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A study of stump growth in children with below-knee amputations.

The growth of the stump has been studied in eighteen children with below-knee amputations. Measurements were available shortly after operation and later at skeletal maturity. It was found that all patients achieved less than expected growth and that the reduction was greater in those patients who had had amputation for congenital deformity.

Adolescent↗

The value of stump split skin grafting following amputation for trauma in adult upper and lower limb amputees.

One hundred and twenty adult patients were reviewed in whom split skin grafts were applied to the stump following traumatic amputation of the upper limb (44 amputees) or lower limb (76 amputees). The average follow-up period was seven and a half years after initial amputation. There was delay in prosthetic fitting in all patients. Approximately one third of patients complained of occasional minor ulceration, controlled by removing the prosthesis for a few days or modification of the prosthesis. Further revision surgery, including excision of the grafted skin often combined with proximal bone resection, but not removal of the proximal joint, was necessary in 29% of below-elbow amputees and approximately 50% of below and above-knee amputees. At the above-elbow level, use of skin grafts allowed prosthetic fitting because of preservation of sufficient length of the stump. Despite the fact that revision surgery may often be necessary, split skin grafting has a definite place in the early management of the stump following traumatic limb amputation in the adult. Preservation of stump length with the knee or elbow joint allows easier rehabilitation and lower energy expenditure when using the prosthesis. Partial foot amputation, when combined with skin grafting usually requires subsequent revision to a more proximal level to obtain a satisfactory result.

Amputation Stumps↗

Post-amputation phantom pain and autonomous stump movements responsive to doxepin.

A 40-year old man with post-amputation phantom pain and involuntary autonomous movements experienced dramatic relief of both pain and autonomous movements with administration of the antidepressant doxepin. The pathophysiology of pain and post-amputation autonomous movements, as well as the therapeutic response to doxepin are discussed in terms of the effects of limb amputation on spinal excitability and alterations in both spinal and supraspinal transmitter functions.

Adult↗