Department of Plastic Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
Department of Orthopaedic and Plastic Surgery, Al-Awda Hospital, Gaza strip, Tal al-Zatar, Palestine.
Injury. 2022 Jul;53(7):2541-2549. doi: 10.1016/j.injury.2022.05.031. Epub 2022 May 20.
Ballistic injuries during the Great March of Return (GMR) protests in Gaza have resulted in young, civilian amputees. This article defines this unique population, their injuries and clinical variables that impacted on amputation.
A multidisciplinary team (MDT) assessed 103 lower limb amputees (104 stumps). Individualized prescriptions of care were formulated and applied for both stump and prosthesis management. The cohort's health state was assessed at screening by applying the EQ-5D-L5 questionnaire. The EQ-5D-L5 will be repeated on completion of the prescription of care.
The population is predominantly young, male, suffering unilateral amputation with an equal ratio of above knee (AKA) to below knee (BKA) amputations. 18% were amputated immediately and 82% with delay. Most amputations occur within 15 days of gunshot wound (GSW). All tissue elements were affected by the severe, ballistic injury. Division, gapping and tissue loss consolidated the decision for amputation rather than limb salvage. Knee zone injury was common, influencing the high numbers AKAs. Primary injury ramified beyond the amputated leg: 38% have contralateral leg injuries. 20% had physiological challenges requiring Intensive care unit (ICU) admissions. Infection was reported in 49% of amputees with 12% reporting acute sepsis. Psychologically, 49% reported severe, or extreme, anxiety and depression. AKAs were associated with greater morbidity: amputees are significantly younger, have more proximal vascular injuries, receive delayed amputations and experience longer time intervals to stump healing. ICU care and contralateral leg injuries were more frequent. One third of amputees used their prostheses', one third did not and one third do not have a prosthesis yet. The limiting factor for repair was supply of materials. 11% of amputees needed no adjustment to stump or prosthesis. Surgical stump revision was recommended in 26% of stumps and prosthetic management in 41%. A further 22%, subject to the success or failure of prescribed prosthetic adjustment, could require stump revision.
Youth, proximal injury, high numbers of AKA, psychosocial issues and the need for stump and prosthetic support define this group of amputees. Unifying expertise within a National MDT will promote continuity of care necessary for decades to come. The ultimate aim is an evidence-based amputee care system in Gaza, with lower limb specialists promoting best outcomes, judicious allocation of funds and maximising amputee quality of life.
在加沙地带的“回归大游行”（GMR）抗议活动中发生的弹道伤导致年轻的平民截肢。本文定义了这一独特人群，描述了他们的受伤情况和影响截肢的临床变量。
一个多学科团队（MDT）评估了 103 例下肢截肢者（104 个残端）。为残端和假肢管理制定了个体化的护理方案，并进行了应用。通过应用 EQ-5D-L5 问卷在筛查时评估了队列的健康状况。完成护理方案后将重复使用 EQ-5D-L5 进行评估。
该人群主要是年轻男性，单侧截肢，膝上（AKA）和膝下（BKA）截肢比例相等。18%的患者立即截肢，82%的患者延迟截肢。大多数截肢发生在枪伤（GSW）后 15 天内。所有组织元素都受到严重的弹道损伤的影响。分裂、缺口和组织损失决定了截肢而不是肢体保留。膝关节区损伤很常见，这导致了大量 AKA 的发生。原发性损伤不仅限于截肢肢体：38%的患者对侧肢体受伤。20%的患者因生理挑战需要入住重症监护病房（ICU）。49%的截肢者报告有感染，12%的患者报告有急性败血症。49%的患者报告有严重或极度焦虑和抑郁。AKA 与更高的发病率相关：截肢者明显更年轻，有更靠近血管的损伤，接受延迟截肢，残端愈合的时间间隔更长。ICU 护理和对侧腿部损伤更为常见。三分之一的截肢者使用假肢，三分之一的截肢者不使用假肢，还有三分之一的截肢者尚未配备假肢。修复的限制因素是材料供应。11%的截肢者无需调整残端或假肢。建议对 26%的残端进行手术残端修整，对 41%的患者进行假肢管理。根据所规定的假肢调整的成功或失败，另有 22%的患者可能需要残端修整。
年轻人、靠近损伤部位、大量 AKA、心理社会问题以及对残端和假肢的支持，定义了这组截肢者。在一个国家多学科团队内集中专业知识，将为未来几十年的连续性护理提供保障。最终目标是在加沙建立一个基于证据的截肢者护理系统，下肢专家将促进最佳结果，合理分配资金，并最大限度地提高截肢者的生活质量。
