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PubMed2004

Biphasic modulation of behavioral nociceptive responses by morphine in adult mice after amputation.

Amputation of a segment of the tail produced long-lasting changes in nociception and morphine-induced antinociception. Plastic changes in nociceptive transmission may occur at the spinal cord as well as supraspinal structures after tail amputation. Acute hyperalgesia is detected at the remaining part of the tail as well as hindpaw. Morphine induced facilitation of the hot-plate (HP) response at a low dose and a greater dose of morphine is required to produce complete inhibition of the HP response. Since these effects happen at five weeks after the surgery, tail amputation may serve as a mouse model for studying long-term plastic changes in central nervous system after amputation.

Amputation, Surgical↗
PubMed1992

[Prevalence of diabetes in a 2-year material of amputations in Hordaland].

There are few data available on amputations in Norway. We present data on major amputations in Hordaland county (405,000 inhabitants), western Norway, during a 2-year period. The total number of amputated patients was 16.4 per year per 100,000 inhabitants. This figure is low compared with those of other Scandinavian reports. 34.6% of the patients had diabetes. Smoking is a major risk factor in all groups. Diabetics, smokers and men were younger when amputated than non-diabetics, non-smokers and women.

Aged↗
PubMed2005

The incidence of amputation in diabetes.

The reported incidence of amputation varies enormously between countries, races and communities, but gives an indication of the suffering and costs caused by disease of the foot in diabetes. However, the field is highly complex and interpretation of available data requires great care; many factors underlie the differences which have been reported. Community-wide information is not widely available, and most published work derives from selected populations. Published work is also characterised by lack of consensus in the use of terms such as "lower extremity amputation", "major" and "minor" amputation, as well as by the use of inconsistent criteria for the selection of operations for study. Some publications refer to all operations performed, while others refer to the latest undertaken on any one limb or in any one patient. Incidence may be expressed in terms of either the total (diabetic and non-diabetic), or the "at risk" (diabetic) populations. The former may be useful as a (partial) measure of disease burden in a community, while the latter can be used as an indirect measure of the quality of overall management of diabetes in a population. However, the extent to which either can be used as a measure of the quality of specialist care of an individual presenting with limb-threatening disease is uncertain. Ultimately, an amputation is only a treatment, and in no other medical condition is the number of operations, or other treatments, used as an indication of either disease burden or the quality of care. Quality of care of foot disease in diabetes can, and should, be best assessed in terms of survival, function/incapacity and wellbeing.

Adult↗
PubMed2005

[Incidence and risk factors for non-traumatic lower extremity amputation in hemodialysis patients].

BACKGROUND AND AIMS: The purpose of this study was to assess the incidence and risk factors for non-traumatic lower extremity amputation (LEA) in patients on haemodialysis (HD). METHODS: We investigated our HD population attending our clinic between Jan 1988 and Dec 2002, who had had LEA. Uni- and multivariate analyses were used to determine association of LEA with demographic characteristics such as diabetes, hypertension, smoking, myocardial infarction, stroke, dyslipidaemia, haematocrit, urea, creatinine, calcium, phosphorous, parathyroid hormone (PTH) and albumin levels. RESULTS: Of 516 patients, 20 (3.9%) underwent 32 amputations; 21 major and 11 minor. The incidence was 1. I amputees/100 p-years. There were 11 (10.8%) diabetics and 9 (2.2%) non-diabetics; incidence of 4.2 and 0.6 amputees/100 p-years, respectively. Non-diabetic amputees were older than non-amputees: 68.9 vs 58.2 years (p = 0.013) and had been on HD longer: 71.4 +/- 44 vs 42 +/- 37 months (p = 0.019). There were 60% deaths within the first year of amputation and the causes were 60% cardiovascular. Univariate analysis indicated significant association of LEA with ageing, diabetes, smoking, myocardial infarction, stroke, high cholesterol, and low PTH levels. Multivariate Cox regression identified independent associations of amputation with diabetes, previous myocardial infarction and stroke and/or transient ischaemic attack. CONCLUSIONS: The incidence of LEA in HD patients is very high and is associated with diabetes and previous cardiovascular events. Advanced age and longer time on HD are factors related to LEA in non-diabetics. With increasing numbers of diabetics and older people on HD, new strategies are needed for peripheral arterial disease management so as to avoid its progression to critical ischaemia.

Adolescent↗
PubMed2005

Fillet flap: a successful procedure to preserve the optimum length of below-the knee-amputation stump in congenital constriction band of the leg.

The use of 'spare part' tissue from an amputated segment to cover a stump with soft tissue deficiency is a viable option for augmenting the shape of the stump and preserving functional length of the stump without additional donor morbidity. The procedure requires no microsurgical skill if the tissues are used as pedicle fillet flaps transfer. This concept of fillet flap makes the amputation distal to an unfavourable definitive amputation site such as in congenital constriction band possible. We report herein a case of amputation distal to constriction ring to illustrate the application of fillet flap in reconstruction surgery.

Adult↗
PubMedDate not supplied

[Traumatic vasculo-orthopedic combined lesions: 18-years retrospective evaluation of epidemiology and risks factors for amputation].

This study was undertaken to assess retrospectively the epidemiology and risk factors for amputation of combined vasculo-orthopaedic traumatic lesions, during a 18-year period, from March 1987 to May 2005, comprising the review of the clinical charts of 149 patients. The series includes a predominance of male patients (84%) with an average age of 34 years. Eighty-five per cent of the lesions resulted from traffic accidents (49% velocipedes, 39% automobiles, 12% trampling), 10% were consequence of falls and 5% resulted from agriculture activities. Orthopaedic lesions include 83 fractures of upper limbs (22 open), 123 of lower limbs (67 open), 21 scapulo-thoracic dissociations and 27 knee dislocations. Vascular lesions include 8 subclavian, 20 axillary, 25 braquial, 10 radial, 6 ulnar and 2 diverse, in the upper limbs; and in lower limbs 4 iliac, 27 femoral, 52 popliteal, 5 tibio-peroneal trunk, 5 anterior tibial, 12 posterior tibial and 12 peroneal. Overall mortality was 3.3% and the amputation rate was 17%. Knee dislocations were responsible for one third of amputations, followed by fractures of bone legs. The association of femur to bone legs fractures from one side and of the knee to bone legs fractures from the other, coursed with high levels of amputation, together with lacerations and crushing of the limbs. The prompt diagnosis of the lesions and the immediate, hierarchic and multidisciplinary approach were considered also as relevant prognostic factors in the management of these most demanding conditions.

Adult↗
PubMed2006

Amputation osteoplasty.

Amputation osteoplasty is a technique modification promoted by Ertl to enhance rehabilitation after transtibial amputation. Two different techniques for creating sealing of the medullary canal and a distal bone block have been described in the literature. One technique consists of a periosteal sleeve that is sutured over the cut end of the bone. The second technique consists of hinging a segment of fibula into a slot in the cut end of the tibia. The desired goal of amputation osteoplasty is to create an end-bearing limb to enhance rehabilitation. In addition to creation of a bone bridge, Ertl also recommends myoplasty, neuroplasty, individual vessel ligation, and a special skin closure. This report is a small case series of five patients successfully treated with lower extremity amputation osteoplasty, to illustrate the techniques and report initial good results. Two patients had each of the techniques and one patient had both of the techniques. All five patients had good wound healing, accelerated rehabilitation, and the ability to use end-bearing prostheses.

Adult↗
PubMedDate not supplied

[Sociodemographic factors and their influence on anxiety and depression in patients after limb amputation].

AIM: The aim of this study was to assess the score of HADS and the correlation with sociodemographic factors and personality traits in patients after limb amputation. METHOD: 45 patients after limb amputation due to atherosclerosis and 30 persons from a control group participated in the study. HADS Scale and the Maudsley Personality Inventory created by Eysenck were used in the study. Socidemographic data were collected by means of the Sociodemographic data questionnaire. RESULTS: In comparison to the control group, patients after limb amputation achieved a higher score in HADS-A and HADS-D and in the N scale of the Maudsley Personality Inventory. Higher levels of anxiety and depression were noticed in patients suffering from phantom limb pain and in patients with neurotic personality traits. CONCLUSION: Patients after limb amputation need multidisciplinary care because of higher levels of anxiety and depression (especially patients with phantom limb pain and those with neurotic personality traits).

Adaptation, Psychological↗
PubMed2006

Forequarter amputation of the upper extremity for musculoskeletal tumors: posterior approach revisited.

Forequarter amputation entails surgical removal of entire upper extremity, scapula and clavicle. Several techniques of forequarter amputation have been described. The anterior approach has been the preferred technique of exploration of axillary vessels and brachial plexus. The posterior approach has been condemned to be unreliable and dangerous for most large tumor of the scapula and suprascapular area. We describe a surgical technique using posterior approach of exploration of major vessels for forequarter amputation of upper extremity in eight patients who presented with humeral-scapular tumor. There were six patients with osteosarcoma: three with tumor recurrent and three chemotherapy recalcitrant tumors with vessels involvement. One patient had massive fungating squamous cell carcinoma and another had recurrent rhabdomyosarcoma. Four patients had fungating ulcer and six patients had multiple pulmonary metastases at the time of surgery. The mean estimated blood transfusion was 900 ml (range 0-1600 ml) and two patients did not require transfusion. The duration of surgery ranged 2.5-6.0 hours (mean 3.8 hours). Two patients with known pulmonary metastases required post-operative intensive care monitoring. The mean duration of survival was 5.8 months. The posterior approach of exploring major vessels for forequarter amputation of upper extremity with musculoskeletal tumor is safe and reliable.

Adolescent↗
PubMed1991

[Amputation and arthrodesis of the shoulder joint after brachial plexus lesions].

Nine patients with severe irreversible brachial plexus lesions were submitted to arthrodesis of the shoulder joint and/or amputation of the forearm, the latter with the object of fitting an artificial limb. In one patient, the arm was re-implanted and biceps function of strength M2 was obtained. Three patients were submitted to microsurgical interventions on the plexus. All of the patients were visited in their homes after an average period of observation of three years (1-8 years). Seven patients were equipped with prostheses, three of these with myoelectric prostheses. One patient employed an orthosis and one had been submitted to arthrodesis of the shoulder joint only. Three of the patients were fitted with prostheses 12 years after the accident but nevertheless obtained good prosthetic function. One of these patients had even been fitted with a prosthesis on the non-dominant side. Forearm amputation was chosen in order to control rotation and to avoid projection of the proximal part of the prosthesis up over the shoulder joint. The absent/reduced sensibility at the level of the amputation did not result in pressure problems from the prosthesis. All of the patients used their prostheses. Pain is not an indication for amputation surgery but does not hinder a good functional result.

Accidents, Traffic↗
PubMed1991

[Economic amputations of the lower limbs due to ischemia. I].

The problem relating to leg amputation following ischemia are analysed in the first part of this study, bearing in mind that amputation must be as conservative as possible in order to ensure the best quality of life. Following a short review of the topic and the introduction of recent trends, the case for amputation, which must be early in order to be conservative, is studied. The first part of this article concludes with a discussion of Doppler and clinical evaluations as techniques used to determine the level of amputation.

Amputation, Surgical↗
PubMedDate not supplied

Diabetic foot amputations. Part I: Digital.

Foot lesions in diabetic patients with sensory deficiencies are ignored or not noted by the patients, therefore, leading to major infections of the soft tissue and/or bone. This can be quite devastating with subsequent loss of limb and life-threatening if the extent of the problem is not recognized and prompt treatment initiated. If an amputation is necessary, it should be performed at the lowest level possible. Part I of this series of articles, concerning diabetic foot amputations, will review the pathogenesis, indications, objective vascular criteria, basic surgical principles and complications of diabetic foot amputations. Case reports with various digital amputation procedures and their postoperative care will also be presented in detail. A team approach should be used in the treatment of diabetic foot disorders. The podiatrist, along with admitting internist, leads a team of other specialists including: radiologist, vascular surgeon, infectious disease physicians and plastic surgeon, depending on the progression of foot pathology.

Aged↗
PubMed1990

Traumatic amputation. Mechanisms of injury, treatment, and rehabilitation.

Traumatic amputations are one of many injuries that can occur to the body's musculoskeletal systems. Degloving, partial and total amputations are common types of traumatic injuries. Since traumatic amputations are very life threatening, emergency treatment must be initiated quickly and directed toward profuse blood loss and potential hypovolemia. Not only do traumatic amputees undergo extreme physiological changes, but they must also encounter the psychological trauma of an amputation. Due to a loss of body part(s) and alteration in body image, the amputee often experiences the stages of grieving which may take months and years to resolve. Extensive rehabilitation with the use of an interdisciplinary team approach is one of the most successful ways to return the amputee to the work place. A combination of occupational therapy, physical therapy, vocational rehabilitation and psychological support generally promote a sense of well being and return the traumatic amputee to a level of independence.

Accidents, Occupational↗
PubMed1990

Place of transmetatarsal amputations: a 5-year experience and review of the literature.

A series of 30 patients who underwent transmetatarsal amputation over a 5-year period was analysed. The indications for amputation were gangrene, rest pain and ulceration. The mean age was 75 years and the male to female ratio was 3:2. A higher level of amputation was required in 50% of patients. Of a series of factors analysed for their influence upon outcome (age, diabetes, peripheral pulse status, pre-existing infection, smoking habits, previous digital amputation, prior sympathectomy and/or vascular reconstruction), none had any predictive value in terms of wound healing.

Aged↗
PubMed1989

[Determining the amputation level].

The peripheral amputation level (at the knee or below the knee) is the most important factor in obtaining optimal functional results and reducing the relatively high operative mortality of above-knee amputations in patients with occlusive arterial disease. Measurement of transcutaneous oxygen tension has proved to be a helpful tool for realizing this therapeutic principle. Comparison with another group of amputees without pO2 measurement indicates that the ratio of above-knee to below-knee amputation or knee disarticulation could be changed from 2:1 to 1:4. The reduced number of above-knee amputations also resulted in decreased operative mortality (3.2% vs 11.4%).

Amputation, Surgical↗
PubMed1989

Amputation level and hind limb regeneration in larvae of the Egyptian toad Bufo regularis Reuss: length, volume and rate.

Study of the influence of the amputation level on regeneration length and volume and on the rate of regeneration of the hind limbs of a larval stage of Bufo regularis revealed that, during dedifferentiation and blastema accumulation and growth, the parts regenerating from proximal and distal amputation levels were almost the same length and volume, and grew at the same rate, irrespective of the amputation level. During blastema differentiation and morphogenesis, however, there were significant length, volume and elongation rate differences between parts regenerating from different amputation levels. The results also demonstrated that there was a strong positive correlation between regeneration length and volume, but that the elongation rate was not correlated to regeneration volume.

Amputation, Surgical↗
PubMedDate not supplied

Amputation in the diabetic population: incidence, causes, cost, treatment, and prevention.

Amputation is a complex problem for a patient, the health care system, and the country. Every endeavor should be made to try to reduce the incidence of amputation. The only way this can be done is by identifying the causative problems and designing interventions to solve those problems. The new era of amputation prevention for the patient with diabetes includes the development of comprehensive wound or foot care programs that use state-of-the-art noninvasive vascular testing, quality angiography, distal vascular reconstruction procedures, aggressive infection control, total contact casting as appropriate, use of growth factors to enhance wound healing, use of orthotic shoes to prevent recurrence, and extensive patient education. By implementing these new systems into the health care system, data for amputation incidence hopefully will be reduced in the future.

Adolescent↗
PubMed1987

Amputations in the diabetic foot.

This article presents an overview of the pathogenesis of diabetic foot lesions that lead to lower extremity amputation surgery. The magnitude of this problem is presented together with a brief historical perspective. Indications for "local amputation" of the foot are discussed as well as preoperative noninvasive hemodynamic evaluation of the patient, with determination of level of amputation. Surgical management is covered in detail, with discussion of factors important for amputation wound healing, selection of anesthesia and operative technique, use of tourniquet, and antibiotic considerations.

Amputation, Surgical↗