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PubMedDate not supplied

[Functional evaluation of elderly patients with lower limb amputation followed at a university hospital].

We studied 40 elderly with lower limb amputation (above the malleolus), who attended a hospital outpatient clinic (Orthoses and Prostheses Unity, University Hospital, State University of Campinas), from June 1994 to June 1999. Our objectives were to evaluate the independence level according to the Barthel's Index and to identify relationships between the mentioned Index and the type and level of amputation, as well as the prosthetic use. The subjects had a high degree of independence, according to the Barthel's Index. We found statistical significance only for the relationship between the Barthel's Index and the type of amputation, suggesting that the elderly with unilateral amputation were more independent than those who had undergone bilateral amputation.

Activities of Daily Living↗
PubMed2001

The scope of amputations in a Nigerian teaching hospital.

In developing countries, amputations have been performed due to trauma and infections; whereas in developed counties, trauma, diabetes and peripheral vascular diseases are the usual indications. Current practice in Nigeria suggests a change of relative indications, hence, this study. A five-year (July 1994 to June 1999) review of amputation records from the medical records, operating theatre, wards and physiotherapy department was carried out retrospectively. Amputation types, age, sex and indications were analysed. Fifty-eight amputations were performed in 56 patients (47 males, nine females, M: F = 5.2 : 1, age range 7-70 years, mean 33.3 +/- S.D 18.2). There were 42 lower and 16 upper limbs. Trauma accounted for 48.3%; followed by diabetes (29.3%), tumours (12.1%), infections (8.6%) and one indeterminate cause (1.7%). There was bias for sex, age and type of extremity as trauma was the commonest indication in male patients aged 30 years and below (and in the upper limb) whereas diabetes predominated in female patients above 30 years (and in the lower limb). Infection, as an indication for amputation, has now become a rear guard indication. Diabetes, previously uncommon, now appears in the forefront. These findings call for early detection and aggressive management of diabetic foot lesions.

Adult↗
PubMed1992

Lower extremity amputation in scleroderma.

Scleroderma or Systemic Sclerosis (SSC) is a disorder characterized by fibrosis of the skin and multiple internal organs. The pathological lesion is a triad of small artery intimal proliferation, medial thinning and adventitial scarring. Autoamputation of fingers and toes is often seen, but only a few cases of limb amputation in scleroderma patients have been reported. The Pittsburgh Scleroderma databank includes 1,030 patients with SSC. Among these were seven patients who sustained lower limb amputation. There were four patients with the CREST variant of SSC, two with diffuse scleroderma, and one who had SSC/rheumatoid arthritis/polymyositis overlap who sustained limb amputation. Of the seven, three were male and five had a significant smoking history. Ages ranged from 46 to 71 years. All patients underwent amputation for nonhealing ulcerations. No problems with postoperative wound healing were seen. Pathologic changes typical of SSC in addition to atherosclerotic peripheral vascular disease were described in one case. Three patients were successfully fitted with prostheses and became independent ambulators. Four patients could not be fitted with prostheses. No skin problems were reported related to prosthetic use. Our review demonstrates that SSC patients who undergo amputation can become successful prosthetic users and should be considered for prosthetic prescription.

Aged↗
PubMed1992

Influence of failed arterial reconstruction on the outcome of major limb amputation.

BACKGROUND: Unsuccessful vascular repair may further preexisting limb ischemia and thus increase the risk of revascularization procedures. METHODS: The results of 94 primary major amputations (group A) have been analyzed and compared with 112 secondary ablations (group B) carried out after failed revascularization efforts. All patients suffered from chronic critical ischemia (grades III and IV) of the lower extremities. In group A the severity of ischemic symptoms was more pronounced (trophic changes in 80% vs 66% in group B), and a preponderance for older age, diabetes mellitus, and incidence of cardiac failure and cerebrovascular insufficiency was evident. RESULTS: In patients undergoing secondary amputation the final transection level was adversely affected by preceding unsuccessful reconstructive attempts. In spite of the better risk profile, 30% of patients in group B were subjected to above-knee amputation compared with 13% of patients in group A. The aggravated limb ischemia caused by graft failure is reflected by the decrease of the mean ankle systolic pressure index from 0.27 to 0.13 (before and after failed revascularization attempts). Although more amputations at the below-knee level were performed initially in group A, primary wound healing was obtained among these subjects in 68% of patients (compared with only 39% for patients in group B). CONCLUSIONS: In a substantial number of cases preexisting limb ischemia may be promoted by failed attempts at vascular reconstruction, thus leading to severe wound healing complications and a higher level of amputation.

Aged↗
PubMed1992

Evaluation of survival times after limb amputation, with and without subsequent administration of cisplatin, for treatment of appendicular osteosarcoma in dogs: 30 cases (1979-1990).

Appendicular osteosarcoma was diagnosed in 30 dogs. Fifteen dogs were treated by limb amputation alone, and 15 dogs were treated by limb amputation followed by 2 doses of cisplatin given IV approximately 2 and 7 weeks after limb removal. Mean survival time after limb amputation alone +/- SD was 190 +/- 138 days (median, 168 days); 7 dogs survived longer than 6 months, and 3 dogs survived more than 1 year. Fourteen of 15 dogs treated by amputation and administration of cisplatin survived a mean of 315 +/- 158 days (median, 290 days) after amputation, and 1 dog was still alive at 1,095 days; 13 dogs survived longer than 6 months and 5 dogs survived more than 1 year. Survival time was significantly (P less than 0.05) greater in dogs given cisplatin.

Amputation, Surgical↗
PubMedDate not supplied

Amputation: preoperative psychological preparation.

More than 90 percent of all amputations are now due to the complications of chronic disease. Because most amputations can be anticipated, the preoperative period allows the opportunity for psychological preparation of the patient. This article highlights the important contribution family physicians can make before patients undergo amputation. Common patient reactions before and after amputation are reviewed, and an illustrative case is described. Our experience and review of the literature suggest that psychological intervention during the preoperative period is associated with a less complicated postoperative adjustment and grieving experience. The family physician can promote patient adjustment by providing accurate information, eliciting unspoken fears, and encouraging the involvement of the patient's family. By emphasizing the patient's enduring characteristics and his or her past coping ability, we believe that family physicians can lessen the psychological distress of amputation and facilitate adaptation.

Adaptation, Psychological↗
PubMed2004

[Rehabilitation of patients after lower limb amputation as a basic element of adaptation to normal life].

Amputations of bottom limbs are serious problem. Loss of leg causes always heavy psychical injury, it makes life more difficult, as well as moving and self-service. The change of appearance and shape of body demands adaptations of patient and his neighbourhood. Every amputation is not only heavy physical injury but also violent and long-lasting psycho-emotional and social stress. Most of patients are afraid of unknown, so it's necessary to decrease their fear, they expect our help in solving their social and domestic problems. The aim of investigations is to show the process of adapting to normal life of people after amputation of bottom limb on example of their rehabilitation. The following investigative methods were used: steered observation, interview, Polish version of questionnaire RNL (reintegration to normal living) in small modification and inquiry. Investigations were conducted in two hospital wards and the rehabilitation centre. The group consisted of 82 patients--59 men (72% of group) and 23 women (28%). The numerous group (43%) were people between 50-69 years old. Only a few patients after amputation go to special out-patients' department. The main reason of it is the lack of rehabilitation centre in the neighbourhood. 1/5 of the group regularly uses rehabilitation at expert, however most patients over 70s do not use any rehabilitation. Frequent form of activity at studied people is morning exercises and easy exercises of stump. Lack of physical activity is typical for 1/3 of group. Physically active are only 12 patients (15%). Near half of the group uses artificial limbs, but 1/5 of group does not want to have it. Most of them is over 70 years old. Results of investigation show the need of opening the larger quantity of rehabilitation centres to make the rehabilitation more common and accessible. Essential meaning has also bigger motivation of patients to physical activity as well as using artificial limbs, which do facilitate functioning in everyday life and improve the mood of patients after amputation.

Activities of Daily Living↗
PubMed2005

Misadventure in traditional medicine practice: an unusual indication for limb amputation.

Limb amputation is a major cause of disability in Nigeria, and inadequate health facilities for limb salvage procedures and rehabilitation have increased the burden of amputation surgery in our environment. The common indication for limb amputation in Nigeria is limb gangrene due to trauma. A road traffic accident is an important cause of the trauma, and the role of the traditional bonesetters in the increasing incidence of limb gangrene has been reported. The complications of the traditional bonesetter's practice in Nigeria account for about 50-60% of the limb gangrene necessitating amputation in our hospitals. Misadventures in traditional medicine practice are not new to us. People have lost their lives in the cause of testing the efficacy of traditional medicine. This paper reports an unusual indication for limb amputation in Nigeria following misadventure in a traditional medicine practice in a rural community.

Adult↗
PubMed1992

Factors influencing reintegration to normal living after amputation.

This study identified factors affecting reintegration to normal living (RNL) after lower extremity amputation. A questionnaire was used to evaluate RNL at a veterans' medical center and private rehabilitation clinic. The patients were 42 elderly individuals (68 +/- 1.5 years). Eighty-eight percent were men and 76% had additional health problems. Unilateral below-knee amputations, unilateral above-knee amputations, and bilateral amputations accounted for 38%, 36%, and 26% of subjects, respectively. Eleven questions were asked to evaluate mobility, self-care, work, recreation, social activities (daily functioning), relationships, social self, and life events (perception of self). The median overall RNL score was 16 of 22 (range, 5 to 22). Poor reintegration occurred in community mobility, work, and recreation. Perception of self questions showed satisfactory reintegration. Examination of variables impacting reintegration showed only additional illness significantly reducing the RNL score. It was concluded that current rehabilitative efforts regarding home mobility and psychological adjustment are satisfactory. More attention to community mobility, recreation, and additional illnesses would improve RNL after amputation.

Activities of Daily Living↗
PubMed2006

[The adaptation process and behavioral responses of a patient with peripheral arterial occlusive disease who has undergone amputation].

The purpose of this study was to explore the adaptation and behavioral responses of an 85 year-old woman who suffered from gangrene related to peripheral arterial occlusive disease and finally underwent lower limb amputation. The field method was adopted. Records of the patient's behaviors were collected by observation and interviews. The data were recorded by nursing process recording and analyzed using the Behavior Classification Model. The findings showed the patient's behavioral responses to be categorized by three phases. The first phase was the impact phase: patient objected to amputation strongly because it would destroy her body image. She experienced moods of anxiety and denial moods etc. The second phase was the regressive phase: after the amputation, the patient experienced a sense of loss and discomfort while having to cooperate with medical treatment and rehabilitation. Silence, withdrawal, and despair were some of her reactions. The third phase was the acceptance/ reconstruction phase: the patient accepted the fact of her amputation with time and started her rehabilitation. During the process of providing nursing care, we helped the patient to vent her emotional responses, helped her to develop awareness of her ability to face the loss of her limb, and aggressively planned individualized rehabilitation for her. Finally, these interventions enabled the patient to overcome the impact of her amputation. The findings of this study should provide references for further clinical nursing care.

Adaptation, Psychological↗
PubMedDate not supplied

[Lower limb amputations caused by tumours and prosthetic rehabilitation in Croatia from 2000 to 2004].

During the period of five years (2000-2004) we monitored 46 patients (25 males and 21 females) who were admitted to Clinical Institute for Rehabilitation and Orthopaedic Aids in Zagreb for the first prosthetic rehabilitation following the lower limb amputation which was caused by a tumour. The average age of patients was 51 +/- 17.11 years. According to the pathohistological diagnosis the most common cause of lower limb amputations was osteosarcoma. According to the level of amputation the most frequent was trans-femoral amputation (50%) and the least frequent was knee disarticulation (8.7%). The average number of days from the amputation to the beginning of prosthetic rehabilitation was 108 +/- 67.05. At the time of admission 15.2% of patients had local complications of the stump and 34.8% of patients complained of phantom pain. The average number of days of prosthetic rehabilitation was 35 +/- 7.94. The medium daily use of the prosthesis was 5 hours and the medium walking speed was 12 sec/10 m. At the time of admission for the prosthetic rehabilitation 10.9% of patients used a wheelchair, 8.7% walked with a walker and others with two crutches. At the time of discharge 89.1% of patients were able to walk with a prosthesis and two crutches, 4.4% with one crutch and 6.5% were able to walk without crutches. We can be satisfied with the results of prosthetic rehabilitation because patients regained mobility and full independence in performing their daily activities.

Adolescent↗
PubMed2006

Functional outcome after major lower extremity amputation: a survey on lower extremity amputees.

The post-operatve course of amputees is poorly documented. This cross-sectional survey was unertaken to determine functional outcomes of 213 patients who had undergone either a below-knee or above-knee amputation from 2000 to 2002 in a state-hospital setting. The study comprises a self-constructed questionnaire and interview conducted by phone. Of the 213 amputees, 41 out of 61 documented telephone numbers of the patients were useful for contact. Only 30 amputees were available for the study as the remaining 11 had passed away. Included in the questionnaire was the modified Barthel Index, a measurement to assess the amputees' ability to carry out activities of daily living (ADL). It contains ten questions pertaining to ADL with a total score of 20 points. Two-thirds of the respondents (67%) use their prosthesis for less than six hours per day. The Barthel Index of 30 patients ranged from 9-20 (mean 17.7). However, the mean Barthel Index in those with and without prosthesis was 18.4 and 15.2 respectively, but this difference was not significant. Half of the respondents were unable to maintain their pre-amputation jobs, while the remaining 50% were still able to work. Forty seven percent of amputees took less than a year to return to their activities, while 33% took between one to two years. Regarding the adequacy of preamputation information provided by the doctors, 73% amputees responded in the affirmative, while 27% felt otherwise. Amputees were still facing substantial disabilities following major amputation of the lower limb. Although 80% of respondents surveyed own prosthesis, the full use of prosthesis is suboptimal due to prosthetic-related problems. Most amputees had a good functional outcome based on the modified Barthel Index. Some amputees were unhappy as they felt that they were insufficiently informed regarding post-amputation expectation prior to the amputation. Despite good support from family, the community support for amputees is still lacking.

Activities of Daily Living↗
PubMed1991

[Finger tip amputations in children].

Among the various alternative forms of treatment of digital tip amputations, replantation of the amputated tip as composite graft or conservative treatment (healing by secondary intention) are of special interest for the management of fingertip injuries in children. From 1986 until 1987, the authors treated thirteen fingertip amputations in children between one and eight years of age (mean 3.5 years). In twelve cases, the amputated tip was reattached as composite graft, one injury healed by secondary intention. Twelve children were reexamined according to a prospective protocol after a mean follow-up time of 3.4 years. In three cases, primary healing of the replanted tip could be observed, in eight cases partial necrosis and superficial mummification preceded complete healing. At follow-up, seven cases presented with an anatomical tip, four with a slight asymmetry. Distal phalangeal length was identical to the opposite side, but in two cases a maximal loss of length of 2 mm was observed. Fingernails showed no significant deformities, although nail bed injuries had occurred in 90% of the cases. Sensitivity was normal in all cases. Child and parents considered the final result excellent in 75% and good in 25%. Reattachment as composite graft or conservative treatment for management of fingertip amputations in children (Zone I to III according to Rosenthal) is recommended and discussed.

Amputation, Traumatic↗
PubMed1991

[The course after amputation of upper extremities with special reference to the use of prostheses and social conditions].

Sixty-six patients with upper limb amputations were followed-up in their homes. The object of this article was to assess the course as regards the prosthesis, the extent to which this was employed, and to investigate the factors which influence the type of prosthesis and the social conditions of the patient. The amputees were divided into four groups. Twenty-six employed an active prosthesis for more than eight hours daily, six for less than eight hours daily, 16 employed passive prostheses and 18 did not employ prostheses. 65% of the amputations were performed on account of accidents. A group of six were submitted to amputation as part of the treatment of irreversible brachial plexus lesion. The investigation demonstrated the significant importance of the year of amputation. This is explained by late development of the prosthesis supply and the possibilities for rehabilitation and the legislative conditions. Great differences were observed between the prosthetic conditions at the primary equipment and at follow-up investigation. The type of prosthesis employed depended on loss of the dominant arm, prostheses available and the general condition of the individual patient. There were differences in the mental reactions for patients with planned and traumatic amputations. It is recommended that this patient group should be ensured rapid fitting with prostheses by an experienced prosthesis and adequate rehabilitation within a geographically manageable district. This patient group requires team therapy and this functions best when the relevant staff are experienced with this type of patient.

Adolescent↗
PubMed1991

Psychosocial, functional, and 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, or posttraumatic amputation were evaluated for the impact of chronic disability on quality of life, as measured by the Arthritis Impact Measurement Scale (AIMS) and the Psychosocial Adjustment to Illness Scale (PAIS). A self-administered PAIS for spouses assessed psychosocial adjustment of spouses or significant others. A final questionnaire ranked the reasons for either continuing medical therapy or accepting amputation. The PAIS scores differed significantly between osteomyelitis patients and both nonunion and amputation patients (p less than .05). The presence or absence of pain produced significant differences in AIMS and PAIS scores of nonunion and osteomyelitis patients (p less than .05). Subscale analysis of AIMS scores revealed significant differences among the three groups in health perception and scale of orthopedic problem: osteomyelitis patients were more severely affected than nonunion or amputation patients. The PAIS detected no statistically significant difference in psychosocial adjustment of spouses of patients in the three population groups. The most common reason for continuing medical and surgical management of nonunion and osteomyelitis was expectation for cure. The amputee group chose ablation to avoid further treatment. Differences in psychosocial and functional ability were related to disease diagnosis, pain, status of fracture healing, and timing of amputation.

Adaptation, Psychological↗
PubMed1990

Surgical techniques for conserving tissue and function in lower-limb amputation for trauma, infection, and vascular disease.

Certain factors regarding amputation level, such as the level of traumatic amputation, the position of a malignant tumor in a limb, or the level to which gangrene has progressed, cannot be changed. More important, in this regard, is the attitude of the surgeon toward amputation. This attitude determines the care with which the final level is selected, the manner in which the amputation is performed, and the way in which postoperative management, including prosthetic care, is handled. To achieve the desired long-term result for the amputee, the surgeon should view amputation as a reconstructive procedure rather than a destructive one, should be willing to do staged procedures to preserve potentially functional tissue, should be ready to consider and plan innovative surgical approaches, and should keep abreast of prosthetic advances as they affect surgical technique and postoperative management.

Amputation, Surgical↗
PubMed1990

Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.

Objective criteria can predict amputation after lower-extremity trauma. The authors examined the hypothesis that objective data, available early in the evaluation of patients with severe skeletal/soft-tissue injuries of the lower extremity with vascular compromise, might discriminate the salvageable from the unsalvageable limbs. The Mangled Extremity Severity Score (MESS) was developed by reviewing 25 trauma victims with 26 severe lower-extremity open fractures with vascular compromise. The four significant criteria (with increasing points for worsening prognosis) were skeletal/soft-tissue injury, limb ischemia, shock, and patient age. (There was a significant difference in the mean MESS scores; 4.88 in 17 limbs salvaged and 9.11 in nine limbs amputated; p less than 0.01). This scoring system was then prospectively evaluated in 26 lower-extremity open fractures with vascular injury over a 12-month period at two trauma centers. Again, there was a significant difference in the mean MESS scores; 4.00 for the 14 salvaged limbs and 8.83 for the 12 amputated limbs (p less than 0.01). In both the prospective and retrospective studies, a MESS score of greater than or equal to 7 had a 100% predictable value for amputation. This relatively simple, readily available scoring system of objective criteria was highly accurate in acutely discriminating between limbs that were salvageable and those that were unsalvageable and better managed by primary amputation.

Adult↗
PubMed1990

[Do we amputate too much or too little? A retrospective analysis of the situation in the East Bohemian Region].

A retrospective analysis of 1146 amputations of the lower extremities in five departments of the East Bohemin a region revealed that the number of amputations in the thigh is higher and less frequently preceded by angiographic examination and reconstruction operations of the arteries as compared with distinguished departments abroad. The mortality after amputations was 12.5%. The results call for more intensive training of vascular surgeons and the establishment of vascular surgical departments where it would be possible by early reconstruction operations made in time to prevent amputations or at least shift the height of the amputation in the most distal direction possible.

Amputation, Surgical↗