Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “AMPUTATION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMed2003

Amputation for acute ischaemia is associated with increased comorbidity and higher amputation level.

BACKGROUND: There is some evidence that the early outcome of major amputation is worse after failed thromboembolectomy, but the risk factors and results of amputation done for acute ischaemia have never been compared with those for chronic ischaemia in a large series of patients. METHOD: Retrospective review of 30 day outcome for all 322 primary amputations done for arterial disease during 1992-8. There were 286 patients (163 male; median age 76 years) who had 270 amputations for chronic ischaemia and 52 for acute ischaemia. RESULTS: The acute group had higher prevalences of cardiac disease (48% versus 29%-p<0.02), limiting pulmonary disease (27% versus 13%-p<0.02) and ASA grades 4 and 5 (27% versus 14%-p<0.05). Amputation below the knee was less common after acute ischaemia (31% versus 60%-p<0.001). There were trends towards more revisions (19% versus 11%) and higher mortality (25% versus 19%) in the acute group but neither reached statistical significance. CONCLUSION: Patients having major amputations for acute ischaemia have higher levels of pre-existing comorbidity than those with chronic ischaemia and are twice as likely to require amputation above the knee. They should be managed as a particularly high risk group.

Acute Disease↗
PubMedDate not supplied

Canine osteosarcoma. Treatment by amputation versus amputation and adjuvant chemotherapy using doxorubicin and cisplatin.

Osteosarcoma was diagnosed in 38 dogs. Thirty-six tumors originated from the appendicular skeleton and two from the axial skeleton. Nineteen of the dogs were treated with amputation alone, and 19 were treated with amputation and adjuvant chemotherapy consisting of doxorubicin and cisplatin. The 36 dogs with appendicular osteosarcoma had complete amputation of the affected limb, whereas the two dogs with osteosarcoma of the axial skeleton had an en bloc resection. The mean survival of the 19 dogs treated with amputation alone was 218 days (median, 175 days). Ten dogs were alive at 6 months and four survived 1 year. None of the dogs survived longer than 16 months. Radiographic lesions consistent with metastatic osteosarcoma were seen after surgery in the nine dogs in which radiographs were taken. The mean survival of the 19 dogs treated with amputation and chemotherapy was 415 days (median, 300 days). Drug toxicity was not observed. Fifteen dogs were alive at 6 months, seven dogs were alive at 1 year, 5 dogs were alive at 2 years, and two dogs were alive at 3 years or longer. One dog is alive and well at 25 months. Radiographic lesions suggestive of metastatic osteosarcoma developed in the other 18 dogs. The 19 dogs treated with amputation and chemotherapy had significantly longer survival times than the dogs treated with amputation alone.

Amputation, Surgical↗
PubMed2003

Minor environmental trauma and lower extremity amputation in high-risk patients with diabetes: incidence, pivotal events, etiology, and amputation level in a prospectively followed cohort.

This study determined the incidence, pivotal events, etiology, and levels of amputation in a prospectively followed cohort of 400 people with diabetes and a prior healed foot ulcer who participated in a randomized footwear trial. Participants were seen every 17 weeks for 2 years. Subjects with foot lesions were referred to their healthcare provider for treatment. In this cohort, 11 participants required lower limb amputation (rate 13.8 per 1000 person-years). Pivotal event analysis revealed that only one amputation was related to footwear, six amputations were due to non-footwear-related minor environmental trauma, two were due to progression of vascular disease (dry gangrene from critical ischemia), one was due to a self-care injury while cutting the toenails, and one was due to a decubitus ulcer. Previously proposed strategies to reduce the amputation rates in individuals with diabetes have focused heavily on footwear and education. However, even with this emphasis, amputation rates in the United States are still high. This study suggests that the prevention of minor environmental trauma, including household accidents, merits additional attention. We believe that further efforts to reduce amputation rates for individuals with diabetes will need to emphasize the prevention of minor trauma, especially in those already compromised with neuropathy and vascular disease.

Aged↗
PubMedDate not supplied

Lower limb amputation 2: once the decision to amputate has been made.

This is the second of four articles on lower limb amputation. The first article (Vol 6(17): 970-7) discussed the indications for amputation and briefly outlined the treatment options that may be tried before the amputation stage is reached. This second article examines the factors that need to be addressed once the decision to amputate has been made. It stresses the importance of preparing the patient and his/her family both psychologically and physiologically for the operation. The techniques and rationale for selecting the optimum level of amputation are then discussed. Finally, the specific levels of lower limb amputation are outlined. The next article in this series will explore the nurse's role in preparing the patient for an amputation, and the final article will address the issues raised when a patient decides that death is preferable to living as an amputee.

Amputation, Surgical↗
PubMed1995

Decision making and results in subtotal and total lower leg amputations: reconstruction versus amputation.

As a result of modern therapeutic and technological advances, the surgeon has the ability to salvage even the most severely injured lower limbs. However, the success of replantation nowadays is no longer measured simply on the basis of restoration of viability but also on functional outcome compared with primary amputation with early prosthetic fitting, the risk to the patient during and after replantation and the overall time of treatment which should not exceed 2 years. Although every major limb replantation has to be considered individually, the decision-making process for reconstruction (replantation/revascularisation) versus amputation with subsequent early prosthetic fitting should be determined by objective criteria. Based on personal experience and an extensive literature search, an algorithm for treatment of amputation or amputation-like injuries to the lower leg has been developed and tested in a clinical study. A 100% viability success rate was achieved. There was not only a significant increase in the percentage of "functional extremities" but also a doubling in grade I results. Moreover, there was a 50% reduction in patients presenting a "non-functional extremity", and no patient required a secondary re-amputation. The replantation risk (e.g., risk of severe systemic disturbance during and/or after replantation) was about 16.6% (2/12) in our study. There was a significant decrease in the postoperative complication rate and no patient died during or after replantation. Based on our experience, if reconstruction in subtotal or total lower leg amputation is done for a well-selected patient group, good functional results with a reasonable replantation risk and a reasonable time for social re-integration can be achieved.

Adult↗
PubMed1977

Muscle blood flow after amputation with special reference to the influence of the amputation level. Assessed by 133 xenon and histamine. An animal experiment.

Amputation on rabbits was found to change the muscle blood flow (MBF) in the limb subjected to surgery as well as in the contralateral extremity, depending on the technique used for amputation and the level at which it was carried out. Amputation was immediately followed by a reduction in MBF in the stump. After amputation of the crus and knee disarticulation, the flow was normalized a few days later and exceeded the preoperative mean flow. After amputation of the femur such an increase in flow was not seen, but when osseous plugging of the medullary cavity was applied, the MBF in the stump was intensified even after amputation of the femur.

Amputation, Surgical↗
PubMed1983

[Transgenicular amputation: an alternative to thigh amputation?].

Since 1976 we attempted to avoid an above-knee (AK) amputation in favor of a knee disarticulation. From 1976 to 1979 83 patients with an average age of 72 years could be amputated through the knee and 55 patients with average age of 73 years had to be submitted to an AK-amputation. As compared to the AK-amputation the transgenicular (TG) resection has the following advantages: 1) Lower postoperative mortality (TG 10%, AK 33%). --2) Higher prosthetic fitting rate (TG 77%, AK 61%). --3) Significantly improved rehabilitation of the patient (walking with artificial limb: TG 67%, AK 20%). --The results of a TG-amputation may be impaired by disturbances of wound healing with subsequent necrosis and/or infection. Among our patients every forth amputation stump following TG-resection had to be reamputated at above-knee level.

Aged↗
PubMed2005

Factor structure of the Trinity Amputation and Prosthesis Experience Scales (TAPES) with individuals with acquired upper limb amputations.

OBJECTIVES: To investigate the factorial composition of the Trinity Amputation and Prosthesis Experience Scales (TAPES), a multidimensional assessment of adaptation to amputation and prosthesis, for use with individuals with acquired upper limb amputations. DESIGN: Cross-sectional survey of members of the British Limbless Ex-Service Men's Association. RESULTS: A total of 101 individuals (men, 100; mean age, 73.8 yrs, SD 11.94) with acquired upper limb amputations (98 traumatic cases) completed the TAPES. Principal components analyses with varimax rotation revealed four psychosocial subscales (general adjustment, social adjustment, optimal adjustment, and adjustment to limitation), four activity-restriction subscales (restriction of lifestyle, social restriction, occupational restriction, and restriction of mobility), and a single prosthesis-satisfaction subscale. Each of these subscales had high internal reliability. CONCLUSIONS: The TAPES structure can be meaningfully represented in terms of nine internally consistent subscales. Additional research needs to be done on the TAPES for use with individuals with upper limb amputations. In particular studies of the scales, predictive validity is warranted.

Aged↗
PubMed1984

Psychological response to amputation as a function of age and time since amputation.

Much of what is known about the psychological response to amputation is derived from studies of veterans. Most recent amputees come from a different group; they are typically older and have experienced medical problems prior to their amputation. In order to investigate the effects of age and time since amputation on psychological response, 66 amputees were assessed by the Symptom Checklist-90, Beck Depression Inventory and interviewed. When classified by time since amputation and by age, the results indicate that older amputees exhibited less depression and fewer psychological symptoms: in contrast, younger amputees evidenced increased depression and psychological symptomatology the longer the time since their amputation.

Adaptation, Psychological↗
PubMed1993

[Can vascular surgery reduce the amputation frequency? A study of amputations in the county of Viborg before and after establishment of an own department of vascular surgery].

In June 1988 a Department of Vascular Surgery was established in the County of Viborg, Denmark. In a retrospective study, 314 patients had 337 major amputations within two time periods: 1986-1987, and 1989-1990. The number of patients seen by a vascular surgeon rose significantly from 19% in the first period to 49% in the last period, and the number of amputations was concurrently significantly reduced by 25%. The largest reduction was observed in 1990, probably due to an increase of vascular reconstructions of 43%. Assuming there is a latency between diagnosing "critical leg ischaemia" and amputation, this will further delay the already convincing results showing that vascular surgery does reduce the frequency of amputations. All patients with suspected critical leg ischaemia or threatened by amputation must be seen, or at least conferred with a vascular surgeon.

Aged↗
PubMed1976

[Amputations for arteritis. Criteria of choice of the level of the amputation].

The practice in arteritis, of economic amputations conserving the knee, is justified by the better quality of the functional results obtained and, also, the risk of later bilateral amputation. This risk, in the series studied here was estimated at 21.6 p. 100. This conservative attitude does, however, have certain risks, the main risk being the necessity for a new amputation at a higher level. The proportion of failures leading to high mid-thigh amputation was of the order of 22 p. 100. To ensure the best possible security in economic amputations, it is important to respect a certain number of criteria which are studied here: the general and psychological condition of the patient, the arteriographic findings, the functional investigations and, finally, the operative test which assesses the vitality of the tissues at the level of the area of section.

Amputation, Surgical↗
PubMed1998

[History of surgical instruments: 8. Instruments and development of amputation technique exemplified by amputation sets from the middle of the 19th century].

The amputation of a limb is one of the oldest surgical procedures. However, in the course of medical history operative techniques and surgical instruments have been improved continuously. With an example of an amputation case of the last century we will summarize this development until the middle of the nineteenth century. Even in the first century Celsus gave a description of an amputation (circular cut). A major step in the development of the operative technique was the introduction of artery forceps by A. Paré in the sixteenth century. Nevertheless, due to a lack of analgesics and narcotics the operation had to take only a few minutes. Therefore the amputation was completed in one cut, i.e. detachment of the skin, muscles and bone at the same level. This technique known as "classic circular cut" was modified several times in the following period: in order to reduce suture tension Petit recommended to transect the skin first and the muscles and bone more proximal ("two-stage circular cut", 1718) and Bromfield approved to cut in turn the skin first, the muscles more proximal and the bone most proximal ("three-stage circular cut", 1773). Finally, Lowdham (1679), Verduyn (1696) and C. J. M. Langenbeck (1810) changed the operative technique to the effect that they used a soft-tissue flap in order to cover the bone without tension ("flap amputation").

Amputation, Surgical↗
PubMed2004

The Trinity Amputation and Prosthesis Experience Scales and quality of life in people with lower-limb amputation.

OBJECTIVES: To undertake preliminary research into quality of life (QOL) for a group of people with a lower-limb amputation and to investigate what aspects of the "prosthetic experience" are most strongly associated with QOL using the Trinity Amputation and Prosthesis Experience Scales (TAPES). DESIGN: Cross-sectional survey. SETTING: Prosthetic limb fitting center. PARTICIPANTS: Sixty-three people older than 18 years with unilateral lower-limb amputation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The TAPES and the World Health Organization Quality of Life Questionnaire-Brief Version. RESULTS: There were no significant differences in any of the QOL domain scores (physical health, psychological, social relationships, environmental) arising from age, gender, level of amputation, or cause of amputation. However, there were significant differences depending on the length of time living with the prosthesis and the degree of prosthetic use. Stepwise regression identified different significant predictors for each domain of QOL. CONCLUSIONS: These findings support the claim that the TAPES can be used to evaluate QOL for this patient group. Further research is warranted to learn how sensitive the scale and its items are to change in clinical status.

Adult↗
PubMed2003

Depression in men with traumatic lower part amputation: a comparison to men with surgical lower part amputation.

This study aimed at comparing the prevalence of depression among traumatic and surgical amputees and examining the relationship between depression and sociodemographic/clinical characteristics of amputees. Participants were 49 patients with traumatic lower part amputation and 35 patients with surgical lower part amputation. The diagnosis of depression in each participating patient was confirmed by means of the Structured Clinical Interview for DSM-IV, Turkish version. The level of depression was assessed by using the Hamilton Depression Rating Scale. The prevalence of depression was 34.7% in the traumatic amputee group and 51.4% in the surgical amputee group (p > 0.05). In the traumatic group, depression was associated with time since amputation but not with other variables. However, in the surgical group, depression was associated with age, education level, marital status, economic status, time since amputation, and whether the patient was treated with prosthesis. Our data indicated that depression is a common clinical condition among amputees. Clinicians may be advised to schedule periodic contacts with amputees over long periods to identify those in need of psychiatric intervention.

Adolescent↗
PubMed1995

Incidence of skin breakdown and higher amputation after transmetatarsal amputation: implications for rehabilitation.

The purpose of this study of patients with transmetatarsal amputation (TMA) is to describe multiple patient characteristics, including the incidence of subsequent skin breakdown and higher amputation, that may influence rehabilitation treatment and outcomes. Data were gathered on all patients having a TMA at this facility between April 1989 and September 1993. One hundred twenty TMAs were performed on 107 patients with a mean age of 62.4 +/- 13.8 years. There were 55 men and 52 women. Thirteen patients (12%) had a bilateral TMA. Twenty-nine patients (27%) developed skin breakdown. Of these, 48% occurred within the first 3 months after surgery. Thirty patients (28%) required a higher amputation. Of these, 60% occurred in the first month after TMA. In addition, this group of patients had a high incidence of diabetes mellitus (77%), hypertension (54%), electrocardiogram (EKG) abnormalities (60%), congestive heart failure (22%), and prior ipsilateral vascular surgery (51%). These results indicate that patients with TMA often present with a complicated medical condition and that they are at high risk of skin breakdown or higher amputation, especially in the first 3 months after surgery. The investigators conclude that patients with TMA may benefit from a rehabilitation program emphasizing protection of the residuum during their return to functional activities. Additional research is needed to determine optimal acute and long-term rehabilitation of patients with TMA.

Amputation, Surgical↗
PubMedDate not supplied

[Epidemiological data on lower leg amputations. A study of 1487 amputations].

The examination is based on the operative amputee statistics at the university hospital Göttingen between 1983 and 1992 as well as the prosthetic treatment statistics at the university hospital for Technological Orthopedics and Rehabilitation (TO Münster) between January 1991 and March 1993. The comparison of epidemiologic data from both hospitals allow to give statements concerning etiology, level of amputation and age distribution. With a percentage of 78.6 dysvascular diseases were the principal cause for amputations at the Göttingen hospital, which is 10% less than described in modern literature. The respective percentage was 43% in Münster, followed by a 35.9% share for amputations caused by trauma. Our results demonstrate the relevance of amputations which are not due to dysvascular diseases in prosthetic treatment.

Adolescent↗
PubMed1995

Amputation history and rehabilitation of black men living in the greater Durban area who have had traumatic amputations of the lower limb.

A survey was undertaken amongst twenty five black men living in the greater Durban area who had had amputations of the lower limbs. The type of amputation care the rehabilitation programme they underwent post-operatively is described. The sample included men from 24 to 50 years of age, of whom the majority were from rural areas. The amputation care intra and post-operatively was marked by the lack of emotional preparation pre-operatively, and lack of rehabilitation information and teaching afterwards. Most respondents had to find information for themselves. This lack of information and teaching seemed to impede physical rehabilitation, with stump sores and limited use of prostheses being the main problems. Vocational rehabilitation was almost totally absent. In contrast to the twenty two respondents who worked before their amputations, only four worked afterwards. The majority had to support their families alone; sixteen of them were totally reliant on a Disability Grant. These problems lead to social isolation, depression, loneliness and other psycho-social problems.

Adult↗