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PubMed2001

[Revascularization of the profunda femoris artery in ischemia of the stump after above knee amputation].

We describe a severe complication after above knee amputation: persisting ischemia of the stump, and its treatment by vascular surgery. Only 4 (2.3%) of 168 above knee amputations performed in our department between June 1985 and September 1999 were followed by ischemia of the stump non responding to conservative treatment. We decided on subsequent revascularization of the ipsilateral deep femoral artery. A femorofemoral bypass graft was successfully implanted. A reamputation or an exarticulation of the hip joint could be avoided. We call special attention to the importance of the deep femoral artery.

Aged↗
PubMed1985

[Free toe transfer to the forearm stump following wrist amputation--a current alternative to the Krukenberg operation].

A new and simplified technique for reconstruction of the gripping ability after total loss of the hand is introduced. Previous techniques have not gained popularity because of the rather complicated procedures trying to extend the stump with two additional toes. Poor skin in the distal end of the stump has been a limiting factor and technically transplantation of two separate toes has been a difficult procedure. The stability in such a grip may be compromised. In the author's modification only one toe is used with an island flap from the big toe. The opposing post in this grip is the stable resection plane of the radius, covered partly by dorsal sensible skin and partly by the first web space skin with the island flap from the big toe. The stability is good because of the width of the post. The mobility of the new "thumb" may be excellent if the balance between the different muscle transfers is optimal and the rehabilitation is done in an adequate way from the beginning. This is a preliminary report of the technique and the preliminary results in three similarly operated patients are very promising. The technique is introduced especially as a modern alternative to the Krukenberg-plasty and may have its greatest value among blind patients with long forearm stumps.

Adult↗
PubMed2001

Intracortical pathway involving dysgranular cortex conveys hindlimb inputs to S-I forelimb-stump representation of neonatally amputated rats.

Reorganization of the primary somatosensory cortex (S-I) forelimb-stump representation of rats that sustained neonatal forelimb removal is characterized by the expression of hindlimb inputs that are revealed when cortical GABA receptors are pharmacologically blocked. Recent work has shown that the majority of these inputs are transmitted from the S-I hindlimb representation to the forelimb-stump field via an, as yet, unidentified pathway between these regions. In this study, we tested the possibility that hindlimb inputs to the S-I forelimb-stump representation of neonatally amputated rats are conveyed through an intracortical pathway between the S-I hindlimb and forelimb-stump representations that involves the intervening dysgranular cortex by transiently inactivating this area and evaluating the effect on hindlimb expression in the S-I forelimb-stump representation during GABA receptor blockade. Of 332 S-I forelimb-stump recording sites from six neonatally amputated rats, 68.3% expressed hindlimb inputs during GABA receptor blockade. Inactivation of dysgranular cortex with cobalt chloride (CoCl(2)) resulted in a significant decrease in the number of hindlimb responsive sites (9.5%, P < 0.001 vs. cortex during GABA receptor blockade before CoCl(2) treatment). Results were also compiled from S-I forelimb recording sites from three normal rats: 14.1% of 136 sites were responsive to the hindlimb during GABA receptor blockade, and all of these responses were abolished during inactivation of dysgranular cortex with CoCl(2) (P < 0.05). These results indicate that the S-I hindlimb representation transmits inputs to the forelimb-stump field of neonatally amputated rats through a polysynaptic intracortical pathway involving dysgranular cortex. Furthermore the findings from normal rats suggest that this pathway might reflect the amplification of a neuronal circuit normally present between the two representations.

Afferent Pathways↗