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PubMed1999

Disarticulation at the ankle using an anterior flap. A preliminary report.

Disarticulation has been carried out in ten ankles in nine patients in whom it was not possible to use a heel flap. Four patients were able to walk with a prosthesis which gave satisfactory function. In five who were bedridden, healing was achieved and was of sufficient quality to allow transfers. There was no operative morbidity or mortality. This technique can be used instead of a transtibial amputation if necrosis or ischaemia of the heel is a contraindication to conventional Syme's amputation.

Adult↗
PubMed1993

Bone tissue kinetics in the surgically disarticulated dog incus.

The incus of the right ear from 4 growing mongrel dogs was surgically disarticulated and left in the middle ear space. The external auditory canal was then filled with teflon paste and sutured. After 6 weeks (D-6 group) and 13 weeks (D-13 group) the animals were sacrificed. The right experimental incus and the left control one were embedded in methyl methacrylate and sectioned in single 50-microns-thick sections according to the principal axis of the two processes. On the microradiographs of each section we evaluated the thickness of the body and of both processes and the percentage area of the primary channels of the secondary osteons and that of the appositional bone tissue. The thickness of the body and of the two processes was more pronounced in all the experimental incuses, in which 6% (in D-6) and 8% (in D-13) of the total area were occupied by new appositional woven bone. In the body of the D-13 group, 9% of the pre-existing bone was substituted by secondary osteons. The results indicate that the incus react to the variations of mechanical stimuli.

Animals↗
PubMed1992

Energy expenditure during walking in subjects with tibial rotationplasty, above-knee amputation, or hip disarticulation.

The surgical treatment of osteosarcoma with a tibial rotationplasty seems to offer functional advantages in comparison with an above-knee amputation. It has not been established whether the functional advantages are accompanied by a lower rate of energy expenditure during walking. In children with a tibial rotationplasty (n = 15), an above-knee amputation (n = 6), or a hip disarticulation (n = 5), energy expenditure was measured during treadmill walking at various walking velocities. The subjects with a tibial rotationplasty were able to walk faster, but there were no differences between the groups in energy expenditure per unit time or per unit distance. Correction for confounding variables including age, sex, height, time since operation, level of activity, and support during walking in a multiple linear regression model did not reveal any significant differences in energy expenditure during walking between groups. 1992 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

Adolescent↗
PubMed1992

[Necessary hip disarticulation in extended echinococcosis of the femur].

The authors have studied one case of pathological fracture of the femoral shaft related to hydatid disease. The diagnosis was based on the presence of whitish vesicles at the surgical procedure. Despite extensive, curettage and a number of other surgical procedures, infected drainage was persisting. The outcome was poor and a hip disarticulation had to be done.

Disarticulation↗
PubMed2004

Disarticulation of the left upper extremity for treatment of giant primary lymphedema--case report.

This unusually rare case of giant primary lymphedema of the left upper extremity in a 21-year old woman, who had undergone five surgical procedures (two Charles' procedures and three partial resections) without lasting clinical improvement, demonstrates the difficulty in achieving satisfactory long-term results in patients with grotesquely huge extremities secondary to primary lymphedema. Disarticulation of the left upper extremity was felt to be the most appropriate surgical option in this severe congenital lymphedema patient.

Adult↗
PubMed1983

Energy expenditure in hip disarticulation and hemipelvectomy amputees.

Energy expenditure was measured using a metabolic measurement cart (MMC) for 8 patients with hip disarticulation (HD, group 1), 10 patients with hemipelvectomy (hp, group 2), and 11 able-bodied subjects (group 3). Velocity and O2 consumption of comfortable, fast, and slow walking speeds were measured with a MMC. Comfortable walking speeds with HD and hp were 51% to 61% of controls (p less than 0.001), but there was no difference in O2 uptake per minute among the three groups. Fast walking speeds for groups 1 and 2 was 70% to 75% of comfortable walking speeds in group 3 (p less than 0.01), and the mean O2 uptake of fast walking speeds in groups 1 and 2 was 40% to 50% more than that of group 3 at comfortable speeds. Energy cost per unit distance (work) was 80% to 125% greater with patient groups than with able-bodied subjects. The difference between the pre- and immediate postexercise pulse rates for comfortable walking speeds were higher in groups 1 and 2 than in group 3.

Adult↗
PubMed1981

A surgical technique for hip disarticulation.

Hip disarticulation is usually elected for malignant bony and soft tissue tumors below the lesser trochanter of the femur. The operation is performed with the patient in a posterolateral position; in the first phase of the procedure the surgeon stands anterior to the patient. After incision of the skin and division of the femoral vessels and nerve, muscles of the anterior thigh are transected off the pelvic bone from lateral to medial starting with the sartorius and finishing with the adductor magnus. Muscles are divided at their origin except for the iliopsoas and obturator externus which are divided at their insertion on the lesser trochanter of the femur. The quadratus femoris muscle is identified and preserved, then the flexor muscles are transected at their site of origin from the ischial tuberosity. During the next phase the surgeon is posterior to the patient, and the pelvis is rotated from the posterolateral to the anterolateral position. After completion of the skin incision, the gluteal fascia, tensor fascia lata, and the gluteus maximus muscles are divided and dissected free of their posterior attachments to expose the muscles inserting by way of a common tendon onto the greater trochanter. These muscles are then transected at their insertion on the bone. The posterior aspect of the joint capsule is then exposed and transected. Finally, the sciatic nerve is divided and allowed to retract beneath the piriformis muscle. To close the wound the preserved muscles are approximated over the joint capsule and the gluteal fascia secured to the inguinal ligament over suction drains. The skin is closed with interrupted sutures.

Disarticulation↗
PubMed1997

Coronary stenting with the half (disarticulated) Palmaz-Schatz stent: immediate results and six-month follow-up.

Coronary stenting with the half disarticulated Palmaz-Schatz stent is particularly suitable for ostial stenoses, diaphragm stenoses, stenoses distal to tortuous segments or coronary bends and localized dissections after balloon angioplasty. Nevertheless very few data regarding the half stent exist and follow-up data are nonexistent. From January of 1994 to December of 1995 a total of 207 half stents were implanted in 175 patients. Most patients had stable or unstable angina and in the majority of cases the stent was implanted due to localized dissection or to suboptimal result. The procedural success rate was 98%. After stent implantation, 82 patients were treated with acetylsalicylic acid (ASA) and oral anticoagulant (group A), whereas 93 were treated with ASA and ticlopidine (group B). Seven patients had subacute thrombosis (5, group A; 2, group B), and six patients had major bleeding (5, group A; 1, group B). Overall, patients in group A had more cardiovascular complications than patients in group B (10, group A; 3, group B; p = 0.047). After 6-mo follow-up, 1 patient had died and 27 patients had symptoms of angina (16%). Thirteen patients underwent a second PTCA (7%) and four patients (2%) were referred for coronary artery bypass. In conclusion, coronary stenting with half Palmaz-Schatz stent appears to be a safe and effective procedure. In selected cases, the half Palmaz-Schatz stent is easier to handle than the complete stent, it is associated with a low rate of clinical restenosis, and it lowers procedural costs.

Aged↗
PubMed1997

Deployment of a previously embolized, unexpanded, and disarticulated Palmaz-Schatz stent.

Stent embolization is a rare but acknowledged complication of placement of disarticulated (half) Palmaz-Schatz stents. We report a case in which we diagnosed a previously unrecognized, embolized, undeployed half-stent in the distal LAD, causing slow flow, and then deployed the stent where it lay, resulting in improved flow. The literature on treatment of coronary stent embolization and on cutting and preparing half-stents for deployment is discussed.

Angioplasty, Balloon, Coronary↗
PubMed1995

Stenting with the half (disarticulated) Palmaz-Schatz stent.

A total of 110 half (disarticulated) Palmaz-Schatz coronary stents were implanted in 102 patients. Procedural success rate was 98%. Elective stenting was performed in five patients. The others received half stents for bail-out situations, including short dissections, relapsing stenoses, dissections not adequately covered by a full stent, ostial stenoses, and thrombus containing lesions. Seventeen patients received no anticoagulation except aspirin. Complications included one procedural death, three acute occlusions (resulting in one Q and two non-Q wave myocardial infarctions), and one non-Q wave infarction related to side branch closure. Stenting with the half Plamaz-Schatz coronary stent is an effective technique. It allows stenting in situations where a full stent may not be ideally suited. Use of only half a stent reduces thrombogenicity and halves costs.

Adult↗
PubMed1979

[Disarticulation in the knee joint (author's transl)].

Based on the results with thirty patients, disarticulation in the knee is to be recommended as a very good amputation level. Two groups of patients seem to be especially suitable for this amputation level: patients with malignant bone tumors of the proximal tibia or fibula and patients with peripheral vascular diseases. Above all, the easy operational technique and the functionally valuable long thigh stump offer decisive advantages as compared with amputation of the thigh. Problems with prosthesis fitting were solved through modification of the socket shape as well as new developments in artificial knee joints.

Adolescent↗
PubMed1998

Wrist-driven prehension prosthesis for amputee patients with disarticulation of the thumb and index finger.

Partial hand amputations may leave significant functional limitations that are difficult to ameliorate by either orthoses or prostheses. Disarticulation of the thumb and index finger at the metacarpophalangeal joint level and the range of motion of the three remaining fingers would be insufficient to provide any type of grasp. In cases like this, a cosmetic hand usually seems to be the best solution. This report describes the design and use of a wrist-driven prehension prosthesis that was applied to a patient and provided a considerable improvement in function and cosmesis.

Amputation, Traumatic↗
PubMed1999

Developing prosthetic weight bearing in a knee disarticulation amputee.

An essential component of prosthetic training in amputees is to achieve full weight bearing through the prosthesis. The end-bearing nature of the intact femur in an individual with a knee disarticulation amputation (KDA) offered a rare opportunity to examine this component. The purpose of this case study was to describe the weight-bearing development in a temporary prosthesis. Longitudinal measurement of gait and balance parameters offer objective data to assess this component of amputee rehabilitation. It was concluded that (1) the temporary prosthesis for a KDA was a successful treatment option in the rehabilitation of a KDA; (2) full weight bearing was achieved in four weeks; and (3) the longitudinal objective measures identified unexpected results.

Journal Article↗
PubMed1995

Rhinoplasty with nasal bone disarticulation to deepen the nasofrontal groove. Experimental and clinical results.

Deepening of the nasofrontal groove is considered a fiddly task. The unwonted chisel ostectomy technique (Skoog, 1974; McCarthy, 1990; Aiach and Levignac, 1991) was therefore modified and evaluated both experimentally and clinically. The hump is removed in one piece together with the nasal bones up to the horizontal part of the frontonasal suture. To accomplish this, the reduction osteotomy has to be performed in a wave line fashion. The depth of resection in the sellion area depends upon the aesthetic planning. In cases with most severe hypertrophy, the osteotome enters the vertical frontonasal suture behind the nasal bones and in front of the nasal spine of the frontal bone. The nasal bones are disarticulated with a levering movement. Cadaver studies demonstrate the safety of the technique: no fracture lines were detected in the frontal process of the maxilla, ethmoid, frontal or lacrimal bones, by either clinical inspection, or by standardised radiological examination. The clinical cases show a convincing outcome.

Female↗
PubMed2001

Results of supracondylar osseous shortening in knee disarticulation.

A twenty-eight-year-old patient who had a knee disarticulation and used a prosthesis that could bear weight through the stump end is presented. He had cosmetic and soft tissue problems in the stump end. To solve these problems, a 7 cm supracondylar shortening osteotomy was performed. The functional and cosmetic results that were obtained from the prosthesis for trans-femoral amputations but which can bear weight through the stump end, fitted 1.5 months after the surgical operation, were evaluated as very good at the end of the 26 months follow-up period.

Adult↗
PubMed2002

Knee disarticulation after total-knee replacement.

An 89-year-old woman who had a total-knee replacement in the past, underwent a knee disarticulation of the same leg because of an ischaemic foot. Eight (8) months postoperatively the stump is fully weight-bearing and the patient is able to walk safely, using a prosthesis and a walking frame.

Aged↗
PubMed1984

Shoulder reconstruction following disarticulation for ruptured mycotic aneurysm.

A method of wound management following shoulder disarticulation is described. In this report, the primary lesion is a mycotic aneurysm of the axillary artery. The pectoralis major muscular flap provides satisfactory coverage and maintains shoulder contour. It can be performed in a single procedure. Preoperative arteriography is important to determine the extent of arterial damage as well as the vascular anatomy of the proposed flap.

Adult↗