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PubMedDate not supplied

The influence of intramedullary nailing upon the development of metastases in the treatment of an impending pathological fracture: an experimental study.

An experimental model has been developed in which the effects of a pathological fracture and intramedullary nailing on metastatic spread have been investigated. The endpoint used was the production of lung metastases in rats inoculated intracortically with a rhabdomyosarcoma. We have found that a pathological fracture markedly increases the incidence of lung metastases and that intramedullary nailing, by decreasing the incidence of fractures, decreases the incidence of lung metastases. The surgical procedure itself does not increase the incidence significantly. It is concluded that in metastatic disease prophylactic nailing of an impending pathological fracture is the treatment of choice.

Animals↗
PubMed1975

[Surgical treatment of malignant bone tumors (author's transl)].

The most important therapeutic principles for the surgical treatment of malignant bone tumors are listed, and the technique and value of biopsy are described in detail. General surgical principles of exochleation, resection, amputation, and exarticulation are given. Reconstructuve measures are touched on briefly, and delayed amputation is rejected. Treatment for metastatic disease is described. The most important malignant bone tumors are discussed, together with the most rational treatment for the, including cytostatic and radiation treatment.

Amputation, Surgical↗
PubMed2003

Congenital longitudinal deficiency of the tibia.

We performed a clinical and radiographic review of 15 patients (19 limbs) with longitudinal deficiency of the tibia treated between 1981 and 2001. Ten limbs with Kalamchi type I deficiencies were managed by through-knee amputation. Five type II deficiencies were treated by foot ablation and tibiofibular synostosis, either at the same time or staged, but prosthetic problems may arise from varus alignment and prominence of the proximal fibula. Patients with type III deficiencies (four cases) were treated by foot ablation. Prosthetic problems relating to proximal or distal tibiofibular instability may necessitate additional surgical intervention.

Abnormalities, Multiple↗
PubMed2005

Improvement of a questionnaire measuring activity limitations in rising and sitting down in patients with lower-extremity disorders living at home.

OBJECTIVE: To improve a self-administered questionnaire that includes 42 dichotomous items and measures activity limitations in rising and sitting down (R&S) in patients with lower-extremity disorders who live at home. DESIGN: Cross-sectional study. SETTING: Outpatient clinics of secondary and tertiary care centers. PARTICIPANTS: Patients (N=759; 47% men; mean age +/- standard deviation, 60.7+/-15.2y) living at home, with lower-extremity disorders resulting from stroke, poliomyelitis, osteoarthritis, amputation, and complex regional pain syndrome type I. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: (1) Unidimensionality, indicating that items assess only a single construct; (2) fit with the one-parameter logistic model (OPLM), yielding information about patient and item location parameters; (3) intratest reliability, indicating consistency of patients' item scores; and (4) content validity, indicating completeness with which the items cover the important aspects of the construct that they are attempting to represent. RESULTS: Thirty-nine of 42 items: (1) loaded on 1 component (variance explained, 59%; item component loadings, >or=.51), (2) showed good fit with the OPLM (P=.15), (3) had a good intratest reliability (Cronbach alpha=.96), and (4) had a good content validity (all important aspects represented). CONCLUSIONS: A unidimensional scale that fits with the OPLM has been developed for measuring activity limitations in R&S in patients with lower-extremity disorders who live at home.

Activities of Daily Living↗
PubMed2005

Syme's amputation: a retrospective review of 10 cases.

Amputation at the level of the ankle joint is a valuable, yet underused procedure for a variety of conditions affecting the foot and ankle. The procedure can provide a comfortable and durable stump that allows a lower extremity amputee to function with minimal disability. The indications, surgical technique, and postoperative prosthetic considerations are reviewed and discussed. Emphasis is placed on the preoperative considerations deemed essential for a successful outcome based on the senior author's experience of 10 cases performed for a wide variety of pathologies. Three case illustrations show the efficacy of the Syme's procedure as an alternative to a higher level amputation, such as below-knee amputation or above-knee amputation.

Adult↗
PubMed2005

Lisfranc and Chopart amputations.

The issue of choosing an amputation level can be difficult for physicians. Every attempt should be made to maintain as much pedal length as possible to increase biomechanical function and ambulatory power. When there is excessive soft tissue loss because of trauma, infection, or vascular compromise, a Lisfranc amputation should be considered as a limb-salvage procedure. A more proximal midfoot amputation than Lisfranc is one at Chopart's articulation. This article addresses Lisfranc and Chopart amputations.

Amputation, Surgical↗
PubMed2001

A reappraisal of a modified through-knee amputation in patients with peripheral vascular disease.

BACKGROUND: Through-knee amputation provides a longer lever arm and improved muscle control of the limb compared with above-knee amputation. Through-knee amputation also allows use of a total end-bearing prosthesis, which avoids the ischial pressure and suspension belts required of the above-knee amputation prosthesis. Several reports in the European literature tout the superiority of the through-knee amputation over the above-knee amputation in the patient with vascular disease. Through-knee amputation has received little attention in the United States, however, owing to the belief that the long flaps necessary to close a standard through-knee amputation are associated with an unacceptable rate of wound problems and offer no functional ambulatory advantage to above-knee amputation. We reviewed our experience with a modified technique of through-knee amputation in a group of patients with severe lower extremity ischemia who were not candidates for below-knee amputation to determine the incidence of wound complications and their functional outcome. METHODS: Since 1996, 12 patients with severe lower extremity arterial insufficiency have undergone through-knee amputation utilizing a technique designed to limit flap length and facilitate the fit of a suction prosthesis. Two patients died of myocardial infarction in the immediate postoperative period and were excluded from the study. In the remaining 10 patients (1 man, 9 women; mean age 63 years (range 40 to 86), the below-knee amputation level was precluded because of gangrene or nonhealing wounds of the mid leg in 5 patients, failure of a previous below-knee amputation attempt in 4 patients, and severe ischemia that would compromise below-knee amputation healing in 1 patient. Nine patients had at least one failed vascular reconstruction procedure. RESULTS: Mean follow-up is 25 months (range 6 to 41). Six (60%) patients had primary healing of their amputations. Two (20%) patients had delayed healing (6 weeks and 8 weeks). Two (20%) patients developed wound infections, which required amputation revision to the above-knee level. Seven (70%) patients were fitted with a suction socket prosthesis and are fully ambulatory. One patient healed but has not ambulated because of ischemia and subsequent ulceration of the contralateral limb. CONCLUSIONS: These data show that through-knee amputation is associated with an acceptable primary healing rate (80%) and satisfactory functional outcomes (70% ambulation) in a high-risk vascular population. The functional advantages of through-knee amputation over above-knee amputation make it the preferred alternative for patients with vascular disease.

Adult↗
PubMed1998

Topical capsaicin as an adjuvant analgesic for the treatment of traumatic amputee neurogenic residual limb pain.

The treatment of amputee residual limb pain can at times be a challenge for the physician. Occasionally, traditional analgesic medication regimens cannot be used or are ineffective in relieving the pain. Topical capsaicin cream has been a beneficial adjuvant medication in the treatment of some painful conditions. The authors present three patients with traumatic upper limb amputations where topical capsaicin cream was of benefit in the treatment of neurogenic residual limb pain. The hope is that these cases will increase awareness of the potential use of capsaicin cream as an adjuvant analgesic in patients with residual limb pain. Common causes of residual limb pain and the pharmacology of capsaicin cream are discussed.

Adult↗
PubMed1983

Amputations.

Explore the source record for details and available documents.

Amputation, Surgical↗
PubMed1998

Natural history of congenital arteriovenous fistula.

There is no more difficult lesion to manage than congenital arteriovenous fistula. The advanced lesions are extremely vascular and unless they lend themselves to total excision, prompt recurrence is the rule. For the same reason, embolization is not successful and as the major feeding vessels are occluded, access to the tumor becomes more and more limited. In order to obliterate the tumor, it must be destroyed at the microvascular level. So far, only ethanol has proved effective in this regard, and this agent must be used conservatively to avoid excessive destruction of normal tissue and systemic damage.

Adult↗
PubMed2004

Syme and his amputation.

The study examines Syme's indications for and technique of amputation at the ankle and reviews the outcome of cases operated on by him for the years 1841-1866. Sources are the Ward Journals and the General Registers of Patients of the Royal Infirmary of Edinburgh for the period under review together with abstracts from contemporary medical journals and surgical textbooks. Ninety-eight cases are included in the study, of which 87 survived and 11 died in the post-operative period. The principal indication for this amputation was 'caries' and the nature of this disorder is outlined. Syme's operative technique is described together with variations recommended by other contemporary surgeons. Syme introduced amputation at the ankle joint with the object of reducing mortality and providing a better stump in cases of disease and injury to the foot. The figures from this study conclude that he was justified on both counts.

Ankle Joint↗
PubMed2004

[Primary multicentric cutaneous epithelioid angiosarcoma of the hand. Case report and review of the literature].

CASE: The case of a primary multicentric cutaneous epithelioid angiosarcoma is described. A 39-year-old female patient presented with a tumor on the left distal forearm and the fourth finger of the left hand. Partial amputation of the left hand and local excision of the tumor on the left forearm were performed. For the next three years the patient was free of local or systemic recurrence. After this time period, a left shoulder exarticulation had to be performed because of tumor recurrence in the left axilla. The patient died 64 months after diagnosis. CONCLUSION: Cutaneous epithelioid angiosarcoma is a highly malignant tumor which has only been described once on the hand. The treatment primarily is a surgical one. If possible, the function of the extremity should be preserved as long as possible.

Adult↗