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At least 37 records · Page 2Linked to original sources
PubMed2005

The analgesic effects of epidural diamorphine and levobupivacaine on established lower limb post-amputation stump pain--a comparative study.

BACKGROUND AND OBJECTIVES: Pain is necessary for survival but chronic pain is disabling and causes significant health and economic problems. Chronic stump pain (pain localized in the stump for >3 months) after amputation is a significant problem among amputees (5-10%). The mechanism of this phenomenon is not very clear yet. In this study we attempted to better understand the role of peripheral and central mechanisms in this condition. METHODS: 12 patients with established lower limb post-amputation stump pain were given lumbar epidural diamorhpine 5 mg in 20 ml normal saline (NS) and levobupivacaine 0.5% (20 ml) 1 week apart. Baseline pain was recorded and then analgesic and side effects as well as their onset and duration were also assessed. RESULTS: Epidural diamorphine was found to relieve the pain of all patients. Its onset was relatively rapid being started within 5-9 min (median = 5.5) by a smooth sensation of warmth involving the lower trunk and legs. Analgesia was complete in 30 min and had a median duration of 20.5 h. Pruritus in 6 patients was the only side effect due to epidural diamorphine. Epidural levobupivacaine, on the other hand, usually relieved the discomfort but failed to do so in 3 patients only despite adequate neural blockade. Its onset of action was slower (10-20 min, median = 11) and duration of effect (median = 12 h) was also shorter than diamorphine. The effects of levobupivacaine were inferior to diamorphine due to the associated motor and sensory paralyses as well as absence of euphoria. Epidural diamorphine provided profound analgesia with normalization of stump sensations and euphoria, probably due to absorption into the spinal cord causing segmental action. CONCLUSION: While peripheral mechanisms played a role, central mechanisms involving the spinal cord were more important in the modulation of established stump pain in the evaluated patients.

Adult↗
PubMed1975

Management of amputation-stump breakdown.

Seven cases of above-knee amputation stump breakdown following surgery for arteriosclerosis obliterans were successfully treated with Travase ointment. (Bacillus subtilis proteinase). Rehabilitation was facilitated because secondary closure of the previously infected necrotic wounds could be more rapidly undertaken.

Administration, Topical↗
PubMed1980

Conservative management of phantom-limb and amputation-stump pain.

The causes of pain in the amputation stump or in the so-called phantom limb are far from clear and a wide variety of methods of treatment have been used with varying degrees of success. Surgical techniques do not always give lasting relief and it is suggested that conservative methods such as vibration therapy and various forms of electrical stimulation may prove more helpful.

Amputation Stumps↗
PubMedDate not supplied

[Radiographic evaluation of the amputation stump in osteosarcoma].

The radiological picture of the amputation stump for osteosarcoma was revised on 57 cases, in which a follow-up after surgery was possible for at least 4 months, with a maximum of over 12 years. In 51/57 cases (89%) no recurrency was observed; in 6/57 cases (11%) a local neoplastic recurrency was confirmed on clinical and histopathological grounds. The usual aspects of late modifications induced by surgery is osteoporosis of the residual bone, which may assume a geographical pattern, with thinning of the stump apex and formation of a periosteal spur directed towards to soft tissues. The typical pattern of the locally recurrent osteosarcoma is that of an infiltrating soft tissue mass with bone erosion and irregular flake-like calcifications. All these signs are evaluated and discussed in order to give a practical guideline to the differential diagnosis between surgery-induced modifications and local neoplastic recurrencies.

Adolescent↗
PubMed1996

[Use of tissue expansion on defective amputation stumps of the lower limbs. Apropos of 5 cases].

Skin flaps are usually required to cover amputation stumps, especially below the knee. Cross-leg flaps or free flaps can be used when local tissue is insufficient, but as emphasized by Rees in 1986, tissue expansion offers another interesting possibility for local coverage. The risk of complications, especially infection, in below-knee tissue expansion is well known, requiring rigorous patient selection based on an evaluation of skin quality, vascularization, and the patient's metabolic and psychologic status. We used this method in 5 patients (3 females, 2 males; mean age 30.4 years) who had been amputated below (n = 4) and above (n = 1) the knee. In 4 cases, amputation of a healthy limb was required after trauma and in 1 case due to purpura fulminans. Seven tissue expanders were used with slow intermittent expansion applied daily. The mean expansion period was 89.4 days. Mean hospital stay for the two operations was 5.66 and 7.33 days, respectively. Assessed on the basis of subjective and objective criteria, functional outcome was excellent in 3 patients and good in one patient. Failure occurred in one case due to infection. Despite the longer treatment period, tissue expansion for skin coverage of defective amputation stumps appears to have several advantages. It is a simple, reliable and reproducible method with a minimal scar area while preserving skin sensitivity. In addition, the length of the tibial shaft can be spared and minimal modifications are needed to fit the prosthesis.

Adolescent↗
PubMed2003

Lengthening of the amputation stumps of the distal phalanges using the modified Ilizarov method.

PURPOSE: The purpose of this study was to introduce the technique for distraction lengthening of the traumatic amputation stumps of distal phalanges less than 10 mm long by using the Ilizarov minifixator (Ito Medical Instruments, Tokyo, Japan) and to report the treatment results and the problems we encountered. METHOD: Six patients (3 men and 3 women) underwent lengthening of the traumatic amputation stumps of distal phalanges using the Ilizarov minifixator. The mean pre-operative length of the distal phalanges was 6.0 mm and the mean deficiency in length was 9.5 mm compared with the contralateral finger or thumb. RESULTS: In 5 of the 6 patients callus lengthening was completed without early consolidation or bone failure related to the traction wires. The mean gain in lengthening of the distal phalanx was 6.8 mm and the mean final length of the distal phalanx was 12.8 mm. After surgery 4 patients had onychoplasty and advancement flap coverage of the distal phalangeal tip because of excessive skin tension and 1 patient had arthrodesis because of flexion contracture of the distal interphalangeal joint. The patients were satisfied with the cosmetic improvement of their fingertips. CONCLUSIONS: Although this callus distraction method required multiple surgical procedures it is considered worthy of more frequent application especially in young patients.

Adult↗
PubMed1981

Fractures in amputation stumps: review of treatment of 16 fractures.

A retrospective study of patients who sustained a fracture of the amputation stump was carried out to determine how these injuries might be prevented and to develop an optimum method of treatment. Review of the records of the Mayo Clinic from 1956 through 1978 revealed that 14 patients had a fracture in the amputation stump and 2 patients had two separate episodes of fracture, for a total of 16 fractures. Each patient's history and the available x-ray films were carefully reviewed. Fifteen fractures involved the femur or hip, and one involved the tibia and fibula. All fractures went on to union, but four of nine treated with internal fixation had comp]lications, three of which required further surgical procedures. At least five fractures in this series might have been prevented by better patient instruction and closer attention to fitting the prosthesis. Half of the fractures resulted from falls in the elderly patient. All five fractures that were treated without internal fixation healed well in a short time. The relatively high complication rate associated with internal fixation contrasted with the relatively rapid rate of union of the fractures treated without internal fixation suggests that these fractures should be treated by conservative measures if possible.

Adolescent↗
PubMed1975

Amputation stump management. A preliminary report on the use of shrink plastic film as a surgical dressing in amputation surgery.

This report describes the use of clear plastic bags on vinyl chloride-vinylidine chloride copolymer (also known as S Film) for the postoperative management of amputation stumps. The bags are shrunk to the stump by the application of heat and act as a primary dressing. Their use has been effective in controlling postoperative oedema and infection as well as giving the surgeon direct visual access to the stump without disturbing the wound. A case of a below-knee amputation managed by this method is described.

Aged↗
PubMed1999

Peri operative ultrasound guided needle localisation of amputation stump neuroma.

Ten patients with clinically suspected neuromas following amputation were submitted for ultrasound examination. Neuromas in seven of the ten patients were identified as the cause of pain with ultrasound guided infiltration of local anaesthetic. Pre operative localisation, using breast localisation wires allowed the neuromas to be surgically excised with reduced dissection. This small study demonstrates that ultrasound is an effective method for identifying and localising neuromas in amputation stumps. This leads to reduced dissection and may lead to a better outcome in these patients.

Adult↗
PubMed1991

The role of microvascular free flaps in salvaging below-knee amputation stumps: a review of 22 cases.

Twenty-two cases of traumatic below-knee amputation stumps with inadequate soft-tissue coverage salvaged with microvascular free flaps were reviewed retrospectively. All patients would have required an above-knee amputation for prosthesis fitting had microvascular free flaps not bee utilized. A total of 24 flaps were used in 22 patients; parascapular 11 (46%), foot filet six (25%), latissimus dorsi four (17%), lateral thigh, tensor fascia lata, and groin one (4%). Free flaps were performed immediately after injury in five (21%) cases, within the first week in two (8%), between 1 and 3 months in 12 (50%), and after 3 months in five (21%). Fifty per cent of the patients had significant other injuries. The patients had a total of 107 operations (mean, 4.9) related to their injury: 33 (mean, 1.5) of those operations were after the free flap, 27 (25%) of which were either performed because of a complication of the free flap or for revision of the free flap. Complications included partial necrosis in five (21%), neuroma in three (13%), hematoma in two (8%), donor site complication in two (8%), thrombosis requiring reoperation in one (4%), and flap failure in one (4%). Patient followup ranged from 12 to 116 months. All patients maintained a functional below-knee prosthetic level. The mean time to ambulation was 5.75 months, and was not significantly affected by flap complications. Most patients employed before their injury were employed after their injury. Despite a protracted course in these severe injured trauma patients, a functional below-knee amputation level was preserved in all cases utilizing microvascular free flaps.

Activities of Daily Living↗