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PubMed1992

Social discomfort and depression in a sample of adults with leg amputations.

We examined the relationship between social discomfort and depression in a sample of 89 adults with leg amputations at two outpatient clinics. It was hypothesized that individuals who reported being uncomfortable with social contacts involving acknowledgement of their amputation or prosthesis were more prone to depression than other patients. A set of questions addressing different aspects of social discomfort demonstrated internal consistency and were used as a scale. Social discomfort was significantly correlated with scores on the Center for Epidemiologic Studies-Depression Scale depression scale (r = .41). Multiple regression analysis showed that social discomfort was a significant independent predictor of depression, after holding constant the effects of age, gender, social support, time since amputation, reason for amputation, and perceived health. These data indicate that health care professionals should view the expression of social discomfort by amputee patients as a possible "marker" for depression. Further studies are planned to develop and validate an expanded social discomfort scale.

Adult↗
PubMed1992

[Abdomino-perineal rectum amputation for therapy of locoregional recurrence after anterior resection].

In a retrospective study (1979-1988) we evaluated the outcome of the abdominoperineal amputations of the rectum in 9 patients for local recurrence after anterior resection. The technical feasibility of the secondary rectum amputation, early and late results and indications for the operation are discussed. The secondary rectum amputation for local recurrence after primary anterior resection is a difficult operation. A low morbidity and a zero mortality are reported. Late results are bad; 8 of 9 reoperated patients are deceased 22 (6-60) months and 1 patient is alive 32 months after the rectum amputation. The only indication for reoperation is an operation with curative intention. The early recognition of a local recurrence is of up-most importance. It is reported that with endorectal ultrasound it is possible to pick up small and asymptomatic local recurrences. Perhaps the recognition of a small local recurrence with endoluminal sonography enables to ameliorate the late results of this rare intervention.

Abdomen↗
PubMed2006

[Pelvic infiltrations following amputation procedures for rectal carcinomas].

INTRODUCTION: The authors present anatomical division of the rectum and then give a short overview of the rectal surgery development. Currently, even in departments specialized in colorectal surgery, 25-30% of the rectal carcinoma cases must be managed by abdominoperineal amputations. COMPLICATIONS OF AMPUTATION PROCEDURES: The study deals with complications following extirpation of the rectum, like bleeding and its management, inflammatory complications during the healing process or following healing of the perineum. However, pelvic relapses, which in most cases cannot be managed surgically, remain the major therapeutic problem. These cases are indicated for systemic treatment with combinations of cytostatic drugs, eventually for radiotherapy. RESULTS: 324 patients with rectal carcinomas were operated at the 1st Surgical Clinic of the VFN in Prague. In 230 cases, resection was completed, in 94 cases, the rectum was amputated. In 78 cases, sutures of the pelvic floor was conducted, 64 cases healed per primam within 3 weeks, 11 healed per secundam within 3 months. In 16 cases, tamponade with surgical cover sheets and longettes was applied. 70% of these patients healed within 12 weeks of the surgery. In 3 cases, chronic fistules persisted for over 6 months. In 11 cases, locoregional relapses occurred. In 2 cases, radical excision was conducted, the other underwent systemic chemotherapy. CONCLUSION: Good preoperative care of the intestine, ATB prophylaxis and saving surgical technique were the precautions taken with the aim to prevent inflammatory complications. With respect to management difficulties of local relapses following amputations of the rectum, a requirement for total excisioning of the mesorectum on the first operation is substantial.

Abscess↗
PubMed2006

[Replantation of amputated ear with microtechnique].

OBJECTIVE: To report replantation of amputated ear with microtechnique in 5 cases. METHODS: From 2002 to 2005, 5 totally amputated ears were replanted and 4 obediently, 1 retrogressively. In every case, 1-2 arteries and 1-3 veins were anastomosed. Seven vessels were detective and 1-6 cm vessels were transplanted from forearm or dorsal side of hand. Amputated ears obtained blood supply again in about 6-10 hours after injury and exploration was enforced for venous crisis in 2 cases, and bloodletting in 1 case. RESULTS: All 5 cases survived. Auricles possess perfect shape, no pigmentation, slight atrophy and perfect sensation. CONCLUSIONS: Amputated ear should be replanted as long as no obvious contusion occurred, and the keys to prevent vascular crisis are cutting off unhealthy vessels, grafting superficial veins for bridging, and the high quality of vascular anastomosis.

Adult↗
PubMed1991

Dual-task assessment of reorganization of postural control in persons with lower limb amputation.

Postural control in persons with lower limb amputation was studied using a cognitive approach to motor learning. The aim of this study was to show that an important characteristic of the central reorganization process after a lower limb amputation is the gradually decreasing need of attentional resources to perform a motor task. A dual-task procedure was developed to estimate the level of automaticity of a quiet, upright standing task. The effect of a concurrent attention-demanding task (Stroop task) on the efficiency of balance control was determined using force-platform measurements at the start and the end of the rehabilitation process. In contrast with a control group, the amputation group showed interference effects on body sway caused by the concurrent task both at the start (p less than .05) and, less severe, at the end of rehabilitation (p less than .05). Improvement of balance control was significant only for the dual-task condition (p less than .05). The results corroborated the hypothesis that dual tasks give information about the restoration of automaticity of postural control as an essential characteristic of the central reorganization process in persons with lower limb amputation. The role of dual-task procedures as a useful approach to skill assessment is discussed.

Adult↗
PubMed1987

Abdominal hysterectomy versus supravaginal uterine amputation: psychic factors.

In the present study, the psychic complaints after abdominal hysterectomy (n = 105) and supravaginal uterine amputation (n = 107) are investigated. The first author interviewed personally all the subjects preoperatively and 6 weeks, 6 months, 1 year and 3 years postoperatively. The proportion of subjects without psychic symptoms increased from 49.5% to 67.7% in the hysterectomy group (p less than 0.01) and from 53.3% to 76.8% in the amputation group (p less than 0.001). The difference between the groups at 3 years phase was significant (p less than 0.01). From the single symptoms, nervousness or irritability and depression, decreased during the follow-up period significantly in the amputation group but not in the hysterectomy group. The results clearly indicate that the view of an increased risk for depression or other psychic complications after removal of the uterus should be revised. On the other hand, the results support our earlier findings that supravaginal uterine amputation is still an applicable method in benign conditions.

Adult↗
PubMed1996

Reduction mammaplasty: the results of avoiding nipple-areolar amputation in cases of extreme hypertrophy.

In extreme cases of breast hypertrophy, amputation of the nipple-areolar complex and transplantation during reduction mammaplasty has been advocated to avoid nipple necrosis. We report our experience with 172 patients having inferior breast pedicle reduction without amputation of the nipple-areolar complex. Mean total weight of resected tissue was 1,946 g (548 to 5,100 g), with a mean nipple-areolar transposition of 10 cm (0.5 to 23 cm). Dividing patients into four groups by weight of resection, we compared complication rates. In this series, where nipple-areola amputation was avoided, there was a 99.6% survival rate of the nipple-areolar complex with 97.1% retention of nipple sensibility. Patients with extreme breast hypertrophy (3,000 g resected tissue) experienced no increase in complications when compared to smaller reductions. In most cases of gigantomastia, amputation of the nipple can be avoided using the inferior breast pedicle technique. Size of breast resection alone should not determine the fate of the nipple.

Adolescent↗
PubMed1995

Replantation by arterialization of the venous system of amputated parts.

Only in four cases out of 800 replantations and revascularizations as the last resort it was necessary to anastomose an artery of the stump to a vein of the amputated part. Three of these cases were very distal finger amputations in zone II and III and one was an auricle amputation with so severely damaged arteries of the amputated part that it was not possible to perform their anastomosis. All of these four clinical cases were successful and they confirm the possibility of arterialization of the venous system which was proved in experiments with rabbit auricle replantation by Mundy and Pajn (1994) and by Farrior and Baker (1988).

Adolescent↗
PubMed1997

Syme's ankle disarticulation: the transmalleolar amputation.

Salvage of the infected extremity in diabetic patients continues to be a complex problem. Amputation at the Syme's level helps maintain patient independence and decreases the rehabilitation expense associated with more proximal amputation. Although the wound complication rates are relatively high, the ultimate healing rate and favorable functional outcomes in this high risk patient population make this an outstanding amputation level for pedal amputation.

Ankle Joint↗
PubMed1998

Salvage of failed amputation about the hip in peripheral vascular disease by open wound care and nutritional support.

Five consecutive patients with wound and/or plastic surgical flap failure after hip disarticulation or amputation at the lesser trochanteric transfemoral level were treated with local tissue debridement, open wound management, culture-specific antibiotic therapy, and nutritional supplementation. All of the patients underwent amputation about the hip as a result of ischemic necrosis of the lower extremity. Four of the five patients were able to achieve wound healing by second intention. The fifth patient died 2 months after the surgery. None of the patients required revision surgery. One patient underwent split-thickness skin grafting to minimize the need for continued wound care. Local wound management combined with nutritional support and culture-specific antibiotic therapy is an acceptable alternative to major amputation stump revision in patients with potentially high morbidity who fail to heal after amputation about the hip.

Adult↗
PubMed1980

Below-knee amputation: is the effort to preserve the knee joint justified?

The records of 50 patients (31 men and 19 women, ranging in age from 49 to 89 years) undergoing definitive below-knee amputation for ischemia from May 1971 to May 1979 were reviewed. Forty-three (86%) had ulceration or necrosis involving the foot or toes. Seven had rest pain without tissue loss. Overall healing rate was 86%. Seven patients (14%) failed to heal and required reamputation above the knee; the functional status of the remaining 43 patients was graded preoperatively and at the time of late follow-up (mean, 3.4 years). Twenty-five of 35 (71%) unilateral below-knee amputees could walk with a prosthesis; ten could not. Seventeen patients (34%) either required an additional, higher amputation or did not use the knee joint to increase mobility. The patient with marginal circulation and marked preoperative functional limitations may have the above-knee level as the chosen site for amputation.

Actuarial Analysis↗
PubMed1987

Resurrection of the amputations of Lisfranc and Chopart for diabetic gangrene.

When a patient with neuropathic diabetic gangrene of the foot has sepsis, it is not always necessary to do a below-knee guillotine amputation or a Syme's amputation. In more than six years we have done 18 successful open Lisfranc's and Chopart's amputations. Improved ambulation has been achieved in three months using simple shoe prostheses. All flaps are fashioned immediately and never sutured. No equinus deformities have developed.

Adult↗
PubMed1988

Hemoglobin and hematocrit as risk factors in below-the-knee amputation for incipient gangrene.

The relationship between complication rate and preoperative levels of hemoglobin and hematocrit was investigated in 186 consecutive below-the-knee amputations for incipient gangrene. Arteriosclerotic amputations had successively higher rates of wound complications and reamputation with increasing hemoglobin and hematocrit. No such association was found among diabetics. Thus, hemoglobin greater than or equal to 7.0 mmol/l and hematocrit greater than or equal to 40 were significant preoperative risk factors in below-the-knee amputation for arteriosclerotic incipient gangrene.

Aged↗
PubMed1998

[Considerations on the management of subtotal and total macro-amputation of the upper extremity].

Between 1982 and 1993, 65 amputation and amputation-like injuries in the upper arm (n = 18), proximal and middle forearm (n = 32) and distal forearm and wrist level (n = 15) were treated in our institution. The overall survival rate in our series was 92.3% (60/65). In 3 of 65 cases early secondary amputation because of vascular failure was necessary. There was one reamputation because of deep infection with beginning sepsis. Severe systemic disturbances were seen in one patients, requiring early reamputation. Twenty-five patients with a follow-up of more than 2 years were reviewed in a retrospective clinical study and evaluated according to the Chen classification. Of 8 patients with upper-arm involvement, 2 had a grade II result, 4 a grade III and 2 a grade IV result. There were 1 grade I, 2 grade II, 2 grade III and 5 grade IV results in the proximal forearm group. In the distal forearm group 2 patients each showed a grade I, II and III result and 1 a grade IV. Taking grades I and II results together, a "functional extremity" could be reconstructed at the upper arm level in 25%, proximal forearm 30%, and the distal forearm in 58%. The main advantage of replantation/revascularization of the upper limb is the possibility of restoring some sensitivity to the hand in addition to partial motor recovery, which always provides twice as much individual motor function as is offered by any type of prosthesis currently available. The higher cost and number of operations needed, as well as the longer postoperative care and longer disability time after replantation/revascularization are nevertheless justified by the significant increase in quality of life.

Adolescent↗
PubMed2006

Lower limb salvage to allow planned trans-tibial amputation.

Early, primary amputations are still necessary for certain patients sustaining high impact lower limb trauma. For cases with extensive proximal tibial bone loss a turn-up bone flap technique has been described to achieve a below-knee stump suitable for a prosthesis. However, in certain circumstances, for example if posterior soft tissues are injured, this type of reconstruction is not possible. This case report demonstrates that converting a severe open proximal tibial fracture to a successful below-knee amputation is also possible with acute limb shortening, flap cover and planned subsequent trans-tibial amputation.

Amputation, Surgical↗
PubMed2003

Results of ray resection and amputation for ring avulsion injuries at the proximal interphalangeal joint.

We investigated the long-term functional results of ray resection (14 cases) and amputation (nine cases) for ring avulsion injuries of ring finger which could not be replanted or underwent failed replantation. The mean follow-up was 37 (range, 24-63) months in the ray resection group and 32 (range, 24-40) months in the amputation group. Grip strength, key pinch strength, chuck pinch strength, hand circumference and palmar volume were decreased in the ray resection group but only grip strength and pulp pinch strength were significantly decreased in the amputation group. These results suggest that ray resection should be avoided in patients with occupations that need strong key and chuck pinch functions.

Adolescent↗
PubMed2001

Increased excitability in the primary motor cortex and supplementary motor area in patients with phantom limb pain after upper limb amputation.

Using functional magnetic resonance imaging and single slice FLASH technique, we investigated reorganization of the hand representation of the primary sensorimotor cortex (SMC) in 16 patients with upper extremity amputation. Patients were asked to perform finger tapping with the intact hand, repetitive eye closing and anteflexion of the amputation stump or intact shoulder. Six normal volunteers served as control. In the normal volunteers activations during shoulder anteflexion, finger tapping and eye closure were located within the central sulcus in a medio-lateral fashion. Patients demonstrated invasion of the face or shoulder representation into the hand representation of the amputated limb. Eight phantom limb pain patients showed significantly greater activation in SMC and supplementary motor area (SMA) in contrast to eight patients without phantom limb pain. We conclude, that different parts of the motor system are affected in patients with phantom limb pain--possibly in the sense of an up-regulation of excitability.

Adolescent↗
PubMed2001

Optimal surgical preparation of the residual limb for prosthetic fitting in below-knee amputations.

A well-performed below-knee amputation can result in a high level of patient satisfaction and function. The potential for a successful result and independent ambulation is good after a transtibial amputation, with approximately 70% to 100% of patients being able to ambulate independently after this procedure. A properly fitted and appropriately designed prosthesis is integral to the achievement of these goals. The approaches and techniques discussed here are essential in optimally preparing the residual limb for prosthetic fitting. Attention to factors such as the preoperative evaluation and the surgical technique can ensure the best possible outcome for amputation patients.

Amputation, Surgical↗