Objectives: The study assessed the clinical and functional outcomes of transfemoral amputations following TKA complications, shedding light on a procedure often considered in extreme cases. Methods: In this retrospective study, six patients undergoing above-knee amputation due to TKA complications were analysed. Diagnosis of periprosthetic joint infection relied on clinical presentation and the Musculoskeletal Infection Society Definition (2011). Patient demographics, comorbidities, and surgical interventions were meticulously recorded. The study aimed to contribute valuable insights into the intricacies of managing complications post-TKA. Results: The study cohort, constituting 0. 002% of total TKA cases, exhibited a mean age of 78. 8 years. Comorbidities, predominantly diabetes, were prevalent. The duration between TKA and amputation averaged 6. 3 years. Surgical interventions, including revisions, debridements, and aspirations, were numerous, reflecting the complexity of managing complications. All patients underwent above-knee amputation using a single-stage approach, with careful consideration of the surgical site's condition. Post-amputation care, including stump care and prosthetic leg options, was tailored to individual patients' needs. Patients were diligently followed for a minimum of 12 months. Stump wounds healed without requiring revisions, and prosthetic limbs were successfully applied to three patients. Mobility status and disability scores, evaluated through the Sickness Impact Profile (SIP), showed significant improvement. Conclusion: The study highlights periprosthetic joint infection as the primary cause of multiple failed procedures leading to amputation. Microbiological findings identified common pathogens, including Staphylococcus aureus and Pseudomonas aeruginosa. Challenges posed by biofilm formation underscored the complexities of antibiotic treatment. Transfemoral amputation emerges as a feasible option for patients with multiple failed TKAs, particularly in cases of persistent infection. The decision-making process should encompass a thorough consideration of the number of failed procedures, cost-benefit analysis, and various psychosocial and economic factors. Further research and extensive multicentric studies are imperative to validate and expand upon these findings. Level of evidence: IV

Lameness of limbs is one of the most important problems of today's cattle farms, which causes irreparable economic losses, so that about 60% of cows in each herd are lame at least once a year (finger injuries in Iran are 31.8%). Injuries of the digits is one of the major causes of lameness in cattle. Bones of the digits in cattle include the first, second and, third phalanx. Two vestigial digits are existed in cattle. The medial digit and the lateral digit are the main weight bearing structures on the forelimb and hindlimb, respectively. One of the practical treatments for injuries of the digits is its amputation. Among the most important causes of digit amputation, can mention osteomyelitis of finger and navicular bones, septic arthritis of interdigital joints, fractures and hoof traumas that have not responded to other conservative treatment. Most of digit amputation procedures perform under local anesthetic techniques with the cattle standing position. Selection of digit amputation techniques depends on several factors, such as the lesion type and the extent of involved anatomical structures. The most common surgical method is to amputate the digit through the distal aspect of the proximal phalanx without the need for a skin flap, which usually has a good prognosis and is effective in improving the economic life of the animal. Todays, limb amputation and the use of prosthesis are indicated in cattle or calf with untreatable musculoskeletal trauma or infection. General anesthesia is recommended for limb amputation. Although the short-term prognosis for limb amputation is good, the long-term prognosis depends on the weight of the animal and caring condition.

Purpose: To report a patient with MEWDS.Patient and findings: A 65-year-old man presented with sudden decrease of vision in his right eye. On ophthalmoscopy of the involved eye, numerous small discrete white lesions were detected superficially and deep in the retina around the disc and macula. On visual field examination, enlargement of the blind spot was detected. Fluorescein angiography was unremarkable. On electroretinography, the a-wave was decreased minimally. The patient was followed and after 2 months, significant improvement of visual acuity and visual field was observed.Conclusion: MEWDS is a rare intraocular inflammatory disease of unknown etiology and in contrast to our patient, more frequent in females. The natural course is generally benign with spontaneous disappearance of the lesions and improvement of vision in 6 to 8 weeks.

Introduction: Complete Amputation of wrist is physical and psychological trauma that can affect person's life. During recent years, various amputated organs were replanted back into their own body leading to improvement in quality of life, function and body image.Case Report: The case was a34 years old man with complete amputation at left hand at wrist level, while working with chainsaw. Patient was admitted to the emergency unit at Fatemi hospital of Ardabil city, and underwent tosurgeryfor replantation.Conclusion: Complete amputation of wrist and its successful replantation are among rarely occured and reportable cases. The5-month follow-up indicated a successful operation. During this period, no abnormalities were found in the blood circulation. The finger grasping and nerve development were acceptable and no symptom of infection was observed.

Dear Editor, Fingertip amputation is one of the most common industrial injuries and preservation of finger function, as much as possible, is very important for the affected patients. A thorough review of the most common treatment options for this type of lesion was more than necessary. All treatment modalities must restore the sensory function of fingertip, stable and durable skin and maximum support for nail bed (1).

Background and Aim: One of the most important aspects in oral and maxillofacial surgery is the healing process after periapical surgery during apicotomy, transplantation or pathological surgeries. Past studies with the vascular supply to surgically mobilized dentoalveolar segments, apicotomized transplanted teeth and root resected teeth in periodontal disease, have mentioned occasional encounters with vital root resection and have noted varying degrees of pulpal response to this insult. The purpose of this investigation was to observe the pulpal and periapical responses of dog dental tissues to intentional apical vital root amputation over six months postoperative period.Methods & Materials: Four adult German - Canadian dogs were used in this experimental study. One root of multirooted teeth in left quadrant of each jaw Weresurgically transected and mandibular quadrants for 12; 13,24 and 25 weeks following surgery were obtained after the animals were sacrificed by formalin perfusion of the left and right carotids. The tissue blocks were prepared by routine histological methods. Fisher exact test were used for data analysis.Results: The results demonstrated a disruption of the normal pulpal architecture, with initial pulpal degeneration and subsequent early replacement by the periodontal ligament tissue. An intermediate cemental lining of the root canal occurred in all specimens. There was fat tissue in the apical part of the root in some specimens. Pulpal regeneration were seen in 75% of upper molars and 25% of lower molars. Resorption were took place only in two specimens (12.5%). Severe hyperemia were seen in 62.5% of all specimens.Conclusion: The pulp of multirooted teeth, remain vital after transaction of apical part of the root in dogs.

Objective: Amputation of lower limbs accompanying with serious problems like social, economic, personal and domestic that makes life difficult. As a result of Iraq-Iran war, 578 survivors through bilateral lower limb amputation live in Iran. The purpose of this study was to investigate service satisfaction reported by Iranian bilateral lower limb amputees. Materials & Methods: In this cross sectional study, all war related bilateral lower limb amputees were invited for the interview and 335 participated (response rate=58%). Information about time of injury, the level of amputation, level of education, employment status and rate of the perceived services satisfaction were recorded using a questionnaire. Results: The mean age of the cases was 42.1 (SD=3.6). The majority of the cases were male 97.6% (n=327), and married 97.6% (n=327). The average time after injury was 22.3 (SD:3.9) years. About Two-third (n=237) were unemployed. The most common type of amputation was both below knee 37.6% (no=133). The most service satisfaction reported by amputees was educational facilities and rehabilitation, and the least satisfaction belonged to sport and recreation and health services. The most important problem in receiving health care services was waiting times for appointments and treatment 72% (n=241) and lack of some specialties in small cities 23.2% (n=78). Conclusion: According to results of the study, improvement in accessing to health care services and sport and recreation facilities can lead to higher service satisfaction in war related bilateral lower limb amputees.

Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are associated with psychosis, with a small number being assigned the controversial diagnosis of body identity integrity disorder. In this article, we report two cases of non-psychotic self-amputation and their similarities with a view to highlighting the risk factors and formulating an appropriate management plan.