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At least 307 records · Page 17Linked to original sources
PubMed1994

Amputation or revascularization in the > 70 year old.

An aggressive posture toward limb salvage in the elderly was assessed by retrospective review of a 5 year experience. A total of 302 primary lower extremity revascularizations and 465 primary major amputations were performed; of these, 62 per cent (472/767) were performed in patients 70 years or older (range 70-104, mean 78). Psychosocial status was utilized to indicate primary amputation; revascularization was attempted in all patients capable of ambulation or transfer. Revascularization was performed in 119 patients > 70 years old (44 femoropopliteal, femorotibial, or sequential, 24 extra-anatomic, and 11 miscellaneous) with a 30-day mortality of 8 per cent, thrombosis 12 per cent, and early amputation 7 per cent. There were five additional mortalities and three amputations, for a 77 per cent life and limb salvage at one year. This contrasted with a 2.2 per cent mortality (P < 0.05), 5.4 per cent thrombosis, and 3.3 per cent amputation rate in 183 revascularizations in < 70 year old patients. Primary amputation was performed with an 8 per cent (23/253) mortality in 253 patients > 70 years old undergoing 192 above and 61 below-knee procedures. There were two mortalities in 154 elective cases, but a 22 per cent rate in urgent situations (P < 0.01) ranging from 66 per cent (12/18) for emergency and 25 per cent (3/12) guillotine to 8 per cent (6/69) for physiologic amputation (P < 0.001). Fifty per cent of all amputation survivors died within 1 year. The comparative mortality for 212 amputations in < 70 year old patients was 1.5 per cent (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1997

Amputation and prostheses in Khartoum.

One hundred and seventy patients with major lower limb amputation (MLLA) presenting to The National Prosthetic-Orthotic Centre (NPOC) in Khartoum over a 1-year period were studied. There were 141 males and 29 females giving a M:F ratio of 4.9: 1.0, with mean age of 37 years (range 5-72 years). Forty-one patients (24%) underwent amputation of diabetic septic foot, 30 patients (17.6%) underwent amputation as a result of trauma from road traffic accidents and Madura foot, and war injuries accounted for 29 amputations (17%). One hundred and eleven patients had below knee amputation (BKA), 52 had above knee amputation (AKA) and seven patients had Syme's amputation. Diabetic amputees had higher rate of revisional surgery compared with others because of sepsis and/or flap necrosis. Stump pain was reported by amputees with excessive scarring of the stump and those with undue prominence of bony ends. There are two types of prostheses provided by the NPOC for both BKA and AKA: the peg leg and the conventional prostheses. The Syme's amputees were fitted with either simple hoof or articulated prostheses with solid ankle cushion heel (SACH). The peg leg consists of a leather lined side bearing metal socket connected to a rocker base by side steels. It is used by the country natives as it suits different weather and job conditions, particularly farming, and it can be repaired locally. The urban population use the conventional prostheses which is lighter in weight, can be put on and taken off easily and is cosmetically acceptable. However, these prostheses are more expensive and require frequent repair or replacement. The functional outcome of patient's rehabilitation with the prostheses was significantly affected by the level and indication of amputation. Those with BKA and those amputated because of trauma or Madura foot experienced better functional outcome compared with the diabetics, independent of age. 50% of patients with the AKA and 19% of those with BKA reported poor functional outcome. Surgeons should be more involved with the long-term evaluation of functional outcome in such patients, to offer help if feasible and to modify their technique for future procedures.

Adolescent↗
PubMed1976

Long posterior flap amputation in geriatric patients with ischaemic disease.

A series of 165 primary amputations performed on 148 patients at Queen Mary's Hospital, Roehampton, from 1967 to 1975 is reported. The average age of these patients was 70 years, the oldest being 95. Those aged 70 years and over are considered in special detail. The problems of management of these elderly patients are complex, involving medical, surgical, and social problems. The object of treatment is to restore these patients to their previous way of life with the shortest possible time in hospital. Every patient is assessed with a view to arterial surgery, and amputation is avoided where possible by a lumbar sympathetic block or direct arterial surgery. When amputation cannot be avoided a below-knee level is selected if possible. A long posterior flap technique is used which forms a myoplasty of the gastrocnemius muscle; thus the ischaemic anterior tibial skin is avoided. Before the operation the patient is assessed by a specialist team and the management is discussed in detail. Every patient is kept in hospital until rehabilitation is achieved to the point of independence inside the home. Of the 90 patients in the group aged 70 years and over, 22% had above-knee amputations and 75% had below-knee amputations, with the result that 69% of the latter were discharged home walking. This result is contrasted with the smaller number who had an above-knee amputation. Below-knee amputation gives the elderly patient a better chance of walking because of the use of the patellar tendon bearing prosthesis. When followed up 36% of those patients with below-knee amputation were fully independent for periods exceeding six months. The price of a below-knee level of amputation is a longer hospital stay, but the quality of function and mobility obtained by the patient makes this worth while.

Age Factors↗
PubMed1999

Wartime amputations.

This paper outlines the causative factors, incidence, and localization of extremity amputations of wounded persons treated at the Osijek University Hospital (Eastern Slavonia) during 1991 and 1992. The medical documentation of 5,024 patients was analyzed. Of these, 1,560 patients were treated in the hospital (31.0%). A total of 1,916 extremity injuries were found in hospitalized wounded patients. Injuries of the lower extremities were found in 1,226 patients and injuries of the upper extremities in 690 patients. Gunshot-explosive fractures of the extremity bones were diagnosed in 1,122 patients (71.9%): 735 (47.1%) in the lower extremities and 387 (25.8%) in the upper extremities. In 90 cases (4.6%), amputation of the extremities (including the fingers) using an open circular or flap technique was performed. Large amputations (above the wrist and ankle joints) were performed on 40 patients (2.6%). Amputation of the upper extremities was performed on 53 patients (58.9%), and amputation of the lower extremities was performed on 37 patients (41.1%). Injuries of the major blood vessels were treated with primary reconstruction in the upper extremities in 44 patients and in the lower extremities in 96 patients. Unstable gunshot-explosive fractures of the long bones were stabilized with external fixation, and fractures of the short bones were stabilized by means of minimal osteosynthesis or external fixation. Secondary amputations (on the lower extremities) were performed on 2 patients because of vascular insufficiency. Not a single secondary amputation procedure was performed because of infection, secondary uncontrolled hemorrhage, or gas gangrene. Amputation is a radical and irreversible intervention, and indications for amputation must be determined by those with great surgical experience and good knowledge of military-surgical doctrine.

Amputation, Surgical↗
PubMedDate not supplied

Bone regrowth after digit tip amputation in mice is equivalent in adults and neonates.

Despite clinical and experimental reports of digit tip regrowth, bone regrowth after amputation through terminal phalanges has not been methodically documented. We have examined bone regrowth in mice after amputation through the terminal phalanx to determine how the level of amputation affects the response and whether the response varies between adults and neonates. Digit tips were amputated, and, at selected intervals greater than 5 weeks after amputation, digits were photographed and processed for whole mount staining with alizarin red stain. Amputations within the distal 40% of the terminal phalanx yielded grossly normal digits within 5 weeks and bone regrowth which usually attained or surpassed the original length. Amputations through the proximal 20% of the distal phalanx precluded nail plate regrowth, and bone grew minimally or regressed. Amputation through the intermediate 40% of the distal phalanx produced digit tips in which bone regrowth was correlated with nail regrowth and in which bone regrowth did not reach original levels. The response in adults and neonates was similar. The correlation between nail regrowth and bone regrowth may help to predict phalangeal bone regrowth after amputation in adults and juveniles.

Journal Article↗
PubMed1977

Transmetatarsal amputation.

We have reviewed the records of 25 patients who underwent a transmetatarsal amputation at San Francisco General Hospital. The average patient age was 63 years old. Twelve of the patients were diabetic, while transmetatarsal amputations were performed in eleven with simple arteriosclerosis. Two patients underwent amputations for either trauma or nonhealing ulcer. Thirteen of the patients healed their amputation, and twelve of these became ambulatory. Eleven required higher amputation, because of nonhealing due to infection in seven and progressive ischemia in four. One patient died on the first postoperative day of pneumonia. The failure group was younger, contained more diabetics, and had a higher incidence of infection. The operative procedure of transmetatarsal amputation is described. We believe that patients with distal gangrene without spreading infection should be considered for transmetatarsal amputation, reserving initial below-knee amputation for those with greater involvement of the foot.

Adult↗
PubMed1997

The status of lower-limb amputation in Bangladesh: a 6-year review.

We conducted a review of 450 single lower-limb amputations performed in our hospital in Bangladesh between July 1982 and June 1987. The incidence of amputation in the specific area of 1000000 inhabitants covered by the hospital was 0.75/10(3) per year. The indications for amputation were: limb ischemia in 366 patients (81%), traumatic crush injury in 45 (10%), diabetes-associated complications in 20 (5%), severe limb infection in 10 (2%), and neoplasm growth in 10 (2%). The ratio of above-knee (AK) to below-knee (BK) amputation was 1:65, and 36 patients (8%) required reamputation, 22 of whom had undergone BK amputation previously. Thus, the number of patients with a final amputation at AK level was 302 (67%). The operative mortality was 21% and the uncomplicated primary wound healing rate was 89% within the survivors. Among the 355 patients who survived the amputation, 265 (75%) were given a prosthesis, 50 (14%) refused a prosthesis, and the remaining 40 (11%) were unfit for a prosthesis. Rehabilitation was successful in 44% of the AK and 86% of the BK amputees. In conclusion, when amputation is inevitable, maximum consideration should be given to the type of surgery performed to avoid rehabilitation failure.

Adolescent↗
PubMed1991

Laser Doppler flowmetry, transcutaneous oxygen tension measurements and Doppler pressure compared in patients undergoing amputation.

The level of amputation continues to present a challenge for surgeons. In view of this, 24 patients who required an amputation of their ischaemic leg were studied prospectively using Laser Doppler flowmetry (LDF), TcpO2 measurements and Doppler ultrasound to assess the best level for amputation. In all patients gangrene of the leg and rest pain were the indication for an amputation. Skin oxygen tension (TcpO2) and skin blood flow (LDF) measurements were obtained the day before surgery on the proposed anterior and posterior skin flaps for below knee amputation and the maximum Doppler systolic pressure was measured. The level of amputation was chosen at surgery by clinical judgement without reference to the measurements mentioned above. A below knee amputation was performed in 17 patients and an above knee in seven. All amputations healed by primary intention. Doppler pressures showed poor discrimination with a median value of 10 mmHg (0-25) in AK patients and 35 mmHg (0-85) in the BK group (p greater than 0.05). In contrast TcpO2 showed a trend. In the BK group the median value was 20 mmHg (4-50) on the anterior and 22 mmHg (2-60) on the posterior flap compared to above knee amputees with median values of 6 mmHg (2-11) and 8 mmHg (3-38), respectively (p greater than 0.05). Laser Doppler seemed more useful. In BK patients the median LDF values were 36 mV (20-85) on the anterior and 34 mV (20-80) on the posterior flap with median LDF values of 10 mV (10-18) on the anterior and 11 mV (8-38) on the posterior flap in the above knee group (p less than 0.01). Laser Doppler flowmetry is a simple objective test, which is a better discriminator of skin flap perfusion than either TcpO2 or Doppler ankle pressures.

Aged↗
PubMed2003

Physiological responses to multiple speed treadmill walking for Syme vs. transtibial amputation--a case report.

PURPOSE: To date, there have been no longitudinal studies comparing walking at different levels of amputation. The objective of this study was to compare the self-selected walking velocity (SSWV) and selected physiologic variables during walking between a Syme and a later transtibial level of amputation for a single subject. Additional comparison was made between the SACH foot prosthesis and a dynamic response foot prosthesis. METHOD: A 35-year-old male with a traumatic Syme amputation later underwent elective transtibial amputation. SSWV and multiple speed treadmill walking tests (53.64, 67.05, 80.46, 93.87 and 107.28 m/min) were evaluated under three conditions (Syme prosthesis with SACH foot, transtibial prosthesis with SACH foot, and transtibial prosthesis with Flex-Foot). RESULTS: Walking with transtibial prosthesis showed minimal differences in oxygen consumption (0 - 5% reduction), heart rate response (0 - 1% reduction), or gait efficiency (0 - 5% improvement) across all speeds when compared with Syme prosthesis (both with SACH foot). However, the SSWV was 6 - 8% faster for the transtibial SACH foot. Walking with transtibial Flex-Foot required less cardiovascular demand than with transtibial SACH foot at higher speeds. CONCLUSIONS: In this case report, it seemed that transtibial amputation did not have adverse effects on selected physiological responses at a variety of walking speeds when compared to Syme amputation, and that the use of a dynamic response foot enhanced his gait performance. Further experimental studies involving more subjects with traumatic Syme and transtibial amputations are required to better understand the effect of these two levels of amputation on energy cost of walking.

Adult↗
PubMed2000

Augmented amputations of the lower extremity.

Ten patients who had amputations of a lower extremity for high-grade sarcomas underwent bone augmentation with either allograft or autograft between 1988 and 1996. There were eight transfemoral amputations and two transtibial amputations. The transferred segments consisted of one proximal tibia and six distal tibia autografts, two allografts, one autograft talar dome and first metatarsal, and one with a patellar cap of a supracondylar amputation. The average length of followup was 54 months. There were no nonunions of any of the grafts. There were three wound problems requiring additional operations. One autograft resorbed, and one autograft had a late infection. There was one local recurrence. Augmentation to provide length resulted in a 42% increase in bone length in those performed purely for length. All patients were able to use standard prostheses. Functional outcome was appropriate to the amputation level. Half of the patients avoided more proximal levels of amputation because of the ability to augment the osteotomy. The use of nonvascularized structural autografts or allografts is a simple procedure that can produce a superior residual limb in patients undergoing amputation. Its use should be considered in patients for whom traditional amputation techniques will result in poor function, difficulty in fitting a prosthesis, or greater than necessary anatomic loss.

Adolescent↗
PubMed2002

Limb amputation and limb deficiency: epidemiology and recent trends in the United States.

BACKGROUND: The purpose of this study was to provide a comprehensive perspective on the epidemiology and time trends in the incidence of limb amputations and limb deficiency in the United States. METHODS: Data from the Healthcare Cost and Utilization Project from 1988 through 1996 were used to calculate rates of congenital deficiency, trauma-related, cancer-related, and dysvascular amputations in the United States. Trends over time in adjusted rates were then examined using linear regression techniques. RESULTS: Dysvascular amputations accounted for 82% of limb loss discharges and increased over the period studied. Over all years, the estimated increase in the rate of dysvascular amputations was 27%. Rates of trauma-related and cancer-related amputations both declined by approximately half. The incidence of congenital deficiencies remained stable. CONCLUSIONS: The risk of amputations increased with age for all causes and was highest among blacks having dysvascular amputations. Increasing risk of dysvascular amputations, particularly among elderly and minority populations, is of concern and warrants further investigation.

Adolescent↗
PubMed2004

From major amputation to prosthetic outcome: a prospective study of 190 patients in a defined population.

In this prospective study, the overall treatment and outcome of patients that underwent major lower limb amputation in a defined population is described. The study was performed over a five year period in the Health Care District of North-East Skåne, Sweden. Some 190 patients, permanent inhabitants of the Health Care District, underwent major lower limb amputation. Sixteen (16) of these patients had amputations before the study started and went through late second leg amputation during the period. One hundred and seventy four (174) patients had primary major amputation. Seventy nine (79) were men and 95 were women, with a median age of 81. The re-amputation rate was 17% although the primary knee preservation ratio was as high as 3.0:1. Rigid dressing was the standard method following trans-tibial amputation and was used for 5-7 days. ICEROSS silicone liner was used for compression therapy in 90% of all cases that resulted in delivery of a prosthesis. Prostheses were delivered to 43% of all patients with primary amputations. These patients spent a median of 13 days at the orthopaedic clinic. 55 days at the rehabilitation unit. Pressure casting was used as a standard method in the production of the prosthetic socket. ICEX carbon-fibre socket was used in 52%. New procedures, treatments and techniques were introduced, standardised and evaluated whilst the routines in the hospital were reorganised. In this way, a system has been implemented that better guarantees the outcome of the whole procedure and the service received by this category of patients.

Aged↗
PubMed1987

Predicting stump healing following amputation for peripheral vascular disease using the transcutaneous oxygen monitor.

In patients with peripheral vascular disease requiring amputation, a below-knee stump is likely to result in improved function compared to above-knee. Unfortunately, clinical assessment of skin circulation is inaccurate, making the decision of amputation level difficult. The transcutaneous oxygen monitor has been investigated as a method of assessing skin circulation. A prospective study using the monitor in 51 amputations based on clinical assessment has shown that a transcutaneous oxygen tension (tcPO2) greater than 40 mm Hg is associated with stump healing, while measurements below that level lead to an unpredictable outcome. Half of the patients undergoing above-knee amputation had a tcPO2 level greater than 40 mm Hg at the below-knee site, suggesting that a successful distal amputation might have been performed. A further prospective study of 50 patients requiring amputation for peripheral gangrene showed that when amputations were performed at the lowest level in the limb with a tcPO2 greater than 40 mm Hg there was a higher rate of below-knee amputations (72%) and a higher rate of successful stump healing. Review of the literature confirms the potential of the monitor as a non-invasive, simple and accurate method of predicting stump healing.

Amputation, Surgical↗
PubMed2004

Long-term lower extremity prosthetic costs in children with traumatic lawnmower amputations.

OBJECTIVES: To evaluate prosthetic costs of pediatric lawnmower amputations; to see if reducing the incidence of pediatric lawnmower amputations could result in significant cost savings; and to consider if a cost analysis could be useful to implement more safety features (voluntarily or legislatively). DESIGN: Pediatric lawnmower amputees from 1980 to 2000 were reviewed to determine age at time of injury, level of amputation, number of prostheses, and lifetime per prosthesis. A standard prosthetic program beginning at amputation and ending at age 18 years was constructed. An aggregate cost was calculated according to the proportion of amputation levels. The cost burden for prosthetic care was estimated from the statistics of US pediatric lawnmower injuries. SETTING: Referral pediatric orthopedic center. PATIENTS: Fifty-three lower extremity amputees with 58 lower extremity amputations at a mean +/- SD age of 4.7 +/- 2.5 years were reviewed. RESULTS: The percentage of amputee children injured by riding lawnmowers was 80%; the percentage injured by riding lawnmowers engaged in reverse was 39%. Prosthetic costs from the time of injury to the age of 18 years range from 73,140 dollars to 116,040 dollars per single lower extremity amputation. With 600 to 650 new childhood amputations per year due to lawnmowers, the new annual burden for prosthetic costs thus ranges from 43.88 to 75.42 million dollars, or (600)(73,140 dollars) to (650)(116,040 dollars). CONCLUSIONS: Further encouragement of lawnmower manufacturers to install improved safety devices (such as those to disengage power while in reverse mode of operation), new research on improved safety measures, and continued promotion of educational campaigns regarding the dangers of children being around and/or operating riding lawnmowers and garden tractors should be pursued. This will result in significant cost savings as well as incalculable health savings.

Amputation, Traumatic↗
PubMed1981

Rehabilitation for lower extremity amputation.

The results of rehabilitation for lower-extremity amputation were analyzed to assess the impact of a center that used a coordinated team combined with modern surgical and prosthetic techniques. Data for group 1 patients (amputated between July 1, 1975, and June 30, 1977) demonstrated a healing rate of 63%, a mean rehabilitation time of 128 days, a mean hospitalization time of 68 days, and a rehabilitation rate of 69% for those who could walk prior to amputation. Data for group 2 (amputated between July 1, 1977, and July 30, 1979) demonstrated an amputation healing rate of 97%, an average rehabilitation time of 30.8 days, a mean hospitalization time of 38 days, and a rehabilitation rate of 100% for those patients who could walk before amputation. There was no difference between groups 1 and 2 in surgical mortality; all other variables, however, showed significant improvement for group 2 patients. Comparison within the same institution of the results of rehabilitation for lower-extremity amputation before and after the initiation of a dedicated amputation center clearly demonstrated the superiority of the center concept.

Adult↗
PubMed1991

Failed femorocrural reconstruction does not prejudice amputation level.

From January 1985 to December 1989, 500 consecutive patients presented to a single vascular unit with limb-threatening acute or critical ischaemia. Vascular reconstruction was attempted unless the patient had insufficient viable tissue to permit weight bearing or complete absence of run-off vessels in the calf. Fifty patients underwent a primary amputation and 450 patients underwent vascular reconstruction, of whom 265 had a femorocrural bypass. Sixty secondary amputations were performed following femorocrural bypass failure. The below-knee amputation to above-knee amputation ratio (BKA:AKA) was 2.0 in the primary amputation group and 1.1 in the secondary amputation group. Direct comparison between the two groups is not valid as they are clinically different. The combined BKA:AKA ratio was 1.4. This compares favourably with the BKA:AKA ratio of recent published series and figures from the National Amputation and Limb Fitting Services. It suggests that an unselective policy of vascular reconstruction for critical ischaemia does not lead to a higher proportion of above-knee amputations.

Acute Disease↗
PubMed1984

Somatosensory cortical map changes following digit amputation in adult monkeys.

The cortical representations of the hand in area 3b in adult owl monkeys were defined with use of microelectrode mapping techniques 2-8 months after surgical amputation of digit 3, or of both digits 2 and 3. Digital nerves were tied to prevent their regeneration within the amputation stump. Successive maps were derived in several monkeys to determine the nature of changes in map organization in the same individuals over time. In all monkeys studied, the representations of adjacent digits and palmar surfaces expanded topographically to occupy most or all of the cortical territories formerly representing the amputated digit(s). With the expansion of the representations of these surrounding skin surfaces (1) there were severalfold increases in their magnification and (2) roughly corresponding decreases in receptive field areas. Thus, with increases in magnification, surrounding skin surfaces were represented in correspondingly finer grain, implying that the rule relating receptive field overlap to separation in distance across the cortex (see Sur et al., '80) was dynamically maintained as receptive fields progressively decreased in size. These studies also revealed that: the discontinuities between the representations of the digits underwent significant translocations (usually by hundreds of microns) after amputation, and sharp new discontinuous boundaries formed where usually separated, expanded digital representations (e.g., of digits 1 and 4) approached each other in the reorganizing map, implying that these map discontinuities are normally dynamically maintained. Changes in receptive field sizes with expansion of representations of surrounding skin surfaces into the deprived cortical zone had a spatial distribution and time course similar to changes in sensory acuity on the stumps of human amputees. This suggests that experience-dependent map changes result in changes in sensory capabilities. The major topographic changes were limited to a cortical zone 500-700 micron on either side of the initial boundaries of the representation of the amputated digits. More distant regions did not appear to reorganize (i.e., were not occupied by inputs from surrounding skin surfaces) even many months after amputation. The representations of some skin surfaces moved in entirety to locations within the former territories of representation of amputated digits in every monkey studied. In man, no mislocation errors or perceptual distortions result from stimulation of surfaces surrounding a digital amputation.(ABSTRACT TRUNCATED AT 400 WORDS)

Afferent Pathways↗
PubMed1996

Syme amputation: results in patients with severe forefoot ischemia.

Since 1980, 35 patients (age range 40-77 years) with severe forefoot ischemia have undergone a unilateral Syme amputation. Thirty-one patients (89%) were diabetic. The indication for amputation was either extensive forefoot gangrene or ulceration too advanced for a digital or transmetatarsal amputation. Twenty-two amputations (63%) were immediately preceded by either percutaneous transluminal angioplasty (four) or a bypass procedure to the popliteal artery (five) or an infrapopliteal artery (13). Primary healing occurred in 19 (86%) of 22 amputations immediately preceded by revascularization and in 10 (77%) of 13 limbs undergoing amputation alone. Twenty-eight (97%) of the 29 patients with successful primary healing were successfully rehabilitated. Rehabilitation rendered 13 patients fully ambulatory, 15 ambulatory with intermittent use of a walker or cane and one unable to walk. At follow-up of four months to 13 years (mean 42 months), the cumulative ambulatory rate at 1, 3, and 5 years was 92, 80 and 80%, respectively. Syme amputation allows a return to a functional ambulatory status in a high percentage of patients with severe forefoot ischemia. These findings suggest that Syme amputation is an acceptable option in dysvascular patients with severe forefoot ischemia.

Adult↗