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PubMedDate not supplied

[Prosthetic management of the elderly following amputation of the lower extremities].

We report on 162 patients with one- or two-sided amputations above the ankle joint. Seventy-nine percent of these patients were candidates for artificial limbs; substantial differences are shown in respect to the height of the amputation: there are considerably more patients who can use a prosthesis after a lower leg amputation than after one- or two-sided upper leg amputation. Counterindications for prostheses were, on the whole, principally arterial scleroses. As expected, almost 95% of the one-side amputees, and approximately 100% of the (considerably younger) both-side amputees were discharged from hospital with a degree of self-sufficiency. Some of the patients not provided with an artificial limb were able to return home as well (87.5%). Absolute independence was seldom reached and social assistance had to be arranged for many amputees.

Activities of Daily Living↗
PubMed1988

Transcutaneous oxygen tension as a predictor of success after an amputation.

We measured local transcutaneous oxygen tension at the foot and proximal and distal to the knee in 162 patients who then had 206 amputations. When the values for oxygen tension at the foot and distal to the knee were compared with the success or failure of healing after an amputation of the foot or distal to the knee, respectively, a clearly increasing probability of failure was correlated with decreasing transcutaneous oxygen tension. However, even at a tension of zero the probability of failure was not 100 per cent. The results were similar for diabetic and non-diabetic patients. Preoperative values for transcutaneous oxygen tension were a much more consistent predictor of success or failure of healing after an amputation of the foot or distal to the knee than were measurements of systolic blood pressure at the ankle, but neither was predictive of the outcome after an above-the-knee amputation.

Amputation, Surgical↗
PubMed1987

New bone formation at amputation sites in electrically burn-injured patients.

Sixty-one amputation sites in 43 electrically injured men were examined for significant new bone formation. Twenty-eight amputations were classified as long bone (6 above knee, 4 below knee, 4 above elbow, 14 below elbow); 28 small bone (9 hand or finger and 19 foot or toe); and 5 disarticulations. Significant new bone formation occurred at the amputation site in 23 (82%) of the 28 long bone cases, but none occurred in the small bone or disarticulation cases. This difference was significant at the 0.0001 level (chi square = 40.53, 2 df). Fourteen (78%) of upper and nine (90%) of lower extremity sites had significant new bone formation. The average time from amputation to diagnosis of new bone was 38 weeks, range from 5 to 110 weeks. Eight of these 23 patients required surgical revision of the stump and/or revision or reconstruction of their prosthesis. Clearly, the ability to predict new bone formation in electrical burn amputees has important clinical and economic applications.

Adolescent↗
PubMed1985

Uses of transcutaneous oxygen monitoring in the management of below-knee amputations and skin envelope injuries (SKI).

Conventional noninvasive hemodynamic techniques may fail to predict reliable healing of skin envelope injuries (SKI) in determining the site and timing of late amputations and the probability of healing of SKI following revascularization of ischemic extremities. This study reports the use of multiple transcutaneous oxygen mapping as performed in a cohort of 12 limbs requiring below-knee amputation (Group I), 21 patients requiring revascularization for SKI with prompt healing (Group II-A) or delayed healing (Group II-B), and 14 patients with nonischemic SKI (Group III) who also experienced healing. PtcO2 values greater or equal to 25 mm Hg were associated with healing of below-knee amputations, while early or late healing complications occurred when amputation flap PtcO2 was less than 25 mm Hg. PtcO2 mapping demonstrated significantly lower (PtcO2 less than 20 mm Hg) values surrounding nonhealing SKI in Group II-B compared to Group II-A and III. These nonhealing SKI appear as "Islands of Ischemia" following revascularization, despite adjacent normal pedal PtcO2 values. These "Islands" tend to occur in diabetic patients with advanced pedal atherosclerosis.

Aged↗
PubMed1984

A new approach to the use of the Krukenberg procedure in unilateral wrist amputations. An original functional-cosmetic prosthesis.

A new therapeutic approach based on the Krukenberg procedure for patients with wrist amputations, together with a functional-cosmetic prosthesis, is described. The indications for this surgery are modified since the operation was originally designed for patients with bilateral wrist amputations or for the blind patient with a unilateral or bilateral amputation. This new approach is based on personal observations and studies of the socioeconomic condition of many amputated patients in Venezuela who reject the use of a conventional prosthesis or orthesis.

Adult↗
PubMed1978

Cutaneous blood flow and its relation to healing of below knee amputation.

Twenty-six patients undergoing below the knee amputation for ischemic disease of the lower part of the leg had skin blood flow determinations made at the level of the amputation. Flow was measured using the 133Xe clearance technique preoperatively as well as at four and eight weeks after amputation. Amputation was performed using the standard long posterior flap technique, and patients were treated with either an immediate postoperative prosthetic fit or a controlled environment treatment system. Healing occurred primarily in 19 patients; a local below the knee revision was required in two and an above the knee revision in one patient. Flow was lower than in the nondiseased control group in almost all instances preoperatively, but no definite level below which healing would not occur was identified. Postoperatively, skin flow increased in all instances and had reached levels equal to that for the normal control group by eight weeks or sooner. This suggests that, in many instances of nonhealing, local below the knee revisions may be successful without requiring the higher above the knee procedure. No significant differences were noted between patients with diabetes and those without diabetes or either method of postoperative treatment in terms of healing or cutaneous flow.

Adult↗
PubMed1984

Syme amputation in children: indications, results, and long-term follow-up.

Syme amputations are not always effective. Heel pad migration, skin sloughs, and problems with prosthetic fitting may complicate a seemingly simple procedure. We reviewed 69 Syme amputations performed in 62 children at the Los Angeles Shriners Hospital between 1956 and 1980. The major indication was leg length discrepancy, due to either paraxial fibula hemimelia (33 cases) or proximal focal femoral deficiency (19 cases). The average age at amputation was 5.6 years, with an average follow-up of 10.5 years (range 1-25 years). The results were assessed by a combination of chart review, patient recall examinations, and questionnaires. Satisfaction in adulthood was high. Early complications included three skin sloughs and one infection. Late complications included 2 retained os calcis apophyses, 1 exostosis, and 16 cases of heel pad migration. Only one of the heel pad group required revision; prosthetic adjustment resolved the others. Prosthetic knees were often too low because of failure to limit the length of the stump appropriately. Syme amputation should be considered a primary reconstructive procedure, rather than a last resort, in fibula hemimelia and proximal femoral focal deficiency.

Adolescent↗
PubMed1984

[A report of self-amputation of the penis with subsequent complication of myiasis].

A 38-year-old male was admitted to our emergency ward on Oct. 27, 1982, because of severe pain at his penoscrotum. Upon physical finding on admission, his penis was found to have been completely amputated 2 cm distally near the root with a razor by himself to commit suicide a few days before admission. On the affected part were much coagulated blood mass and slough and moreover there were 50 maggots about 5 mm long swarming and wrigling, but no bleeding yet and little sign of inflammation. After exclusion of these maggots and cleaning the slashed surface, cutaneous urethrostomy was performed. Postoperative course was favorable but we could not prevent the patient from leaping to his death 45 days after the operation. Self-amputation of the penis with subsequent complication of myiasis is a very rare condition. Since the report of self-amputation of the penis by Matsushita in 1937, this case is the 16 th in Japan. In most cases the patients had mental disorder. In this case the patient was schizoid. On the other hand, 133 cases of myiasis were reported in Japan from 1903 to 1983. In the present case the species that caused myiasis was Lucilia ampullacea. A very rare case of self-amputation of the penis with subsequent complication of myiasis is documented with a review of the literature on this subject.

Adult↗
PubMed1984

Immediate, early, and late postsurgical management of upper-limb amputation.

This series is composed of 47 patients who underwent immediate, early, or late postoperative prosthetic fitting after upper-limb amputation. The purpose of this review was to analyze the impact of rapid postoperative fitting on upper-limb amputation, and to assess general prosthetic prescription and guidelines for upper-limb amputees. It would appear that in adult amputations there is a "Golden Period" of fitting for upper-limb prosthetic devices and this period appears to be within the first month after amputation. There appears to be no difference in ultimate prosthetic acceptance rate or use patterns as a function of the type of prosthesis initially provided. Based upon this combined review between the Tucson and Atlanta VA Medical Centers, the authors would suggest that all upper-limb amputees be fitted as rapidly as possible (within 30 days) with conventional prosthetic devices, and when they have shown motivation and skill in the use of conventional devices, then to re-evaluate them for appropriate externally powered prosthetic components.

Adolescent↗
PubMed1983

Doppler-determined segmental pressures and wound-healing in amputations for vascular disease.

One hundred and two diabetic and non-diabetic patients with severe vascular disease of the lower extremities were studied in the vascular laboratory at the Mayo Clinic prior to amputation. The level of amputation was chosen on the basis of clinical findings alone. Sixty-seven of the amputations were the classic below-the-knee type. The tests performed included determinations of segmental systolic pressures of the arm, thigh, calf, and ankle determined with the Doppler ultrasonic velocity detector. Contrary to other reports, we found no demonstrable relationship between calf pressure or calf-arm pressure index and the degree of healing of below-the-knee amputations in diabetic or non-diabetic patients.

Adult↗
PubMed1982

Segmental transcutaneous measurements of PO2 in patients requiring below-the-knee amputation for peripheral vascular insufficiency.

An accurate method is needed to quantitate the healing potentials of the possible sites of amputation in dysvascular limbs. We evaluated the segmental transcutaneous measurements of PO2 in thirty-seven patients who required below-the-knee amputation because of peripheral vascular insufficiency. The fifteen patients with below-the-knee transcutaneous PO2 values of forty millimeters of mercury or more had no delay in healing of the below-the-knee amputation. Seventeen of nineteen patients with values of more than zero but less than forty millimeters of mercury had healing at the below-the-knee level, in two after local revision. The three patients who had below-the-knee values of zero required re-amputation above the knee.

Aged↗
PubMed1982

Clinical criteria and ankle pressure measurements in predicting healing of below-knee amputations.

Since the ultimate success or a below-knee amputation depends upon preoperative, intraoperative and postoperative factors, it is not surprising that success or failure is difficult to predict on the basis of assessment of a single preoperative variable. In this study, discriminant function analysis was carried out on data obtained prospectively from 33 patients who had below-knee amputation. It showed that, by using the level of ankle systolic pressure and the severity of diabetes and of infection as discriminators, patients could be divided quite accurately into two groups - those whose amputation would be successful and those whose amputation would not. The study also showed that by using multivariate analysis to construct a single index of prediction, success can be forecast with a reasonably high degree of accuracy. Multivariate analysis is more accurate than the single-variate method.

Amputation, Surgical↗
PubMed1982

Factors affecting the results of below knee amputation in patients with and without diabetes.

During a five year period, 113 below knee amputations were performed upon 100 patients. Multiple factors were examined for the effects on wound complication and reamputation rates. Healing without reamputation occurred in 91.9 per cent of those in the diabetic group and in 76.5 per cent of those in the nondiabetic group, p less than 0.05. Cellulitis of the foot did not significantly affect healing below the knee in patients with diabetes, 82.5 per cent with cellulitis versus 87.5 per cent without cellulitis, p greater than 0.05, but did affect healing in those in the nondiabetic group, 81.8 per cent success versus 66.7 per cent, p less than 0.05, and affected their minor wound complication rate, 50.0 per cent with cellulitis versus 26.5 per cent without cellulitis. Absence of femoral pulses uniformly predicted a nonhealing below the knee amputation in patients with cellulitis, whereas in patients without cellulitis, healing occurred in 85 per cent. Hemoglobin levels were inversely proportional to success rates only in patients with diabetes and cellulitis, 10.54 +/- 1.68 versus 12.85 +/- 2.30 grams per deciliter for failures, p = 0.016. Elevated white blood counts were predictive of failure to heal below the knee amputations only in those in the nondiabetic group without cellulitis, 10,110 +/- 3,200 cells per millimeter3 for success versus 13,750 +/- 3,300 cells per millimeter3 for failures, p = 0.018. Use of wound drains correlated with a 55.0 per cent wound complication rate versus 16.1 per cent when drains were not used. Wound complications were minimized when amputations were closed with subcuticular suture and skin tapes.

Amputation, Surgical↗
PubMed1982

Preservation of upper extremity devascularizations and amputations for replantation.

Cooling the amputated part and the partially amputated devascularized extremity is critical for a successful replantation attempt. Cooling devascularized or amputated tissue is the simplest and most effective method for preventing the detrimental effects of ischemia. Successful microsurgical revascularization begins with proper treatment in the local referring emergency room. Proper care and transportation of the patient and his devascularized or amputated extremity are essential.

Amputation, Traumatic↗
PubMed1995

[Preoperative determination of optimal amputation level in end-stage arterial occlusive disease].

For the preoperative determination of the amputation site in occlusive arterial disease of the lower extremity (i.e. healing by first intention in spite of a peripheral amputation level below the knee or at the knee) we developed a score by analyzing 500 patients with 523 amputations retrospectively. By means of a prospective study (100 consecutive lower limb amputations) this score has proved to be a helpful tool for realizing our therapeutic principle.

Amputation, Surgical↗
PubMedDate not supplied

Replantation and amputation of digits: user analysis.

There now is extensive literature on the survival and function of replanted digits but little on the function of the hand as a whole after this procedure, as opposed to amputations. In our review of the literature, we found almost nothing on the patient's perspective of the outcome from these procedures. This study was a preliminary attempt to study the outcome of these procedures from the patient's viewpoint. There were nine replantations and ten amputations of digits in the final study groups, based on medical record screening and patient questionnaires. Multivariate analysis, Hotelling T2, was used to test significant differences between the variables in the two groups. Significant differences were found in the two groups. The replantations had longer lengths of treatment and therapy, were off work longer (34.4 wk of therapy and 40 wk off work), and rated their function poorer compared with amputations. The patients with digit amputations had 7.2 wk of therapy and lost 6.8 wk of work. Ninety percent of the amputees rated their function as good or excellent, in contrast to 44.4% of the replantation patients. These findings are supported by existing literature that suggests that single-digit replants do not help with function of the whole hand, which is the therapeutic aim.

Absenteeism↗
PubMed1994

[Indication and choice of amputation level of the lower extremity in obliterative vascular diseases].

The work substantiates the indications for amputation of the lower limb in patients with obliterating diseases of the vessels. The main among them are progressive gangrene and decompensated ischemia of the limb in impossible performance of a restorative operation. It is pointed out that the level of the amputation should be chosen according to the condition of collateral circulation. Ultrasonic examination based on Doppler effect, allowing measurement of regional systolic pressure, is of principal significance in its evaluation. Analysis of the results of amputations in 111 patients with consideration for the value of regional systolic pressure showed that in 61 (51%) patients the amputation was performed through the leg or foot with immediate favorable results.

Amputation, Surgical↗
PubMed1994

[Teat amputation in cattle--indications, surgical results and economy].

Based on the experience gained after the performance of 204 teat amputations with complete closure of the wound, medical as well as economic aspects were discussed. Various types of severe teat injuries leading to a teat amputation were listed. Surgery was successful in 94.6% of all animals subjected to the teat amputation. Approximately 50% of the animals had a reproductive life span after surgery of more than one year. The most common reasons for culling were inconvenience at milking and insufficient milk yield. The milk yield during a lactation period dropped by an average of 5.5%. Cost efficiency of the procedure was evaluated by partial budgeting. The result of this analysis suggested that in most cases, from the economic standpoint of view, there might be an indication for teat amputation.

Amputation, Surgical↗