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At least 433 records · Page 24Linked to original sources
PubMed1981

Replantaion of portions of four fingers-long-term functional results.

We present a seven-year follow-up of a previously published case of 4-finger replantation in one hand. Replantation of the digits proved justified, yielding favorable results in sensory return, motor function, and appearance. We note that finger replantations distal to the proximal interphalangeal joint are associated with better functional results than those at more proximal levels. Impaired motion of the distal interphalangeal joint does not appreciably restrict the function of the hand, provided adequate range of active movement is preserved at the metacarpophalangeal and proximal interphalangeal joints. An uninjured proximal interphalangeal joint is critical in achieving favorable motor return after finer replantation. Technical excellence in digital nerve repair contributes to favorable sensory axonal regrowth. Digital replantation distal to the proximal interphalangeal joint may be viewed as primary microneurovascular reconstruction of a problem finger amputation stump. We believe, in the case of sharp amputation distal to an intact proximal interphalangeal joint, that single-digit replantation is indicated, given the likelihood of favorable functional and aesthetic results.

Adult↗
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↗
PubMed1993

Below knee amputation in war surgery: a review of 111 amputations with delayed primary closure.

The results of 111 acute below-knee amputations in war wounded were reviewed. The majority of the patients were wounded by exploding mines. The amputation stumps were not closed primarily but secondarily after an average of 6.4 days. Reamputation above the knee was necessary in only one case of wound sepsis. After delayed primary closure 84% of the stumps healed without problems. The best results were obtained when the stump closure was performed within 1 week after the amputation. No cases of gas gangrene or tetanus were encountered.

Afghanistan↗
PubMed1993

Functional and esthetic reconstruction of a mutilated hand using multiple toe transfers and iliac osteocutaneous flap: a case report.

With reconstructive microsurgical techniques, some previously hopelessly mutilated hands have become reconstructable. The functional and esthetic results of such hands can be improved to an acceptable degree with through prereconstruction evaluation and planning. This case report demonstrates the approach to reconstruction of a mutilated hand using the following: a pedicle groin flap for soft tissue reconstruction of the first web space and the amputation stump of the thumb; a combined second and third toe transfer for reconstruction of opposable fingers at the amputated index and middle finger stumps; a single second toe for reconstruction of the thumb, and an iliac osteocutaneous flap for reconstruction of the ulnar border of the palm.

Accidents, Occupational↗
PubMed1989

Comparison of soft dressing and rigid dressing in the healing of amputated limbs of rabbits.

Thirty white male New Zealand rabbits underwent forelimb amputation below the elbow under sterile operating conditions. Fifteen of the amputation stumps were dressed in a soft, bulky dressing while the remaining 15 rabbits had their stumps immobilized in a rigid plaster dressing. On each of the postoperative days 3, 6, 9, 12 and 15, three rabbits from each group were killed and the amputated limb disarticulated and fixed in formalin. Then, histological examination of the suture line and subcutaneous tissue was carried out by a pathologist to determine the effects, if any, that the type of immobilization has on wound healing. Based on microscopic evaluation of wound approximation, interstitial edema and presence of granulation tissue, there was no significant difference between the stumps immobilized in a plaster dressing and those dressed with a soft, bulky dressing.

Amputation Stumps↗
PubMed2001

Major lower limb amputation following failed infrainguinal vascular bypass surgery: a prospective study on amputation levels and stump complications.

The effect of failed vascular bypass surgery on final amputation level and stump complications is the subject of debate. The aim of this prospective cohort study was to assess the influence of previous infrainguinal bypass surgery on amputees in the authors' centre. Over a three-year period, 234 amputations (219 patients) were performed for critical ischemia. The cause of ischemia was either peripheral obstructive arterial disease (POAD) or diabetes mellitus (DM). Forty-eight percent (48%) (113 amputations) had ipsilateral vascular bypass surgery prior to amputation and 52% (121 amputations) had not. Final amputation level and the post-operative complications of infection, significant stump pain and delayed wound healing were used as the outcome measures for this study. At the end of the study period these outcome measures were used to compare the influence of previous bypass surgery on the two groups of amputees. There was a significantly higher rate of transfemoral amputations (TFA) (32.7%) vs. 16.5%; p < 0.05) and stump infection rate (42% vs. 23%; p < 0.05) in the bypass group. Significant stump pain (p = 0.23) and delayed wound healing (p = 0.24) was more prevalent in the bypass group although statistical significance could not be demonstrated.

Adult↗
PubMed1992

Psychophysiological contributions to phantom limbs.

Recent studies of amputees reveal a remarkable diversity in the qualities of experiences that define the phantom limb, whether painless or painful. This paper selectively reviews evidence of peripheral, central and psychological processes that trigger or modulate a variety of phantom limb experiences. The data show that pain experienced prior to amputation may persist in the form of a somatosensory memory in the phantom limb. It is suggested that the length and size of the phantom limb may be a perceptual marker of the extent to which sensory input from the amputation stump have re-occupied deprived cortical regions originally subserving the amputated limb. A peripheral mechanism involving a sympathetic-efferent somatic-afferent cycle is presented to explain fluctuations in the intensity of paresthesias referred to the phantom limb. While phantom pain and other sensations are frequently triggered by thoughts and feelings, there is no evidence that the painful or painless phantom limb is a symptom of a psychological disorder. It is concluded that the experience of a phantom limb is determined by a complex interaction of inputs from the periphery and widespread regions of the brain subserving sensory, cognitive, and emotional processes.

Amputation, Surgical↗
PubMed1985

The association between lowest palpable pulse and wound healing in below knee amputations.

A retrospective study of 191 patients undergoing 203 Burgess type below knee amputations for end-stage peripheral vascular disease showed that the only clinical feature which associated significantly with wound healing was the lowest palpable pulse. The pulse level was noted preoperatively and was compared with the healing rates in the amputation stumps. When the femoral pulse was absent, 79% of below knee amputations failed. When the femoral pulse was palpable, only 29% wound breakdown occurred. When the popliteal or more distal pulses were palpable, only 10% failure was recorded.

Adult↗
PubMed1992

[Profuse hemorrhage from the axillary artery in electric burn: prevention and treatment].

A total of 53 cases of electric burns were admitted to our unit during the 1977-1985 period. In 19 cases an upper limb was involved, accounting 35.8 percent of the total. In 15 cases disarticulation of the shoulder was done, and in 3 of them a profuse hemorrhage from the axillary artery occurred as a result of infection of the amputation stumps. The second segment of the axillary artery was ligated during the amputations in the other 4 cases, no hemorrhage occurred in them.

Adult↗
PubMed1988

The role of non-invasive vascular studies in determining levels of amputation.

Various non-invasive vascular studies have been reported to provide valuable data for selection of the optimum level of amputation in limbs in patients who have vascular disease. We evaluated three such methods: (1) measurement of the change in the transcutaneous PO2 after inhalation of oxygen; (2) determination, by the Doppler method, of segmental blood pressure; and (3) measurement of the temperature of the skin. The records of eighty patients (ninety amputations) were retrospectively reviewed for correlations between the results of the vascular studies and the outcome of the amputation. Measurement of transcutaneous PO2 was found to be the most accurate predictor of successful healing of an amputation; the other two measurements were less reliable. The values for transcutaneous PO2 both at rest and after inhalation of oxygen were significantly different (p less than 0.001) for the patients who had a healed amputation compared with those who had a failed amputation. Regardless of the initial value, if, after inhalation of oxygen, the transcutaneous PO2 reached ten millimeters of mercury or more, it predicted healing of the amputation stump with a sensitivity of 98 per cent. When the level of amputation was selected on the basis of clinical judgment at the time of operation, the sensitivity was only 90 per cent.

Adult↗
PubMed1988

Motor activity in the stump of an amputated leg during free walking in cockroaches.

1. A rhythmic pattern of motor activity was recorded in the stump of an amputated leg during free walking in cockroaches. 2. During relatively rapid walking, extensor (depressor) and flexor (elevator) muscles in the intact coxa of the amputated leg showed one burst of activity during each cycle of bursting in an adjacent, intact leg. However, during slower walking these muscles could show two or three bursts of activity during each cycle of bursting in an intact leg. 3. Motor bursts in the stump of an amputated leg showed features similar to those of bursts recorded from intact legs. Burst duration increased with an increase in period, and the bursts generally showed consistent timing (phase) relative to bursts in most of the intact legs. 4. The motor pattern recorded in a stump was very like that recorded in an intact leg during walking, and unlike that recorded during searching for a foothold (defined in the text). It is concluded that after the amputation of most of a leg, motor neurones innervating muscles in the stump of the amputated leg continue to be driven by the interneurones that normally drive the intact leg during walking. Analysis of the motor pattern in the stump may therefore reveal important features of the locomotor control system.

Amputation Stumps↗
PubMed1998

Epithelioid angiosarcoma arising in a surgically constructed arteriovenous fistula: a rare complication of chronic immunosuppression in the setting of renal transplantation.

Immunosuppression in the setting of solid organ transplantation is associated with the development of a variety of malignant tumors, most commonly squamous carcinomas and non-Hodgkin's lymphomas. Sarcomas, apart from Kaposi's sarcoma, are relatively infrequent. We recently encountered a 71-year-old man with chronic renal failure, treated by allograft kidney transplantation, who developed a high-grade epithelioid angiosarcoma at the site of a nonfunctioning arteriovenous fistula, previously constructed for hemodialysis. At diagnosis, the patient had numerous satellite nodules of angiosarcoma involving the distal skin, soft tissues, and bones. After a below-elbow amputation, there was a rapid local recurrence at the amputation stump. Currently, the patient is alive with numerous pulmonary metastases, 6 months after amputation. A literature review identified three recently reported identical cases of epithelioid angiosarcoma arising in nonfunctioning arteriovenous fistulae. All three patients had been treated by kidney transplantation for renal failure, suggesting a possible causal association between these events. We performed polymerase chain reaction for human herpes virus 8, the recently recognized herpes virus proposed as a major etiologic agent of Kaposi's sarcoma, and possibly some conventional angiosarcomas, but we failed to identify any viral DNA within the tumor.

Amputation, Surgical↗