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PubMed1989

Adjustment to amputation among adolescent oncology patients.

With increased patient survival, the psychosocial consequences of amputation in cancer patients has become increasingly important. The following study examined the psychosocial correlates of amputation in 16 male and 17 female Brazilian adolescent patients aged 10-20 years who had lost a limb to cancer. Interviews were conducted within 12 months of amputation. Eighty-two percent indicated that they were involved in preoperative decision making, but only 58% understood the limitations in functioning after undergoing an amputation. Before surgery, the most frequently chosen confidante was the mother, followed by a sibling, staff member, and a friend. The major postoperative problems in these patients were walking, pain, and social issues. Overall, 75% of the amputees felt they were independent in and out of the home. Most individuals (66.6%) had, but fewer (58%) wore, their prosthesis. Prior to amputation, 30 patients were enrolled in school and 13 had a job. Of 15 who returned to school, 67% could not keep up with the school work and 93% had problems getting along with their classmates. Of five patients who returned to their jobs, no one reported discrimination in hiring or promotion; however, four workers felt they had lost a job because of their amputation, and two reproted having to change jobs. Many had altered their lifestyles to suit their disability, but the social and educational adjustment of these patients appears promising. Proper education of school faculty, classmates, and medical staff may enhance the adjustment of adolescent cancer amputees.

Adaptation, Psychological↗
PubMedDate not supplied

Amputation as a consequence of stroke.

The purpose of this study was to determine if a significant correlation exists between the side of hemiplegia caused by a cerebrovascular accident and side of a subsequent major lower-extremity amputation. We also attempted to determine if a relationship exists between the time from cerebrovascular accident to the amputation, or level of amputation, and any concomitant risk factors including diabetes mellitus, hypertension, heart disease, or cigarette smoking. Forty-seven patients were included in the study; 40 of the 47 had an amputation on the side of the hemiplegia, which represented a statistically significant relationship (chi 2 = 5.00, p less than 0.05). The cause of limb loss was chronic ischemia in all cases; trophic ulcers and pressure necrosis played a significant role in 23 cases. No conclusions could be made between the level of amputation or time between the cerebrovascular accident and amputation in relation to the presence or absence of diabetes mellitus, hypertension, heart disease, or cigarette smoking.

Aged↗
PubMed1988

The role of the vascular laboratory in the management of major lower limb amputations.

Since the assumption that vascular laboratory data improves the predictability of below-knee (BK) amputation healing is largely based on retrospective studies, a comparison between the success rates of BK amputations was performed between two consecutive 50-month periods. During the first period the level of major lower limb amputations was determined by clinical judgement alone whereas during the second period analysed pressure data from a vascular laboratory was available. During the first period 16 out of 48 amputations (33%) failed whereas only 10 out of 60 amputations (17%) failed during the second period of the study. The results from this comparison suggest that vascular laboratory data can be used to improve the success rate in below-knee amputations.

Aged↗
PubMed1988

Amputations due to lower-limb ischemia. Analysis of a 3-year series.

Lower-limb amputation was performed on 261 patients from a catchment population of 232,500 in 1984-1986, and 253 of the amputees were retrospectively followed up. In 241 cases amputation was performed because of threatening or manifest gangrene, 95 of them without preceding consultation with vascular surgeons. In 19 cases amputation followed thromboembolectomy. Of the 127 patients seen by vascular surgeons, 66 were judged to be unsuitable for reconstructive surgery, 22 because of poor general health and 44 because of contraindicating vascular status. In the 61 patients with vascular reconstruction prior to amputation, the level of amputation did not differ from that in patients without such antecedent surgery. The proportion of cases rejected for vascular surgery rose from 18% in 1984 to 33% in 1986. The need for amputation could probably be reduced by earlier detection and vascular surgical evaluation of arterial insufficiency.

Adult↗
PubMed1987

Lower extremity amputations: a 5-year review and comparative study.

In order to review major lower extremity amputations at the Toronto East General and Orthopaedic Hospital Inc. between 1979 and 1984, 60 patients with 42 below-knee, 17 mid-thigh and 20 Callander through-knee amputations were studied retrospectively. The three amputation groups demonstrated comparable rates of stump healing. A previous history of vascular surgery on the extremity increased the risk for both delayed healing and failure to heal. The Callander through-knee amputees were rehabilitated earlier and more easily than were the mid-thigh amputees, and once rehabilitated they were more likely to continue using their prostheses. The authors recommend that, when possible, the chosen site of amputation for the majority of patients should be below the knee, but when this is not practical a through-knee amputation should be done in preference to a mid-thigh amputation.

Adult↗
PubMed1986

[Determination of the amputation level by transcutaneous PO2 measurement and distal arterial systolic pressure].

Transcutaneous oxygen partial pressure measurement (TcPO2) using a polarographic probe heating the skin at 44 degrees C provides informations about the capacity of blood to supply skin with oxygen. As oxygen is necessary for tissue survival, TcPO2 could constitute an adequate parameter for the determination of an amputation level. Among 67 amputations performed between 1983 and, 1984, we included in this study 34 patients (35 amputations), in whom TcPO2 was preoperatively measured (24 males, 10 females, mean age 67 years, range 19-86 years). Twenty two were diabetics. Twenty patients suffered from severe ischemia (stage Fontaine 4); 13 patients suffered from chronic diabetic lesions or/and osteomyelitis and two patients suffered from frostbite. The follow-up period lasted until operative wound was healed or a more proximal amputation was undertaken (mean 2.5 months, range 15 days to 10 months). Five operative wounds did not heal, so that a more proximal amputation was undertaken. TcPO2 was below 20 mm Hg in 3 of these 5 patients. TcPO2 was above 20 mm Hg in 24 among 30 patients in whom operative wound healed. When TcPO2 is above 20 mm Hg, the probability of operative wound healing is 92%. When TcPO2 is below 20 mm Hg, the risk of a more proximal amputation is 33%. Distal systolic blood pressure has no predictive value. It is concluded than when TcPO2 is above 20 mm Hg, the probability of healing of operative wound is clinically acceptable. When TcPO2 is below 20 mm Hg, 1 of 3 patients will be reamputated at a more proximal level, but healing does occur in 66% of patients.

Adult↗
PubMed1987

Fluorometric quantification of low-dose fluorescein delivery to predict amputation site healing.

This retrospective study evaluated quantification of skin fluorescein delivery by fiberoptic fluorometry as a means of predicting the healing potential of an amputation site. Fluorometry uses a dual-channel fiberoptic light guide--one channel transmits blue light to excite the fluorescein in the skin under study, and the other transmits emitted fluorescence from the skin to a photomultiplier tube where it is measured. Ten minutes after intravenous administration of sodium fluorescein (4 to 8 mg/kg), fluorometric readings were obtained at more than 100 reading sites. In the 86 cases without preoperative cellulitis at the site of amputation, preoperative fluorometry clearly distinguished between healing and nonhealing sites. Healing sites averaged 79% of the fluorescence of a healthy reference area (dye fluorescence index [DFI] = 79), while failing sites averaged only 27% (p less than 0.01 by ANOVA). In all but one case where the DFI was greater than 42, the amputation healed. In all cases where the DFI was less than 38, the amputation failed. In general, uncertainty was limited to sites with values between these limits. The technique maintained its high accuracy in patients with diabetes and for distal amputations. However, it was not accurate at sites of active cellulitis (12 cases). There were no significant adverse effects from the slow injection of the low dose of fluorescein used for this technique. We conclude that fluorometry is an effective means of predicting healing in patients undergoing amputation.

Amputation, Surgical↗
PubMed1985

The choice of procedure following thumb amputation.

The attributes that make the thumb unique are position, stability, strength, length, motion, sensibility, and appearance. Of these qualities, the first four must be present to an acceptable extent for function to approach normality, while the latter three are very desirable but not essential. Reconstructive alternatives following amputation can be considered in four broad groups: where the length is acceptable but the covering is poor; subtotal amputation, where length is equivocal; total amputation with the basal joint preserved; and total amputation with the basal joint destroyed. In the first group, soft-tissue cover can be improved by local flaps with or without a neurovascular pedicle or by microvascular free pulp transfer. In the second group, metacarpal lengthening by distraction, with or without phalangization, may give adequate length. In total amputations, one may choose osteoplastic reconstruction, pollicization, or toe-to-hand transfer. Which solution is selected depends on the level of the amputation, the presence and nature of injuries to other digits, occupational and social factors, and the availability of tissues.

Amputation, Traumatic↗
PubMed1978

[Amputation of the knee joint in vascular diseases].

Reported are 97 extensive amputations in 87 patients from 1975 to 1977. Postoperative early mortality was 47% and depended on the disease and the various factors that made amputation necessary. Amputations in chronic occlusive vascular disease without septicemia had a far lower mortality, 10%. Amputations in patients with septicemia resulted in a mortality of 90%. According to Burgess, amputations of the lower leg, exarticulation in the knee joint, and myeloplastic and open amputation of the thigh should be considered in that order. Exarticulation in the knee joint is only feasible in the presence of an open, deep, femoral artery.

Acute Disease↗
PubMed1983

The Syme amputation in patients with congenital pseudarthrosis of the tibia.

Eight patients with congenital pseudarthrosis of the tibia had a Syme amputation and were followed for an average of 5.9 years. The average age at amputation was 8.2 years, and an average of 3.8 surgical procedures were performed prior to the amputation in each patient. None of the pseudarthroses healed, but in spite of that the Syme amputation can be recommended when amputation is necessary. With a simple orthosis, the child can then engage in normal activities. The operation provides a longer stump than do conventional amputations, as well as better skin coverage and more potential for further growth of the tibia from the distal epiphysis.

Adolescent↗
PubMed1978

Rehabilitation outcome of patients with dual disability of hemiplegia and amputation.

The records of 30 patients with the dual disability of hemiplegia and amputation were reviewed. Six factors noted to have influenced the success of rehabilitation were: (1) age; (2) sequence of onset of disability, whether amputation or hemiplegia first; (3) localization of dual disability, whether ipsilateral or contralateral; (4) side of hemiplegia; (5) level of amputation; (6) availability of prolonged hospital stay and training. The final functional status was better if: (1) the amputation preceded the CVA; (2) the amputation and hemiplegia were ipsilateral; (3) amputation and hemiplegia were both on the right side. The hospital stay of patients with dual disability ranged from 4 months to 1 year. Those who had disability on contralateral sides and those who had left hemiplegia required a more prolonged hospital stay.

Adult↗
PubMed1978

Amputations resulting from electrical injury: a review of 22 cases.

Twenty-two cases of electrical injury with a combined total of 43 major amputations are reviewed. Electrical injury resulting from contact with high-voltage current (greater than 1000 volts) commonly results in significant systemic damage. The purpose of this study was to develop statistical data on the rehabilitation and eventual outcome of these patients. Most of the injuries were job related and involved young male adults. Upper-extremity amputations were predominant, and more than 50% of the patients had two or more limbs amputated. In addition to major amputations, other obstacles to rehabilitation included skin burns and limitation of joint motion. The length of hospitalization in a rehabilitation facility for these amputees was greater than for patients with amputations due to other causes. Prostheses were fitted for 95% of the amputated limbs. At the follow-up stage of rehabilitation, 50% of the patients were either employed or pursuing career training or educational goals.

Adult↗
PubMed1982

Predictive value of distal perfusion pressure in the healing of amputation of the digits and the forefoot.

To evaluate the role of distal perfusion pressure in predicting the healing of 31 digit and forefoot amputations preoperative digital, transmetatarsal and ankle systolic pressures were retrospectively compared with the eventual results of amputation. A photoplethysmography transducer placed distal to an occluding cuff was used to measure digital and transmetatarsal level systolic blood pressure. Ankle pressures were measured with Doppler ultrasound. Twenty-six amputations healed initially, whereas, four required reamputation proximal to the ankle. There was no difference in mean ankle Doppler pressure between the healed and failed groups. Mean photoplethysmography derived transmetatarsal pressure was significantly higher in the healed group, 116 +/- 47 millimeters of mercury as compared with the failed group, 44 +/- 88 millimeters of mercury. The difference in mean photoplethysmography digital pressure in the healed and failed groups--75 +/- 36 and 4 +/- 9 millimeters of mercury, respectively--was highly significant, p less than 0.001. Failure of digit or forefoot amputation occurred in all limbs with photoplethysmography derived pressures of less than 20 millimeters of mercury. A transmetatarsal or digital photoplethysmography pressure of greater than 20 millimeters of mercury was associated with amputation healing in all instances. These data suggest that photoplethysmography distal perfusion pressures may be valid predictors of the healing potential of minor foot amputations for end stage ischemia.

Adult↗
PubMed1981

[Thumb reconstruction after amputation injuries].

Reconstruction of the thumb following amputation injuries: In this review of the different methods of thumb reconstruction following traumatic amputation, the procedures applicable in the primary care of the hand are first mentioned and demonstrated: replantation of a thumb, cover of a distal amputation with a neurovascular flap and salvage of a thumb with intermediate segmental loss. In most instances the thumb reconstruction is performed as a secondary procedure. The indication and the selection of the method depend upon the level of amputation, the dominance of the injured hand, and the presence of other injuries to the same hand as well as age, sex, occupation, and intelligence of the patient. There are several different operative methods: 1) Deepening of the first web space (phalangisation of the first metacarpal) by means of a Z-plasty with proximal transposition of the insertion of the adductor pollicis muscle. 2) Lengthening of the first metacarpal with a bone graft either as Gillies cocked hat procedure or as interposition following distraction of the osteotomized two parts of the metacarpal in one stage or as continuous distraction (Matev). --Both methods are performed often in combination and are indicated in loss of the thumb at the base of the proximal phalanx or at the MP-joint in the non-dominant hand or in unskilled workmen. 3) Osteoplastic methods with bone graft, tube pedicle and neurovascular island flap have the risk of absorption of the bone graft and therefore more limited indications. These are given in unskilled manual workers with no other injured digits and in multiple loss of digits where toe transfer is not appropriate. 4) Transposition of another intact or partially amputated digit on a neurovascular pedicle. The two different operative techniques depend upon the presence or loss of the first metacarpal and the thenar muscles. The indication is given in amputations at any point proximal to the base of the proximal phalanx in either hand of most women, children and skilled workers. 5) Free toe transfer is indicated if there is not any other finger or part of a finger available and the first metacarpal is preserved. In exceptional cases a free transfer of a digit of the contralateral hand is possible.

Amputation, Traumatic↗
PubMed1994

[Preserving the length of amputation stumps by microvascular flap transfer of the lower extremity].

With different case reports we want to show the role of microvascular tissue transfer in preservation of lower extremity amputation length. To salvage amputation stumps after traumatic amputation, as well as in case of chronic soft tissue problems after amputation, the radialis forearm flap is preferred for smaller defects, for example after transmetatarsal amputation, whereas with the latissimus dorsi muscle flap bigger areas can be reconstructed. But also the tensor fascia latae flap and the scapular flap can be used for soft tissue reconstruction. With microvascular soft tissue transfer amputation stump length can be preserved in order to have a better functional outcome, especially for prosthetic rehabilitation.

Adolescent↗
PubMedDate not supplied

The Syme's amputation: a correlation of surgical technique and prosthetic management with an historical perspective.

In 1843, James Syme introduced an amputation which he believed had numerous advantages over more proximal amputations. Despite these claims, utilization of the Syme's amputation has been limited due to a less than ideal compatibility of the surgical result with prosthetic design and function. In this article, the history of the Syme's amputation is reviewed along with indications and surgical technique. Modifications to the original surgical procedure are discussed as well as advantages and disadvantages inherent to the Syme's amputation. A description of the biomechanical function of the residual limb/prosthesis and management of the Syme's amputee is provided emphasizing the quest for an ideal prosthesis which is found, could very well allow Dr. Syme's amputation to reach the potential as he had originally envisioned.

Amputation, Surgical↗
PubMed1994

Forequarter amputation for soft tissue tumors.

Forequarter amputation is a radical surgical procedure initially described for the treatment of traumatic injuries in 1908. This procedure has been used more recently in the treatment of soft tissue tumors. This report describes the experience in the Division of Surgical Oncology at the University of Illinois over a 20-year period. Between 1970 and 1991, 10 patients underwent forequarter amputations for malignant disease. Nine of these patients had soft tissue tumors and one a malignant melanoma. Four patients underwent amputation as primary treatment of their tumor, and six underwent the procedure as treatment for recurrent tumor. All patients are presently alive with a mean follow-up of more than 10 years. Three patients had recurrent tumor after the forequarter amputation. One local failure was salvaged with a chest wall resection, and two patients had distant failure. Forequarter amputation remains an effective procedure for local control of tumors of varying histology involving the shoulder girdle and upper arm. The most common indication for this procedure is a recurrent soft tissue tumor for which limb sparing procedures are not applicable. Forequarter amputation should remain a rarely used, but important, surgical option for the treatment of patients with soft tissue tumors.

Adolescent↗
PubMed1993

Quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower-extremity amputation.

One hundred nine patients with long-bone fracture nonunion, chronic refractory osteomyelitis, and posttraumatic amputation were evaluated to assess the impact of chronic disability on the quality of life. The quality of life parameters were defined by a functional assessment instrument, the Arthritis Impact Measurement Scale (AIMS), and a Psychosocial Adjustment to Illness Scale (PAIS). A spouse PAIS self-report instrument was administered to assess the psychosocial adjustment of spouses or significant others. A final questionnaire was developed to determine the reasons, in order of their importance, for either continuing medical therapy or accepting amputation. The PAIS scores differed significantly between osteomyelitis patients and nonunion or amputation patients. The presence or absence of pain produced significant differences in AIMS and PAIS scores of nonunion and osteomyelitis patients. Subscale analysis of AIMS scores showed significant differences among the three groups with respect to health perception and scale of orthopaedic problem. The osteomyelitis patients were more severely affected than the nonunion or amputation patients. The PAIS was unable to detect any statistically significant differences in psychosocial adjustment of the spouses of patients in each of the three population groups. The most frequent reason for continuing medical and surgical management of nonunion and osteomyelitis was hopeful expectation for cure. The group who chose amputation did so in an attempt to put an end to the need for medical and surgical treatment. Differences in psychosocial and functional ability were related to disease diagnosis, pain, status of fracture healing, and timing of amputation. This study provides further insight into the quality of life experience for patients with long-term orthopaedic problems.

Adaptation, Psychological↗