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At least 613 records · Page 34Linked to original sources
PubMedDate not supplied

[Prospective study of prevalence and risk factors for painful phantom limb in the immediate postoperative period of patients undergoing amputation for chronic arterial ischemia].

OBJECTIVE: To determine the prevalence and risk factors associated with postoperative phantom limb pain (PLP) in patients amputated for chronic ischemia of a lower limb. PATIENTS AND METHOD: Prospective, longitudinal, epidemiological study of patients amputated for chronic grade IV ischemia. PLP, defined as the perception of pain > or = 3 on a verbal scale of 0 to 10, was assessed in the first week after surgery. Candidate risk factors analyzed were patient characteristics, course of ischemic disease, and features of surgery or anesthetic technique. RESULTS: The prevalence of PLP was 26% (14 patients) in a total of 53 amputations performed on the same number of patients over one year. Mean patient age was 68.4 +/- 11.2 years, and 45 (84.9%) were diabetics. Phantom limbs were felt by 9 patients (17%), and a painful stump was reported by 5 (10%). The most common PLP symptoms were a burning sensation and painful paresthesia. Risk factors identified, in order of statistical significance, were prior amputation (p < 0.0002), oral antidiabetic therapy (p < 0.02) and type of amputation (p = 0.05). Logistic regression analysis of variables revealed increased risk of PLP in patients with a prior amputation (odds ratio [OR] 8.1) and those receiving oral antidiabetic therapy (OR 3.9). Insulin treatment was a protective factor (OR 0.5). CONCLUSIONS: The prevalence of PLP among patients with chronic ischemia of the lower limb in our setting is considerable, although low in comparison to the prevalence reported for other settings. Identifying risk factors such as those described in this study helps to establish the profile of patients toward whom to direct measures to prevent PLP.

Administration, Oral↗
PubMed1976

An index of healing in below-knee amputation: leg blood pressure by Doppler ultrasound.

Preoperative Doppler ultrasonic assessment of below-knee (BK) arterial signals and systolic blood pressures was performed on 50 patients undergoing 53 BK amputations for advanced ischemia. No patient was excluded from initial BK amputation unless gangrene at that level or severe joint contracture was present. Failure of healing of the BK amputation occurred in all five limbs with an undetectable Doppler arterial signal (and thus pressure) below the knee. Failure of amputation occurred in four of 16 limbs with detectable arterial signals and BK pressures less than 70 mm. Hg. Healing occurred in all 32 limbs with BK pressures greater than 70 mm. Hg. The differences in healing between these three groups are highly significant (p less than 0.005). This study suggests that Doppler ultrasonic assessment of BK arterial signals and pressures may be a simple hemodynamic correlate of healing of a BK amputation. Absence of a detectable arterial signal below the knee may be an indication for initial above-knee (AK) amputation in advanced ischemia.

Amputation, Surgical↗
PubMedDate not supplied

Chiropody may prevent amputations in diabetic patients on peritoneal dialysis.

BACKGROUND: A multidisciplinary approach has been shown to be of benefit in the prevention of lower limb ulceration and amputation in patients with diabetes, but there is less information on the role of such an approach in patients receiving dialysis treatment. OBJECTIVE: The purpose of the present study was to determine whether the institution of a chiropody program would result in fewer amputations in diabetic patients on peritoneal dialysis (PD). DESIGN: Retrospective chart review. SETTING: The PD program at a tertiary-care hospital. PATIENTS: Patients with diabetes that were enrolled in the PD program between January 1997 and December 1999, inclusive, that were offered the opportunity to see a chiropodist, and that agreed to be seen. A total of 132 patients were included. INTERVENTION: Education about foot care, assessment, and, in some instances, treatment by a chiropodist. RESULTS: Patients with an amputation were more likely to be male (p < 0.01) and have peripheral vascular disease (p < 0.001) compared to those without an amputation. They also had a lower average mean arterial pressure (p < 0.05), lower weekly creatinine clearance (p < 0.01), higher mean erythropoietin dose (p < 0.05), and longer duration of end-stage renal disease (p < 0.001). Factors that were predictive of shorter time to death or amputation were older age [hazard ratio (HR) = 1.03, p < 0.05], peripheral vascular disease (HR = 2.66, p< 0.01), and cerebrovascular disease (HR = 2.70, p< 0.01). Being seen by a chiropodist was protective (HR = 0.39, p < 0.01). CONCLUSION: The current study suggests that a chiropody program may help to prevent amputation in patients with diabetes on PD.

Adult↗
PubMedDate not supplied

The scope of extremity amputations in a private hospital in the south-south region of Nigeria.

BACKGROUND: The aim of the study was to review extremities amputation cases in a private medical establishment in Port Harcourt with a view to identifying the incidence, indications, and limb status at surgery. METHODS: Hospital records were reviewed on amputation cases from June 1998 to May 2003. Upper and lower limb amputations done elsewhere with stump reviews by us were included. RESULTS: Thirty-four cases were reviewed, with a male to female ratio of 2.1:1. The 2nd to 4th decade produced 67.6 percent of the victims. Trauma contributed 70.5 percent of the cases, with road trauma contributing 47 percent of the entire series. Gangrene as a result of injury complication was the commonest indication for surgery. Lower limb amputations were commoner (n = 24) than upper limb amputations (n = 10). Below knee amputation was the commonest procedure performed. The percentage of the patients who consulted the traditional bone setter before presentation in hospital was 33%. CONCLUSION: Complications of injuries arising from road traffic accidents are a major cause of limb loss in our environment. Ignorance and cultural beliefs expose innocent persons to quacks especially traditional bone setters. Education and strong legislation is advocated to prevent unwarranted limb loss.

Accidents, Traffic↗
PubMedDate not supplied

Preventing amputations in patients with diabetes and chronic kidney disease.

Amputations of the lower extremities add significantly to the morbidity and mortality of patients with diabetes and chronic kidney disease (CKD). Dialysis nurses are in an optimal position to make a positive impact on the high rate of amputation among patients with diabetes receiving dialysis through early detection and intervention. Routine foot screening and education can assist in identifying and preventing ulcer-initiating events and reduce the incidence of lower extremity amputation in these patients. This article provides a review of the literature on evidence that assessment of the feet of patients with diabetes is successful in preventing amputations, as well as identifying risk factors for foot ulcers and amputation, assessment methods. The article will also describe a foot risk classification system that can predict the risk for amputations of the lower extremities.

Amputation, Surgical↗
PubMed2002

Major limb amputation in Ibadan.

A prospective study of patients who had major limb amputation at the University College Hospital Ibadan over a 5-year period is presented. One hundred and one major limb amputations were performed within this period (71 Males, 30 Females, M:F = 2.3:1). Trauma accounted for 48% of the cases followed by diabetes in 26%, soft tissue infection in 13% and tumours also in 13%. The major post-op complication was wound infection. In accordance with the findings in other centers, a higher proportion of the amputations (69%) were carried out in the lower limbs. Patient's refusal to accept amputation resulted in a delay in amputation in 49 patients. This delay (before surgery) ranged from 1 day to 150 days, with a mean of 15.49 (SD 9.V). From this study, we found that a reduction in vehicular accidents and increasing emphasis on efficient foot care (and glycaemic control) in the diabetic may significantly reduce the rate of amputations in our environment.

Adult↗
PubMed1992

The prevalence and incidence of lower extremity amputation in a diabetic population.

OBJECTIVE: To describe the incidence of lower extremity amputations and sores or ulcers and investigate risk factors for these complications. DESIGN: Cohort. SETTING: Primary care. PARTICIPANTS: Population-based sample (N = 1210) of younger-onset diabetic persons (diagnosed before age 30 years and taking insulin) and a stratified random sample (N = 1780) of older-onset diabetic persons (diagnosed after age 30 years). Baseline and 4-year follow-up examinations were completed by 996 and 891 younger-onset persons, respectively, and by 1370 and 987 older-onset persons, respectively. MAIN OUTCOME MEASURES: Amputations and sores or ulcers of the lower extremities. RESULTS: Four-year incidence of amputations was 2.2% in both groups. Incidence of sores or ulcers was 9.5% in younger-onset and 10.5% in older-onset persons. In younger-onset persons, significant risk factors for amputation with odds ratios (and 95% confidence intervals) include age, 2.0 for 10 years (1.2 to 3.1), history of sores or ulcers, 10.5 (3.7 to 29.8), diastolic blood pressure, 2.1 for 10 mm Hg (1.3 to 3.5), and pack-years smoked, 1.3 for 10 years (1.0 to 1.6). Risk factors for sores or ulcers include glycosylated hemoglobin, 1.6 for 2% (1.3 to 2.0), retinopathy, 1.3 for two steps (1.1 to 1.6), and current smoking, 2.3 (1.0 to 5.6). In older-onset persons, risk factors for amputation are history of sores or ulcers, 4.6 (1.7 to 12.2), proteinuria, 4.3 (1.6 to 11.5), glycosylated hemoglobin, 1.5 for 2% (1.0 to 2.2), sex, 2.8 for males (1.0 to 7.5), and duration of diabetes, 1.8 for 10 years (1.0 to 3.2). For sores or ulcers, risk factors are glycosylated hemoglobin, 1.6 for 2% (1.3 to 2.0), duration, 1.5 for 10 years (1.0 to 2.1), proteinuria, 2.2 (1.1 to 4.3), and diastolic blood pressure, 0.8 for 10 mm Hg (0.6 to 1.0). CONCLUSIONS: Several factors offer potential for modification for the prevention of amputations but require further study. These include blood pressure, glycosylated hemoglobin, and smoking.

Adolescent↗
PubMed2004

Influence of transmetatarsal amputation in patients requiring lower extremity distal revascularization.

When a transmetatarsal amputation (TMA) is required, successful long-term limb salvage is questioned. We evaluated the influence of TMA on limb salvage in patients undergoing lower extremity revascularization. Patients who had distal bypasses extending to the infrapopliteal arterial tree and adjunctive TMA were retrospectively reviewed. Limb salvage was determined with life-table analysis. Twenty-four patients (29 limbs) were evaluated: 15 male and 9 female. Average age was 64.2 years old. Gangrene was the indication for bypass and TMA in 25 (86.2%) patients. Seven limbs were lost to follow-up. Nine of the remaining 22 limbs required below-knee (8) or above-knee (1) amputations, seven limbs within the first 3 months. In the group of patients who had major amputations within the first 3 months, graft thrombosis was the cause of leg amputation in six (85.7%) cases. No significant predictors of early major amputation were identified. Limb salvage was 62 per cent at 1 year in the TMA group. In comparison, among historical controls requiring distal revascularization and no adjunctive toe or foot amputations, limb salvage was 76.5 per cent (P = NS). Long-term limb salvage is dependent on successful lower extremity revascularization. Requirement for TMA should not influence the decision for limb salvage.

Amputation, Surgical↗
PubMed2003

[Evaluation of diabetic foot amputation rate].

In 1987, it was created the first portuguese Diabetic Foot Clinic in Oporto, at the Hospital Geral de Santo António. The distinction between neuropathic and ischaemic foot was the key stone to reduce drastically the rate of major amputations in the first two years of activity. Since then and until 1995 the rate of major amputations had stabilised around 8%. The aim of the present study was to evaluate if there was any change in the last three years. A retrospective study was performed reviewing the clinical files of 843 new patients between 1998 and 2000. The 593 patients who presented with a foot ulcer with or without infection were selected: 60.4% with neuropathic foot and 39.6% with ischaemic one. Overall, 31 of the 593 patients with ulcer or infection were treated with major amputation (5.2%). There was a statistical difference between the major amputation outcome among the two types of foot (p < 0.001). Necrosis showed to carry a poor prognosis (30.7% in ischaemic foot vs 8,3% in neuropathic, p = 0.024). There was no further statistical significance for age, sex, type or duration of diabetes as risk factors for major amputation. This retrospective study has showed a slight reduction in the rate of major amputations since 1995. Poor prognosis was related to necrosis and ischaemic foot. Further improvement requires harder investment in patients' education, as well as in alerting the primary health care physicians, for the most unpredictable catastrophic complication of diabetes.

Aged↗
PubMed1979

Noninvasive hemodynamic evaluation in selection of amputation level.

Various noninvasive techniques of hemodynamic evaluation have been used to determine the optimal level of amputation. Noninvasively obtained measurements of pressure and blood flow in the lower extremity have been found to be reliable in predicting the probable healing of an amputation. In patients with severely calcified noncompressible arteries, noninvasive electromagnetic flowmeter measurements of peak pulsatile flow provide a more accurate indication of the vascular status of the patient than do blood pressure measurements which, in such patients, frequently exceed 300 millimeters of mercury. Skin thermistor thermometry does not appear to be applicable in patients with extensive severe ischemia of the leg. The need for a reliable method of determining the lowest possible level of amputation is well recognized. Such factors as wound edge bleeding and clinical judgment too often lead to above the knee amputation when, frequently, a more distal amputation could have been possible. Our experience has shown that noninvasive techniques for hemodynamic evaluation are a valuable aid to clinical judgment in determining accurately the lowest level for successful limb amputation.

Amputation, Surgical↗
PubMed2005

Family poverty accounts for differences in lower-extremity amputation rates of minorities 50 years old or more with diabetes.

Rates of leg amputations in diabetics are known to differ among racial/ethnic groups, but the relationship between family poverty and the risk of amputation has not been fully addressed. One-hundred-seven diabetic patients, all 50 or more years old and all from ZIP code tabulation area 778, underwent their first amputations at one hospital. Linear regression evaluated differences in age and atherosclerosis severity among African-American, Hispanic-American and other patients. chi2 statistics evaluated differences among African-American, Hispanic-American and other patients, with respect to sex and type of amputation. chi2 statistics evaluated differences among fractions of African- American, Hispanic-American and other patients, with respect to those residents 50 years old and older and those of poor families. Patient groups did not differ in regard to age, atherosclerosis severity, sex or type of amputation (P>0.05). The percents who were African-American, Hispanic-American, and other (33%, 21%, and 47%, respectively) differed markedly from those of persons 50 or more years old [13%, 7%, and 79%, (w=0.81, P<0.00001)] and mirrored those of poor families [37%, 19%, and 44% (w=0.08, P>0.05)]. Family poverty accounts for differences in diabetic amputation rates of African Americans, Hispanic Americans and other persons 50 or more years old.

Age Factors↗
PubMed2005

[Lower limb amputations in patients with acute arterial insufficiency].

Over the ten-year period (1992-2002) 301 patients underwent lower limb amputation at the Department of Purulent Surgery. In 25 patients, the cause of major amputation was acute arterial insufficiency. The patients were distributed in two groups: the first group patients (n=19) underwent secondary amputation and the second group patients (n=6) were provided major amputation, without attempts at restoration of the main blood flow. On secondary amputation the results appeared worse than on primary amputation.

Acute Disease↗
PubMed2006

Devastating consequences of subway accidents: traumatic amputations.

The efficiencies of the subway system are tempered by the occurrence of accidents, some with devastating injuries. The purpose of this study is to examine our experience with traumatic amputations after subway accidents. A retrospective trauma registry review (1989-2003) of 41 patients who presented to Bellevue Hospital, New York City, with amputations from subway accidents was undertaken to examine the following end points: age, sex, Injury Severity Score, time and mechanism of accident, history of psychiatric disorders and alcohol use, admission vital signs, Glasgow Coma Scale score, amputation type, associated injuries, limb salvage rate, operative procedures, mortality, and disposition. Elevated alcohol levels and prior psychiatric diagnoses were present in 39 per cent and 17 per cent of the patients, respectively. Patients were stable on admission with a mean systolic blood pressure of 114 mmHg, hematocrit of 32, and Glasgow Coma Scale score range of 13 to 15. The most common amputation was below knee, and patients underwent an average of three operative procedures. Limb salvage was attempted in eight patients with no successes. Amputation wound infection rate was 32 per cent and mortality rate was 5 per cent. Victims of subway trauma who arrive at the hospital with devastating amputations have an excellent chance of surviving to discharge.

Accidents↗
PubMed1990

[Late vascular damage after unilateral leg amputation].

The higher incidence of infrarenal aortic aneurysms in war-veterans with above knee amputations indicates that leg amputation besides arteriosclerotic risk factors constitutes a relevant pathogenetic factor for the late development of an abdominal aortic aneurysm. A retrospective study of 25 mainly young patients with above knee amputation showed that already one year after leg-loss a typical adaptive narrowing of the pelvic and leg arteries with significant reduction of the flow volume of 37% on the amputated side could be registered. Unilateral flow reduction resp. interruption causes an asymmetric flow pattern at the aortic bifurcation. The changed hemodynamics are probably the main cause for late damage to the aorto-iliac vessels. The clinical importance of these results is that patients with unilateral leg amputation should have regular follow up investigation in order to detect late sequelae on the aorto-iliac vessels and to perform elective surgery for abdominal aortic aneurysm. Ipsilateral occlusive arterial disease as well as abdominal aortic aneurysms must be regarded as secondary late damage after leg amputation justifying obligatory indemnification.

Adolescent↗
PubMed1990

Long-term function of persons with atherosclerotic bilateral below-knee amputation living in the inner city.

Long-term function of 24 elderly persons with atherosclerotic bilateral below-knee amputation living in an inner city for at least six months after the second amputation, was determined. Twenty-one (87.6%) subjects were living at home; three were living in nursing homes. Fourteen (70%) of 20 subjects who received bilateral prostheses were ambulators. At interview, the mean age was 75.2 years; 4.87 years was the mean time since the second amputation. Ten (50%) subjects remained ambulatory. Among the other ten who received prosthesis, loss of ambulation occurred mostly due to medical factors, at an average of 3.47 years after the second amputation. Those no longer ambulatory were older and "sicker," and the interval between amputations was shorter. Fifteen (62.5%) subjects were independent in dressing, 14 (58.4%) in toileting, and only nine (33.3%) in bathing. All but one subject required housekeeping assistance. The anticipated effect on function of environmental and socioeconomic factors could not be demonstrated in this sample. Survival time and retention of ambulatory skills for an average of nine years after the second amputation in eight (33.3%) subjects who died before the end of the study was longer than previously described. The high rate of success in rehabilitation and in maintenance of ambulatory skills fully justifies intensive restorative efforts for this group of amputees.

Activities of Daily Living↗
PubMed1990

[Current status of amputation surgery].

Limb salvage by revascularisation of occluded arterial pathways is main goal of vascular surgical activities. However, if dying or gangrenous tissue has to be removed, the question of: where to amputate--and the potential rehabilitation has to be answered. Septic amputation being an emergency operation has to be compared with elective one with definitive shaping of the stump. In major amputations knee disarticulation is preferred nowadays as being mostly "atraumatic" and well able for rehabilitation. In minor amputations bunions of the great and the little toes should be preserved especially in case the whole phalangeal and metatarsal forefoot amputation seems to have better results than removal of the first of fifth toe together with their metatarsia. A distal borderline amputation can only be performed in diabetics and after revascularisation of the feeding arterial tree.

Amputation, Surgical↗
PubMed1990

Do pre-operative antibiotics reach the operative field in amputation surgery for peripheral vascular disease? A pilot study.

Amputation surgery in patients with peripheral vascular disease is associated with high revision and mortality rates. A prospective pilot study examined the intra-operative delivery of cefoxitin sodium to the amputation site, and used pre-operative transcutaneous oxygen pressure measurement to try to predict the tissue antibiotic levels at the amputation site. Antibiotic concentrations were measured in plasma and muscle from the amputation site at the time of amputation, and a significant difference in antibiotic distribution was found between healed and failed amputations. Transcutaneous oxygen pressures correlated with the antibiotic distribution.

Adult↗
PubMedDate not supplied

Level of amputation following failed vascular reconstruction for lower limb ischemia.

The effect of a failed lower limb vascular procedure on the ultimate level of amputation in patients presenting with end-stage ischemia is an issue of ongoing controversy. A series of 71 patients with 75 lower extremity amputations over a 3-year period was reviewed to compare the level of amputation and morbidity between two groups of amputees: one that had vascular operations before amputation and the other undergoing primary amputations. Failed vascular reconstructions led to increased morbidity and poor healing, statistically significant increases in the level of amputation, and prolongation of hospital stay. The high price of failure must be considered in the evaluation of vascular operations in patients with tissue loss or infection.

Aged↗