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PubMed1990

Lower extremity amputation: open versus closed.

Wound breakdown was assessed in 117 amputations for nonhealing lesions and peripheral vascular closure (chi 2 10.34). Nonhealing occurred in 10/63 amputations with primary skin closure when compared with those not closed (p less than .01). All 54 amputation sites treated by the open technique healed without revision. Of 22 toe amputations, the open technique performed in 14 patients required a mean of nine postoperative days; the closed-toe amputation technique performed in 8 patients needed a mean of 5.8 days; the closed-toe amputation requiring revision needed a mean of 36.3 days. Healing rates were significantly different when the wound was left open versus primarily closed (chi 2 8.56 p less than .01). Nineteen transmetatarsal amputations (TMA) were completed; 10 open TMAs required a mean of twenty-four days; 9 closed TMAs required a mean of fifteen days; and revision a mean of eighteen days. Of 51 below-the-knee amputations (BKA), 20 open BKAs required a mean of thirteen days; 3 closed BKAs required a mean of 18.5 days; and 1 revision required two hundred fifty-eight days postoperatively. Twenty-five above-the-knee amputations (AKA) were performed; the 10 open AKAs required a mean of sixteen days; the 15 closed AKAs required a mean of eleven days. There was no significant difference in healing rates of TMA, BKA, or AKA. Healing rates of toe amputations and amputation overall are, however, significantly different. Closed lower extremity amputation wounds require fewer hospital days than open, except if problems in wound healing require revision.

Adult↗
PubMed2005

Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study.

BACKGROUND: Surgical treatment of peripheral vascular disease (PVD) in dialysis patients is controversial. METHODS: We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation. RESULTS: Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896) or amputation (n = 2,046) in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR) 19.0, 95% CI (confidence interval) 13.86-25.95]. The odds of dying within 30 days and within 1 year were higher (30 day OR: 1.85, 95% CI: 1.45-2.36; 1 yr OR: 1.46, 95% CI: 1.25-1.71) in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (< 33rd percentile of propensity score) and moderate likelihood of amputation (33rd to 66th percentile) but not in high likelihood group (> 66th percentile). The number of hospital days in the amputation and revascularization groups was not different. CONCLUSION: Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.

Aged↗
PubMed2003

Nineteenth century amputations at the Royal Berkshire Hospital, Reading.

AIM: To describe 19th century amputations carried out at the Royal Berkshire Hospital, Reading. METHODS: A retrospective analysis of hospital archives. RESULTS: Details of 276 amputations were analysed. The majority (86%) were in men and boys. The median age was 33 years. The ratio of leg:arm amputation was 2:1. Trauma accounted for 58% of amputations. Of 52 arm amputations, 42 were due to trauma, compared with 37 of 110 leg amputations (P < 0.001). Mortality was higher following amputation for trauma than for disease (P < 0.01). Mortality following leg amputation was 16% compared with 3.8% after arm amputation (P < 0.05). Death rate following compound fracture was 23%. CONCLUSIONS: Compared with today, the population undergoing amputation and the indications for amputation in the 19th century differ significantly. However, it is apparent that in those patients who were selected to undergo amputation acceptable survival figures could be achieved.

Amputation, Surgical↗
PubMed2004

Demographics of traumatic amputations in children. Implications for prevention strategies.

BACKGROUND: The demographics of traumatic amputations in children are not well known. The purpose of this review was to identify those demographics for use as a possible guide for prevention strategies. METHODS: The study was a retrospective review of the data on children with traumatic amputation who had received care at one center in the upper midwestern United States from 1980 to 2000. The child's gender and age at the time of the amputation, the date and etiology of the amputation, and the amputation level were tabulated. Statistical analyses of seasonal variations were performed. RESULTS: There were 256 amputations in 235 children. The mean age (and standard deviation) at the time of the amputation was 7.9 +/- 5.0 years. The amputation involved one extremity in 217 children, two extremities in sixteen, and three and four extremities in one child each. Of the 256 amputations, 165 involved the lower extremity. The traumatic amputation was caused by a lawnmower in sixty-nine children, farm machinery in fifty-seven, a motor-vehicle accident in thirty-eight, a train in twenty, and miscellaneous mechanisms in fifty-one. The mean age at the time of the injury varied according to the mechanism of injury and ranged from 1.9 years for burns to 11.5 years for boating injuries. Fifty-four (78%) of the sixty-nine children with a lawnmower amputation were five years of age or less. There were significant seasonal variations: the mean date of the lawnmower injuries was June 10, the mean date of the farming injuries was September 2, and the mean date of the motor-vehicle-related injuries was July 16. CONCLUSIONS: There are common patterns of traumatic amputations in children based on the mechanism of injury, the season, and the age of the child. The ideal time for an educational campaign for the prevention of lawnmower injuries appears to be March and April and should be directed toward parents. The best times for such a campaign for the prevention of farming-related accidents appear to be both the spring and the early fall, and the campaign should be directed toward both parents and older children.

Adolescent↗
PubMed1996

Variation in the incidence and proportion of diabetes-related amputations in minorities.

OBJECTIVE: To identify the age-adjusted and level-specific incidence of amputations associated with diabetes in Hispanics, African-Americans, and non-Hispanic whites. RESEARCH DESIGN AND METHODS: We used a database from the Office of Statewide Planning and Development in California that identified all hospitalizations for lower-extremity amputations in the state in 1991. Amputation level was defined by ICD-9-CM codes 84.11-84.18 and were categorized as toe, foot, leg, and thigh amputations. RESULTS: The age-adjusted incidence of diabetes-related amputation per 10,000 persons with diabetes in 1991 was 95.25 in African-Americans, 55.98 in non-Hispanic whites, and 44.43 in Hispanics. Hispanics had a higher proportion of amputations (82.7%) associated with diabetes than did African-Americans (61.6%) or non-Hispanic whites (56.8%) (P < 0.001). African-Americans had the highest age-adjusted incidence rate for each level in people with and without diabetes. African-Americans underwent more proximal amputations compared with non-Hispanic whites and Hispanics (P < 0.001). Diabetes-related amputations were 1.72 and 2.17 times more likely in African-Americans compared with non-Hispanic whites and Hispanics, respectively. CONCLUSIONS: Hispanics had proportionally more amputations associated with diabetes than did African-Americans or non-Hispanic whites. A significant excess incidence of both diabetes- and non-diabetes-related amputations and proportionally more proximal amputations were identified in African-Americans compared with Hispanics and non-Hispanic whites. A possible explanation could be the higher prevalence of peripheral vascular disease in African-Americans. Public health initiatives, which have been demonstrated to reduce the incidence of diabetes-related lower-extremity amputations, should be implemented, and additional work should focus on minority groups.

Adult↗
PubMed1996

Statistical analysis of amputations and trends in Korea.

Epidemiological research on amputees is being continued extensively world wide, but there are different epidemiologic reports from country to country. This study undertakes an epidemiologic report of the medical records of amputees in Korea which has developed very rapidly, when compared with other countries. This study included 4258 amputees who either had an amputation and/or received prosthetic training at Yonsei University College of Medicine, Severance Hospital from January 1970 to June 1994. The most common cause of amputation was trauma (66.7%), and the second most common cause was peripheral vascular disease. While amputations due to infection or trauma were the most common in the 1950's, amputations due to peripheral vascular disease have gradually increased until they now make up 23.5% of all amputations in the 1990's. Lower limb amputation, more common than upper limb amputation, accounted for 68.7% of all amputation. Multiple amputation accounted for 9.3% of all amputations, and the occurrence rate of multiple amputation was relatively higher in cases of burn injuries, train accidents, frostbite, and Buerger's disease than in cases brought about by other causes. The various amputation causes change according to the circumstances of the times, as can be seen in this study.

Adolescent↗
PubMedDate not supplied

Amputations in diabetic patients: a plea for footsparing surgery.

The authors observed a rather high rate of primary major amputation (above-knee or below-knee) performed for diabetic foot problems as well as an important revision rate for minor amputations (forefoot or toe) in diabetics. They reviewed their experience in order to compare it with more recent data from the literature, pleading for foot-sparing surgery. From 1993 to 1998, 186 amputations were performed on 146 diabetic patients. The cause of foot ulcers was neuropathy in 43 of them (51 episodes of diabetic foot problems) while in the remaining 103 patients (135 episodes of diabetic foot problems), diabetic macroangiopathy (absent ankle pulses) was on cause. For neuropathic foot problems, amputations were almost minor, resulting in a limb salvage rate of 90%. Only five of these patients (12%) had primary major limb amputation versus 43 of the dysvascular patients (42%). The reasons for major amputation by first intention were extensive tissue loss, intractable infection or non-reconstructible occlusive vessel disease, as judged by the surgeon. A foot-sparing surgery was attempted in 92 dysvascular cases. In only 44 of them, a preliminary vascular repair was performed. Twenty eight percent of the primary toe amputations and 24% of the forefoot amputations required secondary revision to a more proximal level. Minor amputations in case of diabetic neuropathy were characterized by a more favourable outcome: only 14% of the toe and 9% of the forefoot amputations failed. During follow-up, only 63% of the major amputations regained an autonomic walking capability with their prosthesis. Wound healing problems in diabetic foot are mainly due to infection and poor tissue perfusion. An aggressive control of the infection and distal revascularization of calf- or foot arteries, whenever possible, could improve the results of diabetic foot surgery. The poor functional recovery after major amputation (only 63% autonomic gait with limb prosthesis) argues for foot-sparing surgery whenever possible.

Aged↗
PubMed2002

[Pathogen resistance and other risk factors in the frequency of lower limb amputations in patients with the diabetic foot syndrome].

UNLABELLED: Patients with diabetes mellitus undergo more amputations due to peripheral vascular disease, neuropathy and especially to infection requiring long-lasting antibiotic therapy than non diabetic patients. The aim of our study was to assess the association between the presence of resistant pathogens presented in diabetic ulcers and the frequency of lower limb amputations. METHODS: 191 diabetic patients consecutively treated for the diabetic foot in our foot clinic were included into two years retrospective study. Peripheral ischemia, the presence of osteomyelitis and the incidence of all Gram positive and negative resistant pathogens (defined as resistance to all oral antibiotics) especially of resistant Staphylococcus species presenting in diabetic foot ulcers were determined. RESULTS: 50/191 (26%) patients underwent amputation, of whom 44/50 (88%) had minor and 6/50 (12%) had major amputations. 53/181 (29%) patients with diabetic foot ulcers had resistant pathogens in their defects. Amputated patients had significantly more resistant microorganisms than patients without amputations--24/42 (57%) vs. 29/139 (21%); p < 0.001. Resistant Staphylococcus species were found in 21% (38/181) of all patients. Patients with amputations had significantly more resistant Staphylococcus species in comparison with patients without amputations--18/42 (43%) vs. 20/139 (14%); p < 0.001. Significantly higher incidence of peripheral vascular disease--79% (38/48) vs. 60% (81/136); p < 0.05 and osteomyelitis--69% (33/48) vs. 13% (18/140); p < 0.001--were found in patients with amputations in comparison with patients without amputations. CONCLUSION: The presence of pathogens resistant to all oral antibiotics and especially of resistant Staphylococcus species was significantly higher in diabetic patients with lower limb amputations in comparison with patients without amputations.

Amputation, Surgical↗
PubMed2004

[Major and minor amputation rates and lower critical limb ischemia: the epidemiological data of western Tuscany].

BACKGROUND: The aim of this study was to evaluate the incidence of major amputations and critical limb ischemia in an unselected population of western Tuscany. METHODS: Out of an overall 1234000 people living in Pisa and surroundings (western Tuscany), a total amount of 306 patients underwent 319 different major/minor amputations during the year 2002 in private and public hospitals, both in Tuscany and in other regions. RESULTS: 84.6% (n = 270) of the amputations were atherosclerotic, while 15.4% (n = 49) were non-atherosclerotic. The patients with unreconstructable critical limb ischemia, who underwent amputations at the symptomatic limbs, had a minor amputation rate (at toes or forefoot) of 46.7%, while the major amputation rate (over the ankle) was 53.3%. The 144 major amputations were performed in 76.4% (n = 110) of the cases above the knee and in the remaining 23.6% (n = 34) of cases below the knee. Early hospital mortality rates of the amputees for ischemic causes were 7.6% in patients who underwent major amputations, and 0.8% in cases with minor amputations, respectively. Overall, in western Tuscany, the incidence of the major amputation rate per million inhabitants was 117 cases per year, with a total of 468 new cases of reconstructable and unreconstructable critical limb ischemia per year (this number was calculated multiplying by 4 the number of major amputations). CONCLUSIONS: On the basis of our real epidemiological data, the theoretical major amputation rates per year were 408 in Tuscany and 6652 in Italy, respectively. The extrapolation of our results showed that the overall critical limb ischemia incidence consists of 1638 cases in Tuscany and of 26676 patients in Italy, respectively.

Adolescent↗
PubMed2006

[Lower-limb amputations and diabetes].

BACKGROUND: A reduced incidence of lower-limb amputations in diabetic patients is a highly prioritised goal. The frequency and prognosis of amputations in our hospital area was recorded in the present study. MATERIAL AND METHODS: All patient records from 1990 to 1999 from the hospitals in Hamar and Elverum, with operation codes for lower-limb amputations, were examined. Known diabetes, smoking status, previous angiography or vascular surgery, and survival until January 31st 2002 were recorded. RESULTS: 412 amputations in 270 patients were recorded. 118 patients (44%) had diabetes, 96% of them had diabetes type 2. Diabetic patients were subject to 51% of the amputations. On average, 0.31% of known diabetic patients in our hospital area had amputations of lower-limb(s) annually during the study period. The mean annual incidence of amputations in diabetic persons was 550 per 100,000 and in non-diabetics 17 per 100,000. The mean age at the first amputation was 77 years. Multiple and distal operations were more frequent in diabetics. Mortality 30 days after the first amputation was 11% in diabetics and 24% in non-diabetics and after one year it was 32% for diabetics and 51% for non-diabetics. INTERPRETATION: The amputation frequency in our hospital area is similar to that in other parts of Norway. About one half of lower-limb amputations are performed in diabetic patients. Most amputees are old and mortality after amputation is high.

Aged↗
PubMed1996

Obesity and metabolic disorders in adults with lower limb amputation.

Anthropometric and biochemical research was conducted on 94 subjects with various levels of lower limb amputation. The purpose of the work was to investigate the features of obesity progression and disorders of cholesterin metabolism, as well as to develop adequate training exercises. Anthropometric research was conducted by calipermetry; the biochemical research was done by various methods to determine exempt and total cholesterin and triglycerides in the blood serum. The research establishes the frequency of obesity progression relative to the level of amputation, as well as the features of the excessive body mass. Type 11A hyperlipoproteidemia was evident. It is characterized by rapid progress of atherosclerotic vascular disease and coronary disease (CD). Cyclic and acyclic exercises were developed for prophylaxis and therapy. Anthropometric research on the determination of body fat mass was conducted on 68 subjects with various levels of lower limb amputation. The nondirect method of measuring skin folds of several parts of the body was used to determine the extent of lipogenesis. Biochemical research of cholesterin metabolism was conducted on 26 subjects with lower limb amputation (a different group). Anthropometric research revealed an increase of body fat mass directly related to the level of amputation. The largest amount of fat in the body mass was noted for the subjects with bilateral transfemoral (above-knee) amputation or transfemoral plus transtibial (below-knee) amputation. Both groups averaged 25.9%. The body fat mass increased chiefly in the subcutaneous fat. Increase of the internal fat mass was less noticeable. The frequency of obesity progression in subjects with unilateral transtibial amputation equaled 37.9%; in subjects with transfemoral amputation, 48.0%; and in subjects with bilateral transfemoral or transfemoral plus transtibial amputation, 64.2%. Young subjects demonstrated obesity progression during the first year after amputation. Biochemical research revealed changes in the cholesterin fractions typical for type 11A hyperlipoproteidemia. This type of hyperlipoproteidemia is often accompanied by atherosclerotic vascular diseases and CD. On the basis of the research and clinical observation, exercises were developed aimed at prophylaxis and treatment of the revealed changes. Exercises are described for subjects with various levels of lower limb amputation when using exercise machines and when swimming.

Adult↗
PubMed2000

Classification of the pattern of intrauterine amputations of the upper limb in constriction ring syndrome.

Twenty patients with congenital upper limb amputations caused by constriction rings were reviewed to classify the pattern of these amputations. In the 20 patients studied, 31 upper limbs had congenital amputations. The pattern of amputation was classified into three types. Proximal upper limb amputation was considered type I and was only seen in one limb. The most common pattern of amputation was digital amputation associated with "coning" or "superimposition" of the digits (type II) and was seen in 20 hands. Type II amputations were subclassified according to the involvement of all, ulnar, radial, or central digits by the constriction ring. In type III amputations (N = 10 limbs), there was no associated coning or superimposition of the digits. This type of amputation was subclassified into type IIIA (multiple-digit amputations within the same hand) and type III B (single-digit amputation). Associated anomalies are reviewed and the pathogenesis of constriction rings is discussed.

Amniotic Band Syndrome↗
PubMed1997

The life style of young persons after lower limb amputation caused by injury.

In order to determine whether lower limb amputation changes the social life and free time activities of persons who were at the time of amputation young, a questionnaire was sent to 519 persons after trans-tibial or higher level of lower limb amputation who were at the time of amputation younger than 51 years, amputated because of injury, permanently resident in Slovenia and had visited the outpatient prosthetics clinic of the Rehabilitation Institute of Slovenia at least once in the last five years (1989-94). There 228 responses, which were statistically analysed. It was found that after amputation most persons participated less frequently in social activities, especially persons who were older at the time of amputation and also those who are older today. Changes in participation in social activities were not influenced by level of education. Free time activities changed after amputation. Some 93 persons completely changed their free time activities and only 30 were still interested in the same activities as before. The three most frequent free time activities before amputation were cycling, team ball games and farm work. After amputation they were reading, watching television and/or listening to radio and music and housekeeping. It is concluded that lower limb amputation severely changes the social life and free time activities of persons who were young at the time of amputation.

Adaptation, Psychological↗
PubMed1985

Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain.

In a prospective study 58 patients undergoing limb amputation were interviewed the day before operation about their pre-amputation limb pain and 8 days, 6 months and 2 years after limb loss about their stump and phantom limb pain. All but one patient had experienced pain in the limb prior to amputation. Pre-amputation limb pain lasted less than 1 month in 25% of patients and more than 1 month in the remaining 75% of patients. At the first examination the day before amputation 29% had no limb pain. The incidence of phantom pain 8 days, 6 months and 2 years after amputation was 72, 65 and 59%, respectively. Within the first half year after limb loss phantom pain was significantly more frequent in patients with long-lasting pre-amputation limb pain and in patients with pain in the limb immediately prior to amputation. Phantom pain and pre-amputation pain were similar in both localization and character in 36% of patients immediately after amputation but in only 10% of patients later in the course. Both the localization and character of phantom pain changed within the first half year; no further change occurred later in the course. The incidence of stump pain 8 days, 6 months and 2 years after limb loss was 57, 22 and 21%, respectively. It is suggested that preoperative limb pain plays a role in phantom pain immediately after amputation, but probably not in late persistent phantom pain.

Adult↗
PubMed1984

Guillotine amputation in the treatment of nonsalvageable lower-extremity infections.

Primary definitive amputation performed in the presence of distal-extremity infection carries the risk of wound infection and additional limb loss. We reviewed 75 below-knee amputations performed for nonsalvageable foot infections. Patients were retrospectively divided into two groups: group 1 underwent open ankle guillotine amputation followed by definitive below-knee amputation, and group 2 underwent primary definitive below-knee amputation. In group 1, 97% of patients achieved primary healing after revision, and none required amputation at a higher level. In group 2, 78% of patients achieved primary healing, but 11% required revision of the amputation to the above-knee level. These data supported the following conclusion: guillotine ankle amputation followed by below-knee amputation for the nonsalvageable, infected lower extremity is associated with a significantly lower amputation failure rate than primary definitive amputation.

Aged↗
PubMed1994

Results of lower extremity amputations in patients with end-stage renal disease.

PURPOSE: The purpose of this study was to determine the impact of end-stage renal disease (ESRD) on the outcome of patients undergoing lower extremity (LE) amputation. METHODS: Hospital charts and vascular surgery registry data were reviewed for all patients who underwent LE amputation over a consecutive 56-month period. The results of 84 patients with ESRD (137 amputations) were compared with 375 patients (442 amputations) without ESRD. RESULTS: Hospital mortality rate was significantly greater in patients with ESRD than patients without ESRD, 24% versus 7% (p = 0.001). Patients with ESRD undergoing minor amputations had mortality rates three times greater than patients without ESRD undergoing major LE amputations. In patients with ESRD requiring bilateral or unilateral above-knee amputation hospital mortality rates were 43% and 38%, respectively. In addition, patients with ESRD were seven times more likely to undergo bilateral amputation than patients without ESRD over a mean follow-up period of 17 months. No kidney transplant patients died after amputation. CONCLUSION: ESRD has a profound negative impact on morbidity, mortality, and survival rates after LE amputation. Attempts at prevention of amputation with aggressive foot care and patient education in this high-risk group should be the focus of therapy.

Adult↗
PubMed2005

Racial differences in primary and repeat lower extremity amputation: results from a multihospital study.

OBJECTIVE: African Americans have a much higher risk of major (above- or below-knee) lower extremity amputation and a lower rate of limb-preserving vascular surgery or angioplasty than white patients. This article analyzes two potential pathways for racial disparities: primary amputation, defined as a major amputation performed without any prior attempt at revascularization, and repeat amputation, defined as a major amputation subsequent to a previous through-foot or major amputation. METHODS: Randomly selected medical records were reviewed for 248 African American, 30 Hispanic, and 235 white or other-race patients undergoing above- or below-knee amputation between 1995 and 2003 at three Chicago teaching hospitals. Chronic disease prevalence and severity, preadmission functional status, clinical presentation, and vascular history were used to test the risk-adjusted effect of race and ethnicity on rates of primary and repeat amputation. RESULTS: Controlling for demographic, functional, chronic disease, and clinical characteristics, African American patients were 1.7 times more likely to have undergone both primary (P = .01) and repeat (P = .03) amputation than white or other-race amputees. Race remained a significant independent risk factor even after controlling for the higher severity of illness, greater disability, and more complex presentation of African American amputees. CONCLUSIONS: Higher rates of primary and repeat amputation for African American patients at study hospitals, which all have significant vascular surgery capacity and an aggressive policy of limb salvage, suggest that these rates may be even higher at less well equipped institutions. Improving access to primary and preventive care for lower-income patients could reduce amputation rates among African Americans.

Adult↗
PubMed1999

Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: a matched case-control study.

OBJECTIVE: To quantify the differences in physical disability and handicap experienced by patients with lower extremity sarcoma who required amputation for their primary tumor as compared with those treated by limb-sparing surgery. DESIGN: Matched case-control study. Twelve patients with amputation were matched with 24 patients treated by limb-sparing surgery on the following variables: age, gender, length of follow-up, bone versus soft-tissue tumor, anatomic site, and treatment with adjuvant chemotherapy. PATIENTS: Patients who underwent above-knee amputation (AKA) or below-knee amputation (BKA) for primary soft-tissue or bone sarcoma, who had not developed local or systemic recurrence, and who had been followed up for at least 1 year since surgery. MAIN OUTCOME MEASURES: The Toronto Extremity Salvage Score (TESS), a measure of physical disability; the Shortform-36 (SF-36), a generic health status measure; and the Reintegration to Normal Living (RNL), a measure of handicap. RESULTS: Mean TESS score for the patients with amputations was 74.5 versus 85.1 for the limb-sparing patients. (p = .15). Only the physical function subscale of the SF-36 showed statistically significant differences, with means of 45 and 71.1 for the amputation versus limb-sparing groups, respectively (p = .03). The RNL for the amputation group was 84.4 versus 97 for the limb-sparing group (p = .05). Seven of the 12 patients with amputations experienced ongoing difficulty with the soft tissues overlying their stumps. CONCLUSIONS: There was a trend toward increased disability for those in the amputation group versus those in the limb-sparing group, with the amputation group showing significantly higher levels of handicap. These data suggest that the differences in disability between amputation and limb-sparing patients are smaller than anticipated. The differences may be more notable in measuring handicap.

Adult↗