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PubMed1992

The social and economic outcome after upper limb amputation.

This paper reports a study of 66 upper limb amputees in County Funen, Denmark who were visited in their homes by the author. The purpose of this study was to evaluate for the same period of time the social and economic outcome for a population of upper limb amputees compared with the normal population. The number of amputees investigated corresponds to the annual number of persons becoming upper limb amputees in Denmark. The aetiology of registered amputees also corresponds to the Danish Amputation Register. The amputees had become "better placed" in the social system after amputation independent of prosthetic use. The mean age of the amputees corresponded with the age where people reach their best social grouping. Their social migration quotient was higher than the background population and reflected the amputees better income and housing conditions. The reasons for these surprising results must be the high grade social system in a sophisticated industrial county. None of the amputees were required to pay for rehabilitation or prosthetic supply. A lower divorce rate for the amputees was explained by a symbiosis between the amputees and their partners to protect their future existence. Only 14% lived alone. Those who had their sexual debut after amputation were 3 years later in sexual experience than the rest of the amputees because of difficulties during the maturing process.

Age Factors↗
PubMed1992

A standardised trans-tibial amputation method following chronic occlusive arterial disease.

The histo- and biochemical parameters of leg muscles from patients with chronic occlusive arterial disease were examined. The outcome of these tests indicated that it is not possible visually to determine the amputation level accurately at the time of surgery. These test results therefore encouraged the authors to develop a standardised surgical procedure for trans-tibial amputations. With this standardised technique specific musculature is resected to assure that no pathological tissues remain. This surgical prophylaxis is meant to prevent the development of gas gangrene and thus to obtain primary healing. Eighty-six trans-tibial amputations were performed and in 93% of these the knee joint was preserved.

Amputation, Surgical↗
PubMed1984

The place of amputation in the management of the ischaemic lower limb in the dysvascular geriatric patient.

Statistics show that today the majority of amputations of the leg are peripheral vascular disease in patients over the age of 60. The stages of management are discussed and in particular a plea made for taking a balanced view of vascular salvage procedure and amputation as alternative treatments. The advantages are stressed for these patients to be treated in a unit where the resources for appropriate investigation are available and the surgeon has the support of a multi-disciplinary team. The importance of the pre- and post-amputation rehabilitation programme is discussed.

Aged↗
PubMed1999

Penile stump advancement as an alternative to perineal urethrostomy after penile amputation.

PURPOSE: We describe a method for avoiding perineal urethrostomy, and maintaining penile cosmesis and function after penile amputation. MATERIALS AND METHODS: Penile reconstruction was performed in 1 patient with traumatic total amputation of the penis and 1 undergoing near total penectomy for carcinoma by advancing the penile stump and covering the resultant phallus with rotational full thickness scrotal flaps. RESULTS: Both patients were able to void while standing, and have intact sensation and erectile capability in the residual neophallus. CONCLUSIONS: Perineal urethrostomy is not necessary after penopubic penile amputation. Advancement of residual cavernosal tissue and skin coverage with scrotal flaps minimize altered body image, and maintain sensation and normal voiding position.

Adult↗
PubMed1976

Chemical composition of the skeletal parts of the extremity of the adult rat following below-knee amputation and immobilisation in a plaster cast.

The chemical composition, i.e. ash and calcium contents and organic, hydroxyproline, and hexosamine contents of the acetone-dried diaphyseal cortical bone powder of the tibias and the femurs, was studied in adult rats after a) below-knee amputation and b) immobilisation of the one hind leg in a plaster cast. There were no significant differences in the chemical composition of the chemical composition of the bones of the treated extremity as compared with the corresponding bones from the non-treated control leg, either at different times after the amputation and immobilisation, respectively, or when all obtained values from each bone were tested together. The percentage hydroxyproline content of the tibia was found to be significantly higher than that of the femur in both extremities, both in the amputation and in the immobilisation experiment. The pro mille hexosamine content of the tibia, on the other hand, was significantly lower than that of the femur in both extremeities in the immobilisation experiment.

Amputation, Surgical↗
PubMed2001

Healing of partial flap necrosis in ankle disarticulation amputation by débridement and continued weight-bearing.

Five patients with partial tissue loss of the weight-bearing surface of the heel pad following ankle disarticulation were treated with residual-limb debridement and continued end-weight-bearing using a total-contact cast. The patients, ranging in age from 53 to 76 years, had insulin-requiring diabetes and insensate heel pads and were low-demand, limited-activity, community walkers before amputation surgery. Each underwent amputation surgery as a consequence of peripheral vascular disease. All patients progressed to complete wound healing over 3 to 6 months and were able to return to their previous ambulatory level using a prosthesis. At a minimum 2-year follow-up, no patient experienced further residual-limb complications. Partial loss of the weight-bearing heel pad in ankle disarticulation amputation does not preclude successful return to independent ambulation using a standard ankle disarticulation prosthesis. Weight-bearing ambulation need not be avoided during healing.

Aged↗
PubMed2002

[The value of the Syme amputation in selected cases of diabetic foot].

The aim of this paper was to assess the surgical and functional results of Syme's amputation in patients with infected necrosis of the fore- and midfoot caused by diabetes. The material consisted of 5 patients (4 men) age ranging from 44 to 78 years. No stump healing was achieved in a 44 year old man with arteriosclerosis who did not agree to a higher amputation. Prostheses were implemented in patients whose wounds healed 3-6 weeks after surgery. Follow-up period ranged from 2 to 6 years. Three patients died 4-5.5 years after surgery. One patient (equipped with a prosthesis) was observed for a period of 2 years, after which she gave up further medical care. One patients is doing well and using his prosthesis 6 years after surgery. In selected cases of diabetic foot, the Syme's amputation is a useful method of treatment, both from a surgical and functional aspect.

Aged↗
PubMed1990

A model for prediction of failure in amputation of the lower limb.

A logistic regression analysis of eighteen variables in eighty-three lower limb amputations was performed in order to predict stump failure. Five variables were identified as having a significant effect on the logistic model: Age had an inverse relation to failure rate (p less than 0.005). This effect was mediated through a subgroup of 23 patients who had had a vascular operation (p less than 0.02), as this group had a higher failure rate and were younger than those without previous vascular surgery. Furthermore, the surgical experience (p less than 0.005) was of major importance for stump failure. Experienced surgeons had a failure rate of 2% while less experienced had a rate of 29% (p less than 0.001). In addition, it was confirmed that the higher the skin perfusion pressure (p less than 0.05) and the amputation level, (p less than 0.05) the better the healing. A model including "skin perfusion pressure," "previous vascular surgery," "amputation level" and "surgical experience" had a good predictive capability with a misclassification rate of 0.08-0.11. Therefore it is suggested that a logistic model including these variables could be a helpful tool to predict the risk of stump failure.

Adult↗
PubMed1990

The modified Chopart's amputation.

A modified Chopart's amputation has been designed to overcome the complications of the traditional Chopart's amputation of plantar flexion and skin breakdown over the anterior talus and calcaneus. The modifications are: (1) contouring of the talus and calcaneus; (2) transfer of the anterior and posterior tibialis tendons and the extensor communis and hallucis to the neck of the talus and sustentaculum tali; (3) anterior advancement of the plantar flap; and (4) lengthening of the tendo Achillis. This procedure has been performed in a prospective manner on eight feet in six children. An average 3.5-year follow-up term has not revealed any complications. The modified Chopart's procedure appears to be a functional, useful amputation for children requiring foot ablation secondary to congenital malformations.

Amputation, Surgical↗
PubMed1989

[Technics of primary and secondary amputation of the foot].

Maintenance therapy of the traumatized foot by partial amputation, in contrast to lower-leg amputation with subsequent artificial leg adjustment, should always be attempted if there is any possibility of shaping a stump that is independent of the prosthesis. As in former years, the disarticulation technique is performed; however, today the technique has been modified to obtain more functional results and to conserve tissue, which may mean that transosseous amputation is practicable. The quality of the soft-tissue flap and stability are the determining factors in the quality of the stump. These prerequisites mean that the operative technique must be adapted to the requirements of the patients; the soft tissue must be preserved and procedures used that will permit reconstructive procedures later.

Amputation, Surgical↗
PubMed1989

[Rehabilitation following amputation].

Rehabilitation after amputations is a complex interdisciplinary task which depends on numerous factors: the reason for and the level of the amputation, the quality of the stump and the limb fitting, the patient's general mental and physical state, and particularly his and his family's motivation. Strictly speaking, the normal functions can never be fully restored, even with the help of the most up-to-date techniques and rehabilitation facilities. For optimal results, full coordinated use should be made of the available methods of diagnosis and treatment. The course of rehabilitation is determined from the outset by the level of the amputation and the surgical technique. Emphasis is put on stump treatment, limb fitting, and training of the amputee, with or without a prosthetic replacement. Technical aids also are extensively used in the rehabilitation of amputees and includes various items for performing daily activities, from the workplace to the wheel chair. Even when fully equipped, a small number of amputees still remain permanently dependent on others.

Amputation, Surgical↗
PubMed1986

Amputation alternatives in the lower limb, stressing combined management of the traumatized extremity.

A methods approach for the care of the traumatic lower extremity amputee is presented, emphasizing joint surgical approach, specifics of management, ideal amputation levels, and functional rehabilitation. The role of the plastic surgeon with an interest in free flaps is ever increasing and has elevated the level and quality of traumatic extremity amputation. Therefore, an understanding by the plastic surgeon of the orthopedic, prosthetic, functional, and rehabilitation principles becomes as important as the orthopedic surgeon's appreciation of current microvascular reconstruction potential. Fortunately, large numbers of traumatic amputees are not available for study in the civilian population. With better-quality extremity salvage by free flap coverage, this number is decreasing. However, the problem will never be eliminated and efforts to produce the best possible amputation must be expended by the best techniques and personnel. Prosthetic management continues to develop with exciting innovations on the horizon. Currently, the modular concept of prosthetic design (Fig. 26) is a practical, cosmetic standard. Newer space-age materials and design changes should facilitate the functional potential of the traumatic amputee. Characteristics of traumatic lower extremity amputees are youth, immaturity, arrogance, and psychological instability, but they are usually cooperative following the initial shock and reality of the situation. These young people deserve our best efforts to allow them to become integrated into society and continue an active life, albeit passive or active (Fig. 27).

Amputation, Surgical↗
PubMed1984

Traumatic partial foot amputation.

Twenty patients in whom partial foot amputation had been performed following trauma were evaluated for successful retention of the foot. Of ten transverse stumps, only three partial feet were retained. Failure was related to poor terminal coverage from skin grafts and to equinus deformity. All ten longitudinal forefoot amputations resulted in salvage of the foot. In traumatic partial foot amputations only bone stock that is protected by innervated plantar skin should be preserved, and skin grafting should be done only in nonweight-bearing areas. Equinus deformity can be minimized by preserving and/or transplanting dorsiflexor tendons into residual bone and by supporting the foot in a custom-made ankle-foot orthosis.

Adult↗
PubMed1981

Prosthetic fitting problems of the quasi-Syme amputation.

Unless the original Syme amputation technique has been precisely followed, an amputation stump capable of tolerating little or no end-bearing will frequently result. Such a stump must be fitted with a below knee type of prosthesis as if the patient were a below-knee amputee. Even though it is not designed for other than a below-knee amputation, the socket can be modified to provide a satisfactory prosthesis for a Quasi-Syme stump.

Amputation, Surgical↗
PubMed1995

[Contralateral replantation after bilateral traumatic lower leg amputation. Case report with 6 year follow-up].

A 66-year-old patient attempted suicide by jumping in front of a train. The lower extremities were amputated at different levels. On the right side, there was a complete amputation within the distal third of the lower leg. Proximal to the amputation site, there was an extensive soft-tissue and bone defect. On the left side, there was a crush injury of the tarsal and mid-tarsal bones. The left lower leg showed only few injuries. An ipsilateral (anatomical) replantation was not possible. In order to save one lower extremity, we decided to carry out a cross-over (contralateral) replantation of the right foot to the left lower leg. After a follow-up of six years, the patient is able to walk well with her prosthesis on the right side and the right foot hooked up to the left lower leg. Functionally, this treatment (cross-over replantation-one-side prosthesis of the lower leg) is much better than the prosthesis on both extremities, as the result has shown. Also from a psychological point of view, it seems to be better for the patient to preserve one extremity even with a cross-over replanted foot.

Aged↗
PubMed1994

Lower limb amputation: striking the balance.

During a 5-year period, 210 patients (125 male: aged 43-96 years, median 76 years) had 228 primary amputations for peripheral arterial disease. Level selection was by clinical criteria, and there were 148 below-knee (BK, 65%), 72 above-knee (AK, 32%) and eight Gritti-Stokes (GS, 3%). Revision was needed in 43 (19%). The 30-day mortality was 14%. There were 69 patients who had previously undergone bypass grafting (< 30 days in 36; 30 days-1 year 20; > 1 year 13). In these there were 57% BK and 43% AK with a revision rate of 13%--no worse than in patients who had not had attempted limb salvage. Decisions about rehabilitation were made by a team of doctors, nurses and therapists. The 69 patients fitted with prosthetic limbs between 1987 and 1990 were followed up for eventual mobility (minimum 6 months). Of these patients, 81% used their prosthesis at least around the house, but only 16% achieved near normal mobility. This series fails to support the claim that failed arterial bypass surgery prejudices amputation level or healing. Despite attempts to achieve a high rate of below-knee amputation and good rehabilitation, the revision rate remains high and really good prosthesis usage remains low in these elderly patients.

Adult↗
PubMed1995

The effect of prosthetic alignment on relative limb loading in persons with trans-tibial amputation: a preliminary report.

The prosthetic sockets of 14 independent persons with unilateral trans-tibial (BK) amputation were mounted on an adjustable alignment pylon. Vertical ground reaction forces were recorded in neutral prosthetic alignment and in 10 degrees of prosthetic socket varus, valgus, flexion, and extension. Stance phase time, peak vertical ground reaction force, and impulse were all found to be increased on the sound limb when compared to the amputated residual limb. Significant differences were found in stance phase time and peak vertical ground reaction force when comparing malaligned with neutrally aligned prosthetic limbs. Significant differences were also seen in impulse between neutrally aligned and malaligned prosthetic limbs. The results suggest that prosthetic malalignment in persons with trans-tibial amputation leads to increased loading of the contralateral limb.

Adult↗