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PubMedDate not supplied

Computer-supported identification and intervention for diabetic patients at risk for amputation.

We used the fully automated medical record system at Kaiser Permanente of Ohio to direct appropriate interventions to diabetic patients at risk for amputation. The computer identified all patients with a diagnosis of diabetes, reminded physicians, at the moment of care, of the need to enter the patient's risk status for amputation, and kept track of patients at medium or high risk for amputation who were due for an evaluation with education in the podiatry department. Two years and four months after activation of this reminder system, the risk level had been determined for 76% of the diabetic population (n = 10,000), and two thirds of those at medium or high risk had received the appropriate intervention. In patients in the medium and high risk groups, the risk ratio for amputation was 17.5.

Amputation, Surgical↗
PubMed1998

Anatomical and histological observations of fore- and hind limb toes in adult mice after amputations performed at the age of two weeks.

Amputation of fore- and hind limb toes in order to numerically identify mice, although an effective and conditionally accepted method, is an ethical issue because of the pain involved and because of the detrimental long term side effects that may be encountered. In transgenic mice sacrificed between the ages of 1 and 1-1/2 y, and in which toe amputations were performed at the age of 2 wk, we observed anatomical (n = 60) and histological (n = 10) changes in bones and soft tissues. In stumps, meduallary cavities of sectioned phalanges became sealed and, therefore, some regrowth must have occurred distal to the amputation plane. However, an important increase in width is seen in the diaphysis of transected bones (P < 0.001) when compared to normal phalanges. Normal epidermis-dermis reorganisation occurred in the stumps. Therefore, when considering solely detrimental long-term side effects related to bone growth and tissue reorganization, toe amputations to numerically identify mice seems an acceptable procedure.

Amputation, Surgical↗
PubMed1986

Effects of denervation and delayed amputation on forelimb regeneration in Xenopus laevis froglets.

Left forelimbs of postmetamorphic Xenopus laevis froglets were repeatedly denervated prior to and following amputation. Amputations were performed 14, 21, 28, or 42 days after the original denervation. A tissue-regenerative response resulting in the formation of a spike-shaped, heteromorphic outgrowth was found in the sham-denervated and control animals, but dedifferentiation of the stump tissues was not apparent. Tissue-regenerative outgrowths were not observed in the denervated cases; instead, dermal wound healing and stump and scar formation occurred. In both control and experimental cases, however, a periosteal proliferative response to amputation injury led to the development of a greatly thickened periosteum the length of the amputated radius-ulna as well as a cap of cartilage at the distal end of these bones. We conclude from these results that forelimbs of postmetamorphic froglets are incapable of adjusting to a prolonged nerveless state sufficient to allow the normal tissue-regenerative response of spike outgrowth formation.

Animals↗
PubMed2006

Level-adjusted perioperative risk of sacral amputations.

BACKGROUND AND OBJECTIVES: Sacral amputations above the S2 body often involve increased surgical complexity leading to long-term morbidity. The purpose of this study was to determine whether proximal sacral amputations have substantially higher perioperative morbidity compared with more distal sacral amputations. METHODS: We evaluated the effect of sacral amputation level on perioperative outcomes within 90 days of surgery. Outcome measures included blood loss, intensive care unit (ICU) and hospital stay, hospital cost, and incidence of a major and minor morbidity. Survival analyses were adjusted for the level of resection and histological appearance. RESULTS: Thirteen proximal and 14 distal resections were performed. In comparing proximal versus distal resections, median estimated blood loss was 4 L versus 1 L (P < 0.001), ICU stay was 4 days versus 0 days (P = 0.012), hospital stay was 19 days versus 8 days (P = 0.001), hospital cost was 28,800 dollars versus 7,500 dollars (P = 0.003), with one or more major complications in 85% versus 29% (P = 0.011). Survival analysis demonstrated that the sacral resection level did not influence survival (P = 0.936), whereas the type of tumor did influence survival (P = 0.012). CONCLUSION: Tumor resections above S2 demonstrate increased perioperative morbidity, suggesting that proximal osteotomies be reserved for patients with a realistic cure potential.

Adenocarcinoma↗
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↗
PubMed2006

Hip and knee frontal plane moments in persons with unilateral, trans-tibial amputation.

Persons with unilateral, lower-extremity amputation are at risk of developing osteoarthritis in their intact limb. Among persons without amputation, knee osteoarthritis disease severity has been linked to elevated frontal plane knee moments. Therefore, the purpose of this study was to examine knee and hip frontal plane moments in persons with unilateral, trans-tibial amputation. We hypothesized that knee and hip internal abduction moments are greater in the intact limb compared to the prosthetic side. Three-dimensional gait mechanics were measured bilaterally from 10 persons with unilateral, trans-tibial amputation during walking to calculate lower-extremity joint moments. The intact limb knee and hip peak internal abduction moments were 46% and 39% greater, respectively, than on the prosthetic side. The intact side knee and hip peak internal abduction moments were 17% and 6% greater, respectively, than normal. Larger moments suggest joint loading is of higher magnitude on the intact side, which may be predisposed to premature joint degeneration, particularly knee osteoarthritis.

Adult↗
PubMed2000

Influencing factors and ambulation outcome in patients with dual disabilities of hemiplegia and amputation.

OBJECTIVE: To determine the ambulatory outcome and predictive factors of successful ambulation training in patients with both hemiplegia and lower extremity amputation. DESIGN: A retrospective study. SETTING: A rehabilitation center of a university hospital. PATIENTS: Twenty-three patients with dual disabilities consecutively admitted to the rehabilitation center from 1984 to 1994. MAIN OUTCOME MEASURES: Ambulatory outcome was measured using physical therapists' and physicians' notes at discharge or the last available clinical visit. Ambulation ability was graded as community and noncommunity ambulation, which included indoor ambulation and nonambulation. Several clinical features were reviewed to assess their association with ambulation outcome. RESULTS: About two thirds of the 23 patients could be trained to be ambulatory: 10 (43.8%) achieved community ambulation and 5 (21.7%) achieved indoor ambulation. Of the clinical factors, only mental status showed a statistically significant association with good ambulation outcome (p<.05). When odds ratios were considered, several factors, including mild motor involvement, transtibial amputation, amputation before cerebrovascular accident, age younger than 60 years, and the presence of ipsilateral hemiplegia and amputation, showed trends toward association with increased ambulation achievement, although these associations were not statistically significant. CONCLUSION: Impaired mental status seemed to be the most influential negative predictive factor of achieving community ambulation. If subjects with dual disabilities are properly selected, satisfactory results of ambulation training will be obtained.

Aged↗
PubMedDate not supplied

Cecal amputation within the right ventral colon for surgical treatment of nonreducible cecocolic intussusception in 8 horses.

OBJECTIVES: To report a surgical technique for treatment of nonreducible cecocolic intussusception and outcome in 8 horses. STUDY DESIGN: Retrospective study. ANIMALS: Eight horses with nonreducible cecocolic intussusception treated by cecal amputation through a right ventral colotomy. METHODS: Data were obtained from medical records and telephone conversations by using a standardized questionnaire. The large colon was exteriorized and, if necessary, evacuated of its contents through a pelvic flexure enterotomy. A second colotomy was made on the ventral surface of the right ventral colon (RVC) centered over or immediately distal to the intussusceptum. In most horses, attempts to manually reduce the intussusception by pushing the cecum from within the RVC through the cecocolic orifice were unsuccessful. Invaginated cecum was then pulled into the RVC and amputated; the cecum was either ligated with umbilical tape or sutured proximal to the site of amputation. After amputation, the remainder of the invaginated cecum was reduced. After further resection to healthy tissue, the typhlectomy was closed with a double-inverting suture pattern. RESULTS: The median horse age was 2 years (range, 1 to 8 years). Duration of colic ranged from 6 hours to 6 months. Median surgical time was 180 minutes (range, 135 to 300 minutes). Median duration of antibiotic therapy was 7 days (range, 5 to 14 days). Median duration of hospitalization was 12 days (range, 6 to 21 days). All horses survived to hospital discharge. One horse died 3 months postoperatively; however, the remainder survived (median survival, 30 months; range, 6 to 96 months) and returned to or exceeded previous function. CLINICAL RELEVANCE: Despite some contamination during surgery, horses with nonreducible cecocolic intussusception that underwent this method of surgical treatment had a good prognosis.

Animals↗
PubMedDate not supplied

Penile amputation and sheath ablation in the horse.

OBJECTIVE: To report a surgical technique for penile amputation and sheath ablation in horses. Study Design-Retrospective study. Animals or Sample Population-Twenty-five adult geldings of various breeds with conditions requiring penile amputation and sheath ablation. METHODS: The medical records of horses that had penile amputation and sheath ablation were reviewed. Briefly, the technique involved en bloc resection of the skin and subcutaneous tissues of the inner and outer lamina of the prepuce and penile shaft. Resection of the penile shaft, proximal to diseased segments, and spatulation of the urethral mucosa was followed by fixation of the penis to the ventral abdomen and closure of the peripreputial skin over the ventral aspect of the penis and creation of a new mucocutaneous junction at the urethral orifice. RESULTS: Mild to moderate postoperative hemorrhage occurred in all horses. Partial dehiscence of the mucocutaneous junction occurred in 8 horses; all healed by second intention. Postoperative pain lasting 24 to 48 hours occurred in 7 horses; 1 required epidural analgesia for pain relief. Long-term follow-up was available for 8 horses; none had any long-term complications. CLINICAL RELEVANCE: Partial amputation of the penis with pexy to the ventral abdomen and revision of the peripreputial skin can be used as an alternative to en bloc resection and penile retroversion for lesions involving the free part of the penis and the prepuce. It requires smaller incisions and results in less alteration to the normal appearance of the external genitalia than retroversion techniques, while still allowing the surgeon to remove extensive portions of the penis and extirpate the regional lymph nodes.

Animals↗
PubMed2006

Amputation neuroma following a circumcision: a case report.

We present a case of neuroma formation following the circumcision of an 11-year-old boy. Amputation neuroma is an extremely rare clinical finding. In the literature only a few cases of amputation neuroma have been reported, mainly located in the biliary tract, in the cystic duct, or in the main hepatic duct after cholecystectomy [1, 4, 8]. There are also few reported cases localised at the orbit, on the great auricular nerve [2], and in the neck after radical neck dissection for oral cancer [5, 7]. Neuroma formation has also been reported after digital amputation [6]. The only reported case of genital amputation neuroma is in a 27-year-old infibulated African woman [3].

Child↗
PubMed2001

Giant intrasacral cellular schwannoma treated with high sacral amputation.

STUDY DESIGN: A case report of a man with a gigantic cellular schwannoma in the sacrum treated with high sacral amputation accompanied by careful nerve root-sparing dissection. OBJECTIVES: To describe the atypical clinical course of an intrasacral cellular schwannoma and the surgical procedure of high sacral amputation performed in a way to prevent needless sacrifice of functionally essential nerve roots. SUMMARY OF BACKGROUND DATA: Fundamentally, a cellular schwannoma is a benign tumor, but the clinical course is atypical. The symptoms are mild and the clinicopathologic features often mislead us to make a diagnosis of malignancy. The occurrence rate of intraosseous cellular schwannoma was reported to be 0.2% of all bony tumors, and the main location was the retroperitoneal space in the pelvis. Forty-one cases of giant intrasacral schwannomas have been reported so far. Among them, large sacral schwannoma with anterior cortex erosion and associated intrapelvic extension was extremely rare. METHODS: The patient presented with a 5-year history of right leg and buttock pain, which did not disturb his daily activities. After a histopathologic diagnosis and a complete set of image studies, high sacral amputation with preservation of uninvolved nerve roots was performed at S1-S2 through a combined anterior and posterior approach. Both S1 nerve roots and the right S2-S3 nerve roots were saved using a threaded saw. The lumbar spine was stabilized to the pelvic girdle using spinal instrumentation with posterolateral fusion. RESULTS: Eighteen months after the tumor was resected the patient had a very good clinical outcome, and there were no radiologic signs of instability or recurrence of the tumor. Locomotor function of both lower extremities and bowel and urinary functions were well maintained. The patient returned to his previous work. CONCLUSIONS: High sacral amputation following a combined anteroposterior approach provided good results without causing any disability. A detailed preoperative planning and careful dissection of uninvolved nerve roots prevented unnecessary neurologic impairment in locomotion and the detrusor and anorectal function.

Dissection↗
PubMed1988

Long-term follow-up of Syme amputations for peripheral vascular disease associated with diabetes mellitus.

Ten patients underwent Syme amputation for diabetic peripheral vascular disease between 1980 and 1986 and were observed postoperatively for an average of 5 years. Surgical wounds healed in only five of the 10 patients; they were then fitted for a permanent Syme's prosthesis. All failures resulted from the inability to heal the surgical incisions primarily. The clinical records of these patients were retrospectively analyzed for predictors of successful clinical outcome. The ischemic index, grade of the lesion, initial wound treatment, and presence of the infection at the time of amputation were not found to be reliable predictors of a successful level of amputation. Clinical assessment of both the vascular and nutritional status of the patient was necessary to predict a successful result at this level of amputation.

Adult↗
PubMed2004

Measurement properties of the Frenchay Activities Index among individuals with a lower limb amputation.

OBJECTIVE: To assess the reliability and validity of the original and a modified version of the Frenchay Activities Index (FAI) among individuals with a lower limb amputation. DESIGN: Two week test-retest design. SETTING: South Western Ontario Amputee Program, London, Ontario, Canada. SUBJECTS: Consecutive sample of 84 individuals, primarily men (78.6%), mean age 56.5 years with a unilateral transtibial (71.4%) or transfemoral amputation related to traumatic (59.5%) or vascular causes. INTERVENTIONS: All subjects completed a questionnaire containing the FAI and other scales, the 2-minute walk and timed up and go tests during a regularly scheduled clinic visit. Fifty-five subjects completed a second FAI which was mailed to them two weeks later. Twenty-nine others completed the second FAI upon return for testing related to another project. MAIN MEASURES: FAI, Activity-specific Balance Confidence Scale, Prosthetic Evaluation Questionnaire-Mobility Scale, 2-minute walk, timed up and go and walking device aid use. RESULTS: Relative reliability for the FAI (intraclass correlation coefficient (ICC) = 0.79) and FAI-18 (ICC = 0.78) was acceptable, however bias between measurements was detected. Hypothesized relationships (p < 0.001) between both FAI versions and the Activity-specific Balance Confidence Scale, Prosthetic Evaluation Questionnaire-Mobility Scale, 2-minute walk and timed up and go test were observed. Significant group differences were observed for amputation cause, mobility device use, age and years as an amputee. Neither version distinguished between amputee level or gender groups. CONCLUSIONS: The original and modified FAI are valid and reliable tools for unilateral amputees. Reliability is adequate to detect group but not individual level differences. Additional FAI-18 items did not substantially improve the ability to detect between-amputation-group differences.

Activities of Daily Living↗
PubMed1976

Vital root amputation. A clinical and histological study.

An investigation was designed to study the clinical and histological effects of delaying endodontic therapy for a period of 2 weeks without dressing of the exposed pulp, after vital intentional root amputation had been carried out on periodontally involved teeth. From the results obtained it was possible to conclude that: 1. Endodontics, prior to surgical root amputation, remains the treatment of choice. 2. When preoperative endodontics is not possible, the approach used in this study will provide good results without severe, adverse clinical or histological effects. 3. The altered periodontal condition and tooth form do not interfere with the performance of definitive endodontics 2 weeks after surgery. 4. Definitive preparation of the cut tooth surface at the time of root amputation facilitates maintenance of oral hygiene after removal of the periodontal dressings. 5. The high percentage of involvement of the distobuccal root of the first maxillary molar in periodontal situations requiring correction by root amputation, may be due to the anatomy of this root.

Adult↗
PubMed1985

Supravaginal uterine amputation with peroperative electrocoagulation of endocervical mucosa. Description of the method.

Discussion on the advantages of abdominal hysterectomy versus supravaginal uterine amputation has concentrated on the incidence of carcinoma in the remaining stump, mortality, and other serious complications. During the period 1952-78 we have performed 2712 supravaginal amputations with peroperative electrocoagulation of endocervical mucosa. The incidence of stump carcinoma was 0.11% in this material. In our prospective studies we have shown that supravaginal amputation has certain advantages over abdominal hysterectomy as regards long-term morbidity. In this paper we describe the method we are using when performing supravaginal uterine amputation.

Cervix Uteri↗
PubMed2000

[Phantom limb after amputation--overview and new knowledge].

Almost all patients who have an extremity amputated will experience a phantom limb. Amputations of other parts of the body can also cause phantom sensations. One fourth of all women who undergo mastectomy relates phantom breast sensations. Phantoms are common following rectum amputation and may be significant as indicators of rectal tumor relapse. Visual phantoms can appear in patients who undergo eye amputation. Phantom phenomena occur after tooth extraction, ureterocystectomy, penectomy, plexus avulsion or spinal cord injury. The causes underlying phantom sensations are unknown. Sensory deprivation in animals causes reorganization of the cortical and subcortical maps: the areas representing the deprived input shrink and the neighbouring areas expand. The mapping allocates areas to represent the most used peripheral inputs. Every level of the nervous system seems to exhibit plasticity. The primary site seems to be the cortex. The cellular basis of plasticity is unclear. Significant sensory and motor reorganization was found in humans suffering phantom pain. There was a strong relationship between the amount of cortical reorganization and the intensity of phantom pain. These findings may influence the rehabilitation of the amputee. It was shown that pain and cortical reorganization can be reduced or even prevented by the active use of prostheses.

Animals↗
PubMed2001

Disability evaluation and impairment rating for the person with an amputation.

Impairment rating for the person with an amputation requires a total body assessment in addition to the amputated extremity. In particular, those systems essential for prosthetic wear and function, skin coverage, sensation and motor function, and proximal joint range of motion should be included. Spinal function, pain, and psychologic impairment are frequently involved as secondary issues related to the amputation. All of these systems must be assessed and a determination made whether permanent impairment is present. The final calculation of the impairment rating uses the appropriate body systems and worksheets. Most persons with an amputation will have some appropriate work restrictions applied and all will have future medical needs.

Adult↗