanks

Yazarlardan Karya POLAT YÖK 100/2000 bursiyeridir.

References

1. Clover AJP, Jemec B, Redmond AD. The extent of soft tissue and musculoskeletal injuries after earthquakes; describing a role for reconstructive surgeons in an emergency response. World J Surg. 2014 Oct;38(10):2543–50.
2. Wong CNC, Yu JMK, Law SW, Lau HMC, Chan CKM. Bilateral transtibial amputation with concomitant thoracolumbar vertebral collapse in a Sichuan earthquake survivor. J Orthop Surg Res. 2010 Jul 14;5:43.
3. Aït-Mohammed F, Waroux S, Lefort H. [The nursing role in field amputation]. Rev Infirm. 2015 Mar;209:19–21.
4. Bortolin M, Morelli I, Voskanyan A, Joyce NR, Ciottone GR. Earthquake- Related Orthopedic Injuries in Adult Population: A Systematic Review. Prehosp Disaster Med. 2017 Apr;32(2):201–8.
5. Wen PS, Randolph MG, Elbaum L, De la Rosa M. Gender Differences in Psychosocial and Physical Outcomes in Haitian Amputees. Am J Occup Ther. 2018;72(3):7203205090p1–8.
6. Li WS, Chan SY, Chau WW, Law SW, Chan KM. Mobility, prosthesis use and health-related quality of life of bilateral lower limb amputees from the 2008 Sichuan earthquake. Prosthet Orthot Int. 2019 Feb;43(1):104–11.
7. Li L, Reinhardt JD, Zhang X, Pennycott A, Zhao Z, Zeng X, et al. Physical function, pain, quality of life and life satisfaction of amputees from the 2008 Sichuan earthquake: A prospective cohort study. J Rehabil Med. 2015 May;47(5):466–71.
8. Wang Q, Chen C, Zhang S, Tang Y, Wang H, Zhou X, et al. Pain issues in the victims with lower-limb amputation: 10 years after the 2008 Sichuan earthquake. Disabil Rehabil. 2022 Apr;44(8):1346–53.

9. Knowlton LM, Gosney JE, Chackungal S, Altschuler E, Black L, Burkle FM, et al. Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies: report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict. Prehosp Disaster Med. 2011 Dec;26(6):438–48.
10. Ceylan MF, Serbest S, Güven N. Deprem yaralanmaları ve ampütasyon, gözlemlerimiz ve önerilerimiz. TOTBİD Dergisi. 2022 Apr 26;21(3):325–32.
11. Wolfson N. Amputations in natural disasters and mass casualties: staged approach. Int Orthop. 2012 Oct;36(10):1983–8.
12. Dağlar B. Deprem yaralanmalı hastada kompartman sendromu. TOTBİD Dergisi. 2022 Apr 26;21(3):283–8.
13. Özkaya U, Yalçın MB. Deprem yaralanmalı hastada kompartman sendromu ve ezilme (crush) sendromu ayrımı: Fasyotomi kime ve ne zaman? TOTBİD Dergisi. 2022 Apr 26;21(3):312–5.
14. Safari S, Najafi I, Hosseini M, Sanadgol H, Sharifi A, Alavi Moghadam M, et al. Outcomes of fasciotomy in patients with crush-induced acute kidney injury after Bam earthquake. Iran J Kidney Dis. 2011 Jan;5(1):25–8.
15. Demir BK, Başaran C. Deprem sonrası çocuk hasta, ezilme (crush) sendromu. TOTBİD Dergisi. 2022 Apr 26;21(3):304–11.
16. Yin Y, Zhu T. Ventricular fibrillation during anesthesia in a Wenchuan earthquake victim with crush syndrome. Anesth Analg. 2010 Mar 1;110(3):916–7.
17. Chunguang Z, Rigao C, Fuguo H, Chongqi T, Yueming S, Guanglin W, et al. Characteristics of crush syndrome caused by prolonged limb compression longer than 24 h in the Sichuan earthquake. Emerg Med J. 2010 Aug;27(8):627–30.
18. Chen X, Zhong H, Fu P, Hu Z, Qin W, Tao Y. Infections in crush syndrome: a retrospective observational study after the Wenchuan earthquake. Emerg Med J. 2011 Jan;28(1):14–7.
19. Best practice guidelines on emergency surgical care in disaster situations [Internet]. [cited 2023 Mar 6]. Available from: https://www. who.int/publications-detail-redirect/best-practice-guidelines-on-emergency-surgical-care-in-disaster-situations
20. Webster JB, Crunkhorn A, Sall J, Highsmith MJ, Pruziner A, Randolph BJ. Clinical Practice Guidelines for the Rehabilitation of Lower Limb Amputation: An Update from the Department of Veterans Affairs and Department of Defense. Am J Phys Med Rehabil. 2019 Sep;98(9):820–9.
21. Iezzoni LI, Ronan LJ. Disability legacy of the Haitian earthquake. Ann Intern Med. 2010 Jun 15;152(12):812–4.
22. Clinical Practice Guidelines for the Rehabilitation of Lower Limb Amputation: An Update From the Department of Veterans Affairs and the Department of Defense [Internet]. APTA. 2019 [cited 2023 Mar 6]. Available from: https://www.apta.org/patient-care/evidence-based-practice-resources/cpgs/clinical-practice-guidelines-for-the-rehabilitation-of-lower-limb-amputation-an-update-from-the-department-of-veterans-affairs-and-the-department-of-defense
23. Wang Q, Chen C, Zhang S, Tang Y, Wang H, Zhou X, et al. Quality of Life in Lower-Limb Amputees 10 Years After the 2008 Sichuan Earthquake: A Cross-Sectional Study. Disaster Med Public Health Prep. 2022 Aug;16(4):1573–9.
24. Lam TWJ, Tang LCL, Chau WW, Law SW, Chan KM. The Effect of Age, Gender and Socioeconomic Status on Self-esteem, Body Image and Quality of Life of Amputees: An Evaluation Seven Years after the 2008 Sichuan Earthquake. Disability, CBR & Inclusive Development. 2019 Feb 23;29(3):32–47.
25. Wong CK, Ehrlich JE, Ersing JC, Maroldi NJ, Stevenson CE, Varca MJ. Exercise programs to improve gait performance in people with lower limb amputation: A systematic review. Prosthet Orthot Int. 2016 Feb;40(1):8–17.
26. Littman AJ, Boyko EJ, Thompson ML, Haselkorn JK, Sangeorzan BJ, Arterburn DE. Physical activity barriers and enablers in older Veterans with lower-limb amputation. J Rehabil Res Dev. 2014;51(6):895–906.
27. Demir Y, Aydemir K. Gülhane lower extremity amputee rehabilitation protocol: A nationwide, 123-year experience. Turk J Phys Med Rehabil. 2020 Dec;66(4):373–82.
28. Choo YJ, Kim DH, Chang MC. Amputation stump management: A narrative review. World J Clin Cases. 2022 May 6;10(13):3981–8.
29. Krajbich JI, Pinzur MS, Potter BK, Stevens PM, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. Fourth edition. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2016. 20 p.
30. Modest JM, Raducha JE, Testa EJ, Eberson CP. Management of Post- Amputation Pain. R I Med J (2013). 2020 May 1;103(4):19–22.
31. Johnson MI, Mulvey MR, Bagnall AM. Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Cochrane Database Syst Rev. 2015 Aug 18;8(8):CD007264.
32. Tilak M, Isaac SA, Fletcher J, Vasanthan LT, Subbaiah RS, Babu A, et al. Mirror Therapy and Transcutaneous Electrical Nerve Stimulation for Management of Phantom Limb Pain in Amputees - A Single Blinded Randomized Controlled Trial. Physiother Res Int. 2016 Jun;21(2):109–15.
33. Madsen UR, Hommel A, Berthelsen CB, Bååth C. Systematic review describing the effect of early mobilisation after dysvascular major lower limb amputations. J Clin Nurs. 2017 Nov;26(21–22):3286–97.
34. Schon LC, Short KW, Soupiou O, Noll K, Rheinstein J. Benefits of early prosthetic management of transtibial amputees: a prospective clinical study of a prefabricated prosthesis. Foot Ankle Int. 2002 Jun;23(6):509– 14.
35. Ali MM, Loretz L, Shea A, Poorvu E, Robinson WP, Schanzer A, et al. A contemporary comparative analysis of immediate postoperative prosthesis placement following below-knee amputation. Ann Vasc Surg. 2013 Nov;27(8):1146–53.
36. Gailey R, Gaunaurd I, Raya M, Kirk-Sanchez N, Prieto-Sanchez LM, Roach K. Effectiveness of an Evidence-Based Amputee Rehabilitation Program: A Pilot Randomized Controlled Trial. Phys Ther. 2020 May 18;100(5):773–87.