Hemodynamic study of muscle perfusion in amputees_Journal of Biomedical Engineering

Authors：

BAI Taoping , XUE Jiezhong , LI Zhongyou , LI Xiao , YAN Fei ,  JIANG Wentao

Department of Mechanics Science and Engineering, Sichuan University, Sichuan Provincial Key Laboratory of Biomechanical Engineering, Chengdu 610065, P. R. China;

Corresponding author：

JIANG Wentao, Email: scubme_jwt@outlook.com

Keywords：

Hemodynamics of the residual limb; Finite element analysis; Rehabilitation intervention; Muscle atrophy

DOI：

10.7507/1001-5515.202509030

Video：

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To provide a reference for determining the hemodynamic environment of blood vessels and the nutrient supply of residual limbs, as well as for rehabilitation treatments aimed at reducing muscle atrophy after amputation, this study employed contrast-enhanced computed tomography technology to obtain angiographic images of the vascular system in residual limbs. A vascular model was established through three-dimensional reconstruction and mesh generation, followed by hemodynamic analysis using the finite element method. Based on the blood flow velocities in the femoral artery—0.09 m/s at rest, 0.23 m/s during exercise, and 0.32 m/s during steady-state exercise—the inlet velocities of the residual limb arteries were determined. Calculations yielded the inlet flow velocity, blood flow rate, and blood supply volume. As the inlet velocity increased, the mass flow rates in the superficial femoral artery and deep femoral artery showed the most significant increases, reaching 2.50E-3 kg/s and 2.67E-3 kg/s, respectively. In contrast, the blood flow in the lateral and medial femoral circumflex arteries did not exhibit significant changes. Increasing the inflow velocity did not significantly alter the minimal wall shear stress in the vessels. However, the maximum wall pressure in each vessel rose significantly with increased mass flow rate. Excessively high wall pressure may trigger atherosclerosis, particularly in higher-positioned vessels such as the superficial femoral artery. In addition, due to differences in blood supply, muscles experienced varying degrees of atrophy. Specific treatments for atherosclerosis should be considered during limb rehabilitation. Future research might explore combining rehabilitation training with other methods to promote localized muscle blood supply.

Citation： BAI Taoping, XUE Jiezhong, LI Zhongyou, LI Xiao, YAN Fei, JIANG Wentao. Hemodynamic study of muscle perfusion in amputees. Journal of Biomedical Engineering, 2026, 43(1): 131-137. doi: 10.7507/1001-5515.202509030 Copy

1.	Finco M G, Kim S, Ngo W, et al. A review of musculoskeletal adaptations in individuals following major lower-limb amputation. J Musculoskelet Neuronal Interact, 2022, 22(2): 269-283.
2.	Eckard C S, Pruziner A L, Sanchez A D, et al. Metabolic and body composition changes in first year following traumatic amputation. J Rehabil Res Dev, 2015, 52(5): 553-562.
3.	Park D H, Bradish C F. The management of the orthopaedic sequelae of meningococcal septicaemia: patients treated to skeletal maturity. J Bone Joint Surg, 2011, 93(7): 984.
4.	Renström P, Grimby G, Morelli B, et al. Thigh muscle atrophy in below-knee amputees. Scand J Rehabil Med Suppl, 1983, 9(9): 150-162.
5.	Prbsting E, Blumentritt S, Kannenberg A. Changes in the locomotor system as a consequence of amputation of a lower limb. Z Orthop Unfallchir, 2017, 155(1): 77-91.
6.	Shapiro L T, Huang M E. Inpatient rehabilitation of survivors of Purpura Fulminans with multiple limb amputations: a case series. Arch Phys Med Rehabil, 2009, 90(4): 696-700.
7.	Aulivola B, Hile C N, Hamdan A D, et al. Major lower extremity amputation: outcome of a modern series. Arch Surg, 2004, 139(4): 395.
8.	林永辉, 武继祥, 刘宏亮, 等. 释放接受腔股三角区的挤压力对大腿截肢者残肢肌肉萎缩的影响. 中国康复医学杂志, 2020, 35(6): 710-712.
9.	但建波, 蒋文涛, 刘展, 等. 下肢截肢残端肌肉萎缩的生物力学研究进展. 医用生物力学, 2011, 26(6): 580-584.
10.	Sherk V D, Bemben M G, Bemben D A. Inter limb muscle and fat comparisons in persons with lower-limb amputation. Arch Phys Med Rehabil, 2010, 91(7): 1077-1081.
11.	Henson D P, Edgar C, Ding Z Y, et al. Understanding lower limb muscle volume adaptations to amputation. J Biomech, 2021, 125: 110581.
12.	Ding Z Y, Henson D P, Sivapuratharasu B, et al. The effect of muscle atrophy in people with unilateral transtibial amputation for three activities: Gait alone does not tell the whole story. J Biomech, 2023, 149: 111702.
13.	Aslam A, Shoukat H, Jahan S. Relationship between muscular impairment and psychological health with lower extremity functions in patients with transtibial amputation. J Pak Med Assoc, 2022, 72(9): 1788-1791.
14.	Levy H A, Ulrich M N, Messer C, et al. Impact of unilateral transfemoral amputation on lumbar bone and muscle quality. Am J Phys Med Rehabil, 2025, 104(6): 544-550.
15.	Jaegers S M, Arendzen H J. An electromyographic study of the hip muscles of transfemoral amputees in walking. Clin Orthop Relat Res, 1996, 328(328): 119-128.
16.	Schmalz T, Blumentritt S, Reimers C D. Selective thigh muscle atrophy in trans-tibial amputees: an ultrasonographic study. Arch Orthop Trauma Surg, 2001, 121(6): 307.
17.	陈东, 武继祥, 陈南, 等. 全面承重小腿假肢对小腿截肢后残肢肌肉萎缩速度的影响研究. 中国康复, 2017, 32(1): 86-87.
18.	Moirenfeld I, Ayalon M, Ben-Sira D, et al. Isokinetic strength and endurance of the knee extensors and flexors in trans-tibial amputees. Prosthet Orthot Int, 2000, 24(3): 221-225.
19.	Caron M A, Thériault M E, Paré M È, et al. Hypoxia alters contractile protein homeostasis in L6 myotubes. FEBS Lett, 2009, 583(9): 1528-1534.
20.	李小龙, 晏菲, 董瑞琪, 等. 一种表征残肢血管结构变形的参数方法. 医用生物力学, 2016, 31(1): 19-23.
21.	Dong Ruiqi, Jiang Wentao, Zhang Ming, et al. Review: hemodynamic studies for lower limb amputation and rehabilitation. J Mech Med Biol, 2015, 15(4): 1530005.
22.	Yan Fei, Jiang Wentao, Dong Ruiqi, et al. Blood flow and oxygen transport in descending branch of lateral femoral circumflex arteries after transfemoral amputation: a numerical study. J Med Biol Eng, 2017, 37(1): 1-11.
23.	何思利, 蒋文涛, 董瑞琪, 等. 动脉流量对于肌肉萎缩的影响. 生物医学工程学杂志, 2019, 36(1): 68-72, 79.
24.	刁珺杰, 蒋文涛, 李忠友, 等. 下肢截肢患者心血管系统集中参数模型的血流动力学数值研究. 工程力学, 2023, 40(4): 233-242.
25.	Sions J M, Beisheim E H, Hoggarth M A, et al. Trunk muscle characteristics: Differences between sedentary adults with and without unilateral lower limb amputation. Arch Phys Med Rehabil, 2021, 102(7): 1331-1339.
26.	谭宏昌, 彭智. 截肢病人残端综合征的康复治疗. 现代康复, 2000(3): 384-385.
27.	Shoemaker J K, Phillips S M, Green H J, et al. Faster femoral artery blood velocity kinetics at the onset of exercise following short-term training. Cardiovasc Res, 1996(2): 278-286.
28.	Ballaz L, Fusco N, Crétual A, et al. Acute peripheral blood flow response induced by passive leg cycle exercise in people with spinal cord injury. Arch Phys Med Rehabil, 2007, 88(4): 471-476.
29.	Hoelting B D, Scheuermann B W, Barstow T J. Effect of contraction frequency on leg blood flow during knee extension exercise in humans. J Appl Physiol, 2001, 91(2): 671-679.
30.	Bramley J L, Worsley P R, Bader D L, et al. Changes in tissue composition and load response after transtibial amputation indicate biomechanical adaptation. Ann Biomed Eng, 2021, 49(12): 3176-3188.
31.	Sanders J E, Lam D, Dralle A J, et al. Interface pressures and shear stresses at thirteen socket sites on two persons with transtibial amputation. J Rehabil Res Dev, 1997, 34(1): 19-43.
32.	孔健达, 解瑛傲, 陈世娟, 等. 血流限制训练干预老年肌少症: 生物学机制和应用方案建议. 中国组织工程研究, 2024, 28(23): 3743-3750.
33.	秦欢, 支金草, 王淑瑾, 等. 运动在肌萎缩重建中作用机制的研究进展. 中国病理生理杂志, 2025, 41(9): 1814-1822.
34.	杨珍, 孔德伟, 吴铭, 等. 运动疗法防治废用性肌萎缩的研究进展. 临床医学研究与实践, 2025, 10(27): 174-177,198.
35.	王振泽, 徐智, 晏菲, 等. 下肢假肢接受腔对残肢肌肉萎缩影响的数值研究. 生物医学工程学杂志, 2018, 35(6): 887-891, 899.

1. Finco M G, Kim S, Ngo W, et al. A review of musculoskeletal adaptations in individuals following major lower-limb amputation. J Musculoskelet Neuronal Interact, 2022, 22(2): 269-283.
2. Eckard C S, Pruziner A L, Sanchez A D, et al. Metabolic and body composition changes in first year following traumatic amputation. J Rehabil Res Dev, 2015, 52(5): 553-562.
3. Park D H, Bradish C F. The management of the orthopaedic sequelae of meningococcal septicaemia: patients treated to skeletal maturity. J Bone Joint Surg, 2011, 93(7): 984.
4. Renström P, Grimby G, Morelli B, et al. Thigh muscle atrophy in below-knee amputees. Scand J Rehabil Med Suppl, 1983, 9(9): 150-162.
5. Prbsting E, Blumentritt S, Kannenberg A. Changes in the locomotor system as a consequence of amputation of a lower limb. Z Orthop Unfallchir, 2017, 155(1): 77-91.
6. Shapiro L T, Huang M E. Inpatient rehabilitation of survivors of Purpura Fulminans with multiple limb amputations: a case series. Arch Phys Med Rehabil, 2009, 90(4): 696-700.
7. Aulivola B, Hile C N, Hamdan A D, et al. Major lower extremity amputation: outcome of a modern series. Arch Surg, 2004, 139(4): 395.
8. 林永辉, 武继祥, 刘宏亮, 等. 释放接受腔股三角区的挤压力对大腿截肢者残肢肌肉萎缩的影响. 中国康复医学杂志, 2020, 35(6): 710-712.
9. 但建波, 蒋文涛, 刘展, 等. 下肢截肢残端肌肉萎缩的生物力学研究进展. 医用生物力学, 2011, 26(6): 580-584.
10. Sherk V D, Bemben M G, Bemben D A. Inter limb muscle and fat comparisons in persons with lower-limb amputation. Arch Phys Med Rehabil, 2010, 91(7): 1077-1081.
11. Henson D P, Edgar C, Ding Z Y, et al. Understanding lower limb muscle volume adaptations to amputation. J Biomech, 2021, 125: 110581.
12. Ding Z Y, Henson D P, Sivapuratharasu B, et al. The effect of muscle atrophy in people with unilateral transtibial amputation for three activities: Gait alone does not tell the whole story. J Biomech, 2023, 149: 111702.
13. Aslam A, Shoukat H, Jahan S. Relationship between muscular impairment and psychological health with lower extremity functions in patients with transtibial amputation. J Pak Med Assoc, 2022, 72(9): 1788-1791.
14. Levy H A, Ulrich M N, Messer C, et al. Impact of unilateral transfemoral amputation on lumbar bone and muscle quality. Am J Phys Med Rehabil, 2025, 104(6): 544-550.
15. Jaegers S M, Arendzen H J. An electromyographic study of the hip muscles of transfemoral amputees in walking. Clin Orthop Relat Res, 1996, 328(328): 119-128.
16. Schmalz T, Blumentritt S, Reimers C D. Selective thigh muscle atrophy in trans-tibial amputees: an ultrasonographic study. Arch Orthop Trauma Surg, 2001, 121(6): 307.
17. 陈东, 武继祥, 陈南, 等. 全面承重小腿假肢对小腿截肢后残肢肌肉萎缩速度的影响研究. 中国康复, 2017, 32(1): 86-87.
18. Moirenfeld I, Ayalon M, Ben-Sira D, et al. Isokinetic strength and endurance of the knee extensors and flexors in trans-tibial amputees. Prosthet Orthot Int, 2000, 24(3): 221-225.
19. Caron M A, Thériault M E, Paré M È, et al. Hypoxia alters contractile protein homeostasis in L6 myotubes. FEBS Lett, 2009, 583(9): 1528-1534.
20. 李小龙, 晏菲, 董瑞琪, 等. 一种表征残肢血管结构变形的参数方法. 医用生物力学, 2016, 31(1): 19-23.
21. Dong Ruiqi, Jiang Wentao, Zhang Ming, et al. Review: hemodynamic studies for lower limb amputation and rehabilitation. J Mech Med Biol, 2015, 15(4): 1530005.
22. Yan Fei, Jiang Wentao, Dong Ruiqi, et al. Blood flow and oxygen transport in descending branch of lateral femoral circumflex arteries after transfemoral amputation: a numerical study. J Med Biol Eng, 2017, 37(1): 1-11.
23. 何思利, 蒋文涛, 董瑞琪, 等. 动脉流量对于肌肉萎缩的影响. 生物医学工程学杂志, 2019, 36(1): 68-72, 79.
24. 刁珺杰, 蒋文涛, 李忠友, 等. 下肢截肢患者心血管系统集中参数模型的血流动力学数值研究. 工程力学, 2023, 40(4): 233-242.
25. Sions J M, Beisheim E H, Hoggarth M A, et al. Trunk muscle characteristics: Differences between sedentary adults with and without unilateral lower limb amputation. Arch Phys Med Rehabil, 2021, 102(7): 1331-1339.
26. 谭宏昌, 彭智. 截肢病人残端综合征的康复治疗. 现代康复, 2000(3): 384-385.
27. Shoemaker J K, Phillips S M, Green H J, et al. Faster femoral artery blood velocity kinetics at the onset of exercise following short-term training. Cardiovasc Res, 1996(2): 278-286.
28. Ballaz L, Fusco N, Crétual A, et al. Acute peripheral blood flow response induced by passive leg cycle exercise in people with spinal cord injury. Arch Phys Med Rehabil, 2007, 88(4): 471-476.
29. Hoelting B D, Scheuermann B W, Barstow T J. Effect of contraction frequency on leg blood flow during knee extension exercise in humans. J Appl Physiol, 2001, 91(2): 671-679.
30. Bramley J L, Worsley P R, Bader D L, et al. Changes in tissue composition and load response after transtibial amputation indicate biomechanical adaptation. Ann Biomed Eng, 2021, 49(12): 3176-3188.
31. Sanders J E, Lam D, Dralle A J, et al. Interface pressures and shear stresses at thirteen socket sites on two persons with transtibial amputation. J Rehabil Res Dev, 1997, 34(1): 19-43.
32. 孔健达, 解瑛傲, 陈世娟, 等. 血流限制训练干预老年肌少症: 生物学机制和应用方案建议. 中国组织工程研究, 2024, 28(23): 3743-3750.
33. 秦欢, 支金草, 王淑瑾, 等. 运动在肌萎缩重建中作用机制的研究进展. 中国病理生理杂志, 2025, 41(9): 1814-1822.
34. 杨珍, 孔德伟, 吴铭, 等. 运动疗法防治废用性肌萎缩的研究进展. 临床医学研究与实践, 2025, 10(27): 174-177,198.
35. 王振泽, 徐智, 晏菲, 等. 下肢假肢接受腔对残肢肌肉萎缩影响的数值研究. 生物医学工程学杂志, 2018, 35(6): 887-891, 899.

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Hemodynamic study of muscle perfusion in amputees

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