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PubMed1985

The side-to-side flap technique in below-the-knee amputation with long stump.

Wound healing, as well as surgical and prosthetic aspects of the residual limb, was investigated in the below-the-knee amputation using the side-to-side flap technique. Of 23 patients, 74% achieved primary wound healing. The stump length ranged from 27% to 70% of the normal limb, and the mean percentage was 56%. The group with long stumps did not show increased risk of wound complication. All the patients had a nonbulbous dome-shaped stump that posed no prosthetic difficulty. This technique allows the longest possible limb to be preserved, and expenditure of the least amount of energy in ambulation.

Adult↗
PubMed1997

Lower limb amputation and grade of surgeon.

BACKGROUND: The aim of this study was to identify clinical and operative risk factors that might influence the rate of independent ambulation following major limb amputation. METHODS: Between 1989 and 1993, 172 patients had 193 lower limb amputations for peripheral vascular disease: 98 below-knee, 86 above-knee and nine through-knee. RESULTS: The overall revision rate was 13.5 per cent. Revision was significantly more frequent in those patients who had a previous vascular reconstruction. Only 26 per cent of patients were able to ambulate independently after rehabilitation and limb-fitting. Univariate risk factor analysis suggested that independent ambulation was not affected by age, mode of presentation, the presence of ischaemic heart disease, diabetes, smoking status, previous vascular reconstruction or the level of amputation. However, fewer patients whose amputation was performed by a junior trainee could walk with a prosthetic limb (P = 0.03). CONCLUSION: Patients considered suitable for walking training should have amputation performed by a senior trainee or consultant to optimize independent ambulation with a prosthetic limb.

Aged↗
PubMed1995

Prosthetic fitting and ambulation in a paraplegic patient with an above-knee amputation.

The combination of paraplegia with an above-knee amputation is a complex injury that makes the rehabilitation process difficult. This article describes a case of T12 paraplegia and an above-knee amputation. After the rehabilitation course, the patient achieved full ambulatory independence with an ischial containment, contoured adducted trochanteric controlled alignment method (CATCAM) prosthesis and a knee ankle foot orthosis (KAFO). Difficulties in fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed.

Activities of Daily Living↗
PubMed1992

The fate of bilateral lower limb amputees in end-stage vascular disease.

Sixty-six patients with end-stage peripheral vascular disease who had undergone bilateral major amputation of the lower extremities in our institution during the 10-year period January 1980-December 1989 were reviewed. There were 46 males and 20 females with an age range from 34 to 91 years (mean 67.7 years). A 98.5% follow-up was achieved. Of these patients 25% underwent their second amputation in the first, 50% within the second and 75% within the third postoperative year, notwithstanding the fact that prior attempts at revascularisation had been performed in 62% of all patients. The 30-day hospital mortality was 4.5%. The initial level of amputation was metatarsal in 14.4%, below knee in 66.6%, through knee in 9.9% and above knee in 9.1%. Out of a total of 132 stumps 89 healed by primary intention. Following secondary revisions and amputations the final level of amputation was metatarsal in 7%, below knee in 49%, through knee in 14% and above knee in 30%. Survival rates were 62% after 2 years, 31% after 5 years, and 14% after 8 years. By this time all diabetics had died, while 33% of non-diabetics were still alive (p greater than 0.02). Age, sex and amputation level had no bearing upon survival rate. Forty-three patients (65.1%) were ambulatory after their first amputation, but following contralateral amputation barely more than half (23 patients) were able to walk. In the presence of bilateral stage IV disease it is highly important to rehabilitate the patient immediately following unilateral amputation before considering amputation of the contralateral limb, otherwise the patient will not become ambulatory.

Adult↗
PubMed2004

Characterisation of prosthetic feet used in low-income countries.

Eleven kinds of prosthetic feet that were designed for use in low-income countries were mechanically characterised in this study. Masses of the different kinds of prosthetic feet varied substantially. Dynamic properties, including damping ratios and resonant frequencies, were obtained from step unloading tests of the feet while interacting with masses comparable to the human body. Data showed that for walking, the feet can be appropriately modeled using their quasistatic properties since natural frequencies were high compared to walking frequencies and since damping ratios were small. Roll-over shapes, the effective rocker (cam) geometries that the feet deform to under walking loads, were determined using a quasistatic loading technique and a spatial transformation of the ground reaction force's centre of pressure. The roll-over shapes for most of the prosthetic feet studied were similar to the roll-over shape of the SACH (solid-ankle cushioned heel) prosthetic foot. All roll-over shapes showed a lack of forefoot support, which may cause a "drop-off" experience at the end of single limb stance and shorter step lengths of the contralateral limb. The roll-over shapes of prosthetic feet appear useful in characterization of foot function.

Artificial Limbs↗
PubMed2001

Use and satisfaction with prosthetic devices among persons with trauma-related amputations: a long-term outcome study.

OBJECTIVE: To document and examine the use, satisfaction, and problems with prosthetic devices among persons who suffered a trauma-related lower limb amputation. DESIGN: Abstracted medical records and follow-up interview data were collected for a retrospective cohort of persons with a lower limb trauma-related amputation who received their acute care at the University of Maryland R. Adams Cowley Shock Trauma Center, Baltimore, MD, between 1984 and 1994. Patients with spinal cord injury, traumatic brain injury, or only toe amputations were excluded. RESULTS: There were 146 patients identified. Of those, 9% died during the acute admission and 3.5% died after discharge. Seventy-eight amputees were available for interview (68% response rate). The majority of those interviewed were male (87%), and two-thirds had undergone amputation before age 40 yr. Nearly 95% had a prosthesis and wore it an average of 80 hr (SD = 33) per week. Despite high use, only 43% reported being satisfied with the comfort of their prosthesis. About one-quarter of all users reported problems with wounds, skin irritation, or pain. Traumatic amputees used an average of four prostheses since injury, about one new prosthesis every 2 yr. Statistical analyses revealed that males reported higher prosthetic use (P < 0.01). Higher Injury Severity Score negatively impacted on prosthetic use (P < 0.01). Phantom pain negatively influenced reported satisfaction with the prosthesis (P < 0.03) CONCLUSIONS: Although almost all persons living with trauma-related amputations use prosthetic devices, the majority are not satisfied with prosthetic comfort. Phantom pain and residual limb skin problems are also common afflictions in this population.

Adult↗
PubMedDate not supplied

Gait kinematics in below-knee child amputees: a force plate analysis.

A complete gait analysis was performed on six children with below-knee amputations to determine the kinematics and kinetics of amputee gait in children. A relatively new method of analysis--the inverse dynamic relationship--was used to determine the joint moments in the sagittal plane of the joints in the intact limb and the remaining portion of the amputated limb. The joint moments in the sagittal plane of the intact limb in the child amputee were found to be normal or below normal during level walking. From this study, it was concluded that providing a child amputee has a good prosthetic fit, there will be no increased forces across the joints of the intact or amputated limb and consequently no predisposition to premature degenerative arthritis.

Adolescent↗
PubMed2003

A feasibility trial of a prefabricated immediate postoperative prosthetic limb system.

In this feasibility trial, 32 consecutive patients undergoing transtibial or knee disarticulation amputation had application of a prefabricated immediate postoperative prosthesis in the operating room following lower extremity amputation. Partial weightbearing was initiated on the first postoperative day. Twenty-nine underwent primary amputation as a consequence of nonsalvageable gangrene or diabetic foot infection. Others were performed at the time of wound closure following traumatic amputation for a crushed extremity and one was performed for an infected nonunion of the tibia and fibula. Seventeen of the 29 patients with diabetes were insulin dependent. Nine patients required renal dialysis and were diagnosed with concurrent malnutrition. Twenty were male and 12 were female, with an average age of 61.6 (range, 42-90) years. The average time to custom prosthetic limb fitting was 8.1 (range, 4-16) weeks. This preliminary experience with a commercially available pneumatic immediate postoperative prosthetic limb system supports its role in the early rehabilitation of lower extremity amputees.

Adult↗
PubMed1992

Lower-limb proprioception in above-knee amputees.

A proprioception measurement system was designed and constructed to evaluate lower-limb knee joint proprioception in ten above-knee amputees. The system permitted the testing of subjects in a position simulating late swing phase of gait. The threshold for detection of slow passive motion and the ability to reproduce specified lower-limb positions were recorded for the sound and the prosthetic limbs of the subjects. A significant difference was detected between prosthetic and sound limb passive motion detection threshold; however, no difference was found between prosthetic and sound limb passive motion reproduction. This finding suggests the importance of hip joint motion appreciation in the amputees' proprioception of the prosthetic knee joint when these motions are associated. Prosthetic limb passive motion reproduction error decreased with age, suggesting that the amputees may improve their ability to use remaining lower limb proprioceptive mechanisms to compensate for the loss of anatomic knee joint structures.

Adult↗
PubMed1984

An old Cornish hand.

A wooden upper limb prosthesis, made c.1601, is illustrated with its documentation. It has remained in the possession of the descendants of its original wearer.

Artificial Limbs↗
PubMed2006

Limb deficiency and prosthetic management. 3. Complex limb deficiency.

UNLABELLED: This self-directed learning module highlights rehabilitation and prosthetic issues associated with complex limb deficiencies. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses rehabilitation and prosthetic management of patients with amputations for complex limb deficiencies secondary to trauma. Mechanisms of injury, prosthetic issues, prosthetic components, and potential problems in prosthetic fitting will be discussed. OVERALL ARTICLE OBJECTIVE: To evaluate common problems associated with complex limb deficiency.

Adult↗
PubMed1994

Phantom limb experiences in congenital limb-deficient adults.

This case report describes phantom limbs in four adults with congenital limb deficiency. Case 1, with congenital absence of the left arm below the elbow, received a minor injury of the stump at age 16 and subsequently developed a full-length phantom arm, hand and fingers. Cases 2 and 3, at the ages of 26 and 30, underwent minor surgery of the lower limbs and subsequently developed vivid, full-length phantoms of their legs. Case 4, aged 31, was born with a shortened and deformed right leg, and underwent amputation of the foot and deformed part of the leg at age 3. Beginning at age 6, she developed a full-length phantom leg and foot that touched the floor, which persisted for more than 20 years. The descriptions by these four adults lend credibility to earlier reports of phantom limbs in congenital limb-deficient children. They also indicate that these phantoms may persist into adulthood.

Abnormalities, Drug-Induced↗
PubMed1995

Psychosocial consequences of upper limb injury.

Upper limb surgeons have little in the way of training in the identification or management of the psychological aspects of limb injury. Surgeons in training tend to see their specialty in technical terms, only slowly appreciating that the psychological state of the patient profoundly affects outcome in many cases. The case report that follows charts the psychological progress of a patient following severe upper limb injury. Surgeons usually view rehabilitation in physical terms. This report emphasizes the psychological aspects of a major limb injury to a policeman (MP) who subsequently studied psychology at PhD level.

Adaptation, Psychological↗
PubMed1999

Psychological adjustment and coping in adults with prosthetic limbs.

The potential mediating effects of different coping strategies on the adjustment to living with a prosthetic limb were investigated in 44 adult amputees. Participants completed a questionnaire inquiring about coping, pain, emotional well-being, demographics, and disability-related variables. The coping strategy adopted and the extent of the adjustment to the prosthetic limb varied with age, site of limb loss, and cause of amputation. Furthermore, coping style mediated the adjustment to wearing a prosthetic limb. The results are discussed in terms of future applications and research.

Adaptation, Psychological↗
PubMedDate not supplied

Prosthetic use in patients with burns and associated limb amputations.

A review of 11 patients who sustained burns that were complicated by limb amputation was completed to determine their eventual ability to use prosthesis. Amputations included six below-elbow, four above-elbow, three below-knee, and three above-knee amputations. Ten of the 11 patients (91%) had open wounds on the stump limbs and nine patients (82%) required skin grafting procedures on the amputated limbs. Delays in prosthetic fitting because of continued surgeries, open wounds, skin grafts on the stump limb, and breakdown of the stump were identified. However, eight of these patients (73%) were eventually able to wear prosthetic devices. Fisher's exact test was used to test the influence of the number and site of the amputations and skin grafting on the stump on successful prosthesis use. None of these tested items were found to be significant. The results demonstrate that most patients with burns who require limb amputation can achieve successful prosthesis use.

Adult↗
PubMedDate not supplied

Rehabilitation and orthotic management of congenital and acquired meromelia in the lower limbs of children.

Children with limb deficiencies or amputations of the lower extremities should be enabled to stand or walk according to their state of development, because standing and walking are among the most important preconditions for the best possible integration. Supplying them with a prosthesis, orthosis and orthoprosthesis is therefore indispensable for rehabilitation. While a prosthesis replaces parts of the extremities, an orthosis stabilizes the existing extremity. Orthoprostheses compensate longitudinal malformations, have a supporting effect, allow growth to be controlled and compensate for shortening. Just as important as the remedy is early medical treatment. The medical team taking care of the patient works out a treatment plan where responsible cooperation with the parents is of utmost importance. The focus of all efforts is, of course, the handicapped child. Examples are used to demonstrate the course of successful rehabilitation of children and adolescents with damaged limbs. Equally the psychological situation of the parents and child is taken into consideration.

Activities of Daily Living↗
PubMed2000

Upper extremity socket design options.

A careful evaluation of the amputee's physical situation is necessary to determine the best available prosthetic options. Evaluation of the psychologic and vocational needs are needed to determine the most appropriate designs. Other factors, such as hobby and sport activities, need to be determined to complete the prescription. Because the function of a prosthesis cannot restore all of the lost capability of the missing limb, every effort should be taken to provide the best available substitute by careful prescription, design, and construction.

Activities of Daily Living↗
PubMed2000

[Three-dimensional finite element analyses on the transtibial residual limb and its prosthetic socket].

This paper presents a method for developing a nonlinear finite element model to analyze the load transfer between the transtibial residual limb and its prosthetic socket. The model was developed on the basis of three-dimensional geometry of the residual limb, internal skeleton, soft liner and socket. Interface elements, were used to connect the skin and the liner to simulate the friction/slip boundary conditions. The analyses were performed in two steps to simulate the donning procedure and the load-bearing situation. The model can be used to predict the pressures, shear stresses and slip between the residual limb and its socket under different external loads. Four models with different degrees of socket rectifications were analyzed.

Artificial Limbs↗